Does referral to specialist paediatric palliative care services reduce hospital admissions in oncology patients at the end of life?

Abstract

Background:Despite advances in the treatment of childhood cancer, some children continue to die from their disease. This study aimed to assess the impact of specialist paediatric palliative care services (SPPCSs) on the number of hospital admissions in children who subsequently died from cancer in Yorkshire, UK.Methods:An extract of patients aged 0–19 years from the Yorkshire Specialist Register of Cancer in Children and Young People (YSRCCYP) diagnosed from 1990 to 2009 were linked to inpatient hospital episodes data and a SPPCS database. Deaths were included if they occurred before 31 August 2011. Differences in hospital admission patterns were assessed using negative binomial regression and presented as incidence rate ratios (IRRs).Results:Of 2508 children on the YSRCCYP, 657 (26%) had died by the censoring date. A total of 211 children had been referred to the local SPPCS, of whom 182 (86%) had subsequently died. Referral to SPPCS was associated with a significant reduction in the rate of planned hospital admissions (IRR=0.60, 95% CI 0.43–0.85). Central nervous system tumours showed significant decreases for all planned and emergency admissions compared with all other diagnostic groups.Conclusion:Referral to SPPCS significantly reduced the number of planned hospital admissions for children and young people with cancer before their death, which are often integral to paediatric oncology treatment regimens. Overall, our findings show that SPPCS have a role in reducing hospital admissions during end of life care of paediatric cancer patients with potential personal, social and economic benefits.

Effect of pediatric palliative care programs on health care resource utilization and costs among children with life-threatening conditions: a systematic review of comparative studies

“…We excluded a further 3656 after screening the titles and abstracts, and retrieved 109 papers for full-text review (κ value = 0.25, 95% confidence interval [CI] 0.22-0.28, indicating fair agreement according to Fleiss 9 ). Nine articles fulfilled the inclusion criteria (Figure 1), 5,[10][11][12][13][14][15][16][17] (κ = 0.83, 95% CI 0.64-1.00, indicating almost perfect agreement). Two additional studies 18,19 were identified in the weekly automated search updates, for a total of 11 included studies.…”

“…Four cohort comparisons 11,12,14,15 used administrative data and survey techniques 14 to explore differences between cohorts of children with and without access to PPCPs. Observation periods varied, from the last day of admission before death to the referral to a PPCP.…”

“…cancer-related deaths, 11,14 and two included deaths from any cause. 12,15 The interventions by which children were classified as being in the PPCP group included use of a PPCP (program or hospice provider 11,15 ) or inpatient palliative care consultation.…”

“…12,15 The interventions by which children were classified as being in the PPCP group included use of a PPCP (program or hospice provider 11,15 ) or inpatient palliative care consultation. 12 One study focused on an important element of PPCP, advance care planning, as identified by parental planning of the child's location of death.…”

A enfermagem ante os desafios enfrentados pela família na alimentação de criança em quimioterapia

“…Nesse sentido, a hospitalização é configurada como uma experiência perturbadora, já que distancia a criança da vida cotidiana, de seus hábitos de descanso, lazer, higiene e alimentação, amigos e família. Isso pode fazer com que rejeite tudo que o ambiente hospitalar oferece (16).…”