Feasibility of Early Palliative Care Consultation for Children With High-Risk Malignancies

Mahmood, Laila; Casey, Denise; Dolan, James G.; Dozier, Ann; Korones, David N.

doi:10.1002/pbc.26024

Cited by 23 publications

(30 citation statements)

References 22 publications

(48 reference statements)

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“…The growing number of publications and pilot initiatives demonstrate genuine energy to embed PC into conventional healthcare and improve the timing of PC discussion. 33,[35][36][37] However, the results of this study suggest that PC integration at diagnosis remains an unmet objective.…”

Section: Discussionmentioning

confidence: 83%

“…Comparing PC provision within studies and across publications, it is apparent that PC integration was delayed at two time points: first PC discussion occurs late in the illness trajectory, and there is a delay between the initial conversation and start of PC. The growing number of publications and pilot initiatives demonstrate genuine energy to embed PC into conventional healthcare and improve the timing of PC discussion . However, the results of this study suggest that PC integration at diagnosis remains an unmet objective.…”

Section: Discussionmentioning

confidence: 89%

See 1 more Smart Citation

Palliative care initiation in pediatric oncology patients: A systematic review

et al. 2018

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Palliative care (PC) aims to improve quality of life for patients and their families. The World Health Organization and American Academy of Pediatrics recommend that PC starts at diagnosis for children with cancer. This systematic review describes studies that reported PC timing in the pediatric oncology population. The following databases were searched: PubMed, Web of Science, CINAHL, and PsycInfo databases. Studies that reported time of PC initiation were independently screened and reviewed by 2 researchers. Studies describing pilot initiatives, published prior to 1998, not written in English, or providing no empirical time information on PC were excluded. Extracted data included sample characteristics and timing of PC discussion and initiation. Of 1120 identified citations, 16 articles met the inclusion criteria and comprised the study cohort. Overall, 54.5% of pediatric oncology patients received any palliative service prior to death. Data revealed PC discussion does not occur until late in the illness trajectory, and PC does not begin until close to time of death. Despite efforts to spur earlier initiation, many pediatric oncology patients do not receive any palliative care service, and those who do, predominantly receive it near the time of death. Delays occur both at first PC discussion and at PC initiation. Efforts for early PC integration must recognize the complex determinants of PC utilization across the illness timeline.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 89%

Palliative care initiation in pediatric oncology patients: A systematic review

et al. 2018

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“…Patients who received late PC consultation (<30 days prior to death) were less likely to receive hospice care and more likely to die in the ICU 26,27 . While consultation occurs earlier than selected adult populations, 24 studies are still assessing the feasibility and facilitation of earlier PC consultation in pediatric populations 3,5 . New models of providing pediatric palliative oncology care can lead to improvements in access and timing of PC provision for pediatric oncology patients and families 28 …”

Section: Discussionmentioning

confidence: 99%

Defining palliative opportunities in pediatric patients with bone and soft tissue sarcomas

Ebelhar

Allen

DeGroote

et al. 2020

Pediatric Blood & Cancer

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Background Pediatric patients with sarcomas experience significant morbidity and compromised quality of life throughout their course. These times could be viewed as opportunities for increased subspecialty palliative care (PC). Systematically defining opportunities for additional PC support has not occurred in pediatric oncology. The frequency, timing, and associated factors for palliative opportunities in pediatric patients with sarcomas are unknown. Methods A priori, nine palliative opportunities were defined (disease progression or relapse, admission for symptoms, social concerns or end‐of‐life, intensive care or bone marrow transplant admission, phase 1 trial or hospice enrollment, do‐not‐resuscitate status). A single‐center retrospective review was conducted on patients aged 0‐18 years with bone/soft tissue sarcomas who died from January 1, 2012 to November 30, 2017. Demographic, disease, and treatment data were collected. Descriptive statistics were performed. Opportunities were evaluated over quartiles from diagnosis to death. Results Patients (n = 60) had a mean of nine (SD = 4) palliative opportunities with the majority occurring in the last quartile of the disease course. Number and type of opportunities did not differ by demographics or diagnosis. Eighteen patients (30%) received PC consultation a median of 2.2 months (interquartile range [IQR] 11.5) prior to death. Consultation was unrelated to diagnosis or total opportunities. Conclusions Patients with sarcomas incur repeated events warranting subspecialty PC, which increase toward the end‐of‐life. Increased PC utilization may help decrease suffering and bolster family coping during these episodes. Additional work should further refine if opportunities differ across cancers, and how to incorporate this framework into clinical oncology care to prevent missed opportunities for PC.

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“…Of the 42 included studies, 11 examined the impact of specialist paediatric palliative care, 44,48,57,58,62,64,66,70,73,74,88 14 explored factors affecting access 23,43,45,56,65,68,71,75,76,[78][79][80][81][82][83]89 and 17 studies investigated both 46,47,[49][50][51][52][53][54][55][59][60][61]63,67,69,72,77,[84][85][86][87]90 (see Table 1 for study characteristics). Using the MMAT, 25 studies were categorised as quantitative non-randomised, 12 as quantitative descriptive and 5 as qualitative stud...…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Thirty-one studies (all quantitative) examined the impact of and/or characteristics of children receiving specialist palliative care; 24 included a comparator group of children not receiving this, 23,43-51,54-64,78,86-88, 90 1 compared children receiving late and early specialist input, 52,53,84,85 and 6 used a single-group study design. 66,67,69,70,73,74 Of the remaining 11 studies (6 quantitative and 5 qualitative), 10 explored the views of healthcare staff 65,71,72,[75][76][77][79][80][81][82][83]89 and 1 the views of parents and young people. 68 Of the 31 studies examining outcomes and/or characteristics of children, the majority (n = 21) drew their sample of children and young people from a single centre.…”

Section: Study Populationsmentioning

confidence: 99%

Specialist paediatric palliative care for children and young people with cancer: A mixed-methods systematic review

et al. 2020

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Background: Specialist paediatric palliative care services are promoted as an important component of palliative care provision, but there is uncertainty about their role for children with cancer. Aim: To examine the impact of specialist paediatric palliative care for children and young people with cancer and explore factors affecting access. Design: A mixed-methods systematic review and narrative synthesis (PROSPERO Registration No. CRD42017064874). Data sources: Database (CINAHL, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO) searches (2000–2019) identified primary studies of any design exploring the impact of and/or factors affecting access to specialist paediatric palliative care. Study quality was assessed using The Mixed Methods Appraisal Tool. Results: An evidence base of mainly low- and moderate-quality studies ( n = 42) shows that accessing specialist paediatric palliative care is associated with less intensive care at the end of life, more advance care planning and fewer in-hospital deaths. Current evidence cannot tell us whether these services improve children’s symptom burden or quality of life. Nine studies reporting provider or family views identified uncertainties about what specialist paediatric palliative care offers, concerns about involving a new team, association of palliative care with end of life and indecision about when to introduce palliative care as important barriers to access. There was evidence that children with haematological malignancies are less likely to access these services. Conclusion: Current evidence suggests that children and young people with cancer receiving specialist palliative care are cared for differently. However, little is understood about children’s views, and research is needed to determine whether specialist input improves quality of life.

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Feasibility of Early Palliative Care Consultation for Children With High-Risk Malignancies

Abstract: Early palliative care consultation is feasible for children with high-risk cancer and is acceptable to children, families, and pediatric oncologists.

Cited by 23 publications

References 22 publications

Palliative care initiation in pediatric oncology patients: A systematic review

Palliative care initiation in pediatric oncology patients: A systematic review

Defining palliative opportunities in pediatric patients with bone and soft tissue sarcomas

Specialist paediatric palliative care for children and young people with cancer: A mixed-methods systematic review

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