Integrative Approaches in Pediatric Palliative Care

Shafto, Kate; Gouda, Suzanne; Catrine, Kris; Brown, Melanie

doi:10.3390/children5060075

Cited by 6 publications

(11 citation statements)

References 64 publications

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“…Advanced pain management for children with serious illness often requires multimodal analgesia. This describes an approach of utilizing multiple analgesic agents (such as basic analgesia, opioids, adjuvant analgesia), regional anesthesia (such as nerve blocks or neuroaxial analgesia), rehabilitation (such as physical therapy, motor graded imagery), psychological (such as cognitive behavioral therapy) and integrative (formally known as “non-pharmacological”) therapies (such as massage, hypnosis) which usually act synergistically for more effective pediatric pain control with fewer side effects than a single analgesic or modality [ 34 , 35 , 36 , 37 ].…”

Section: Common Myths and Misconceptions In Pediatric Palliative Cmentioning

confidence: 99%

Delivering Pediatric Palliative Care: From Denial, Palliphobia, Pallilalia to Palliactive

Friedrichsdorf

Bruera

2018

Children

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Among the over 21 million children with life-limiting conditions worldwide that would benefit annually from a pediatric palliative care (PPC) approach, more than eight million would need specialized PPC services. In the United States alone, more than 42,000 children die every year, half of them infants younger than one year. Advanced interdisciplinary pediatric palliative care for children with serious illnesses is now an expected standard of pediatric medicine. Unfortunately, in many institutions there remain significant barriers to achieving optimal care related to lack of formal education, reimbursement issues, the emotional impact of caring for a dying child, and most importantly, the lack of interdisciplinary PPC teams with sufficient staffing and funding. Data reveals the majority of distressing symptoms in children with serious illness (such as pain, dyspnea and nausea/vomiting) were not addressed during their end-of-life period, and when treated, therapy was commonly ineffective. Whenever possible, treatment should focus on continued efforts to control the underlying illness. At the same time, children and their families should have access to interdisciplinary care aimed at promoting optimal physical, psychological and spiritual wellbeing. Persistent myths and misconceptions have led to inadequate symptom control in children with life-limiting diseases. Pediatric Palliative Care advocates the provision of comfort care, pain, and symptom management concurrently with disease-directed treatments. Families no longer have to opt for one over the other. They can pursue both, and include integrative care to maximize the child’s quality of life. Since most of the sickest children with serious illness are being taken care of in a hospital, every children’s hospital is now expected to offer an interdisciplinary palliative care service as the standard of care. This article addresses common myths and misconceptions which may pose clinical obstacles to effective PPC delivery and discusses the four typical stages of pediatric palliative care program implementation.

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Section: Common Myths and Misconceptions In Pediatric Palliative Cmentioning

confidence: 99%

Delivering Pediatric Palliative Care: From Denial, Palliphobia, Pallilalia to Palliactive

Friedrichsdorf

Bruera

2018

Children

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“…Researchers agree that acupuncture is safe in the hands of qualified practitioners. 50,53,60,63,64,68,75 While much of the evidence of effectiveness is not strong, added to the safety data this has, however, been sufficient for experts to recommend acupuncture across a number of symptoms in clinical practice and treatment guidelines. Most authors state that further research is needed to explore the extent and use of acupuncture in palliative care.…”

Section: Discussionmentioning

confidence: 99%

“…From the 28 review articles found in the PubMed search, the evidence for acupuncture in palliative care was found to be conflicting or insufficient in some reviews for pain, [47][48][49] neuropathy, 50 dyspnoea, 51 hot flashes, 47 nausea and vomiting, 50 xerostomia, 47 hiccups, 52 insomnia, 53 leucopenia, 47 chronic kidney disease, 54 and cognitive effects. 55 But acupuncture was also found to be effective or showing promising results for palliative care in general 56 and in the treatment of specific symptoms: pain, [57][58][59][60] cancer pain, 50,53,[61][62][63][64][65][66] nausea and vomiting, 47,53,[59][60][61][62][63][64][66][67][68] neuropathic pain, 64,69 dyspnoea, 20,59,64,67 hot flashes, 50,59,62,…”

Section: Evidence For Acupuncture In Palliative Carementioning

confidence: 99%

“…57,74 Seven articles were found that discuss safety of acupuncture in palliative care. 50,53,60,63,64,68,75 Filshie focuses on addressing safety issues 75 ; the other articles generally conclude that acupuncture can be a safe procedure in palliative care if administered by qualified practitioners, provided key safety issues are addressed, 50,53,63,64,68 similarly for children. 50,60 Recommendations to use acupuncture in palliative care…”

Section: Evidence For Acupuncture In Palliative Carementioning

confidence: 99%

“…Acupuncture is recommended in palliative care for pain control, 95 and more broadly for chronic and acute pain, cancer pain, dyspnea, and postoperative nausea and vomiting. 60 It is recommended for pain control in the Netherlands 96 and Ontario, Canada. 97 Acupuncture is recommended in hospital-based pediatric palliative care in Minnesota, United States (https://www.childrensmn.org/for-health-professionals/ refer-patient-childrens/pain-medicine-palliative-care-hospice) and Ontario, Canada, (https://www.macpeds.com/documents/ PediatricPalliativecarecard.pdf).…”

Section: Evidence For Acupuncture In Palliative Carementioning

confidence: 99%

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Acupuncture as a Treatment Within Integrative Health for Palliative Care: A Brief Narrative Review of Evidence and Recommendations

Birch

Bovey

Alræk

et al. 2020

The Journal of Alternative and Complementary Medicine

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Background: Acupuncture is one of the fastest developing evidence bases in Complementary Medicine and is one of the leading therapies included within integrative health care. This narrative review includes two separate parts: the first is about evaluation of the current evidence status in reviews on acupuncture and the second examines and gives examples of available recommendations on acupuncture in treatment guidelines from health care experts and public health organizations recommending acupuncture as a viable treatment in patients in palliative care. Methods: Electronic searches were performed in PubMed using the terms ''acupuncture'' + ''palliative'' and adding the term ''safety'' to find review articles documenting safety and evidence of effectiveness of acupuncture for treatment of symptoms in palliative care patients. Treatment guidelines that recommend use of acupuncture for symptom control in palliative care were found by searching through a database currently under construction by the lead author. Results: Acupuncture shows emerging evidence for 17 indications in palliative care. Examples were found and presented of publications recommending acupuncture for treatment of symptoms for patients in palliative care from Government, public health, oncology, and medical expert sources. The most publications are in oncology, but other conditions were found and a number were found in pediatric care. Conclusions: While the evidence for use of acupuncture to treat symptoms in palliative care patients is relatively weak, the evidence base is growing. Experts worldwide are also increasingly recommending acupuncture as a treatment for symptoms in palliative care. Since acupuncture is a safe, nonpharmacological treatment but with small, clinically significant effects, these recommended uses appear as pragmatic efforts to bridge the gap of treatment options available to this patient group.

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