Location of Death and End-of-Life Characteristics of Young Adults with Cancer Treated at a Pediatric Hospital

Mark, Melissa; Yang, Gang; Ding, Lili; Norris, Robin E.; Thienprayoon, Rachel

doi:10.1089/jayao.2018.0123

Cited by 6 publications

(21 citation statements)

References 22 publications

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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%

“…44,56,61,62,66,67,69,78 Overall, these 31 studies address diagnoses from infancy to young adulthood, with only three studies focused on young adults, which included any malignancy. 54,58,86 Five studies included some children and young people with conditions other than cancer. 61,67,70,73,88 Of the 11 studies exploring stakeholder views, 3 recruited paediatric oncology staff from single hospitals 75,77,82,83 and 1 from multiple hospitals, 79,80 1 recruited staff involved in providing palliative care to children with cancer from primary, tertiary and community settings, 76 4 recruited paediatric oncologists via professional organisations 65,71,72,81 and 1 recruited parent and young person dyads from three hospitals.…”

Section: Study Populationsmentioning

confidence: 99%

“…We identified five broad service types from the included studies: hospital-based palliative care teams with referral triggering an initial consultation 46,[50][51][52][53]58,[61][62][63][64]67,69,[73][74][75]77,[82][83][84][85]87,88 (n = 17), hospice services 23,45,47,55,56,59,60,65,86 (n = 8), home-based services 48,57,70,90 (n = 4), integrated oncology services 44,66 (n = 2) and an integrated oncology inpatient unit (n = 1). Three studies referred to palliative care consultation only, 43,54,78 and three a palliative care team, 68,79,81 although it is likely that these were all referring to hospital-based teams.…”

Section: Models Of Deliverymentioning

confidence: 99%

“…There were concerns about the representativeness of samples in 14 of the quantitative studies, due to the single-site design of many studies, long study period and inappropriate participant selection or recruitment methods. 44,46,[48][49][50][51]54,57,61,62,64,70,72,86,89 Assessment of representativeness was not possible in another seven studies because of poor reporting. 66,68,73,78,81,89,90 In eight studies, there were concerns about the comparability of groups (e.g.…”

Section: Study Qualitymentioning

confidence: 99%

“…Out of 12 studies examining type of cancer, 10 found that children with solid tumours were more likely to receive specialist palliative care than children with haematological malignancies. 46,47,49,50,[53][54][55]59,61,63,78,86 Six studies investigated whether disease status (e.g. prognosis, relapse) was associated with access; no consistency was found across these, with some studies reporting conflicting resu lts.…”

Section: Disease Profilementioning

confidence: 99%

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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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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Populationsmentioning

confidence: 99%

Section: Models Of Deliverymentioning

confidence: 99%

Section: Study Qualitymentioning

confidence: 99%

Section: Disease Profilementioning

confidence: 99%

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

et al. 2020

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Patterns of medication use at end of life by pediatric inpatients with cancer

Prozora

Shabanova

Ananth

et al. 2020

Pediatric Blood & Cancer

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Objective To describe medication utilization patterns by pediatric inpatients with cancer during their last week of life. Methods This retrospective study used data from the Vizient Clinical Database/Resource Manager, a national compilation of clinical and resource use data from over 100 academic medical centers and affiliates. Patients (0‐21 years) with malignancy who died during hospitalization (2010‐2017) were included (N = 1659). Medications were categorized as opioid, benzodiazepine, gastrointestinal related, chemotherapy, anti‐infectives, or vasopressors. Exposure to each group was ascertained for all patients at 1 week and 1 day prior to death. Factors associated with exposure were examined using generalized estimating equations, and summarized using adjusted odds ratios (aORs). Results Over the last week of life, there was increased use of opioids (76% to 82%, aOR = 1.55, P < .001) and benzodiazepines (53% to 66%, aOR = 1.36, P = .02), while gastrointestinal‐related medication use decreased (92% to 89%, aOR = 0.69, P = .001). Patients had decreased exposure to chemotherapy (10% to 5%, aOR = 0.46, P < .001) and anti‐infectives (82% to 73%, aOR = 0.41, P = .002). Vasopressor use increased as death approached (15% to 28%, aOR = 1.67, P = .04). Factors significantly associated with exposure varied with medication category, and included age, race, length of stay, malignancy type, death in the intensive care unit, history of hematopoietic stem cell transplant, and do‐not‐resuscitate status. Conclusion During the week preceding death, administration of symptom management medications increased for children with cancer, but use was not universal. Potentially life‐sustaining medications were often continued. Variability in utilization suggests differences in provider/family decision making that warrant further study to develop an evidence‐based approach to end‐of‐life care.

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Palliative home-based care to pediatric cancer patients: characteristics and healthcare delivered

Noriega

García-Salido

Martino

et al. 2021

Support Care Cancer

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Location of Death and End-of-Life Characteristics of Young Adults with Cancer Treated at a Pediatric Hospital

Cited by 6 publications

References 22 publications

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

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

Patterns of medication use at end of life by pediatric inpatients with cancer

Palliative home-based care to pediatric cancer patients: characteristics and healthcare delivered

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