Pediatric palliative care in the community

Abstract

Take free quizzes online at acsjournals.com/ce ONLINE CONTINUING EDUCATION ACTIVITYAfter reading the article "Pediatric Palliative Care in the Community" the learner should be able to: 1. Describe the scope of pediatric palliative care and community-based pediatric palliative care. 2. Review the indications for referral of children with cancer to pediatric palliative care and community-based pediatric palliative care. 3. Discuss the benefits of and barriers to referral of children with cancer to pediatric palliative care and community-based pediatric palliative care. ARTICLE TITLE: Pediatric Palliative Care in the Community CONTINUING MEDICAL EDUCATION ACCREDITATION AND DESIGNATION STATEMENT:Blackwell Futura Media Services is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians.Blackwell Futura Media Services designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit™. Physicians s hould only claim credit commensurate with the extent of their participation in the activity. CONTINUING NURSING EDUCATION ACCREDITATION AND DESIGNATION STATEMENT:The American Cancer Society (ACS) is accredited as a provider of continuing nursing education (CNE) by the American Nurses Credentialing Center's Commission on Accreditation.Accredited status does not imply endorsement by the ACS or the American Nurses Credentialing Center of any commercial products displayed or discussed in conjunction with an educational activity. The ACS gratefully acknowledges the sponsorship provided by Wiley for hosting these CNE activities. EDUCATIONAL OBJECTIVES: ACTIVITY DISCLOSURESThis work was supported by the American Lebanese Syrian Associated Charities (ALSAC). ACS CONTINUING PROFESSIONAL EDUCATION COMMITTEE DISCLOSURESEditor, Director of Continuing Professional Education, and ACS Director of Medical Content Ted Gansler, MD, MBA, MPH, has no financial relationships or interests to disclose. Deputy Editor and ACS Director of Prostate and Colorectal CancersDurado Brooks, MD, MPH, has no financial relationships or interests to disclose. Lead Nursing and Associate Editor Marcia Grant, RN, PhD, FAAN, has no financial relationships or interests to disclose. Associate Editor and Chief Cancer Control Officer Richard C. Wender, MD, has no financial relationships or interests to disclose. AUTHOR DISCLOSURESErica C. Kaye, MD, Jared Rubenstein, MD, Deena Levine, MD, Justin N. Baker, MD, Devon Dabbs, BBA, and Sarah E. Friebert, MD have no financial relationships or interests to disclose.CNE CME SCORING A score of 70% or better is needed to pass a quiz containing 10 questions (7 correct answers), or 80% or better for 5 questions (4 correct answers). INSTRUCTIONS ON RECEIVING CME CREDITThis activity is intended for physicians. For information concerning the applicability and acceptance of CME credit for this activity, please consult your professional licensing board.This activity is designed to be completed within 1.5 hours; physicians should claim only those...

Early Integration of Palliative Care for Children with High‐Risk Cancer and Their Families

“…However, no consensus exists regarding the optimal strategy for achieving this integration. Multiple conceptual and clinical models have been proposed to promote integration of palliative care into the field of adult oncology, but to our knowledge, relatively few models have been described for PPC in the context of pediatric oncology …”

“…The provision of PPC for children with cancer, also known as pediatric palliative oncology (PPO), has been described as “the total care of a child and family.”[35] We believe that this total care philosophy should be guided by the primary oncology team, with collaboration from interdisciplinary clinicians and expert consultants as needed . Successful models of collaborative integration of PPC services that complement primary team management are described in the literature and provide a foundation for the generation of effective and sustainable models of care in PPO …”

“…To capture a wider breadth of patients, PPC principles should emerge from the ground up, ideally woven seamlessly into each aspect of the interdisciplinary care model. This may occur through institutionally supported PPC didactics for nursing staff (ELNEC‐Peds), cancer‐specific PPC training models for clinicians, or embedding PPC‐trained experts within outpatient and inpatient care settings to provide additional guidance and education as needed . Table offers specific examples for each PPO integration model as a possible starting point for institutions motivated to improve the integration of PPC into routine pediatric oncology management.…”

Illness and end‐of‐life experiences of children with cancer who receive palliative care

“…Over the past decade, the field of palliative oncology has developed, bolstered by evidence that patients with high‐risk or incurable disease who receive cancer‐directed care in synergy with palliative care (PC) demonstrate improved outcomes . Specifically in the context of pediatric cancer, the value of palliative oncology has gained traction over the past few years . Integration of PC principles and services into routine cancer care for children with high‐risk disease has been associated with improved symptom management for patients and quality of life (QOL) for both children and families .…”

“What if?”: Addressing uncertainty with families

“…Parents wish to receive extensive prognostic information, and a majority of parents prefer detailed, serial prognostic conversations over time . Clear, honest, and empathic communication creates a framework for identification of patient‐ and family‐centered preferences as a means by which to guide difficult decision making while continuing to foster hope . Assessing and disclosing prognosis in pediatric oncology is challenging, yet oncologists have an ethical obligation to provide timely and accurate prognostic information as desired by the patient and family .…”