The Impact of Palliative Care Consultation on Symptom Assessment, Communication Needs, and Palliative Interventions in Pediatric Patients with Cancer

Zhukovsky, Donna S.; Herzog, Cynthia E.; Kaur, Guddi; Palmer, J. Lynn; Bruera, Éduardo

doi:10.1089/jpm.2008.0152

Cited by 109 publications

(136 citation statements)

References 32 publications

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“…The earlier use of palliative care would have great utility in providing symptom-based, psychosocial and spiritual support in this unique population. 20 These data are limited because it is a single academic center, with a small sample size, included all cancer types, and relied solely on what was available through retrospective chart review so it lacks generalizability. Additionally, the sample itself was limited because it did not include those who died in their homes or in hospice care settings.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Care Characteristics for Young Adults with Cancer Who Die in the Hospital

Keim‐Malpass

Erickson

Malpass

2014

Journal of Palliative Medicine

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Background: Evidence suggests nonelderly adults with cancer are likely to receive aggressive treatment in their last month of life and less likely to receive hospice and/or palliative services. Young adults with cancer (18-39 years) are a unique population, and little is known about the characteristics of their end-of-life care trajectories when they die in the hospital. Objective: The purpose of this descriptive pilot study was to explore the characteristics of death among young adults with cancer who died in a tertiary academic hospital in order to elucidate their end-of-life trajectories. Methods: A retrospective chart review was conducted among hospitalized young adults with a primary cancer diagnosis who died in the hospital within a 10-year period. Study variables were abstracted for quantification and medical record notes were reviewed for validation. Results: A review of 61 patient records indicate that young adults commonly received cancer treatment within weeks of death and that do-not-resuscitate orders were frequently written only when death appeared imminent. Palliative care teams were frequently consulted for management of physical symptoms but often within days of death and most commonly on the day of death. Conclusions: Findings suggest palliative care was initiated late in the care trajectory for young adults with cancer who died in the hospital. This study highlights the need for further inquiry into end-of-life care for young adults with cancer so that interventions can be developed to meet the physical, emotional, social, and spiritual needs of this unique group of patients, their families, and friends.

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Section: Discussionmentioning

confidence: 99%

End-of-Life Care Characteristics for Young Adults with Cancer Who Die in the Hospital

Keim‐Malpass

Erickson

Malpass

2014

Journal of Palliative Medicine

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“…We used Pearson's w 2 test to analyse whether several patient and care characteristics were associated with the different end-oflife issues ever being discussed. We chose patient and care characteristics that were found relevant from literature 2,[32][33][34][35] : age, gender, education, cancer diagnosis, presence of dementia and treatment focus (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Discussing End-of-Life Issues in the Last Months of Life: A Nationwide Study among General Practitioners

Abarshi

Echteld

Donker

et al. 2011

Journal of Palliative Medicine

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Background: Communication is a necessary tool for ensuring the provision of quality patient-centered care for patients who have life-threatening illnesses, and discussing all relevant end-of-life issues should not be limited to cancer patients. Objective: To examine the incidence and timing of general practitioners (GPs) discussing end-of-life issues with patients whose deaths were expected, and to identify the factors associated with them discussing these issues. Methods: Between January and December 2008, GPs participating in a nationally representative sentinel surveillance network of GPs were asked to register, using standardised forms, the extent of discussing 10 end-of-life issues with patients. Results: We examined 252 patients who died nonsuddenly, 38% of whom died of cancer, and 86% of whose treatment goal was palliative care. Our findings show that GPs often waited until very close to death before they discussed end-of-life issues with patients, and discussed spiritual and social issues less than physical symptoms, diagnoses, and psychological problems. In 74% of cases, the GPs were informed of their patients' preferred place of death; and 8 out of 10 patients with known preferences for place of death, died there. Being diagnosed with cancer was associated with a higher frequency of discussing all 10 end-of-life issues than diagnosis with other (noncancer) conditions, but this is a state of mind we did not explore in this study. Conclusion: Promotion of timely discussion of all relevant end-of-life issues, in patients with cancer and noncancer diagnoses, is advisable based on systematic needs assessment.

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Section: Ray Barfieldmentioning

confidence: 94%

“…Despite the fact that palliative care is now widely recognized as a critical part of excellent care for children with life-limiting diseases such as cancer, patients continue to receive this care very late in their illness trajectory [12,13]. In 1 study, the median time between palliative care consultation and death was only 8 days [14]. However, as evidence grows that introducing palliative care early in the course of therapy benefits children with cancer, and as the medical culture becomes more aware of the evidence demonstrating the value of such an approach, pediatric oncology and palliative care will continue to become more integrated.…”

Section: Ray Barfieldmentioning

confidence: 99%

Pediatric Oncology and Palliative Care

Barfield

2014

North Carolina Medical Journal

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Overall, we now cure 70% of the children who are diagnosed with cancer, and in the 30% of cases that are still not curable, we can almost always add time to the child's life. As our ability to cure cancer has improved, we are now paying increased attention to the goal of avoiding or alleviating the suffering associated with cancer and its therapy. Risk stratification aims to avoid undertreatment of children with high-risk cancers and to avoid overtreatment (with all of the associated side effects of therapy) of children with lower-risk cancers. This goal has become an important part of designing treatment protocols over the past 15 years.Whether or not a child will be cured, we know that all children with cancer suffer, as do their families. Pediatric oncology is committed to curing cancer, but palliative care is committed to improving a child's quality of life, irrespective of the potential for cure. Oncology and palliative care are thus twin endeavors, both of which seek what is best for a child and his or her family [1]. Within the 2 broad categories of curing disease and alleviating suffering, there are many specific goals unique to each patient. Palliative care seeks to relieve the physical, emotional, social, and spiritual distress produced by complex, chronic, or life-limiting conditions; to assist in making difficult decisions and setting goals; and to enhance children's quality of life [2].More than a decade has passed since the American Academy of Pediatrics [3] and the Institute of Medicine of the National Academies [4] called for the integration of palliative care into ongoing medical management of lifethreatening illnesses (such as cancer) in children, from diagnosis to the end of life. Since these calls were issued, models of integrated pediatric palliative care have been developed in which curative therapy and palliative care coexist. For children whose lives are going to be short, adding a few months of good-quality life can be transformative. Adding 6 months to the life of a child who would otherwise have died at 3.5 years of age is extending his or her life by nearly 15%.

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The Impact of Palliative Care Consultation on Symptom Assessment, Communication Needs, and Palliative Interventions in Pediatric Patients with Cancer

Abstract: PCC, although late in the course, resulted in the detection of multiple symptom control and communication needs, and corresponding treatment recommendations.

Cited by 109 publications

References 32 publications

End-of-Life Care Characteristics for Young Adults with Cancer Who Die in the Hospital

End-of-Life Care Characteristics for Young Adults with Cancer Who Die in the Hospital

Discussing End-of-Life Issues in the Last Months of Life: A Nationwide Study among General Practitioners

Pediatric Oncology and Palliative Care

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