Increasing Trend and Effects of Pediatric Palliative Care on Children With Noncancer Diagnoses

Szu-Han Chen; En-Ting Wu; Ching-Chia Wang; Min-Yu Su; Chin-Hao Chang; Huey-Ling Chen; Frank Leigh Lu; Shao-Yi Cheng

doi:10.1016/j.jpainsymman.2023.05.018

Increasing Trend and Effects of Pediatric Palliative Care on Children With Noncancer Diagnoses

J Pain Symptom Manage. 2023 Sep;66(3):230-237.e1. doi: 10.1016/j.jpainsymman.2023.05.018. Epub 2023 Jun 6.

Authors

Szu-Han Chen¹, En-Ting Wu¹, Ching-Chia Wang¹, Min-Yu Su², Chin-Hao Chang³, Huey-Ling Chen⁴, Frank Leigh Lu⁵, Shao-Yi Cheng⁶

Affiliations

¹ Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
² Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Pediatric Hematology and Oncology (M.Y.S.), China Medical University Children's Hospital, Taichung, Taiwan.
³ Department of Medical Research (C.H.C.), National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department and Graduate Institute of Medical Education and Bioethics (H.L.C.), National Taiwan University College of Medicine, Taipei, Taiwan.
⁵ Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: frankllu@ntu.edu.tw.
⁶ Department of Family Medicine (S.Y.C.), National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

PMID: 37290731
DOI: 10.1016/j.jpainsymman.2023.05.018

Abstract

Objectives: Pediatric palliative care (PPC), especially among noncancer pediatric patients, faces challenges including late referral, limited patient care, and insufficient data for Asian patients.

Methods: This retrospective cohort study used the integrative hospital medical database between 2014 and 2018 to analyze the clinical characteristics, diagnoses, and end-of-life care for patients aged less than 20 who had died in our children's hospital, a tertiary referral medical center implementing PPC shared-care.

Results: In our cohort of 323 children, 240 (74.3%) were noncancer patients who a younger median age at death (5 vs. 122 months, P < 0.001), lower rate of PPC involvement (16.7 vs. 66%, P < 0.001), and fewer survival days after PPC consult compared to cancer patients (3 vs. 11, P = 0.01). Patients not receiving PPC had more ventilator support (OR 9.9, P < 0.001), and less morphine use on their final day of life (OR 0.1, P < 0.001). Also, patients not receiving PPC had more cardiopulmonary resuscitation on the last day of life (OR 15.3, P < 0.001) and died in the ICU (OR 8.8, P < 0.001). There was an increasing trend of noncancer patients receiving PPC between 2014 and 2018 (P < 0.001).

Conclusions: High disparities exist between children receiving PPC in cancer versus noncancer patients. The concept of PPC is gradually becoming accepted in noncancer children and is associated with more pain-relief medication and less suffering during end-of-life care.

Keywords: Pediatric palliative care; cancer; end-of-life care; noncancer diagnosis.

MeSH terms

Child
Hospice and Palliative Care Nursing*
Humans
Neoplasms* / diagnosis
Neoplasms* / therapy
Palliative Care
Retrospective Studies
Terminal Care*