1
40
9
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Title
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2020 Developing World List
Text
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Developing World 2020 List
URL Address
<a href="http://doi.org/10.1002/cncr.33001" target="_blank" rel="noreferrer noopener">http://doi.org/10.1002/cncr.33001</a>
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A multicountry assessment in Eurasia: Alignment of physician perspectives on palliative care integration in pediatric oncology with World Health Organization guidelines
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Cancer
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
Subject
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Eurasia; global health; low-to-middle-income country (LMIC); pediatric oncology; pediatric palliative care; physician perspectives
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Ehrlich B S; Movsisyan N; Batmunkh T; Kumirova E; Borisevich M V; Kirgizov K; Graetz D E; McNeil M J; Yakimkova T; Vinitsky A; Ferrara G; Li C; Lu Z; Kaye E C; Baker J N; Agulnik A
Description
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BACKGROUND: The World Health Organization (WHO) advocates for early integration of palliative care for all children with life-threatening illness. Provider awareness and misperceptions, however, can impede this imperative. In the Eurasian region, little is known about physician knowledge and perspectives on palliative care. METHODS: The Assessing Doctors' Attitudes on Palliative Treatment survey was developed as an evidence-based and culturally relevant assessment of physician perceptions on palliative care integration into childhood cancer care in Eurasia. Iteratively tested by American and Eurasian palliative care experts, the survey was culturally adapted, translated, and piloted in English, Russian, and Mongolian. The survey was distributed to physicians caring for children with cancer. Fifteen statements were scored in accordance with WHO guidelines to evaluate provider knowledge. The statistical analysis was complemented by a qualitative analysis of open-ended responses. RESULTS: This study received 424 responses from 11 countries in Eurasia. The mean alignment between provider perspectives and WHO recommendations was 70% (range, 7%-100%). Significant independent predictors of higher alignment included country, prior palliative care education, and greater experience with patient death. Respondents primarily described palliative care as end-of-life care and symptom management. Two-thirds of respondents (67%) reported not feeling confident about delivering at least 1 component of palliative care. CONCLUSIONS: This is the first study assessing physician perspectives and knowledge of palliative care in Eurasia and reveals wide variability in alignment with WHO guidelines and limited confidence in providing palliative care. Study findings will inform targeted educational interventions, which must be tailored to the local political, economic, and cultural context.
Identifier
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<a href="http://doi.org/10.1002/cncr.33001" target="_blank" rel="noreferrer noopener">10.1002/cncr.33001</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
Agulnik A
Baker J N
Batmunkh T
Borisevich M V
Cancer
Developing World 2020 List
Ehrlich B S
Eurasia
Ferrara G
Global Health
Graetz D E
Kaye E C
Kirgizov K
Kumirova E
Li C
low-to-middle-income country (LMIC)
Lu Z
McNeil M J
Movsisyan N
Pediatric Oncology
Pediatric Palliative Care
physician perspectives
Vinitsky A
Yakimkova T
-
Dublin Core
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Title
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2020 Developing World List
Text
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Developing World 2020 List
URL Address
<a href="http://doi.org/10.1002/cncr.33151" target="_blank" rel="noreferrer noopener">http://doi.org/10.1002/cncr.33151</a>
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Title
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Barriers to the early integration of palliative care in pediatric oncology in 11 Eurasian countries
Publisher
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Cancer
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
Subject
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Eurasia; global health; low-income and middle-income countries (LMICs); palliative care integration; pediatric oncology; pediatric palliative care; physician perspectives
Creator
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Ehrlich B S; Movsisyan N; Batmunkh T; Kumirova E; Borisevich M V; Kirgizov K; Graetz D E; McNeil M J; Yakimkova T; Vinitsky A; Ferrara G; Li C; Lu Z; Kaye E C; Baker J N; Agulnik A
Description
An account of the resource
BACKGROUND: The early integration of palliative care significantly improves quality of life for children with cancer. However, cultural, structural, and socioeconomic barriers can delay the integration of palliative care into cancer care, particularly in low-income and middle-income countries. To date, little is known regarding the timing of and barriers to palliative care integration in Eurasia. METHODS: The Assessing Doctors' Attitudes on Palliative Treatment (ADAPT) survey evaluates physician perceptions regarding palliative care integration into pediatric oncology in Eurasia. This evidence-based survey was adapted to the regional context; iteratively reviewed by US and regional panelists; and piloted in English, Russian, and Mongolian. After distribution to physicians caring for children with cancer, statistical analysis was complemented by qualitative analysis of open-ended responses. RESULTS: A total of 424 physician responses were received from 11 countries in the Eurasian region. Study findings demonstrated wide variability in access to palliative care experts across countries (18%-96%), with the majority of providers (64%) reporting that the initial palliative care consultation typically occurs when curative options are no longer available. Providers desired an earlier initial palliative care consultation than what currently occurs in their setting (P < .001). Primary barriers to timely consultation included limited access to palliative care services and specialists, lack of physician education, and perceived family resistance. CONCLUSIONS: The current study is the first to identify physician perceptions of the delayed timing of palliative care integration into childhood cancer care and associated barriers in Eurasia. These findings will inform the development of targeted interventions to mitigate local structural and cultural barriers to access and facilitate earlier palliative care integration in the region.
Identifier
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<a href="http://doi.org/10.1002/cncr.33151" target="_blank" rel="noreferrer noopener">10.1002/cncr.33151</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
Agulnik A
Baker J N
Batmunkh T
Borisevich M V
Cancer
Developing World 2020 List
Ehrlich B S
Eurasia
Ferrara G
Global Health
Graetz D E
Kaye E C
Kirgizov K
Kumirova E
Li C
low-income and middle-income countries (LMICs)
Lu Z
McNeil M J
Movsisyan N
palliative care integration
Pediatric Oncology
Pediatric Palliative Care
physician perspectives
Vinitsky A
Yakimkova T
-
Dublin Core
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Title
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September 2020 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
September 2020 List
URL Address
<a href="http://doi.org/10.1016/j.jpainsymman.2020.06.036" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.jpainsymman.2020.06.036</a>
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Investigation of Modifiable Variables to Increase Hospice Nurse Comfort With Care Provision to Children and Families in the Community: A Population-Level Study Across Tennessee, Mississippi, and Arkansas
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Journal of Pain and Symptom Management
Date
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2020
Subject
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community; education; hospice; palliative care; pediatric; training
Creator
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Kaye E C; Gattas M; Kiefer A; Reynolds J; Zalud K; Li C; Lu Z; Baker J N
Description
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Context: Most hospice nurses across Tennessee, Arkansas, and Mississippi report significant discomfort with provision of pediatric palliative and hospice care (PPHC). How best to target and modify variables to increase nurse comfort levels is not well understood. Objective(s): To determine whether modifiable variables are associated with increased hospice nurse comfort with PPHC provision in the community. Method(s): A cross-sectional survey was developed, pilot tested, and distributed to hospice nurses across a tristate region to assess nurse training experiences and comfort with PPHC provision. Targeted subanalyses were conducted to investigate associations between nurse comfort level and clinical, training, and patient frequency variables. Result(s): A total of 551 respondents representing 71 hospices across Tennessee, Arkansas, and Mississippi completed surveys. Hospice nurse comfort with provision of care to children was statistically significantly associated with exposure to prior PPHC clinical experiences (P < 0.001), receipt of formal pediatric PPHC training (P < 0.001), and higher hospice-level (P = 0.01) and individual-level frequency of PPHC provision (P < 0.001). PPHC clinical experience was the most impactful variable with respect to comfort with overall and end-of-life PPHC provision; formal training was the most impactful variable with respect to comfort with management of severe symptoms at the end of life. Conclusion(s): Modifiable variables exist that are readily targetable to improve hospice nurse comfort with PPHC provision. These findings should inform the development and investigation of clinical and educational interventions to empower both nurses and hospices to optimize the provision of quality care to children with serious illness and their families in the community. Copyright © 2020 American Academy of Hospice and Palliative Medicine
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<a href="http://doi.org/10.1016/j.jpainsymman.2020.06.036" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2020.06.036</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
Baker J N
Community
Education
Gattas M
Hospice
Journal of Pain and Symptom Management
Kaye E C
Kiefer A
Li C
Lu Z
Palliative Care
Pediatric
Reynolds J
September 2020 List
Training
Zalud K
-
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Title
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July 2020 List
Text
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July 2020 List
URL Address
<a href="http://doi.org/10.1542/peds.2019-2771" target="_blank" rel="noreferrer noopener">http://doi.org/10.1542/peds.2019-2771</a>
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Title
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Bereaved Parents, Hope, and Realism
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Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
Subject
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Bereavement; Collaboration; Conceptual Framework; Family; Grief; Hope; Life Experiences; Palliative Care; Parents
Creator
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Kaye E C; Kiefer A; Blazin L; Spraker-Perlman H; Clark L; Baker J N
Description
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The article presents a discussion between bereaved parents on the Quality of Life Steering Council at a large academic pediatric cancer center and interdisciplinary pediatric palliative care clinicians about the coexistence of hope and realism. Topics covered include collaborative development of a novel conceptual model, historical frameworks for hope, and definitions and infrastructure of hope.
Identifier
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<a href="http://doi.org/10.1542/peds.2019-2771" target="_blank" rel="noreferrer noopener">10.1542/peds.2019-2771</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
Baker J N
Bereavement
Blazin L
Clark L
Collaboration
Conceptual Framework
Family
Grief
Hope
July 2020 List
Kaye E C
Kiefer A
Life Experiences
Palliative Care
Parents
Pediatrics
Spraker-Perlman H
-
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Title
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March 2020 List
Text
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Citation List Month
March 2020 List
URL Address
<a href="https://pediatrics.aappublications.org/content/144/2_MeetingAbstract/442">https://pediatrics.aappublications.org/content/144/2_MeetingAbstract/442</a>
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Development of an innovative program to improve provision of palliative and hospice care to children and families in the community: The story of QoLA Kids
Publisher
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Pediatrics
Date
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2019
Subject
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cancer patient; cancer prognosis; catchment; child; childhood cancer; conference abstract; controlled study; counselor; distress syndrome; female; Hospice Care; hospital personnel; human; magnet; major clinical study; male; nurse practitioner; outpatient; palliative therapy; patient referral; pediatric hospital; pediatric patient; prognosis; program impact; quality of life; registered nurse; social worker
Creator
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Kiefer A C; Kaye E C; Blazin L J; Baker J N
Description
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Background: Approximately 500,000 children in the United States suffer from serious illnesses each year and 50,000 die annually. Hospice and palliative care services are known to be beneficial for many children with serious illnesses and their families; however, hospice services only reach about 10% of eligible children who die in the United States, with the majority of pediatric patients receiving care through adult hospice organizations. Program Design: The Quality of Life for All (QoLA) Kids program, established in August 2012, is an outpatient, community-based pediatric palliative care and hospice program that strives to enhance quality of life for pediatric patients and families, provide care coordination across multiple settings, mitigate physical, psychosocial, and spiritual distress, ensure a comfortable and peaceful death in the patient's preferred setting, and support bereaved family members and hospital staff. The program represents a partnership between two MAGNET-certified pediatric hospitals and a local home health and hospice agency. QoLA Kids comprises an extensive interdisciplinary team including physicians, nurse practitioners, registered nurses, medical social workers, spiritual counselors, child life specialists, and administrative support staff. Patients are enrolled on either the palliative care or hospice arm of the program, with flexibility to transition easily between arms as clinical status and goals of care evolve. Eligibility for the hospice arm necessitates an expected prognosis of 6 months or less left to live. Program Impact: Since programmatic inception nearly 6 years ago, QoLA Kids has served a total of 330 children and families in the local catchment area. Approximately 41% of patients (n=135) were enrolled on the palliative arm, with the remaining 59% enrolled on hospice (n=195). Between 2012-2017, the mean number of days from enrollment to death was 142 days for patients on the hospice arm (n=76) and 288 for patients on the palliative care arm (n=5). The percentage of patients with malignancies who received palliative care prior to death increased from 71% to 97% within 2 years following program implementation. Conclusions/Future Directions: QoLA Kids is an innovative program that facilitates the provision of palliative care and hospice services and resources to children with serious illness and their families in the community. Through this program, children and families have been able to access palliative care services in their community well before the end of life. After program initiation, an increase in the number of palliative care consults was also seen within the pediatric oncology patient population suggesting that the program may provide an incentive for referral to palliative care. Further investigation is needed to identify optimal metrics for ascertaining the physical and psychosocial benefits from this innovative program.
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2019
Baker J N
Blazin L J
Cancer Patient
Cancer Prognosis
catchment
Child
Childhood Cancer
conference abstract
Controlled Study
Counselor
Distress Syndrome
Female
Hospice Care
hospital personnel
Human
Kaye E C
Kiefer A C
magnet
Major Clinical Study
Male
March 2020 List
Nurse Practitioner
Outpatient
Palliative Therapy
Patient Referral
Pediatric Hospital
pediatric patient
Pediatrics
Prognosis
program impact
Quality Of Life
registered nurse
Social Worker
-
Dublin Core
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Title
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2019 Oncology List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Oncology 2019 List
URL Address
<a href="http://doi.org/10.1177/1049909119836939" target="_blank" rel="noreferrer noopener">http://doi.org/10.1177/1049909119836939</a>
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Impact of Race and Ethnicity on End-of-Life Experiences for Children With Cancer
Publisher
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American Journal of Hospice and Palliative Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Subject
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end of life; ethnicity; oncology; palliative care; pediatric; race
Creator
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Kaye E C; Gushue C A; DeMarsh S; Jerkins J; Li C; Lu Z; Snaman J M; Blazin L; Johnson L M; Levine D R; Morrison R R; Baker J N
Description
An account of the resource
BACKGROUND:: Racial and ethnic disparities in the provision of end-of-life care are well described in the adult oncology literature. However, the impact of racial and ethnic disparities at end of life in the context of pediatric oncology remains poorly understood. OBJECTIVE:: To investigate associations between end-of-life experiences and race/ethnicity for pediatric patients with cancer. METHODS:: A retrospective cohort study was conducted on 321 children with cancer enrolled on a palliative care service at an urban pediatric cancer who died between 2011 and 2015. RESULTS:: Compared to white patients, black patients were more likely to receive cardiopulmonary resuscitation (CPR; odds ratio [OR]: 4.109, confidence interval [CI]: 1.432-11.790, P = .009) and underwent 3.136 (CI: 1.433-6.869, P = .004) CPR events for every 1 white patient CPR event. The remainder of variables related to treatment and end-of-life care were not significantly correlated with race. Hispanic patients were less likely to receive cancer-directed therapy within 28 days prior to death (OR: 0.493, CI: 0.247-0.982, P = .044) as compared to non-Hispanic patients, yet they were more likely to report a goal of cure over comfort as compared to non-Hispanic patients (OR: 3.094, CI: 1.043-9.174, P = .042). The remainder of variables were not found to be significantly correlated with ethnicity. CONCLUSIONS:: Race and ethnicity influenced select end-of-life variables for pediatric palliative oncology patients treated at a large urban pediatric cancer center. Further multicenter investigation is needed to ascertain the impact of racial/ethnic disparities on end-of-life experiences of children with cancer.
Identifier
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<a href="http://doi.org/10.1177/1049909119836939" target="_blank" rel="noreferrer noopener">10.1177/1049909119836939</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2019
American Journal Of Hospice And Palliative Care
Baker J N
Blazin L
DeMarsh S
End Of Life
Ethnicity
Gushue C A
Jerkins J
Johnson L M
Kaye E C
Levine D R
Li C
Lu Z
Morrison R R
Oncology
Oncology 2019 List
Palliative Care
Pediatric
race
Snaman J M
-
Dublin Core
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Title
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2019 Oncology List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Oncology 2019 List
URL Address
<a href="http://doi.org/10.1634/theoncologist.2017-0650" target="_blank" rel="noreferrer noopener">http://doi.org/10.1634/theoncologist.2017-0650</a>
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Title
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Predictors of Location of Death for Children with Cancer Enrolled on a Palliative Care Service
Publisher
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Oncologist
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Subject
The topic of the resource
article.; Death; End of life; Female; Humans; Location of death; Male; Neoplasms/*mortality; palliative care; Palliative Care/*methods; palliative oncology; Pediatric oncology
Creator
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Kaye E C; DeMarsh S; Gushue C A; Jerkins J; Sykes A; Lu Z; Snaman J M; Blazin L J; Johnson L M; Levine D R; Morrison R R; Baker J N
Description
An account of the resource
BACKGROUND: In the U.S., more children die from cancer than from any other disease, and more than one third die in the hospital setting. These data have been replicated even in subpopulations of children with cancer enrolled on a palliative care service. Children with cancer who die in high-acuity inpatient settings often experience suffering at the end of life, with increased psychosocial morbidities seen in their bereaved parents. Strategies to preemptively identify children with cancer who are more likely to die in high-acuity inpatient settings have not been explored. MATERIALS AND METHODS: A standardized tool was used to gather demographic, disease, treatment, and end-of-life variables for 321 pediatric palliative oncology (PPO) patients treated at an academic pediatric cancer center who died between 2011 and 2015. Multinomial logistic regression was used to predict patient subgroups at increased risk for pediatric intensive care unit (PICU) death. RESULTS: Higher odds of dying in the PICU were found in patients with Hispanic ethnicity (odds ratio [OR], 4.02; p = .002), hematologic malignancy (OR, 7.42; p < .0001), history of hematopoietic stem cell transplant (OR, 4.52; p < .0001), total number of PICU hospitalizations (OR, 1.98; p < .0001), receipt of cancer-directed therapy during the last month of life (OR, 2.96; p = .002), and palliative care involvement occurring less than 30 days before death (OR, 4.7; p < .0001). Conversely, lower odds of dying in the PICU were found in patients with hospice involvement (OR, 0.02; p < .0001) and documentation of advance directives at the time of death (OR, 0.37; p = .033). CONCLUSION: Certain variables may predict PICU death for PPO patients, including delayed palliative care involvement. Preemptive identification of patients at risk for PICU death affords opportunities to study the effects of earlier palliative care integration and increased discussions around preferred location of death on end-of-life outcomes for children with cancer and their families. IMPLICATIONS FOR PRACTICE: Children with cancer who die in high-acuity inpatient settings often experience a high burden of intensive therapy at the end of life. Strategies to identify patients at higher risk of dying in the pediatric intensive care unit (PICU) have not been explored previously. This study finds that certain variables may predict PICU death for pediatric palliative oncology patients, including delayed palliative care involvement. Preemptive identification of patients at risk for PICU death affords opportunities to study the effects of earlier palliative care integration and increased discussions around preferred location of death on end-of-life outcomes for children with cancer and their families.
Identifier
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<a href="http://doi.org/10.1634/theoncologist.2017-0650" target="_blank" rel="noreferrer noopener">10.1634/theoncologist.2017-0650</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2018
article.
Baker J N
Blazin L J
Death
DeMarsh S
End Of Life
Female
Gushue C A
Humans
Jerkins J
Johnson L M
Kaye E C
Levine D R
Location Of Death
Lu Z
Male
Morrison R R
Neoplasms/*mortality
Oncologist
Oncology 2019 List
Palliative Care
Palliative Care/*methods
palliative oncology
Pediatric Oncology
Snaman J M
Sykes A
-
Dublin Core
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Title
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2019 Oncology List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Oncology 2019 List
URL Address
<a href="http://doi.org/10.1200/jop.19.00100" target="_blank" rel="noreferrer noopener">http://doi.org/10.1200/jop.19.00100</a>
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Title
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Models of Pediatric Palliative Oncology Outpatient Care-Benefits, Challenges, and Opportunities
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Journal of Oncology Practice
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Subject
The topic of the resource
models; oncology; outpatient care; Pediatric palliative care
Creator
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Brock K E; Snaman J M;Kaye E C; Bower K A; Weaver M S; Baker J N; Wolfe J; Ullrich C
Description
An account of the resource
PURPOSE: Although the bulk of current pediatric palliative care (PPC) services are concentrated in inpatient settings, the vast majority of clinical care, symptom assessment and management, decision-making, and advance care planning occurs in the outpatient and home settings. As integrated PPC/pediatric oncology becomes the standard of care, novel pediatric palliative oncology (PPO) outpatient models are emerging. The optimal PPO model is unknown and likely varies on the basis of institutional culture, resources, space, and personnel. METHODS: We review five institutions' unique outpatient PPO clinical models with their respective benefits and challenges. This review offers pragmatic guidance regarding PPO clinic development, implementation, and resource allocation. RESULTS: Specific examples include a floating clinic model, embedded disease-specific PPC experts, embedded consultative or trigger-based supportive care clinics, and telehealth clinics. CONCLUSION: Organizations that have overcome personnel, funding, and logistical challenges can serve as role models for centers developing PPO clinic models. In the absence of a one-size-fits-all model, pediatric oncology and PPC groups can select, tailor, and implement the model that best suits their respective personnel, needs, and capacities. Emerging PPO clinics must balance the challenges and opportunities unique to their organization, with the goal of providing high-quality PPC for children with cancer and their families.
Identifier
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<a href="http://doi.org/10.1200/jop.19.00100" target="_blank" rel="noreferrer noopener">10.1200/jop.19.00100</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2019
Baker J N
Bower K A
Brock K E
Journal of Oncology Practice
Kaye E C
Models
Oncology
Oncology 2019 List
outpatient care
Pediatric Palliative Care
Snaman J M
Ullrich C
Weaver M S
Wolfe J
-
Dublin Core
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October 2019 List
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Citation List Month
October 2019 List
URL Address
<a href="http://doi.org/10.1542/peds.2019-0160" target="_blank" rel="noreferrer noopener">http://doi.org/10.1542/peds.2019-0160</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Integration of Pediatric Palliative Care Into Cardiac Intensive Care: A Champion-Based Model
Publisher
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Pediatrics
Date
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2019
Subject
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article; child; human; palliative therapy; skill; coronary care unit; multicenter study; staff; patient referral; clinician; hospitalization; total quality management; mortality; comorbidity; conceptual framework; consensus; feasibility study; heart disease; morbidity; rotation
Creator
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Moynihan K M; Snaman J M; Kaye E C; Morrison W E; DeWitt A G; Sacks L D; Thompson J L; Hwang J M; Bailey V; Lafond D A; Wolfe J; Blume E D
Description
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Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy. Copyright © 2019 by the American Academy of Pediatrics.
Identifier
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<a href="http://doi.org/10.1542/peds.2019-0160" target="_blank" rel="noreferrer noopener">10.1542/peds.2019-0160</a>
Rights
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2019
Article
Bailey V
Blume E D
Child
Clinician
Comorbidity
Conceptual Framework
Consensus
coronary care unit
DeWitt A G
Feasibility Study
heart disease
Hospitalization
Human
Hwang J M
Kaye E C
Lafond D A
Morbidity
Morrison W E
Mortality
Moynihan K M
Multicenter Study
October 2019 List
Palliative Therapy
Patient Referral
Pediatrics
Rotation
Sacks L D
Skill
Snaman J M
Staff
Thompson J L
Total Quality Management
Wolfe J