Early Integration of Pediatric Palliative Care in Pediatric Hematopoietic Stem Cell Transplant Patients
distress syndrome; hematopoietic stem cell; palliative therapy; transplantation; child; conference abstract; consultation; controlled study; evidence based practice center; female; Hematopoietic Stem Cells; human; human cell; learning; major clinical study; male; medical record review; morbidity; mortality; Palliative Care; retrospective study; risk assessment; satisfaction; staff training; Stem Cell Transplantation
Topic significance and study purpose/background/rationale: Patients undergoing hematopoietic stem cell transplant (HSCT) are at risk for significant morbidity and mortality and experience distressing psychological and physical symptoms. Access to palliative care services early in the treatment course can mitigate psychological suffering, address physical symptoms, and establish rapport with the palliative care team. There is no standardized practice for palliative care consultations for these patients. The aim of this evidence-based practice project was to determine if the early implementation of a palliative care trigger tool increases the number of palliative care consults in this population. Methods, intervention, and analysis: A pre-intervention survey was administered to assess staff understanding and satisfaction with palliative care services. A retrospective chart review was conducted to determine patients at highest risk for morbidity and mortality from HSCT. A paper trigger tool was developed to identify patients considered highest risk in order to place a palliative care consultation prior to or on admission for HSCT. Implementation included staff education via various medias. The trigger tool was implemented over a 6-month period on a 24 bed HSCT Unit. Findings and interpretation: The staff pre-survey demonstrated support for the project with 79% being very or extremely interested in learning more about palliative care. Additionally, 60% disagreed or strongly disagreed that palliative care services were introduced early enough. Based on a two and a half year retrospective chart review, 51 patients met criteria for early integration of palliative care services and 15 received consultations. To date, the trigger tool has been used on 14 patients and has resulted in early consultation in 11 patients. Discussion and implications: Based on the trigger tool, most patients admitted for HSCT qualify for early integration of palliative care services. The tool effectively identified patients for early integration of palliative care services. Providing early palliative care is an important priority of care for patients undergoing HSCT.Copyright © 2023 American Society for Transplantation and Cellular Therapy
Kent L; Williams M; Pinner LA; Callard E; Fisher J; Pyke-Grimm K
Transplantation and Cellular Therapy
2023
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).
<a href="http://doi.org/10.1016/S2666-6367%2823%2900179-3" target="_blank" rel="noreferrer noopener">10.1016/S2666-6367%2823%2900179-3</a>
Children's outcomes at 2-year follow-up after 4 years of structured multi-professional medical-ethical decision-making in a neonatal intensive care unit
OBJECTIVE: We reviewed our decisions about continuation/withdrawal of life-sustaining treatments in a group of critically ill newborns who were discussed in structured medical ethical decision-making meetings, and provide the surviving children's outcomes at 2-year follow-up. STUDY DESIGN: In an explorative observational study, 61 cases were evaluated. The children involved had been discussed in such a structured way from 2009 to 2012 in a level III-D neonatal intensive care unit. RESULTS: Decisions made were: full treatment (n=6), earlier restriction cancelled (n=3), treatment restriction (n=30) and palliative care (n=22). Parents of six children disagreed with the decision proposed. Thirteen (54%) of the 24 children who survived (39%) had moderate to severe neurological problems; 8 (33%) had additional sequelae; only one 2-year-old child was healthy. CONCLUSIONS: Decisions made varied to a large extent. The poor outcomes should be disseminated among decision makers. Future studies must explore new ways to improve outcome prediction, extend follow-up periods and consider what living with severe handicaps really means for both child and family.
de Boer JC; Gennissen L; Williams M; van Dijk M; Tibboel D; Reiss I; Naghib S; Sol J
Journal of Perinatology
2017
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).
<a href="http://doi.org/10.1038/jp.2017.30" target="_blank" rel="noreferrer noopener">10.1038/jp.2017.30</a>
Developing the Liverpool Care Pathway for the dying child
Child; Humans; England; Health Services Needs and Demand; Pilot Projects; Nurse's Role; Evidence-Based Medicine; Nursing Assessment; Nursing Evaluation Research; Benchmarking; adolescent; Preschool; PedPal Lit; infant; Practice Guidelines; retrospective studies; Documentation/standards; Patient Care Team/organization & administration; Outcome and Process Assessment (Health Care)/organization & administration; Nursing Audit; Palliative Care/organization & administration; Pediatric Nursing/organization & administration; Critical Pathways/organization & administration; Nursing Records/standards; Total Quality Management/organization & administration
In most western societies the death of a child is a rare occurrence. When it does occur, it typically takes place after a period of intensive and often prolonged treatment. In light of the relative infrequency of these events in clinical practice, ensuring that all dying children and their families receive consistent and appropriate care remains a challenge. A retrospective audit of documentation of care for dying children in two paediatric units in the north-west of England illustrated that the care provided was not always documented consistently. This paper highlights work currently underway to develop an integrated care pathway for the care of the dying child based on the Liverpool Care Pathway (LCP). The aim of this work is to facilitate the delivery and recording of optimum care for all dying children and their families.
2006
Matthews K; Gambles M; Ellershaw JE; Brook L; Williams M; Hodgson A; Barber M
Paediatric Nursing
2006
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).
Journal Article