Impact Of A Pediatric Palliative Care Team On Limitations Of Care For Inpatients At A Free-standing, Tertiary- Care Children’s Hospital.
Title
Impact Of A Pediatric Palliative Care Team On Limitations Of Care For Inpatients At A Free-standing, Tertiary- Care Children’s Hospital.
Creator
Plymire C; Miller E; Frizzola M
Identifier
DOI: http://dx.doi.org/10.1016/j.jpainsymman.2015.12.080
Publisher
Journal Of Pain And Symptom Management
Date
2016
Description
Objectives
Understand the role of pediatric palliative care in
end-of-life discussions.
Identify further opportunities for do-not-resuscitate
(DNR) research and analysis of advanced
care planning in pediatrics.
Original Research Background. Discussions surrounding
limitations of care can invoke controversy,
confusion, and anxiety in both healthcare professionals
and families. Some literature exists regarding
the impact of pediatric palliative care teams on ICU
admission, cost, and family satisfaction. Limited information,
however, is available regarding the factors
involved in end-of-life decisions. Understanding these
factors may improve the process of evaluating and
placing limitation-of care orders in children.
Research Objectives. Our study aims to analyze the
timing of DNR order placement prior to death in pediatric
patients. We also aim to further delineate the
specialty of the ordering physician, demographic
data, and location of death.
Methods. We present a retrospective review of 471
deaths between 1/2009 and 10/2014. The palliative
care team was established in September, 2011. For
those patients who had a DNR order in place, we
analyzed patient and physician characteristics as well
as DNR order timing.
Results. The location of death of 49% of patients who
had a DNR in place was in an ICU setting. The death
rate in the ICU was not statistically different following
initiation of the palliative care team (PCT) (p¼0.53).
The overall DNR rate increased following initiation
of the PCT from 30.8% to 39.2% (p¼0.05). The PCT
was consulted in 77% of deaths and ordered the
DNR in 60% of children.
Conclusion. Our results emphasize the important
role of the palliative care team during end-of-life discussions
in children. The palliative care team met
with more than three quarters of families prior to
death, and they placed the DNR order in more than
half of these instances. The initiation of the palliative
care team was associated with a large increase in overall
DNR rates.
Implications for Research, Policy or
Practice. Additional studies are needed in pediatrics
to further delineate the timing of palliative care
consultation in the patient’s overall course of illness,
demographic and cultural influences, and specific patient
conditions, such as tracheostomy dependence.
Understand the role of pediatric palliative care in
end-of-life discussions.
Identify further opportunities for do-not-resuscitate
(DNR) research and analysis of advanced
care planning in pediatrics.
Original Research Background. Discussions surrounding
limitations of care can invoke controversy,
confusion, and anxiety in both healthcare professionals
and families. Some literature exists regarding
the impact of pediatric palliative care teams on ICU
admission, cost, and family satisfaction. Limited information,
however, is available regarding the factors
involved in end-of-life decisions. Understanding these
factors may improve the process of evaluating and
placing limitation-of care orders in children.
Research Objectives. Our study aims to analyze the
timing of DNR order placement prior to death in pediatric
patients. We also aim to further delineate the
specialty of the ordering physician, demographic
data, and location of death.
Methods. We present a retrospective review of 471
deaths between 1/2009 and 10/2014. The palliative
care team was established in September, 2011. For
those patients who had a DNR order in place, we
analyzed patient and physician characteristics as well
as DNR order timing.
Results. The location of death of 49% of patients who
had a DNR in place was in an ICU setting. The death
rate in the ICU was not statistically different following
initiation of the palliative care team (PCT) (p¼0.53).
The overall DNR rate increased following initiation
of the PCT from 30.8% to 39.2% (p¼0.05). The PCT
was consulted in 77% of deaths and ordered the
DNR in 60% of children.
Conclusion. Our results emphasize the important
role of the palliative care team during end-of-life discussions
in children. The palliative care team met
with more than three quarters of families prior to
death, and they placed the DNR order in more than
half of these instances. The initiation of the palliative
care team was associated with a large increase in overall
DNR rates.
Implications for Research, Policy or
Practice. Additional studies are needed in pediatrics
to further delineate the timing of palliative care
consultation in the patient’s overall course of illness,
demographic and cultural influences, and specific patient
conditions, such as tracheostomy dependence.
Rights
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).
Citation List Month
March 2016 List
Citation
Plymire C; Miller E; Frizzola M, “Impact Of A Pediatric Palliative Care Team On Limitations Of Care For Inpatients At A Free-standing, Tertiary- Care Children’s Hospital.,” Pediatric Palliative Care Library, accessed April 23, 2024, https://pedpalascnetlibrary.omeka.net/items/show/10569.