The Impact of Pediatric Palliative Care Involvement in the Care of Critically Ill Patients without Complex Chronic Conditions

The Impact of Pediatric Palliative Care Involvement in the Care of Critically Ill Patients without Complex Chronic Conditions

Spraker-Perlman HL; Tam RP; Bardsley T; Wilkes J; Farley L; Moore D; Sheetz J; Baker JN

Journal of Palliative Medicine

2018

end-of-life care; pediatric palliative care; advanced care planning

BACKGROUND: The impact of pediatric palliative care (PPC) is well established for children with chronic complex diseases. However, PPC likely also benefits previously healthy children with acute life-threatening conditions. OBJECTIVE: To determine the incidence and impact of PPC for previously healthy patients who died in a pediatric hospital. DESIGN: Retrospective chart review of all pediatric deaths over four years. SETTING/SUBJECTS: Patients were 0 to 25 years old, died during an inpatient stay at an academic pediatric hospital >/=48 hours after admission, and had no complex chronic conditions (CCCs) before admission. MEASUREMENTS: One hundred sixty-seven patients met the eligibility criteria. Most died in intensive care settings (n = 149, 89%), and few (n = 34, 20%) received PPC consultations or services. RESULTS: Patients who received PPC services were more likely to receive a multidisciplinary care conference than did patients without PPC support (70.5% vs. 39.9%; p = 0.001), which also occurred earlier for patients who received PPC services (seven days vs. two days before death; p = 0.04). Most patients had documented end-of-life planning in their medical records; however, this occurred earlier for patients who received PPC consultation (9.5 days before death) than for those who did not (two days before death; p < 0.0001). Patients receiving PPC support (67.7%) were also more likely to have a do-not-resuscitate/intubate order before death than those who did not (39.9%; p = 0.004). CONCLUSIONS: Pediatric patients without known CCCs who subsequently die as inpatients benefit from PPC in terms of goals of care discussions and documentation of end-of-life care preferences.

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