Initiating Palliative Care Referrals in Pediatric Oncology


Initiating Palliative Care Referrals in Pediatric Oncology


Cuviello A; Raisanen J C; Donohue P K; Wiener L; Boss R D


Journal of Pain and Symptom Management




palliative care; quality of life; symptom management; pediatric oncology; screening tool; trigger


CONTEXT: Early palliative care (PC) has been shown to improve the quality of life of children with cancer, yet referral practices by pediatric oncology providers remains inconsistent and few patients receive a formal PC consult. OBJECTIVE(S): We sought to describe patient characteristics used by oncologists for PC referral and identify ways to improve PC integration into the care for children with cancer. METHOD(S): This mixed-methods study used semi-structured audiotaped interviews to explore the patient or disease characteristics used by pediatric oncology providers to trigger PC referral. Conventional content analysis was applied to interview transcripts. RESULT(S): 77 participants with diverse experience were interviewed. Over 75% of participants reported that PC was consulted "too late" and cited communication and systems issues as the top barriers. A majority of participants (85%) stated that a screening tool would be helpful to standardize referral practices to PC. Characteristics such as poor prognosis (88%), symptom management (86%), comorbidities (65%), and psychosocial needs (65%) were commonly reported triggers that should initiate PC consultation. However, when presented with case scenarios that included these characteristics, participants did not consistently identify the PC triggers. Nearly 50% of participants stated they had received some formalized PC training, however only one third of these participants noted completing a PC rotation. CONCLUSION(S): Our findings suggest that pediatric oncologists are committed to improving the integration of PC for their patients and that standardization of referral practices, through the use of a screening tool, would be of benefit. Additional PC education might reinforce pediatric oncologists' recognition of palliative care triggers. Copyright © 2020. Published by Elsevier Inc.


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Cuviello A; Raisanen J C; Donohue P K; Wiener L; Boss R D, “Initiating Palliative Care Referrals in Pediatric Oncology,” Pediatric Palliative Care Library, accessed October 3, 2023,