Goal-Concordance in Children with Complex Chronic Conditions

Title

Goal-Concordance in Children with Complex Chronic Conditions

Creator

Harmon A; Jordan M; Platt A; Wilson J; Keith K; Chandrashekaran S; Schlichte L; Pendergast J; Ming D

Publisher

The Journal of Pediatrics

Date

2023

Subject

Hospice Care; Terminal Care; Child; Chronic Disease; Goals; Humans; Only Child; Resuscitation Orders

Description

Abstract Objectives: To characterize delivery of goal-concordant end-of-life (EOL) care among children with complex chronic conditions and to determine factors associated with goal-concordance. Study design: This was a retrospective review of goals of care discussions for 272 children with at least 1 complex chronic condition who died at a tertiary care hospital between January 1, 2014, and December 31, 2017. Goals of care and code status were assessed before and within the last 72 hours of life. Goals of care discussions were coded as full interventions; considering withdrawal of interventions (palliation); planned transition to palliation; or actively transitioning/transitioned to palliation. Results: In total, 158 children had documented goals of care discussions before and within the last 72 hours of life, 18 had goals of care discussions only >72 hours before death, 54 only in the last 72 hours of life, and 42 had no documented goals of care. For children with goals of care, EOL care was goal-concordant for 82.2%, discordant in 7%, and unclear in 10.8%. Black children had a greater than 8-fold greater odds of discordant care compared with White children (OR 8.34, P = .007). Comparison of goals of care and code status before and within the last 72 hours of life revealed trends toward nonescalation of care. Specifically, rates of active palliation increased from 11.7% to 63.0%, and code status shifted from 32.6% do not resuscitate to 65.2% (P < .001). Conclusions: In this cohort, a majority of children had documented goals of care discussions and received goal-concordant EOL care. However, Black children had greater odds of receiving goal-discordant care. Goals of care and code status shifted toward palliation during the last 72 hours of life.

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

May List 2023

Collection

Citation

Harmon A; Jordan M; Platt A; Wilson J; Keith K; Chandrashekaran S; Schlichte L; Pendergast J; Ming D, “Goal-Concordance in Children with Complex Chronic Conditions,” Pediatric Palliative Care Library, accessed March 29, 2024, https://pedpalascnetlibrary.omeka.net/items/show/19094.