Increasing Trend and Effects of Pediatric Palliative Care on Children with Non-Cancer Diagnoses

Increasing Trend and Effects of Pediatric Palliative Care on Children with Non-Cancer Diagnoses

Chen SH; Wu ET; Wang CC; Yu Su M; Chang CH; Chen HL; Lu FL; Cheng SY

Journal of Pain and Symptom Management

2023

Child; child; Palliative Care; survival; terminal care; article; cohort analysis; controlled study; female; human; major clinical study; male; retrospective study; palliative therapy; morphine; Only Child; artificial ventilation; cancer survival; ventilator; cancer patient; analgesia; trend study

Objectives Pediatric palliative care (PPC), especially among noncancer pediatric patients, faces challenges including late referral, limited patient care, and insufficient data for Asian patients. Methods This retrospective cohort study used the integrative hospital medical database between 2014 and 2018 to analyze the clinical characteristics, diagnoses, and end-of-life care for patients aged less than 20 who had died in our children's hospital, a tertiary referral medical center implementing PPC shared-care. Results In our cohort of 323 children, 240 (74.3%) were noncancer patients who a younger median age at death (5 vs. 122 months, P < 0.001), lower rate of PPC involvement (16.7 vs. 66%, P < 0.001), and fewer survival days after PPC consult compared to cancer patients (3 vs. 11, P = 0.01). Patients not receiving PPC had more ventilator support (OR 9.9, P < 0.001), and less morphine use on their final day of life (OR 0.1, P < 0.001). Also, patients not receiving PPC had more cardiopulmonary resuscitation on the last day of life (OR 15.3, P < 0.001) and died in the ICU (OR 8.8, P < 0.001). There was an increasing trend of noncancer patients receiving PPC between 2014 and 2018 (P < 0.001). Conclusions High disparities exist between children receiving PPC in cancer versus noncancer patients. The concept of PPC is gradually becoming accepted in noncancer children and is associated with more pain-relief medication and less suffering during end-of-life care.

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