Can We Adopt Pediatric Palliative Care that is Indivisible with Equity for all?

Can We Adopt Pediatric Palliative Care that is Indivisible with Equity for all?

Fisher PG

Journal of Pediatrics

2024

Palliative Care; Equity; Conference abstract

In this volume of The Journal, two retrospective cohort studies, both based in Ohio, provide insightful data about the deployment of dedicated pediatric palliative care teams. While home-based visits have been a longtime core principle of pediatric hospice care, their value has not been well defined or justified. Thus, Smith et al analyzed healthcare utilization outcomes in a sample of children who received home visits across two well-established pediatric home-based palliative care and hospice programs over 6 years among 195 children, half of whom had neurologic impairment. Children served as their own controls, and following implementation of home-based services, these patients showed significant reductions in inpatient admissions, number of intensive care unit days, and inpatient days. Meanwhile there was a significant increase in clinically relevant phone calls to the home-based hospice and palliative care team, including those calls before visits to the emergency department. Most likely this healthcare model affords children comprehensive management that is more effective and a simply better use of resources, including a reduction in health care expenditures for children with chronic complex conditions, particularly neurologic. Now, we as pediatricians need to inform hospital administrators, payors, parents, and colleagues about the potential of home-based care. We also need to support and possibly subsidize pediatric palliative care. Can we make palliative care referrals standard of care for all children with complex chronic conditions? In a second study by Jones et al across 801 inpatients with high-intensity neurologic impairment at a single children’s hospital, also over 6 years, Black children and children with Medicaid insurance each had significantly lower odds of palliative referral compared with their non-Black and non-Medicaid-insured peers. To make palliative care commonplace in children with chronic complex conditions we will need not only to address the sluggish bureaucracy of children’s healthcare administration, but also to confront and reverse structural racism in provision of these supportive services. We owe this to all our children.

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