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Integration of a palliative and terminal care center into a comprehensive pediatric oncology department
Hana Golan1, Bella Bielorai, Dorit Grebler
1Department of Pediatric Hematology-Oncology, Marion and Elie Wiesel Children's Pavilion, Chaim Sheba Medical Center, Tel-Aviv University Sackler School of Medicine, Ramat Gan, Israel. hana.golan@sheba.health.gov.il
Insights
Integrating palliative care early into pediatric oncology improves patient outcomes. This model ensures most children with cancer receive palliative care, especially those with poor prognoses, reducing suffering and improving end-of-life care.
Area of Science:
- Pediatric Oncology
- Palliative Care Medicine
- Healthcare Management
Background:
- A disconnect between curative cancer treatment and palliative care leads to delayed support and increased suffering in pediatric oncology patients.
- A Palliative Care Unit (PCU) was integrated within the Pediatric Hematology Oncology Department (PHOD) to address this gap.
- The study aimed to assess the impact of this integrated model on hospitalization patterns and palliative care exposure.
Purpose of the Study:
- To evaluate the effectiveness of an integrated palliative care model in pediatric oncology.
- To analyze changes in hospitalization patterns and palliative care utilization.
- To determine the impact on the location of death for pediatric cancer patients.
Main Methods:
- Retrospective analysis of medical records for pediatric oncology patients admitted since 1999 and those who died between 1990-2005.
- Comparison of clinical and prognostic variables between patients receiving palliative care and those who did not.
- Evaluation of changes in the location of death before and after the establishment of the integrated PCU.
Main Results:
- Post-PCU establishment, 59% of pediatric oncology patients were hospitalized in the PCU, including 49% with good prognoses and 91% with poor prognoses.
- Poor prognosis patients accessed PCU earlier and more frequently than those with curable conditions.
- Significant reductions were observed in deaths occurring in general pediatric wards (40% to 4%), hematology-oncology wards (26% to 8%), and at home (28% to 16%).
Conclusions:
- The integrated palliative care model successfully increased exposure to palliative care for the majority of pediatric cancer patients.
- Palliative care was introduced early for poor prognosis patients, facilitating a smoother transition from symptom management to end-of-life care.
- This model demonstrates a positive impact on patient care and reduces suffering in children with cancer.
Background:
The sharp division between curative cancer therapy and palliative care results in the late introduction of palliative care and a high incidence of suffering in children with cancer. We established a Palliative Care Unit (PCU) that is fully integrated with the Pediatric Hematology Oncology Department (PHOD). We wished to explore the impact of such integrative model on patterns of hospitalizations and exposure to palliative care of pediatric oncology patients.
Procedures:
Retrospective search of medical records of patients admitted to the PHOD since PCU establishment in 1999, and of children who died from progressive disease between 1990 and 2005 was performed. Differences in clinical and prognostic variables between PCU and non-PCU patients, and differences in location of death before and after PCU establishment were evaluated.
Results:
The majority (59%) of patients, who were hospitalized after the PCU establishment, were hospitalized in the PCU, including 49% of the good prognosis patients and 91% of the poor prognosis patients. Poor prognosis patients were hospitalized in the PCU earlier and with higher frequency compared to children with curable disease. After PCU opening there was a significant decline in the percentage of patients who died in the general pediatric ward, hematology-oncology ward, and at home from 40%, 26% and 28% to 4%, 8%, and 16%, respectively.
Conclusions:
Our integrative model results in exposure of the majority of children with cancer to palliative care. For poor prognosis patients, palliative care is introduced early enough to allow gradual transition from symptom control after diagnosis to end of life care.
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