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Referrals to a perinatal specialist palliative care consult service in Ireland, 2012-2015
Des L McMahon1, Marie Twomey2, Maeve O'Reilly2
1Academic Department of Palliative Medicine, Education and Research Centre, Our Lady's Hospice & Care Services, Dublin, Ireland.
Insights
Referral patterns for perinatal patients to specialist palliative care services (SPCS) were analyzed. Effective multidisciplinary collaboration enables community-based end-of-life care for these infants.
Area of Science:
- Perinatal medicine
- Palliative care
- Neonatology
Background:
- Specialist palliative care services (SPCS) play a crucial role in managing complex needs of perinatal patients.
- Understanding referral patterns is essential for optimizing care delivery.
Purpose of the Study:
- To analyze referral patterns of perinatal patients to a specialist palliative care service.
- To examine patient demographics, diagnoses, illness duration, place of death, and symptom profiles.
Main Methods:
- Retrospective chart review of all perinatal referrals over a 4-year period (until end of 2015).
- Data collected from a consultant-led paediatric SPCS at two Dublin hospitals.
Main Results:
- 83 perinatal referrals were analyzed.
- Common diagnoses included chromosomal abnormalities (35%), congenital heart disease (25%), and complex neurological abnormalities (11%).
- Most referrals (73.5%) were postnatal; 47% of these were asymptomatic at referral.
- Opioid medication was recommended in 46 cases, achieving symptom control in 93%.
- Of 47 postnatal deaths, 47% occurred at home with community support, highlighting the need for interagency cooperation for home-based care.
Conclusions:
- Perinatal palliative care necessitates effective multidisciplinary teamwork.
- End-of-life care for perinatal patients can be successfully provided in the community with adequate support.
Objective:
To analyse the referral patterns of perinatal patients referred to a specialist palliative care service (SPCS), their demographics, diagnoses, duration of illness, place of death and symptom profile.
Design:
A retrospective chart review of all perinatal referrals over a 4-year period to the end of 2015.
Setting:
A consultant-led paediatric SPCS at Our Lady's Children's Hospital, Crumlin, Dublin, and the Coombe Women & Infants University Hospital, Dublin.
Results:
83 perinatal referrals were received in a 4-year period. Chromosomal abnormalities accounted for 35% of diagnoses, congenital heart disease 25%, complex neurological abnormalities 11% and renal agenesis 4%. 22 referrals (26.5%) were made antenatally, with 61 (73.5%) postnatally. Of the postnatal referrals, 27 (44%) were asymptomatic on referral. An opioid medication was recommended (regularly or as required) in 46 cases. Symptom control was achieved without dose titration in 43 of these cases (93%). Of 47 deaths in this group referred postnatally, 22 of these (47%) died at home with support from community teams. Discharge home for best supportive care required complex interagency communication and cooperation.
Conclusions:
Perinatal palliative care requires effective multidisciplinary work, whether delivered in the inpatient setting or in the community. With appropriate support, end-of-life care can be delivered in the community.
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