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Associations Between Pediatric Palliative Care Consultation and End-of-Life Preparation at an Academic Medical

Matthew Stutz1, Roy L Kao2,3, Leanna Huard4

  • 1Department of Medicine and Pediatrics Residency Program, University of California Los Angeles, Los Angeles, California; mstutz@mednet.ucla.edu.

Hospital Pediatrics
|February 14, 2018
PubMed

Insights

Pediatric palliative care (PPC) consultation is associated with better end-of-life preparation for deceased children. Patients in wards and PICUs with complex conditions are more likely to receive PPC.

Area of Science:

  • Pediatric Oncology
  • Palliative Care Medicine
  • Health Services Research

Background:

  • Pediatric palliative care (PPC) is crucial for improving the quality of life for children with life-threatening conditions.
  • Understanding PPC consultation patterns is essential for optimizing end-of-life care in pediatric patients.

Purpose of the Study:

  • To analyze the utilization of pediatric palliative care consultations among deceased pediatric patients.
  • To investigate the association between PPC consultation and end-of-life care preparation.

Main Methods:

  • Retrospective review of 233 pediatric mortalities.
  • Data extraction from electronic health records, including PPC consultation (CPT codes), diagnoses (ICD codes), and life-threatening complex chronic conditions (LT-CCCs).
  • Statistical analysis using t-tests, Wilcoxon rank test, Fisher's exact test, chi-squared test, and logistic regression.

Main Results:

  • The overall PPC consultation rate was 24%.
  • PPC consultation was more frequent in pediatric wards and PICUs (31%) compared to NICUs (12%), and higher for patients with LT-CCCs (40%) and malignancy (65%).
  • PPC was associated with increased completion of Physician Orders for Life-Sustaining Treatment (POLST) forms and documentation of mental health disorders.

Conclusions:

  • PPC consultation in pediatric wards and PICUs is linked to more LT-CCCs and improved end-of-life planning (POLST completion, mental health documentation).
  • Patients with acute illnesses and those in the NICU are at higher risk of not receiving PPC consultation.
  • Optimizing PPC access for all eligible pediatric patients, especially those in the NICU and with acute conditions, is warranted.
Abstract

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