Timing of Palliative Consultation for Children During a Fatal Illness

Area of Science:

• Pediatric Oncology
• Palliative Care Medicine
• Healthcare Disparities

Background:

• The American Academy of Pediatrics advocates for early pediatric palliative care upon serious illness diagnosis.
• Specialty palliative care consultations are infrequently provided to children who die, often occurring late in the disease trajectory.
• This study investigates factors influencing the timing of palliative care initiation in relation to diagnosis in pediatric decedents.

Purpose of the Study:

• To evaluate the timing of specialty palliative care consultations in relation to diagnosis in a cohort of pediatric decedents.
• To identify factors associated with earlier receipt of pediatric palliative care.
• To inform strategies for improving access to timely palliative care for children with life-limiting illnesses.

Main Methods:

• Retrospective cohort study of pediatric patients with life-limiting diseases who died between 2015-2017.
• Primary outcome: time from palliative-qualifying diagnosis to earliest specialty palliative care consultation.
• Survival analysis used to identify factors associated with earlier palliative care receipt.

Main Results:

• The study included 180 pediatric decedents, with a median age at diagnosis under 1 month.
• Median time to first palliative consultation was 7 days post-diagnosis, significantly earlier than the median 50 days from diagnosis to death.
• Earlier palliative consultation was associated with cardiovascular diagnoses, private insurance, and African American race.

Conclusions:

• Pediatric palliative care consultations in this cohort occurred substantially earlier than previously documented.
• Factors associated with delayed palliative care highlight opportunities to enhance access for dying children.
• Addressing disparities in access to timely pediatric palliative care is crucial.