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Triggers for Palliative Care Referral in Pediatric Oncology
Andrea Cuviello1, Catherine Yip2, Haven Battles3
1Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
Insights
Palliative care (PC) is underutilized in pediatric oncology despite its benefits. Key triggers for PC consultation are often missed, indicating a need for improved screening tools to enhance early integration for better quality of life.
Area of Science:
- Pediatric Oncology
- Palliative Care
- Healthcare Quality Improvement
Background:
- Palliative care (PC) integration improves quality of life for pediatric oncology patients.
- Referral practices and timing for PC remain inconsistent, leading to underutilization.
- Early PC integration is crucial for comprehensive cancer care.
Purpose of the Study:
- To evaluate the utilization of palliative care consultations in pediatric oncology patients.
- To identify "high yield triggers" for PC consultation and assess their translation into practice.
- To determine factors associated with PC consultation in pediatric cancer care.
Main Methods:
- Retrospective chart review of pediatric oncology patients (January 2015 - November 2018).
- Data collection included demographics, disease/therapy characteristics, and consultation notes.
- Analysis focused on the presence of "high yield triggers" for PC consultation.
Main Results:
- Only 5.6% of 931 eligible patients received PC consultation.
- Approximately 94% of patients had at least one identified "high yield trigger" for PC.
- Common triggers included symptom management needs (98%), high-risk disease (86%), and poor prognosis (83%).
Conclusions:
- Identified "high yield triggers" for palliative care consultation are not consistently leading to referrals in pediatric oncology.
- A significant gap exists between the recognition of important triggers and actual PC consultation rates.
- Developing a screening tool incorporating these triggers may improve early palliative care integration for children with cancer.
Abstract:
Palliative care (PC) integration into the care of pediatric oncology patients is growing in acceptance and has been shown to improve the quality of life of children with cancer. Yet timing for referrals and referral practices remain inconsistent, and PC remains underutilized. We conducted a retrospective chart review of pediatric oncology patients treated at an academic institution between January 2015 to November 2018. Data collected included demographics, disease and therapy characteristics, and consultation notes, specifically documenting existence of predetermined "high yield triggers" for PC consultation. Among 931 eligible patients the prevalence of PC consultation was 5.6% while approximately 94% of patients had at least 1 trigger for PC consultation. The triggers that more often resulted in PC consultation included: symptom management needs (98%; n = 51) high-risk disease (86%; n = 45), poor prognosis (83%; n = 43), multiple lines of therapy (79%; n = 41) and a documented ICU admission (67%; n = 35). Our findings suggest that the high yield triggers for palliative care consultation that pediatric oncologists identify as important are not translating into practice; incorporating these triggers into a screening tool may be the next step to improve early PC integration.
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