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Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life: A National Study
Insights
Children in hospice often have complex mental and behavioral health (MHBH) issues. This study identified four distinct MHBH patterns in pediatric hospice patients, emphasizing the need for tailored end-of-life care.
Area of Science:
- Pediatric Palliative Care
- Child Psychology
- Healthcare Informatics
Background:
- Children in hospice care frequently present with complex mental and behavioral health (MHBH) conditions.
- Existing literature lacks detailed understanding of MHBH problem patterns in end-of-life pediatric populations.
Purpose of the Study:
- To identify and characterize distinct patterns of mental and behavioral health problems among children enrolled in hospice care.
- To inform the development of more targeted and effective end-of-life care strategies for pediatric patients.
Main Methods:
- Latent class analysis was applied to a national database of 6195 children in hospice (January 2011 - December 2013).
- Analysis identified four distinct classes based on MHBH comorbidities, age, medication use, and physical health comorbidities.
Main Results:
- Four classes were identified: Neurodevelopment and Anxiety (26.5%), Behavior and Neurodevelopment (20%), Physiology (43.4%), and Mood, Behaviors, and Anxiety (10.2%).
- Classes varied significantly by age, number of MHBH comorbidities, medication burden, and rates of physical health comorbidities or technology dependence.
- The 'Mood, Behaviors, and Anxiety' class exhibited the highest comorbidity and medication load, predominantly in older children.
Conclusions:
- Distinct patterns of MHBH conditions exist in pediatric hospice populations.
- End-of-life care must acknowledge and address these complex, often overlapping, MHBH challenges.
- Tailored interventions are crucial for improving the quality of life for children nearing the end of life.
Abstract:
Children, who enroll in hospice, have complex mental and behavioral health (MHBH) problems. There is limited literature on patterns of these problems among children at their end of life. Using the national database of 6195 children enrolled in hospice between January 1, 2011, and December 31, 2013, and latent class analysis, this study identified 4 distinctive classes of children. Neurodevelopment and anxiety class (26.5% of the sample) had 41.3% of children of 15 years or older, who had an average of 1.4 MHBH comorbidities and took 17 medications; 29.1% had physical health comorbidities, and 23% were dependent on technology. In the Behavior and Neurodevelopment class (20%), 53.1% of the children were between ages 6 and 14 years, who had an average of 2 MHBH comorbidities and took 17 medications. In the Physiology class (43.4%), 65.5% of children were younger than 5 years, had 1 MHBH comorbidity, and took 19 medications. In the Mood, Behaviors, and Anxiety class (10.2%), more than 90% of children were older than 6 years, had 4 MHBH comorbidities, and took 30 medications. In the latter 3 classes, approximately half of the children either had physical health comorbidities or were technology dependent. These findings highlight the importance of end-of-life care that accounts for the likely presence of complicated patterns of MHBH conditions.
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