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Evaluating the Need for Integrated Pediatric Palliative Care Services in a Pediatric Oncology Setting: A
Vasudeva Bhat K1, Krithika S Rao2, Kalasekhar Vijayasekharan1
1Division of Pediatric Hematology and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Insights
Few children with cancer receive palliative care consults, with symptom management being the main referral trigger. This highlights a need to review referral practices in pediatric oncology to improve integrated care.
Area of Science:
- Pediatric Oncology
- Palliative Care
- Quality of Life
Background:
- Early integrated palliative care improves quality of life in cancer patients.
- Pediatric palliative care is established, but formal consults are rare due to limited referral information.
Purpose of the Study:
- To audit pediatric palliative care referrals.
- To identify referral triggers and practices in pediatric oncology.
Main Methods:
- Retrospective audit of 126 pediatric oncology patients' records (Sept 2019 - Sept 2020).
- Data collected included demographics, diagnosis, staging, clinical parameters, referral reasons, and palliative care plans.
Main Results:
- 27% of patients were referred to palliative care, mostly inpatient consults.
- Symptom management (44.7%) and psychosocial support (14.4%) were key referral triggers.
- Solid tumors were more frequently referred than hematological malignancies; 88.8% of families preferred home care for end-of-life needs.
Conclusions:
- Low referral rates and symptom-driven referrals indicate gaps in integrated pediatric oncology care.
- Findings suggest a need to revise palliative care referral criteria and practices.
Objectives:
Early integrated palliative care has shown to improve the quality of life in patients with cancer. During the past decade, pediatric palliative care has become an established area of medical expertise, however due to scant information available regarding the triggers for referral and referral practice very few children receive a formal palliative care consult.
Materials And Methods:
A retrospective audit of medical case records of pediatric oncology patients over a period of 1 year from September 30, 2019, to September 30, 2020, was conducted. Demographic details, diagnosis, staging, clinical parameters, reason for referral, and palliative care plan were captured in a predesigned pro forma.
Results:
Among 126 children with cancer, 27 (21.4%) patients were referred to palliative care. Majority 21 (77%) referrals were inpatient consults. Symptom management 17 (44.7%) was the most common trigger for referral followed by referrals for psychosocial support 12 (14.4%). Children with solid tumors 16 (59%) were more often referred than hematological malignancies. Among those needing end of life care, 8 (88.8%) out of 9 families preferred home than hospital.
Conclusion:
Low incidence of palliative care referral and presence of symptoms as a trigger for palliative care referral suggests gaps in the integrated approach. The study findings prompt a review of palliative care referral criteria and referral practice in a pediatric oncology setting.
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