A National Study to Compare Effective Management of Constipation in Children Receiving Concurrent Versus Standard...

Area of Science:

• Pediatric Palliative Care
• Symptom Management
• End-of-Life Care

Background:

• Constipation is a common and distressing symptom for children at end of life.
• A knowledge gap exists regarding optimal hospice care delivery for pediatric constipation.
• Evaluating different hospice models is crucial for improving symptom management.

Purpose of the Study:

• To assess the effectiveness of concurrent hospice care versus standard hospice care in managing constipation among pediatric patients.
• To identify potential differences in nonhospice provider utilization for constipation management between the two hospice models.

Main Methods:

• Analysis of Medicaid data from 2011-2013.
• Inclusion of children under 21 years old enrolled in hospice care.
• Instrumental variable analysis to compare concurrent versus standard hospice care effectiveness.

Main Results:

• Approximately 14% of pediatric hospice patients received nonhospice treatment for constipation.
• A higher proportion of children in concurrent hospice received nonhospice care for constipation (19.5% vs 13.2%), but this difference was not statistically significant.
• Concurrent hospice care demonstrated no significant advantage over standard hospice in managing pediatric constipation.

Conclusions:

• Concurrent hospice care is not more effective than standard hospice care for pediatric constipation.
• Existing hospice and nonhospice provider practices may adequately manage bowel regimens before constipation becomes severe.
• Further research may explore specific interventions within standard care that contribute to effective constipation management.