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Palliative care referral criteria and application in pediatric illness care: A scoping review
Katherine M Bernier Carney1, George Goodrich1, Amberly Lao2
1School of Nursing, University of Connecticut, Storrs, CT, USA.
Insights
Pediatric palliative care referral criteria are inconsistently applied in research and practice. Further studies are needed to improve identification and access for children with serious illnesses.
Area of Science:
- Pediatric Palliative Care
- Healthcare Access
- Clinical Practice Guidelines
Background:
- Specialty pediatric palliative care addresses unmet needs in children with complex illnesses.
- Current guidelines exist for identifying palliative care needs, but their influence on referral is unclear.
Purpose of the Study:
- To evaluate how palliative care referral criteria are identified and applied in pediatric care and research.
Main Methods:
- A scoping review and content analysis of 37 peer-reviewed articles published between 2010 and 2021.
- Searched five electronic databases for relevant literature.
Main Results:
- Identified eight categories of referral criteria, including disease-related, symptom-related, and psychosocial needs.
- Found two validated referral instruments and seven interventions to improve access.
- Retrospective record reviews identified needs but showed varying service use.
Conclusions:
- Methods for identifying and referring pediatric patients to palliative care are inconsistent.
- Prospective studies and clinical trials are needed to standardize referral practices.
- More research on palliative care referral and outcomes in community settings is essential.
Background:
Specialty pediatric palliative care services can help to address unmet care needs for children with complex and serious illness. Current guidelines support the identification of unmet palliative care needs; however, it is unknown how these guidelines or other clinical characteristics influence pediatric palliative care referral in research and practice.
Aim:
To evaluate the identification and application of palliative care referral criteria in pediatric illness care and research.
Design:
A scoping review with a content analysis approach to summarize results.
Data Sources:
Five electronic databases (PubMed, CINAHL, PsycINFO, SCOPUS, and Academic Search Premier) were used to identify peer-reviewed literature published in English between January 2010 and September 2021.
Results:
We included 37 articles focused on the referral of pediatric patients to palliative care teams. The identified categories of referral criteria were: disease-related; symptom-related; treatment communication; psychosocial, emotional, and spiritual support; acute care needs; end-of-life care needs; care management needs; and self-referrals for pediatric palliative care services. We identified two validated instruments to facilitate palliative care referral and seven articles which described population-specific interventions to improve palliative care access. Nineteen articles implemented a retrospective health record review approach that consistently identified palliative care needs with varying rates of service use.
Conclusions:
The literature demonstrates inconsistent methods for identifying and referring children and adolescents with unmet palliative care needs. Prospective cohort studies and clinical trials would inform more consistent pediatric palliative care referral practices. More research is needed on palliative care referral and outcomes in community-focused pediatrics.
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