Early Versus Late Outpatient Pediatric Palliative Care Consultation and Its Association With End-of-Life Outcomes in...

Area of Science:

• Pediatric Oncology
• Palliative Care
• End-of-Life Care

Background:

• Lack of consensus on optimal timing for early pediatric palliative care (PPC) referral in pediatric oncology.
• Limited research on the impact of PPC referral timing on patient outcomes.

Purpose of the Study:

• To investigate the association between early (<12 weeks) versus late (≥12 weeks) outpatient PPC consultation and demographic, advance care planning (ACP), and end-of-life (EOL) outcomes.
• To explore if early PPC influences ACP documentation and specific EOL metrics.

Main Methods:

• Retrospective review of patient charts and databases.
• Inclusion of deceased pediatric cancer patients (0-27 years) seen at an embedded consultative PPC clinic.
• Analysis of demographic data, disease characteristics, PPC/EOL outcomes including ACP, hospice, DNR, hospital days, and location of death.

Main Results:

• Thirty-two patients received early PPC and 118 received late PPC.
• Early PPC was associated with cancer type (p<0.01) and preference for home death (p=0.02).
• Early PPC and ACP documentation were associated with documenting preferred location of death (p=0.04 for both). Timing was not associated with ACP or other EOL outcomes.

Conclusions:

• While early PPC showed associations with preferred location of death, it did not significantly impact ACP documentation or other end-of-life outcomes when using a 12-week cutoff.
• The study highlights high-quality palliative and end-of-life care across the cohort, potentially explaining the limited impact of timing on specific outcomes.
• Further research is needed to define optimal PPC referral timing and its comprehensive impact on pediatric oncology patients.