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Changes in the End-of-Life Process in Patients with Life-Limiting Diseases through the Intervention of the Pediatric

Jung Eun Kwon1, Yeo Hyang Kim1

  • 1Department of Pediatrics, School of Medicine, Kyungpook National University, Pediatric Palliative Care Center, Kyungpook National University Children's Hospital, Daegu 41404, Republic of Korea.

Journal of Clinical Medicine
|October 28, 2023
PubMed

Insights

Pediatric palliative care (PPC) improved end-of-life care for children with life-limiting conditions (LLC). PPC services led to more advanced care planning and fewer invasive procedures, ensuring peaceful patient and family farewells.

Area of Science:

  • Pediatrics
  • Palliative Care
  • Oncology

Background:

  • Pediatric palliative care (PPC) services were established at Kyungpook National University Children's Hospital in 2019.
  • Life-limiting conditions (LLC) in children and adolescents require specialized end-of-life care.
  • A study was conducted to evaluate the impact of PPC on end-of-life processes.

Purpose of the Study:

  • To compare end-of-life care processes in pediatric patients with LLC before and after the implementation of PPC services.
  • To assess changes in advanced care planning, treatment decisions, and place of death.
  • To evaluate patient and family satisfaction with PPC.

Main Methods:

  • Retrospective analysis of medical records for 48 deceased pediatric patients (<18 years) with LLC.
  • Comparison of two groups: Period 1 (2015-2016, without PPC) and Period 2 (2019-2022, with PPC).
  • Inclusion of a patient/family satisfaction survey for Period 2.

Main Results:

  • PPC implementation (Period 2) was associated with significantly more active advanced care planning (p=0.01) and discussions on withholding/withdrawing treatment (p=0.025).
  • Frequencies of intubation (p=0.000) and CPR (p=0.018) were significantly lower in Period 2.
  • Deaths occurred less frequently in the ICU (p=0.045) in Period 2, with 3 patients choosing home deaths.
  • High satisfaction rates were reported for emotional support (91.7%), practical assistance (91.6%), and symptom management (83.3%) in Period 2.

Conclusions:

  • PPC services significantly enhanced end-of-life care for children with LLC.
  • PPC facilitated crucial discussions on advanced care planning and treatment preferences.
  • The study highlights PPC's role in achieving peaceful and prepared end-of-life experiences for patients and families.

Keywords:
advanced care planningchildintubationpalliative care

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