Timing of Palliative Care Consultation and End-of-Life Care Intensity in Pediatric Patients With Advanced Heart...

Area of Science:

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

Background:

• Children with advanced heart disease (AHD) often experience high-intensity medical care at the end of life (EOL).
• The impact of pediatric palliative care (PPC) on EOL care intensity in this population is not well-defined.

Purpose of the Study:

• To investigate the association between the receipt and timing of PPC consultation and EOL care intensity in pediatric patients with AHD.
• To determine if early versus late PPC consultation influences EOL care intensity.

Main Methods:

• Retrospective cohort study of 218 pediatric patients (0-21 years) with AHD who died in a cardiac ICU between 2014-2022.
• Patients were categorized by receipt of PPC (none, early [≥30 days before death], late [<30 days before death]).
• EOL care intensity, including medical interventions and mortality characteristics, was compared across groups.

Main Results:

• Patients receiving PPC (36% none, 35% early, 29% late) had significantly lower EOL care intensity (77% vs. 96%; p=0.004) and fewer invasive interventions within 14 days of death compared to those without PPC (74% vs. 92%; p=0.004).
• PPC receipt was linked to a lower rate of death during cardiopulmonary resuscitation (12% vs. 32%; p=0.004) and increased use of comfort care (23% vs. 3%; p=0.004).
• Early PPC was associated with fewer invasive interventions within 14 days of death (65% vs. 85%; p=0.033), but overall EOL care intensity remained high for both early and late PPC groups.

Conclusions:

• While early pediatric palliative care consultation is associated with reduced invasive interventions near the end of life for children with advanced heart disease, overall care intensity remains high.
• Early PPC may facilitate timely psychosocial and advance care planning support for families without significantly altering end-of-life goals of care.