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The Scope of Clinical Practice of Inpatient and Outpatient Pediatric Palliative Care Within Pediatric Oncology
Hee Su Park1, Nicholas DeGroote2, Rebecca Williamson Lewis2
1Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Pediatric palliative care (PPC) visits differ between inpatient and outpatient settings. Outpatient visits focus more on goals of care and chronic symptoms, while inpatient visits address acute symptoms and technology use.
Area of Science:
- Pediatric Oncology
- Palliative Care
- Health Services Research
Background:
- Pediatric palliative care (PPC) improves end-of-life (EOL) outcomes for children with cancer.
- The specific content of PPC visits and how it varies by care setting is not well-understood.
Purpose of the Study:
- To compare the scope of PPC practice during inpatient versus outpatient visits for pediatric cancer patients.
- To identify differences in topics addressed during PPC encounters based on care setting.
Main Methods:
- Retrospective cohort study of pediatric cancer patients (0-27 years) receiving PPC between 2017-2022.
- Analysis of PPC visit subdomains (Goals of Care, Symptom Management, Care Coordination) documented in electronic health records.
- Comparison of subdomain frequency by visit type, diagnosis, and proximity to EOL.
Main Results:
- Outpatient PPC visits covered more subdomains (median 10 vs. 8) and were longer than inpatient visits.
- Outpatient visits more frequently addressed goals of care and chronic symptoms (e.g., fatigue).
- Inpatient visits more commonly managed technology use, pain, and acute EOL symptoms (e.g., dyspnea, agitation).
Conclusions:
- PPC practice scope significantly differs between inpatient and outpatient settings.
- Outpatient PPC addresses broader, often chronic, care needs, while inpatient PPC focuses on acute issues.
- Understanding these differences can optimize PPC delivery for pediatric cancer patients.
Background:
While pediatric palliative care (PPC) is associated with improved end-of-life (EOL) outcomes for children with cancer, the content of PPC visits leading to these outcomes is not well-understood. This study aims to compare the scope of PPC practice during inpatient and outpatient visits for children with cancer and their families.
Procedure:
This was a retrospective cohort study of patients 0-27 years with cancer seen by inpatient and/or outpatient PPC within an academic pediatric oncology center between 2017 and 2022. During each PPC visit, documenting clinicians selected the topics, or subdomains, addressed within each domain (Goals of Care, Symptom Management, and Care Coordination). Data were abstracted from the electronic health record, PPC clinic database, and cancer registry. Differences in the frequency of subdomains were analyzed by demographics, location of PPC service, visit type, diagnosis group, proximity to EOL, and billing time.
Results:
Across 467 PPC recipients, there were 7548 PPC visits. Compared to inpatient visits, outpatient encounters encompassed more subdomains (median of 10 vs. 8, p < 0.001) and were 19 min longer on average. Outpatient visits more commonly addressed goals of care and chronic symptoms (e.g., fatigue, appetite), whereas the use of technology, pain, and common EOL symptoms (e.g., dyspnea, agitation, confusion/delirium) were managed more often in the inpatient setting.
Conclusions:
The scope of PPC practice is wide-ranging and distinct between the inpatient and outpatient settings. Many time-intensive topics were addressed more frequently in outpatient visits, while inpatient visits focused on areas related to acute hospitalization.
Key Message:
This retrospective study outlines the distinct content of PPC visits within pediatric oncology across inpatient and outpatient settings. Outpatient visits more commonly addressed goals of care and chronic symptoms, whereas inpatient visits more often addressed the use of technology, pain, and common EOL symptoms.
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