Psychological Domains of Care of Pediatric Palliative Care Within Pediatric Oncology

A childhood cancer diagnosis can have serious psychological impact on patients and families. While psychological and psychiatric providers bring unique expertise, they are not routinely integrated into pediatric palliative care (PPC) teams. This study aims to outline the psychological concerns addressed by PPC providers during visits for children with cancer.

This secondary analysis stems from 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 2017-2022. In the electronic health record (EHR), clinicians selected the topics (subdomains) addressed in each visit. Those related to psychological and psychiatric needs of patients were included. Data were abstracted from the EHR, PPC clinic database, and cancer registry. Differences in the frequency of subdomains were analyzed by demographics, location of PPC service, and more.

Across 467 PPC-recipients, there were 7548 PPC visits, of which 89.8% discussed ≥ 1 psychological subdomain and 40.8% discussed ≥ 2 psychological subdomains. The top five psychological subdomains (wellbeing, anxiety, fatigue/tiredness, sleep difficulties, and depression/sadness) were more strongly associated with outpatient visits than inpatient encounters (p ≤ 0.001). The number of psychological subdomains was positively associated with the number of physical symptoms managed in a visit (p < 0.001).

In an overwhelming majority of visits, PPC clinicians address psychological symptoms. The psychological domains within PPC practice are wide-ranging and likely incompletely recognized. Gaps in recognizing and managing psychological challenges in children with cancer can be addressed by implementing screening tools and incorporating psychologists and psychiatrists within PPC teams.