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The Use of Patient-controlled Analgesia for Children Requiring Symptom Management at End of Life: A Scoping Review
Rosemarie Hanna1, Felicity Hasson2, Esther Beck2
1NI Children's Hospice/Belfast Health, and Social Care Trust, Belfast, Northern Ireland, UK.
Insights
Patient-controlled analgesia (PCA) use in end-of-life pediatric care lacks standardized policies. Further research is needed, especially for non-malignant diagnoses, to improve pain management and incorporate child and parent perspectives.
Area of Science:
- Pediatric Palliative Care
- Pain Management
- Oncology Nursing
Background:
- Pain is a significant symptom for children at the end of life, posing management challenges.
- Patient-controlled analgesia (PCA) is effective for breakthrough pain in other settings but its use in pediatric palliative care is unclear.
Purpose of the Study:
- To review and synthesize evidence on patient-controlled analgesia (PCA) for children at the end of life.
Main Methods:
- A scoping review utilizing the Arksey and O'Malley Framework.
- Identified PCA utilization, implications, safety, and patient/parent perspectives.
Main Results:
- A significant lack of standardized patient-controlled analgesia (PCA) policies for pediatric end-of-life care.
- Evidence is largely organization-dependent and focused on children with malignant diagnoses.
Conclusions:
- Further research on PCA for non-malignant pediatric diagnoses is essential, incorporating child and parent views.
- Nurses are key in developing evidence-based PCA policies for pediatric end-of-life care.
- A call to action for collaborative efforts to implement effective PCA policies.
Background:
Pain is the most common and distressing symptom for children at the end of life, with management challenges causing significant distress for patients and caregivers. Patient-controlled analgesia allows self-administration of preset medication doses for breakthrough pain and has shown benefits in postoperative and chronic pain management. However, its use and effectiveness in pediatric palliative care remain unclear.
Objectives:
To review and synthesize the evidence pertaining to patient-controlled analgesia use for children at the end of life.
Review Methods:
A scoping review used the Arksey and O'Malley Framework to identify: (1) utilization of patient-controlled analgesia, including patient groups, advantages, and proxy use; (2) implications, safety, side effects, and impact on pain; and (3) child and parental perspectives.
Results:
The key finding is a lack of a clearly defined, standardized patient-controlled analgesia policy for use in children at the end of life. Much of the reviewed evidence was organization-dependent, and most related to use for children with a malignant diagnosis.
Conclusions:
Further research is required involving patient-controlled analgesia use with children with a nonmalignant diagnosis, including the perspectives of children and parents. Nurses are integral team members and well-positioned to be developers of policies related to patient-controlled analgesia use in children at the end of life. This is a call to action for nurse clinicians, leaders, researchers, and educators to collaborate to identify and implement an evidence-based, effective policy.
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