Impact of a shared pediatric palliative care program on end-of-life care trends among children: a 10-year

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Chia-Wen Hung1,2, Li-Min Wu3,4

  • 1Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

BMC Palliative Care
|May 4, 2026
PubMed

Insights

Implementing a shared pediatric palliative care (PPC) program improved advance care planning and interdisciplinary collaboration. Further efforts are needed to reduce intensive care unit deaths and align end-of-life care with family preferences.

Area of Science:

  • Palliative Care
  • Pediatric Oncology
  • Healthcare Systems Research

Background:

  • Pediatric palliative care (PPC) enhances symptom management and decision-making but is underutilized in many Asian systems.
  • Delayed referrals and high rates of in-hospital deaths, particularly in intensive care units (ICUs), characterize current end-of-life care for children in these regions.

Purpose of the Study:

  • To evaluate the impact of integrating a shared pediatric palliative care (PPC) program within existing healthcare structures.
  • To assess changes in advance care planning documentation, interdisciplinary communication, and end-of-life care intensity following PPC implementation.

Main Methods:

  • A retrospective cohort study analyzed data from 294 children (0-18 years) who died between 2008-2017 at two Taiwanese medical centers.
  • A shared PPC program, embedding specialists within primary care teams, was implemented in 2011.
  • Key outcomes including do-not-resuscitate (DNR) orders, family meetings, PPC consultations, cardiopulmonary resuscitation (CPR), and place of death were compared across pre- and post-implementation phases.

Main Results:

  • DNR documentation increased significantly (59.2% to 73.9%, p=.03), as did documented family meetings (4.1% to 18.2%, p<.001) and PPC consultations (7.1% to 23.9%, p<.001).
  • While ICU deaths remained high (87.8%-89.8%), CPR rates showed a non-significant decline (p=.09).
  • Cancer diagnosis and older age at diagnosis were independently associated with PPC consultation.

Conclusions:

  • Integration of a shared PPC model positively impacted advance care planning and interdisciplinary collaboration.
  • Strategies to encourage earlier referrals, enhance clinician education, and expand community-based PPC are crucial.
  • These interventions aim to reduce intensive end-of-life care and better align care with family preferences.
Abstract

Keywords:
Advance care planningEnd-of-life careFamily meetingIntensive care unitPediatric palliative care

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