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Enhancing Early Integration of Pediatric Palliative Care: Evaluating a Clinician-Based Versus Criteria-Based Referral

Alexis Fong-Leboeuf1,2,3, Christina Vadeboncoeur1,2,3, Donna L Johnston1,4

  • 1Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.

Children (Basel, Switzerland)
|July 28, 2026
PubMed

Insights

Implementing structured referral criteria significantly increased pediatric palliative care (PPC) referrals for newly diagnosed oncology patients. This led to a substantial reduction in the time from diagnosis to PPC consultation, improving comprehensive care.

Area of Science:

  • Pediatric Oncology
  • Palliative Care
  • Healthcare Management

Background:

  • Early palliative care referral is crucial for comprehensive oncology care.
  • Research on referral patterns in pediatric oncology is limited.
  • Pediatric palliative care (PPC) integration aims to enhance patient outcomes.

Purpose of the Study:

  • To evaluate the impact of implementing referral criteria on PPC consultation patterns.
  • To assess changes in referral rates and timing before and after criteria implementation at CHEO.
  • To determine if structured criteria improve early integration of PPC in pediatric oncology.

Main Methods:

  • Retrospective single-centre chart review of pediatric oncology patients (Oct 2017 - Jan 2024).
  • Comparison of referral patterns and time-to-referral before (pre-July 2019) and after (post-July 2019) criteria implementation.
  • Analysis of electronic medical records for referral data.

Main Results:

  • A statistically significant increase in PPC referrals, from 36.8% to 75.4%, post-criteria implementation (p < 0.001).
  • A significant decrease in median time from diagnosis to PPC referral, from 267 days to 11 days (p < 0.001).
  • Referral time reduction observed across most diagnostic subgroups, excluding CNS tumors.

Conclusions:

  • Structured referral criteria effectively increased PPC referrals for pediatric oncology patients.
  • Implementation of criteria led to a significant and earlier integration of PPC services.
  • These findings support the use of standardized criteria to optimize palliative care delivery in pediatric oncology settings.
Abstract

Keywords:
early referralpediatric oncologypediatric palliative carequality improvementreferral criteria

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