Association of inpatient and outpatient pediatric palliative care with healthcare utilization and end-of-life outcomes in pediatric oncology

IF 2.4 3区医学 Q2 HEMATOLOGY

Pediatric Blood & Cancer Pub Date : 2024-10-20 DOI:10.1002/pbc.31387

Rebecca L. Shamah, Elizabeth George, Nicholas P. DeGroote, Karen Wasilewski, Katharine E. Brock

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引用次数: 0

Abstract

Background

Pediatric palliative care (PPC) is associated with improved end-of-life (EOL) outcomes. Inpatient and outpatient PPC have unique roles during the disease course. Yet, it is unknown whether the location of PPC receipt (inpatient vs. outpatient) is associated with healthcare utilization and EOL outcomes for pediatric and adolescent and young adult oncology patients.

Procedure

A retrospective single-institution chart review of pediatric patients (age 0–28) with cancer who died between January 2015 and December 2022 was performed to compare EOL outcomes and healthcare utilization metrics among inpatient PPC, any outpatient PPC, and non-PPC recipients. Demographics and clinical factors were analyzed by PPC receipt location.

Results

Among 450 patients, 292 (64.9%) received PPC (inpatient only 35%, any outpatient 65%). Patients who died without receiving PPC dropped from 69% to 22% following development of an outpatient PPC clinic (p < .001). In the last 6 months, 1 month, and last week of life, inpatient PPC recipients spent more days admitted to the hospital and intensive care unit (all p < .001), and had more intensive medical interventions performed (p < .01). Outpatient PPC recipients were less likely to receive intravenous (IV) chemotherapy (p < .01) or intubation (p = .05), and more likely to receive hospice, die at home, and have an outpatient do-not-resuscitate order (all p < .001).

Conclusions

PPC receipt substantially increased after the creation of an outpatient PPC clinic, suggesting that outpatient PPC is critical in the provision of PPC to children with cancer. Outpatient PPC was associated with fewer hospital days, IV chemotherapy, and intubation at EOL, while increasing hospice enrollment and home death.

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住院和门诊儿科姑息关怀与儿科肿瘤的医疗利用率和临终结局的关系。

背景：儿科姑息治疗（PPC）与改善生命末期（EOL）预后有关。住院病人和门诊病人的姑息治疗在疾病过程中发挥着独特的作用。然而，接受姑息治疗的地点（住院病人与门诊病人）是否与儿科、青少年和年轻成人肿瘤患者的医疗利用率和临终结局有关，目前尚不得而知：对 2015 年 1 月至 2022 年 12 月期间死亡的儿科癌症患者（0-28 岁）进行了单机构病历回顾，以比较住院患者、任何门诊患者和非住院患者的临终结局和医疗利用指标。人口统计学和临床因素按PPC接受地点进行了分析：在 450 名患者中，292 人（64.9%）接受了 PPC 治疗（住院患者占 35%，任何门诊患者占 65%）。在设立 PPC 门诊后，未接受 PPC 治疗而死亡的患者比例从 69% 降至 22%（p 结论：PPC 门诊的设立大大提高了患者接受 PPC 治疗的比例：门诊患者 PPC 诊所成立后，接受 PPC 治疗的患者大幅增加，这表明门诊患者 PPC 对为癌症儿童提供 PPC 治疗至关重要。门诊就诊与减少住院天数、静脉化疗和临终前插管有关，同时也增加了临终关怀的注册人数和居家死亡人数。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Blood & Cancer 医学-小儿科

CiteScore

4.90

自引率

9.40%

发文量

546

审稿时长

1.5 months

期刊介绍： Pediatric Blood & Cancer publishes the highest quality manuscripts describing basic and clinical investigations of blood disorders and malignant diseases of childhood including diagnosis, treatment, epidemiology, etiology, biology, and molecular and clinical genetics of these diseases as they affect children, adolescents, and young adults. Pediatric Blood & Cancer will also include studies on such treatment options as hematopoietic stem cell transplantation, immunology, and gene therapy.