Lee Annika, DeGroote Nicholas P, Brock Katharine E
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
J Palliat Med. 2023 Nov;26(11):1466-1473. doi: 10.1089/jpm.2023.0063. Epub 2023 May 24.
There is no consensus on what constitutes "early" pediatric palliative care (PPC) referral within pediatric oncology. Few studies report outcomes based on PPC timing. Investigate associations between early (<12 weeks) or late (≥12 weeks from diagnosis) outpatient PPC consultation with demographics, advance care planning (ACP), and end-of-life (EOL) outcomes. Retrospective chart and database review of demographic, disease, visit data, and PPC/EOL outcomes. Deceased pediatric patients with cancer 0-27 years of age seen at an embedded consultative PPC clinic. Patient demographics, disease characteristics, PPC/EOL outcomes: timing/receipt of ACP, hospice enrollment, do-not-resuscitate (DNR) documentation, hospital days in last 90 days of life, concordance between actual and preferred location of death, receipt of cardiopulmonary resuscitation (CPR) at EOL, and death in the intensive care unit. Thirty-two patients received early and 118 received late PPC. Early outpatient PPC was associated with cancer type ( < 0.01). Early PPC ( = 0.04) and ACP documentation ( = 0.04) were associated with documentation of preferred location of death. Early PPC was associated with a preference for home death ( = 0.02). Timing of outpatient PPC was not associated with ACP documentation or other EOL outcomes. In the entire cohort, 73% of PPC patients received hospice, 74% had a DNR order, 87% did not receive CPR at EOL, and 90% died in their preferred location. When using a cutoff of 12 weeks from diagnosis, outpatient PPC timing was only associated with location of death metrics, likely due to high-quality PPC and EOL care among all patients.
在儿科肿瘤学领域，对于什么构成“早期”儿科姑息治疗（PPC）转诊尚无共识。很少有研究报告基于PPC时机的结果。调查早期（<12周）或晚期（诊断后≥12周）门诊PPC咨询与人口统计学、预先护理计划（ACP）和临终（EOL）结果之间的关联。对人口统计学、疾病、就诊数据以及PPC/EOL结果进行回顾性图表和数据库审查。在一家嵌入式咨询PPC诊所就诊的0至27岁已故癌症儿科患者。患者人口统计学、疾病特征、PPC/EOL结果：ACP的时机/接受情况、临终关怀登记、不进行心肺复苏（DNR）文件记录、生命最后90天的住院天数、实际死亡地点与首选死亡地点的一致性、临终时接受心肺复苏（CPR）情况以及在重症监护病房死亡情况。32名患者接受了早期PPC，118名患者接受了晚期PPC。早期门诊PPC与癌症类型相关（<0.01）。早期PPC（=0.04）和ACP文件记录（=0.04）与首选死亡地点的文件记录相关。早期PPC与在家中死亡的偏好相关（=0.02）。门诊PPC的时机与ACP文件记录或其他EOL结果无关。在整个队列中，73%的PPC患者接受了临终关怀，74%有DNR医嘱，87%在临终时未接受CPR，90%在其首选地点死亡。当以诊断后12周为截止点时，门诊PPC时机仅与死亡地点指标相关，这可能是由于所有患者都接受了高质量的PPC和EOL护理。
