Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Pediatrics (S.H.C., E.T.W., C.C.W., M.Y.S., H.L.C., F.L.L.), National Taiwan University Children's Hospital, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Pediatric Hematology and Oncology (M.Y.S.), China Medical University Children's Hospital, Taichung, Taiwan.
J Pain Symptom Manage. 2023 Sep;66(3):230-237.e1. doi: 10.1016/j.jpainsymman.2023.05.018. Epub 2023 Jun 6.
Pediatric palliative care (PPC), especially among noncancer pediatric patients, faces challenges including late referral, limited patient care, and insufficient data for Asian patients.
This retrospective cohort study used the integrative hospital medical database between 2014 and 2018 to analyze the clinical characteristics, diagnoses, and end-of-life care for patients aged less than 20 who had died in our children's hospital, a tertiary referral medical center implementing PPC shared-care.
In our cohort of 323 children, 240 (74.3%) were noncancer patients who a younger median age at death (5 vs. 122 months, P < 0.001), lower rate of PPC involvement (16.7 vs. 66%, P < 0.001), and fewer survival days after PPC consult compared to cancer patients (3 vs. 11, P = 0.01). Patients not receiving PPC had more ventilator support (OR 9.9, P < 0.001), and less morphine use on their final day of life (OR 0.1, P < 0.001). Also, patients not receiving PPC had more cardiopulmonary resuscitation on the last day of life (OR 15.3, P < 0.001) and died in the ICU (OR 8.8, P < 0.001). There was an increasing trend of noncancer patients receiving PPC between 2014 and 2018 (P < 0.001).
High disparities exist between children receiving PPC in cancer versus noncancer patients. The concept of PPC is gradually becoming accepted in noncancer children and is associated with more pain-relief medication and less suffering during end-of-life care.
儿科姑息治疗（PPC），尤其是在非癌症儿科患者中，面临着诸多挑战，包括转诊较晚、患者护理有限以及亚洲患者数据不足。
本回顾性队列研究使用 2014 年至 2018 年综合医院医疗数据库，分析了我院（一家实施 PPC 共同照护的三级转诊医疗中心）死亡的 20 岁以下患者的临床特征、诊断和临终关怀。
在我们的 323 名患儿队列中，240 名（74.3%）是非癌症患者，其死亡时的中位年龄更小（5 岁 vs. 122 个月，P < 0.001），接受 PPC 治疗的比例较低（16.7% vs. 66%，P < 0.001），以及与癌症患者相比，在接受 PPC 咨询后生存天数更少（3 天 vs. 11 天，P = 0.01）。未接受 PPC 的患者接受呼吸机支持的比例更高（OR 9.9，P < 0.001），生命最后一天使用吗啡的比例更少（OR 0.1，P < 0.001）。此外，未接受 PPC 的患者生命最后一天接受心肺复苏的比例更高（OR 15.3，P < 0.001），并且死于 ICU 的比例更高（OR 8.8，P < 0.001）。2014 年至 2018 年，非癌症患者接受 PPC 的比例呈上升趋势（P < 0.001）。
癌症患者与非癌症患者接受 PPC 治疗的比例存在较大差异。PPC 的概念在非癌症儿童中逐渐被接受，与临终关怀期间更多的止痛药物和更少的痛苦有关。
