Paediatric Palliative Care Pain Service Department of Women's and Children's Health, University of Padua, Padua, Italy.
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
BMC Palliat Care. 2024 Aug 6;23(1):202. doi: 10.1186/s12904-024-01532-1.
The current Italian scenario of pediatric palliative care (PPC) services is characterized by inadequate coverage of the territory. Therefore, it is important to improve the referral of patients to the most appropriate setting (community care, general PPC, or specialized PPC) and to improve the delivery of PPC care.
Aiming at obtaining information about the referrals to the Padua Pediatric Hospice that could help estimate the investments needed to improve the provision of care, a retrospective analysis has been carried out. The rate of proper referral and discharge, the number of patients followed at the hospice, the mortality rate, and the length of follow-up were analyzed, and, when possible, data were stratified by oncological and non-oncological diseases.
The analysis showed that of the 870 patients referred to the Padua Pediatric Hospice between 2008 and 2022, 76% were affected by non-oncological conditions. 82% of patients referred were taken in charge and most of the remaining patients have been inappropriately referred. The analysis showed a growing number of total referrals, which increased by 195% from 2008 to 2022. An increase in proper referrals and referrals of non-oncological patients was observed alongside a decrease in oncological patient referrals and a trend toward a decrease in discharge rates. A decreased mortality was observed in patients with non-oncological conditions, with only 6% of deceased patients in 2022. Moreover, a longer survival with a median follow-up length of 43 months was observed among patients with non-oncological conditions who were followed up at the Padua Pediatric Hospice for more than 12 months. Conversely, the short survival rate observed for oncological patients suggests that those patients should have been referred to PPC earlier to benefit from palliative care for longer periods.
Considering these data, it is expected that the number of patients needing PPC services will steadily increase in the next years. Hence, there is a need to invest resources to provide the best care delivery model encompassing specific pathways for the transition into adulthood, the establishment of networks within all the Italian regions, and an efficient referral to the more suitable setting of care.
目前意大利的儿科姑息治疗（PPC）服务状况的特点是覆盖范围不足。因此，重要的是要改善患者向最合适的环境（社区护理、一般 PPC 或专门的 PPC）的转诊，并改善 PPC 护理的提供。
为了获得有关帕多瓦儿科临终关怀转诊的信息，以帮助估计改善护理提供所需的投资，我们进行了回顾性分析。分析了适当转诊和出院率、在临终关怀中心接受随访的患者数量、死亡率和随访时间，并在可能的情况下按肿瘤和非肿瘤疾病进行分层。
分析显示，在 2008 年至 2022 年间，有 870 名患者被转诊到帕多瓦儿科临终关怀中心，其中 76%的患者患有非肿瘤疾病。82%的被转诊患者得到了照顾，其余大部分患者被不当转诊。分析显示，总转诊人数不断增加，从 2008 年到 2022 年增加了 195%。适当转诊和非肿瘤患者转诊的数量增加，而肿瘤患者转诊的数量减少，出院率呈下降趋势。非肿瘤患者的死亡率下降，2022 年死亡患者仅占 6%。此外，在帕多瓦儿科临终关怀中心接受随访超过 12 个月的非肿瘤患者中，观察到中位随访时间为 43 个月的更长生存时间。相反，肿瘤患者的短存活率表明，这些患者应该更早被转诊到 PPC，以更长时间受益于姑息治疗。
考虑到这些数据，预计未来几年需要 PPC 服务的患者数量将稳步增加。因此，有必要投入资源，提供最佳的护理提供模式，包括特定的过渡到成年期的途径、在意大利所有地区建立网络，以及有效转诊到更合适的护理环境。
