Healy Emma W, Piracha Natasha Z
Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, United States.
Pediatric Palliative Care, Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, 630 W 168th St, New York, NY 10032, United States.
Health Care Transit. 2024 Sep 14;2:100072. doi: 10.1016/j.hctj.2024.100072. eCollection 2024.
The transition from pediatric to adult healthcare poses significant challenges for adolescents and young adults (AYA), especially those with chronic conditions, yet most children receive inadequate transition preparation. Research on the transition for patients receiving palliative care services is particularly limited. We sought to address this gap in the literature.
Young adults aged 18 to 35 years who transitioned from the pediatric setting and received adult palliative care services at an urban academic medical center between the dates of February 1st 2020 and July 1st, 2022 were identified retrospectively via electronic medical record. Chart review was used to investigate outcomes of interest, including use of pediatric palliative care services and timing of care conversations.
Only 23 % of patients interfaced with pediatric palliative care, despite all having childhood diagnoses. Pediatric palliative care exposure was associated with a significantly earlier median age of first adult palliative care encounter (19.63 versus 25.06, p = <0.001). Goals of care discussions, code status conversations, and healthcare proxy documentation occurred earlier if pediatric palliative care was involved (18.9 years versus 25.7 years, p < 0.001; 20.9 years versus 30.0 years, p < 0.001; 20.7 versus 28.9, p < 0.001).
Pediatric palliative care services were underutilized in AYA patients, but when used, were associated with earlier adult palliative care encounters, goals of care discussions, code status decisions, and health care proxy identification.
从儿科医疗向成人医疗的过渡给青少年和青年（AYA）带来了重大挑战，尤其是那些患有慢性病的患者，但大多数儿童在过渡准备方面不足。关于接受姑息治疗服务患者的过渡研究尤为有限。我们试图填补这一文献空白。
通过电子病历回顾性识别出2020年2月1日至2022年7月1日期间从儿科环境过渡并在城市学术医疗中心接受成人姑息治疗服务的18至35岁青年。病历审查用于调查感兴趣的结果，包括儿科姑息治疗服务的使用情况和护理谈话的时间。
尽管所有患者都有儿童期诊断，但只有23%的患者接受了儿科姑息治疗。儿科姑息治疗暴露与首次成人姑息治疗接触的中位年龄显著提前相关（19.63岁对25.06岁，p = <0.001）。如果涉及儿科姑息治疗，护理讨论目标、代码状态谈话和医疗保健代理人文件记录会更早进行（18.9岁对25.7岁，p < 0.001；20.9岁对30.0岁，p < 0.001；20.7岁对28.9岁，p < 0.001）。
儿科姑息治疗服务在AYA患者中未得到充分利用，但使用时与更早的成人姑息治疗接触、护理讨论目标、代码状态决策和医疗保健代理人识别相关。
