Journal Article

The impact of specialized pediatric palliative care on advance care planning and healthcare utilization in children and young adults: a retrospective analysis of medical records of in-hospital deaths

Lee, Ji Weon, Kim, Min Sun, Kim, Cho Hee, Lee, Jung

2024

Overview

Background Pediatric palliative care supports children and young adults with life-limiting conditions and their families, seeking to minimize suffering and enhance quality of life. This study evaluates the impact of specialized palliative care (SPC) on advance care planning (ACP) and patterns of end-of-life care for patients who died in the hospital. Methods This is a retrospective cohort study of medical records extracted from a clinical data warehouse, covering patients who died aged 0–24 in an academic tertiary children’s hospital in South Korea. Participants were categorized into before (2011–2013; pre-period) and after (2017–2019; post-period) the introduction of an SPC service. Within the post-period, patients were further categorized into SPC recipients and non-recipients. Results We identified 274 and 205 patients in the pre-period and post-period, respectively. ACP was conducted more and earlier in the post-period than in the pre-period, and in patients who received palliative care than in those who did not. Patients who received SPC were likely to receive less mechanical ventilation or cardiopulmonary resuscitation and more opioids. A multivariable regression model showed that earlier ACP was associated with not being an infant, receiving SPC, and having a neurological or neuromuscular disease. Conclusions SPC involvement was associated with more and earlier ACP and less intense end-of-life care for children and young adults who died in the hospital. Integrating palliative care into routine care can improve the quality of end-of-life care by reflecting patients’ and their families’ values and preferences.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Advance care planning / Advance Care Planning - standards / Advance Care Planning - statistics & numerical data / Advance directives / Analysis / Cardiopulmonary resuscitation / Child / Child, Preschool / Cohort Studies / CPR / Decision making / Delivery of health care / Family / Female / Health care cost / Hematology / Hospital Mortality / Hospitals / Humans / Immunology / Infant / Infant, Newborn / Intensive care / Legal documents / Male / Medical care / Medical care, Cost of / Medical records / Medical Records - statistics & numerical data / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Methods / Multidisciplinary teams / Opioids / Pain Medicine / Palliative care / Palliative Care - methods / Palliative Care - standards / Palliative Care - statistics & numerical data / Palliative Medicine / Palliative treatment / Patient Acceptance of Health Care - psychology / Patient Acceptance of Health Care - statistics & numerical data / Patients / Pediatric Palliative Care / Pediatric research / Pediatrics / Pediatrics - methods / Pediatrics - statistics & numerical data / Psychiatrists / Quality management / Quality of Life Research / Regression analysis / Republic of Korea / Retrospective Studies / Symptom management / Terminal Care - methods / Terminal Care - standards / Terminal Care - statistics & numerical data / Utilization / Variables / Ventilators / Warehouse stores / Young Adult / Young adults