Early Implementation of Pediatric Palliative Care
Sarah Peterson, Viterbo University, La Crosse, Wisconsin
Purpose
The purpose is to discuss the effectiveness
of implementing pediatric palliative care early
in a child’s diagnosis to improve children’s
and their family’s quality of life.
Background & Significance
▪ Palliative care is specialized medical care
for individuals living with a serious illness.
These patients may receive medical care
for symptoms along with treatment. The
goal is to enhance an individual’s current
care and focus on the quality of life for
them and their family (National Institute on
Aging, 2021).
▪ Worldwide, 21 million pediatric patients
may be in need of palliative care (Amari,
2021).
▪ One year following an initial pediatric
palliative care consultation, more than two-
thirds of children are still alive (Taub,
2023).
▪ There have been major gaps identified in
the early implementation of pediatric
palliative care. Many mistake palliative care
for hospice, end-of-life care, or terminal
care. Each of those terms has a unique
goal in care (Neuburg, 2021).
PICOT Question
In pediatric patients, how does early
implementation of palliative care versus no
engagement in palliative care impact children’s
quality of life and their families throughout the
child’s lifespan.
P: Pediatric patients
I: Early implementation of palliative care
C: No engagement in palliative care
O: Impact children’s quality of life and their
families
T: Throughout the child’s lifespan
Literature Review Recommendations
Study Level of Evidence Critical Appraisal Results ▪ Due to the gap in nursing knowledge
Marcus et al. (2020) Level I Twenty-four studies ▪ Children who received specialized pediatric surrounding palliative care, improvements to
were included in the palliative care were associated with a better quality the nursing curriculum should be implemented.
systemic review. of life. This should include more exposure to what
Included in the study ▪ There is an increased growth of pediatric palliative palliative care is and how to incorporate it early
selection were cohort, care programs nationwide, but there is lacking
case-control, evidence-based research. in pediatric care.
randomized ▪ No consistent findings were identified in regards to ▪ Nurses should assess the patient and family’s
controlled, and utilizing supportive services. hopes and fears early by building relationships
before-after studies. with families outside of crisis.
A larger network
regarding research is ▪ Nurses should implement palliative care that
needed to make a emphasizes physical, emotional, spiritual, and
firm recommendation. social care.
Neuburg (2021) Level VII A literature search ▪ Early identification of patient and family goals can ▪ Interdisciplinary coordination of care allows for
was conducted and improve the quality of life for children and families a collaborative approach to address the
an analysis was by encouraging collaboration among clinicians to
completed of articles achieve these goals. multifaceted needs of pediatric patients and
that were relevant to ▪ Early implementation enhances quality of life and their families.
the subject. reduces suffering among pediatric patients. ▪ Nurses should promote strengthening and
▪ Identified a significant gap in nursing knowledge broadening existing research.
regarding palliative care. Many clinicians fail to
initiate this conversation due to misperceptions.
Conclusion
Saad et al. (2020) Level VI Qualitative ▪ Healthcare providers can help to improve patient’s
descriptive research comfort levels by understanding that palliative care The PICOT was partially answered by evidence
design with a focus is used as pain relief.
that shows early implementation will allow
on pediatric oncology. ▪ The timing of implementing palliative care should
This study explored be aligned with end-of-life or advanced disease. healthcare teams to build trusting relationships
the perceptions of ▪ It is extremely valuable to engage in with families outside of crisis (Taub, 2023).
pediatric oncology interdisciplinary collaboration. Palliative care provides comprehensive support
providers at ▪ Communication with the child and family is difficult, for families. This approach improves symptom
Children’s Cancer but effective in improving the patient and family’s
Institute. quality of life. Building strong communication management and enhances communication.
There is limited data to show how early
channels fosters partnership in the care process.
implementation of palliative care can impact
Taub (2023) Level VII This article reviewed ▪ Early implementation of palliative care can help children’s quality of life. Thus, early
multiple sources to determine if medical decisions are being made implementation of pediatric palliative care
review the benefits under family preferences. Another benefit includes
should be studied further.
and barriers to early shifting the term from end-of-life to helping patients
integration of and families on their healthcare journey to improve
pediatric palliative their quality of life and work towards goal-oriented References
care. healthcare decisions. Amarri, S., Ottaviani, A., Campagna, A., & Panfilis, L. D. (2021). Children with medical complexity and paediatric palliative care: A retrospective
cross-sectional survey of prevalence and needs. Italian Journal of Pediatrics, 47(110), 1-7. https://link.springer.com/article/10.1186/s13052-021-
▪ Barriers to implementing pediatric palliative care
01059-8
Marcus, K., L., Santos, G., Ciapponi, A., Bilodeau, M., Wolfe, J., and Dussel, V. (2019). Impact of specialized pediatric palliative care: A systematic
early include clinician misconceptions and review. Journal of Pain and Symptom Management, 59(2), 339-364. https://doi.org/10.1016/j.jpainsymman.2019.08.005
availability of services.
National Institute on Aging. (2021) What are palliative care and hospice care? https://www.nia.nih.gov/health/hospice-and-palliative-care/what-are-
palliative-care-and-hospice-care
▪ Palliative care has been associated with a lower
Neuburg, L., (2020). Early initiation of pediatric palliative care. Journal of Pediatric Health Care, 35(1),114-119.
https://doi.org/10.1016/j.pedhc.2020.05.006
Saad, R., Jurdahi, L., B., Yazbick-Dumit, N., Irani, C., Muwakkit, S. (2020). Paediatric oncology providers’ perspectives on early integration of
risk of high-intensity end-of-life care for children paediatric palliative care. International Journal of Palliative Nursing, 26(3), 100-109. https://doi.org/10.12968/ijpn.2020.26.3.100
with cancer. Taub, S., & Macauley, R. (2023). Early and often: Promoting early integration of pediatric palliative care for seriously ill children with cancer.
Current Problems in Cancer, 47(5), 1-6. https://doi.org/10.1016/j.currproblcancer.2023.101023