Association of Inpatient and Outpatient Pediatric Palliative Care with
Healthcare Utilization and End-of-Life Outcomes in Pediatric Oncology
Abstract
Background: Pediatric palliative care (PPC) is associated with improved
end-of-life (EOL) outcomes. Inpatient and outpatient PPC have unique
roles during the disease course. Yet, it is unknown whether the location
of PPC receipt (inpatient vs outpatient) is associated with healthcare
utilization and EOL outcomes for pediatric oncology patients. Procedure:
A retrospective single-institution chart review of pediatric patients
(age 0-28) with cancer who died between January 2015 – December 2022
was performed to compare EOL outcomes and healthcare utilization metrics
among only inpatient PPC, any outpatient PPC, and non-PPC recipients.
Demographics and clinical factors were analyzed by location of PPC
receipt. Results: Among 450 patients, 292 (64.9%) received PPC
(inpatient only (35%), any outpatient (65%)). The proportion of
patients who died without receiving PPC dropped from 69% to 22%
following development of an outpatient PPC clinic (p<0.001). In
the last six months, one month and week of life, inpatient PPC
recipients spent more days admitted to the hospital and intensive care
unit (all p<0.001), and had more intensive medical interventions
performed (p<0.01). Outpatient PPC recipients were less likely
to receive IV chemotherapy (p<0.01) or intubation (p=0.05), and
more likely to receive hospice, die at home, and have an outpatient
Do-Not-Resuscitate order (all p<0.001). Conclusions: PPC receipt
substantially increased after the creation of an outpatient PPC clinic,
suggesting that outpatient PPC is critical in the provision of PPC to
children with cancer. Outpatient PPC was associated with fewer hospital
days, IV chemotherapy and intubation at EOL, while improving hospice
enrollment and home death.