loading page

Association of Inpatient and Outpatient Pediatric Palliative Care with Healthcare Utilization and End-of-Life Outcomes in Pediatric Oncology
  • +2
  • Rebecca L. Shamah,
  • Elizabeth George,
  • Nicholas P. DeGroote,
  • Karen Wasilewski,
  • Katharine Brock
Rebecca L. Shamah
Emory University School of Medicine
Author Profile
Elizabeth George
Maine Medical Center
Author Profile
Nicholas P. DeGroote
Children's Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center
Author Profile
Karen Wasilewski
Emory University School of Medicine
Author Profile
Katharine Brock
Emory University School of Medicine

Corresponding Author:[email protected]

Author Profile

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.
Submitted to Pediatric Blood & Cancer
03 Jun 2024Review(s) Completed, Editorial Evaluation Pending
23 Jun 2024Editorial Decision: Revise Major
31 Aug 2024Submission Checks Completed
31 Aug 2024Assigned to Editor
31 Aug 20241st Revision Received
02 Sep 2024Review(s) Completed, Editorial Evaluation Pending
18 Sep 2024Editorial Decision: Revise Minor
26 Sep 2024Submission Checks Completed
26 Sep 2024Assigned to Editor
26 Sep 20242nd Revision Received
27 Sep 2024Review(s) Completed, Editorial Evaluation Pending
30 Sep 2024Editorial Decision: Accept