Palliative Care for Children in Hospital: Essential Roles.

Ross Drake

doi:10.3390/children5020026

Abstract

Palliative care for children in pediatric hospitals is a vital part of the network of services supporting children with severe illness. This has been recognized, with a trend over the past decade for an increased number of pediatric palliative care (PPC) services established in pediatric hospitals. The inpatient team is in the unique position of influencing the early identification of children and their families, across the age and diagnostic spectrum, which could benefit from palliative care. These services have an opportunity to influence the integration of the palliative approach throughout the hospital, and in so doing, have the capacity to improve many aspects of care, including altering an increasingly futile and burdensome treatment trajectory, and ensuring improved symptom (physical and psychological) management.

Highlights

Pediatric palliative care (PPC) services have been in development since England led the way with the founding of the first children’s hospice, Helen House, in 1982 and the pioneering hospital-based palliative care team in 1986 at Great Ormond Street Hospital
The mortality rate in the pediatric intensive care unit (PICU) for these children was double compared with those who did not have such a diagnosis (5.4% versus 2.7%), and a child with a life-limiting condition was 75% more likely to die in the PICU once all of the factors had been taken into account
The diversity of conditions affecting children that could benefit from palliative care and the medically fragile nature of these children requires a hospital-based PPC service to be an integral part of the pediatric hospital

Summary

Introduction

Pediatric palliative care (PPC) services have been in development since England led the way with the founding of the first children’s hospice, Helen House, in 1982 and the pioneering hospital-based palliative care team in 1986 at Great Ormond Street Hospital. The experience of the USA has been detailed in a 2012 survey [1], which indicated a creditable 72% of respondents had a PPC program, with the majority having been launched since. There are some requirements of a hospital-based team over and above that of a community-based service They hospital service plays an essential role in identifying children and families in need, which includes integrating the palliative approach within the hospital, liaising effectively with community-based services, and providing impeccable assessment and treatment of pain and other problems to the betterment of the mind, body, and spirit of children and their families

Identification

Integration

Symptom Assessment and Management

Findings

Conclusions