Priorities for global research into children's palliative care: results of an International Delphi Study.

Julia Downing,Mary Ann Muckaden,Joan Marston,Susan Fowler-Kerry,Caprice Knapp

doi:10.1186/s12904-015-0031-1

Abstract

BackgroundThere is an urgent need to develop an evidence base for children’s palliative care (CPC) globally, and in particular in resource-limited settings. Whilst the volume of CPC research has increased in the last decade, it has not been focused on countries where the burden of disease is highest. For example, a review of CPC literature in sub Saharan Africa (SSA) found only five peer-reviewed papers on CPC. This lack of evidence is not confined to SSA, but can be seen globally in specific areas, such as an insufficient research and evidence base on the treatment of pain and other symptoms in children. This need for an evidence base for CPC has been recognised for some time, however without understanding the priorities for research in CPC organisations, many struggle with how to allocate scarce resources to research.MethodThe International Children’s Palliative Care Network (ICPCN) undertook a Delphi study between October 2012 and February 2013 in order to identify the global research priorities for CPC. Members of the ICPCN Scientific Committee formed a project working group and were asked to suggest areas of research that they considered to be important. The list of 70 areas for research was put through two rounds of the Delphi process via a web-based questionnaire. ICPCN members and affiliated stakeholders (n = 153 from round 1 and n = 95 from round 2) completed the survey. Participants from SSA were the second largest group of respondents (28.1 % round 1, 24.2 % round 2) followed by Europe.ResultsA list of 26 research areas reached consensus. The top five priorities were: Children’s understanding of death and dying; Managing pain in children where there is no morphine; Funding; Training; and Assessment of the WHO two-step analgesic ladder for pain management in children.ConclusionsInformation from this study is important for policy makers, educators, advocates, funding agencies, and governments. Priorities for research pertinent to CPC throughout the world have been identified. This provides a much needed starting place for the allocation of funds and building research infrastructure. Researchers working in CPC are in a unique position to collaborate and produce the evidence that is needed.

Highlights

There is an urgent need to develop an evidence base for children’s palliative care (CPC) globally, and in particular in resource-limited settings
Information from this study is important for policy makers, educators, advocates, funding agencies, and governments
Researchers working in CPC are in a unique position to collaborate and produce the evidence that is needed

Summary

Introduction

There is an urgent need to develop an evidence base for children’s palliative care (CPC) globally, and in particular in resource-limited settings. Even when palliative care is available it is often not adapted to the needs of children [2] Several international organisations, such as the International Children’s Palliative Care Network (ICPCN) and the Union Internationale Contre le Cancer (UICC) believe that every child with a life-limiting illness has the right to a high standard of total care, wherever they live in the world, and that the provision of palliative care for children is a global health issue [3]. This was endorsed by the recent World Health Assembly resolution which recognised the importance of CPC and member states committed to developing such services [4]. It has been well documented that there are many challenges to the provision of palliative care for children including a lack of education for families and providers; limited resources; lack of evidence; limited access to medications - including opioids for pain treatment- and the lack of appropriate policies to ensure availability and access within the health care system [2, 5, 6]

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