Review of Themes and Recommendations Encountered in Palliative Care Consults with Pediatric Dialysis Patients (S751)

Abstract

Objectives Understand the complexities of providing recommendations for the pediatric dialysis population. Recognize common symptoms in the pediatric dialysis population. Original Research Background. End stage renal disease (ESRD) requiring dialysis is frequently lifelimiting in children. Mortality rates are approximately 30 times that of the general population, although they are decreasing as available therapies improve. Pediatric palliative care services have been used occasionally in this population; however, there is scant literature available on whether patients with consultations by a designated pediatric palliative care service have common themes to their recommendations or interventions. Research Objectives. The goal of this research was to better characterize palliative care team involvement with this specific population. Methods. The retrospective study reviewed pediatric palliative care consultations for children with ESRD undergoing dialysis from 1/2006-12/2012. Quantitative data regarding patient was collected and impressions from the initial consultation were compiled. Consults were de-identified and re-analyzed for additional underlying themes using consensus coding. Results. Chart review included thirty-seven patients aged 5 weeks through 18 years; seven patients were excluded after initial review. Eligible patients were on chronic hemodialysis, peritoneal dialysis, or acute hemodialysis. Of the standard palliative care metrics identified by the consultation team, the most common was ‘‘complex or time-intensive communication and/or interdisciplinary psychosocial support’’ (65% of consults), followed by ‘‘information/education regarding palliative care and hospice philosophies’’ (59%) and ‘‘clarification of goals and assistance with difficult decision-making’’ and ‘‘resources/transitions,’’ both 41% of consults. More than 50% of patients requiring improved communication with healthcare providers. Specific symptom management recommendations were also detailed, identifying pain (32%), poor sleep (24%), fatigue (27%), and poor appetite (27%). Conclusions. This study demonstrates a retrospective review of one institution’s experience with pediatric end-stage-renal disease patients. Themes addressed during consultation are highlighted to assist palliative care providers and nephrologists in assessing and developing tools for intervention in this patient population. Implications for Research, Policy, or Practice. This study demonstrates important themes for practitioners who deal with this population to address.