Pediatric Palliative Research Articles

“More life and more days”—patient and care characteristics in a specialized acute pediatric palliative care inpatient unit

Only a few acute hospital inpatient units dedicated to pediatric palliative care (PPC) patients exist today. Clinical data on the patients and care provided at specialized acute PPC inpatient units (PPCUs) are scarce. This study aims at describing patient and care characteristics on our PPCU to learn about the complexity and relevance of inpatient PPC. A retrospective chart analysis was performed on the 8-bed PPCU of the Center for Pediatric Palliative Care of the Munich University Hospital, including demographic, clinical, and treatment characteristics (487 consecutive cases; 201 individual patients; 2016–2020). Data were analyzed descriptively; the chi-square test was used for comparisons. Patients’ age (1–35.5 years, median: 4.8 years) and length of stay (1–186 days, median 11 days) varied widely. Thirty-eight percent of patients were admitted repeatedly (range 2–20 times). Most patients suffered from neurological diseases (38%) or congenital abnormalities (34%); oncological diseases were rare (7%). Patients’ predominant acute symptoms were dyspnea (61%), pain (54%), and gastrointestinal symptoms (46%). Twenty percent of patients suffered from > 6 acute symptoms, 30% had respiratory support incl. invasive ventilation, 71% had a feeding tube, and 40% had full resuscitation code. In 78% of cases, patients were discharged home; 11% died on the unit.Conclusion: This study shows the heterogeneity, high symptom burden, and medical complexity of the patients on the PPCU. The high dependency on life-sustaining medical technology points to the parallelism of life-prolonging and palliative treatments that is typical for PPC. Specialized PPCUs need to offer care at the intermediate care level in order to respond to the needs of patients and families.What is Known:• Pediatric patients in outpatient PPC or hospices present with a variety of clinical syndromes and different levels of complexity and care intensity.• There are many children with life-limiting conditions (LLC) in hospitals, but specialized PPC hospital units for these patients are rare and poorly described.What is New:• Patients on a specialized PPC hospital unit show a high symptom burden and a high level of medical complexity, including dependency on medical technology and frequent full resuscitation code.• The PPC unit is mainly a place for pain and symptom management as well as crisis intervention, and needs to be able to offer treatment at the intermediate care level.

Nursing Practice and Care Structure for Children and Their Families in Need of Pediatric Palliative and End-of-Life Care in Japan: A Nationwide Survey.

Many nurses experience difficulties in pediatric palliative care practice. The study aimed to describe the current situation and structure of pediatric palliative and end-of-life care nursing practices for children and their families in Japan. The research subjects were nurses working in hospitals; facilities for persons with severe physical, motor, and intellectual disabilities; and home-visit nursing stations. The practice ratio was calculated using a 79-item survey form, and factor analysis was conducted. A total of 113 facilities (acceptance rate: 26.5%) and 777 nurses (response rate: 44.6%) responded. Five items had a "Practicing" ratio of ≥90%. In factor analysis, 7 domains were identified: "preparing to face the time of death with the child and family," "ensuring child-centered care," "managing symptoms with the child and family," "considering and coordinating for the child's peaceful time of death," "understanding and respecting the culture of the child and family," "assessing the child and family as a whole person," and "performing self-reflection on an ethical issue." Nurses' practice of pediatric palliative care differs by practice domain. It is necessary to reflect on the educational programs under development to improve the quality of life of children and their families.

Pediatric Home-Based Hospice and Palliative Medicine Provider Home Visits: A Multisite Study.

Background: Pediatric home-based palliative care and/or hospice provider (Physician, Advanced Practice Nurse, or Physician Assistant) home visits are an underexplored subject in the literature with little available descriptive data and limited evidence guiding how best to utilize them. Objectives: Describe the population receiving hospice and palliative medicine (HPM) provider home visits and characterize visit themes. Design: Retrospective chart review of electronic medical record (EMR) data Setting/Subjects: A total of 226 individuals 1 month to 21 years of age, who received an HPM provider home visit from January 1, 2013, to December 31, 2018; two large quaternary medical centers in the Midwest. Measurements: Demographic data, content, and details from home visit abstracted from the EMR. Results: The three most common diagnostic groups receiving HPM provider home visits were neurological (42%), congenital chromosomal (26%), and prematurity-related (14%) conditions. Goals of care (GOC) were discussed at 29% of visits; most commonly, goals related to code status (42%), technology dependence (20%), and nutrition/hydration (15%). A change in GOC occurred in 44% of visits. Forms of anticipatory guidance addressed were nutrition (68%), side effects of treatment (63%), pain assessment (59%), decline/death (32%), and allow natural death/do not resuscitate/advance directives (26%). Conclusion: HPM provider visits are diverse in content and changes in plan of care with potential for proactive identification of GOC and provision of important anticipatory guidance around patient decline and end of life. Further research is indicated to establish which populations benefit most and how to leverage this scarce resource strategically.

Listening to the Residents: The Perception of Pediatric Palliative Care Education in a Residency Program in Brazil.

Background: In Brazil, a relevant portion and children suffer without receiving adequate control of their symptoms. Failures in pediatrician training may contribute to this problem. Objective: The goal was to characterize the educational failures perceived by pediatric residents for pediatric palliative care throughout their training. Methods: A cross-sectional study was carried out, with the application of the Pediatric Palliative Care Questionnaire (QCPP) to residents of three pediatrics and specialties of public limits at the Escola de Saúde Pública do Estado do Ceará (ESP-CE), Brazil. Results: The response rate was 68 out of 123 residents (55%). It was reported that they did not consider the specialty as patient care or death. He also feels comfortable explaining the physiological process of dying to his family. The time devoted to CPP teaching, as well as medical residency, was considered reduced. For those who attended a subspecialty, the number they signaled was "0hours" at 82.40%. Conclusion: It can be said that the main flaws in the teaching-learning process of pediatric residents were the number of hours of training in teaching, communication skills training (through participation in conferences) and guidance on the practice of teaching suspension of invasive measures. It was observed that less time reserved for this learning is related to lesser knowledge and greater barriers to the use of palliative care. Those who declared themselves able to take care of children with life-organizing conditions received some teaching in CPP.

Pediatric Oncology, Palliative Care and Low- or Middle- Income Countries: A Call for Action.

Pediatric oncology, which includes cancer screening and therapy in children, poses significant challenges in low- and middle-income countries (LMICs). Palliative care improves children's and their families' quality of life. In LMICs, palliative care resources are scarce, resulting in poor symptom management, psychological support, and spiritual care. All relevant English-language articles on pediatric palliative oncology were searched in PubMed, Google Scholar, Scopus, and Medline databases using the following keywords: "Pediatric Oncology," "Pediatric Palliative Oncology," "Pediatric Palliative Care," "Palliative Care," "Child Cancer," and "Lower- and Middle-Income Countries." This study highlights the significance of incorporating palliative care early in therapy and the recommendations may improve the competence of information provided by medical professionals to patients and families. LMICs have the potential to improve overall treatment and outcomes for child cancer patients and their families by prioritizing the integration of palliative care, guaranteeing a compassionate and dignified attitude toward the disease.

Physicians' Knowledge, Attitudes, and Perception Toward Pediatric Palliative Care in Saudi Arabia: A National Exploratory Survey.

Pediatric palliative care (PPC) helps maintain the quality of life for both children and their families. It has been identified as an important goal within the global health agenda. In Saudi Arabia, the discipline remains in its infancy, as illustrated by the absence of PPC programs in academic and health care institutions. The aim was to conduct a pilot study assessing physicians' knowledge, attitudes, and perceptions toward PPC. Data were gathered through a self-administered questionnaire sent to physicians working in Saudi Arabia. One hundred twelve completed the survey (male 54.2%, n = 50). A total of 40.8% (n = 42) had 20 years or more of experience, 42.9% (n = 48) were from the hematology-oncology specialty, and 68.5% (n = 74) received no training in PPC. Half suggested that children should be informed of their condition but mostly when reaching 12 or 15 years of age. Various physicians reported that the most appropriate time to discuss a transition to palliative care goals is when diagnosing an incurable condition or when despite all efforts, a condition continues to progress and death is expected. Multiple gaps were identified. PPC basic concepts should be included in the formal medical curriculum (e.g., pain management, communication, and ethical considerations at the end of life). There is also a significant need to develop further both primary and specialized palliative care.

Education and Mentoring of Specialist Pediatric Palliative Care Medical and Nursing Trainees: The Quality of Care Collaborative Australia.

The Quality of Care Collaborative Australia (QuoCCA) builds capability in the generalist and specialist paediatric palliative care (PPC) workforce throughout Australia. It supports regional and community services to provide care close to families' homes, as well as building expertise in tertiary centers. Medical Fellows and Nurse Practitioner candidates (specialist trainees) were funded by QuoCCA at four tertiary hospitals throughout Australia supported by an education and mentoring framework. This study explored the activity and experiences of clinicians who had occupied these roles to evaluate their effectiveness to build PPC capability. Online surveys recorded the monthly activity of Medical Fellows, with a point in time check of knowledge, skills and confidence in 2019. Discovery Interview methodology was used to collect detailed experiences of 11 trainees employed between 2018 to 2022 in Queensland. A combination of mentoring and formal and informal education, peer support and practical experience was valuable for trainees. They found the support of the whole interdisciplinary team advantageous to learning. Shadowing experienced team members gave them the opportunity to learn practical skills, especially regarding communication with families. Practicing clinical skills was beneficial, through being on call, attending home visits, supporting families, prescribing medications and developing treatment plans in collaboration with the team.The trainee experience was optimised through learning from families, personal reflection, involvement in research projects and delivering QuoCCA education. The QuoCCA trainee roles for Medical Fellows and Nurse Practitioner candidates exhibit a valuable and effective education and mentorship framework that could be applied to other specialties. The service leadership and collaborative interdisciplinary team support various modes of education and mentoring. The roles not only develop the trainees' specialised PPC clinical skills, they also improve their general clinical practice, including communication, empathy and holistic care. A structured curriculum of education is recommended to protect these positive outcomes.

One Voice Is Good, But More Is Better: Symptom and Toxicity Reporting in Pediatric Oncology.

One Voice Is Good, But More Is Better: Symptom and Toxicity Reporting in Pediatric Oncology.

Dr. David Lysecki

Pediatric palliative care is often an overlooked field of medicine. As terminally ill children make up a small proportion of patients in Canada, a less robust network of resources is available to deliver end-of-life care for these patients. To gain a better insight into this field, we sat down with Dr. David Lysecki, a pediatric palliative care physician at McMaster Children’s Hospital. He is also the founder and head of the Quality of Life & Advanced Care program at McMaster Children’s Hospital and the Division of Pediatric Palliative Medicine in the McMaster University Department of Pediatrics.

Why the Individual Provider Approach to Pediatric Palliative Care Consultation Exacerbates Healthcare Disparities: A Moral Argument for Standard Referral Criteria

Pediatric palliative care is specialized medical care for children who live with serious and life-limiting illnesses, with the central goal to improve quality of life for both children and their families. Presently, a majority of pediatric palliative care referrals are based on the traditional consultative model, in which primary providers serve as the gatekeepers to palliative care access. It is well-known that racial and ethnic healthcare disparities exist across the continuum of care, fraught with healthcare providers' biases that impact the care delivered. This includes the referral practices, allocation and utilization of palliative care services, and leaving vulnerable children and families with potentially unmet palliative care needs. We make the moral argument that the establishment of standard referral criteria for pediatric palliative care services is one simple step that must be taken to begin to address and hopefully ameliorate the impact of providers' biases and disparities that exist within pediatric palliative care.

Specialised Paediatric PAlliativE CaRe: Assessing family, healthcare professionals and health system outcomes in a multi-site context of various care settings: SPhAERA study protocol

BackgroundThe number of children and adolescents living with life-limiting conditions and potentially in need for specialised paediatric palliative care (SPPC) is rising. Ideally, a specialised multiprofessional team responds to the complex healthcare needs of children and their families. The questions of, how SPPC is beneficial, for whom, and under what circumstances, remain largely unanswered in the current literature. This study’s overall target is to evaluate the effectiveness of a SPPC programme in Switzerland with respect to its potential to improve patient-, family-, health professional-, and healthcare-related outcomes.MethodsThis comparative effectiveness study applies a quasi-experimental design exploring the effectiveness of SPPC as a complex intervention at one treatment site in comparison with routine care provided in a generalised PPC environment at three comparison sites. As the key goal of palliative care, quality of life - assessed at the level of the patient-, the family- and the healthcare professional - will be the main outcome of this comparative effectiveness research. Other clinical, service, and economic outcomes will include patient symptom severity and distress, parental grief processes, healthcare resource utilisation and costs, direct and indirect health-related expenditure, place of death, and introduction of SPPC. Data will be mainly collected through questionnaire surveys and chart analysis.DiscussionThe need for SPPC has been demonstrated through numerous epidemiological and observational studies. However, in a healthcare environment focused on curative treatment and struggling with limited resources, the lack of evidence contributes to a lack of acceptance and financing of SPPC which is a major barrier against its sustainability. This study will contribute to current knowledge by reporting individual and child level outcomes at the family level and by collecting detailed contextual information on healthcare provision. We hope that the results of this study can help guiding the expansion and sustainability of SPPC and improve the quality of care for children with life-limiting conditions and their families internationally.Trial registrationRegistered prospectively on ClinicalTrials.gov on January 22, 2020. NCT04236180Protocol versionAmendment 2, March 01, 2021.

Cultivating Gratitude in Bereaved Families: Understanding the Impact of the Bereavement Workshop on the Families of Deceased Patients in the Pediatric Palliative Care Program

Background Grief in parents has been described as a very intense long-lasting experience, characterized by deep sadness, and social isolation, therefore, the recommendation of scientific societies in pediatrics is to provide bereavement care to parents and relatives of deceased children who have previously been cared for by health professionals. Objetive A bereavement workshop for parents is proposed as an intervention strategy, providing accompaniment to the families of deceased patients who received pediatric palliative care (PPC). Methods This is a descriptive, qualitative, and exploratory study. Two focal group sessions were performed in 2019 with 23 families who were formal caregivers of pediatric patients in the Programa de Cuidando de ti (Program “Taking Care of You”), Cali, Colombia. These sessions, guided by the pediatric palliative care group. Data were analyzed using content analysis. Results 60 families received the personalized letter of condolences with invitation to the workshop, 23 families attended the workshop. From the gratitude activity, families made 49 thank you cards, the following categories were highlighted: Communication, Hope, compassion, acceptance, humanization, learning, gratitude, active listening, coping strategies, regards, faith and humanization. Conclusion Strategies that favor adequate emotional management of the grieving process should be promoted. This study reflects the perceptions of parents attending a bereavement workshop. It highlights the gratitude, feelings and reflections of the family members during the health process and the death of the child while receiving accompaniment by a pediatric palliative care team.

Empowering Pediatric Palliative Homecare Patients and Caregivers with Symptom Management Plans.

Pediatric palliative home-based care has been shown to improve symptoms, quality of life, and coordination of care. Despite these successes, hospital utilization in our own palliative home-based care population remained high as some caregivers lacked confidence to manage symptoms at home and had difficulty in recalling or accessing "sick care plans." Our team developed the Symptom Management Plan (SMP), a multi-system "sick care plan," as a quality improvement project with the aim of improving caregiver confidence to manage symptoms at home. An Electronic Health Record-based SMP template was created for common symptoms: respiratory distress, seizures, feeding intolerance, and constipation with core subspecialists' input. Individualized SMPs were created and reviewed with caregivers at every subsequent palliative home nursing visit. Caregivers were surveyed on their confidence 3 and 6-months post-implementation. Resource utilization was analyzed throughout implementation. At 6 months, 73% of caregivers reported "better" or "much better" confidence in managing their child's symptoms after using the SMP, and 76% of caregivers perceived the SMP prevented urgent care or emergency department (ED) visits. After the SMP was launched, the rate of ED visits decreased from 0.86 to 0.47 per 100 patient-days, and admissions decreased from 0.56 to 0.39 per 100 patient-days. These rates further decreased to 0.31 ED visits and 0.19 admissions per 100 patient-days within 4 and 6 months. Introducing the SMP for our home-based palliative care patients was associated with improved caregiver confidence in managing acute symptoms at home and a reduction in hospital utilization.

The Have and Have Nots: Characteristics of Hospitals With a Pediatric Palliative Care Program.

Pediatric palliative care (PPC) is a board-certified subspecialty1 that provides expert medical management to patients with serious illness. PPC improves pain and nonpain symptoms,2,3 optimizes communication and goal concordant care,4,5 and improves patients’ quality of life.6 Still, PPC programs are neither ubiquitous nor uniformly staffed throughout the United States.In this issue of Pediatrics, Weaver et al7 highlights characteristics of hospitals with a pediatric palliative care program. Past studies have investigated PPC program prevalence, team composition, and services offered; however, these studies have relied on self-reporting.8,9 This study is novel because it used The Children’s Hospital Association Annual Benchmark Report to examine PPC program prevalence and the characteristics of hospitals supporting these programs. As such, we now understand that an unacceptable 20% of pediatric hospitals lack a PPC program.This finding could be perceived as the study’s primary takeaway. Yet, its real impact is its elucidation of differences between hospitals that do and do not support a PPC program. Weaver et al grouped characteristics into operational, missional, educational, and financial categories to give the results structure. They found that larger hospitals with higher acuity are more likely to have PPC programs. Hospitals with pediatric-friendly home hospices and/or respite care in their community are more likely to have a PPC program. Results also highlight that hospitals with Joint Commission accreditation or Magnet Nursing Designation, Accreditation Council for Graduate Medical Education training programs, or an Accountable Care Organization are statistically more likely to have a PPC program.This constellation of hospital characteristics suggests that they and their communities have the financial health to optimize all aspects of pediatric health care. Hospital size, visit volumes, patient acuity, and possessing an Accountable Care Organization are all drivers of financial health. Additionally, these hospitals can and do support the costly endeavor of staffing, training, and maintaining Magnet Nursing Designation, Joint Commission accreditation, and Accreditation Council for Graduate Medical Education training programs. They also support a PPC program, which typically cannot cover its operational costs, let alone generate revenue because of how reimbursement structures currently exist. PPC program existence and growth require operational and philanthropic financial support.Hospital financial health may also be a substantial factor why 20% of pediatric hospitals do not have a PPC program. PPC has now been a valuable subspecialty for decades. It is not novel nor is it limited only to end-of-life care and thus of limited utility. These traditional reasons for the lack of a PPC program are no longer relevant. Rather, this study provides data supporting the belief that finances now determine the presence and likely growth of a PPC program within a hospital.This study’s true “pearl” is the unveiling of this disparity. Moreover, without national metrics or other incentives, hospitals lack the motivation and likely will not have or grow PPC programs unless new motivations or mandates emerge. This study is a call to action for all pediatricians to join PPC providers who have long advocated for change. We need state and national PPC payment models to ensure all hospitals can afford programming. We also need national requirements on the presence and staffing requirements of PPC within hospitals to give health systems a reason to accept the costs of supporting a PPC program. Only then will the thousands of children in need of PPC have access to it.10

Pediatric Hospice and Palliative Care Services and Needs Across the Northwest United States.

Given workforce and funding constraints, pediatric hospice and palliative care clinicians often find challenges providing services for seriously ill children and families, particularly in low resource and rural/remote areas. To describe the services, training, and education needs of pediatric hospice and palliative care programs across the Northwest United States as part of the formation of a new regional coalition. Electronic surveys were sent to pediatric hospice and palliative care clinicians through state organizations as part of an email invitation to join the Northwest Pediatric Palliative Care Coalition. Data were analyzed descriptively using univariate analysis. Sixty-four participants representing 37 unique programs responded from seven states, including Washington (41%, n=27), Oregon (38%, n=25), Idaho (11%, n=7), Alaska (5%, n=3), Montana (3%, n=2), Colorado (2%, n=1), and Nevada (2%, n=1). Programs provided pediatric hospice care (42%, n=33/78) and palliative care services (30%, n=26/86). Although 26% (n=15/58) had been providing pediatric hospice and palliative care for >20 years, 40% (n=21/53) reported only serving <5 pediatric patients per year. Specific services provided included pediatric bereavement support (16%, n=37/231), telehealth (14%, n=33/231), and respite (10%, n=23/231). Barriers occurring always, often, or sometimes included lack of trained staff (84%), financial support (59%), and access to home infusions (48%). From the coalition, participants prioritized education on parent/caregiver psychosocial support (40%, n=19/48), goals of care communication (44%, n=21/48), and symptom management (45%, n=21/47). Pediatric hospice and palliative care clinicians face numerous barriers and may benefit from a coalition that provides networking and tailored education.

Preparing a Pediatric Palliative Care Program for Sustainable Support: A Practice Reflection.

Pituch, Kenneth J.; Simon, Natalia; Weaver, Meaghann S.; Lindley, Lisa C. Author Information

Child's Understanding of Cancer when Faced with Advancing Disease: A Retrospective Chart Review

Abstract Introduction It is difficult to comprehend a child's understanding of disease-related information as they might be unwilling to talk or feel inhibited about raising their concerns. Understanding children's perception is important to facilitate better communication in palliative care. Objectives To study child's understanding of advancing disease when referred to the Pediatric Palliative Care Services. Materials and Methods A retrospective chart review of 34 case record forms from March 2019 to March 2020 was conducted after obtaining a waiver of consent and Institutional Ethics Committee approval. The inclusion criteria were children having advanced cancer referred for palliative care, incomplete records were excluded. Data were analyzed using thematic analysis. Results Twenty-three were male, and 11 were female children, the mean age was 12 years. Five major themes were identified—the child's understanding of disease diagnosis and prognosis, nature of communication between parents and the child, barriers to communication, child's means of support, and interventions used during counseling. Conclusion Communication between children suffering from advanced cancer and their parents/caregivers is a sensitive issue, and noncommunication is often due to mutual effort to shield each other from the stress of difficult conversations. Lack of communication contributes to poor coping and forces children to seek comfort in other sources leaving parents distressed. Psychological interventions like resource building and psychoeducation are effective.

Nurses' Perceived Needs and Barriers Regarding Pediatric Palliative Care: A Mixed-Methods Study.

This study aimed to describe nurses' perceived needs and barriers to pediatric palliative care (PPC). Mixed methods with an embedded design were applied. An online survey was conducted for nurses who participated in the End-of-Life Nursing Education Consortium- Pediatric Palliative Care (ELNEC-PPC) train-the-trainer program, of whom 63 responded. Quantitative data were collected with a survey questionnaire developed through the Delphi method. The 47 items for needs and 15 items for barriers to PPC were analyzed with descriptive statistics. Qualitative data were collected through open- ended questions and analyzed with topic modeling techniques. The mean scores of most subdomains of the PPC needs were 3.5 or higher out of 4, and those of PPC barriers ranged from 3.22 to 3.56, indicating the items in the questionnaire developed in this study properly reflect each factor. The needs for PPC were divided into 4 categories "children and adolescents," "families," "PPC management system," and "community-based PPC." Meanwhile, PPC barriers were divided into 3 categories "healthcare delivery system," "healthcare provider," and "client." The keywords derived from the topic modeling were perception, palliative, children, and education for necessities and lack, perception, medical care, professional care providers, service, and system for barriers to PPC. In this study, by using mixed-methods, items of nurses' perceived needs and barriers to PPC were identified, categorized, and weighted, and their meanings were explored. For the stable establishment of PPC, the priority should be given to improving perceptions of PPC, establishing an appropriate system, and training professional care providers.

Impact of an Evidence-Based Pediatric Palliative Care Program on Nurses' Self-Efficacy.

Background The purpose of this study was to determine the effect of a 1-day evidence-based pediatric palliative care continuing professional development program on nurses' and advanced practice registered nurses' perceived self-efficacy regarding palliative care. Method The revised Pediatric Palliative Care Questionnaire was administered to participants before and after a 7½-hour program. A multimodal approach was used to teach topics specific to pediatric palliative care. Results Thirty-one participants completed questionnaires. Notably, most of the participants had provided palliative or end-of-life care, but few had previous education specific to pediatrics. The self-efficacy scores of the participants significantly increased after program attendance (Z = 3.53, p < .001). Conclusion Continuing professional development in pediatric palliative care improves nurses' and advanced practice registered nurses' confidence in their skills to provide this care. Findings of this study support the need for pediatric-specific education in nursing training programs and continuing professional development offerings. Continuing education may be the key to improving access to high-quality care for children living with serious illness and their families. [J Contin Educ Nurs. 2022;53(6):264-272.].

Inpatient Pediatric Palliative Care Consult Requests and Recommendations.

Little is known about the requests for and recommendations from inpatient pediatric palliative care (PPC) consults and whether they differ by patient location (ward vs. intensive care unit) or patient type (new vs. established with PPC). Single-center, retrospective cohort study comparing PPC consult requests and recommendations for children who received a PPC consult between January 1, 2018 and June 30, 2019. Comparisons were made by patient location and patient type using bivariate statistics. Three hundred twenty-seven PPC encounters were evaluated. Symptoms were more likely to be addressed in consults for ward patients than for intensive care unit patients. Compared with established patients, consults for new patients occurred significantly later in the hospital course and were more likely to be for psychosocial support or goals of care. We found variability in PPC consult requests and recommendations that may inform future work and targeted education for primary providers.