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. 2020 Feb;59(2):339-364.e10.
doi: 10.1016/j.jpainsymman.2019.08.005. Epub 2019 Aug 9.

Impact of Specialized Pediatric Palliative Care: A Systematic Review

Katherine L Marcus  1 , Gisella Santos  2 , Agustín Ciapponi  3 , Daniel Comandé  3 , Madeline Bilodeau  4 , Joanne Wolfe  5 , Veronica Dussel  6
Affiliations

Impact of Specialized Pediatric Palliative Care: A Systematic Review

Katherine L Marcus et al. J Pain Symptom Manage. 2020 Feb.

Abstract

Context: Specialized pediatric palliative care (SPPC) is increasingly involved in the care of seriously ill children, yet the evidence on its impact has not been comprehensively reviewed.

Objective: The objective of this study was to assess the effects of providing SPPC to seriously ill children on patient-, caregiver-, and systems-level outcomes.

Methods: We performed a Systematic Review following Cochrane methods.

Data sources: Medline, Embase, PsycINFO, Global Health, The Cochrane Central Register of Controlled Trials, LILACS, and Web of Science were searched from January 1996 to June 2018.

Study selection/data extraction: We included randomized controlled, cohort, case-control, and before-after studies in which exposure to SPPC services was the intervention of interest. All outcomes reported in these studies were included. Two investigators independently selected articles, extracted data, and assessed risk of bias of included studies using standardized criteria.

Results: Twenty-four studies were included in qualitative synthesis: one nonrandomized controlled trial, 16 cohort studies, and seven before-after studies. Evidence certainty was low. Twenty-one studies had one or more area with high risk of bias, most commonly selection bias, low group comparability, risk for confounding, and inadequate statistical reporting. Studies analyzed 46 domains, operationalized as 136 distinct outcomes. SPPC was associated with better child quality of life scores in all four studies that assessed this outcome. No other outcome showed this consistency.

Conclusion: Receiving SPPC was associated with better child quality of life. However, the paucity and low certainty of the evidence precluded any firm recommendations about SPPC practice. Larger collaborative networks and greater consensus regarding SPPC research standards are needed.

Keywords: Palliative care; end of life; outcome assessment; patient-reported outcomes; pediatrics; systematic review.

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Conflict of interest statement

Authors’ Disclosures of Potential Conflicts of Interest:

All authors have completed and submitted the Disclosure of Potential Conflict of Interests forms. KM, GS, DC, and AC indicated no potential conflicts of interest, whereas JW and VD indicated potential academic conflict of interest as they are authors of four and one of the included articles respectively. Of note, they did not participate in data extraction of papers where authorship involved potential conflict.

Figures

Figure 1:
Figure 1:. Flow Diagram of Study Selection Process
Figure 2:
Figure 2:. Risk of Bias Graphs of the 24 Included Studies
A. Risk of bias summary by study; B. Risk of bias summary by assessed item. Abbreviations: EOL - end of life; HC - healthcare; Pt - patient; QOL - quality of life
See this image and copyright information in PMC

References

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