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. 2021 Feb;68(2):e28804.
doi: 10.1002/pbc.28804. Epub 2020 Nov 19.

A quality improvement project to increase palliative care team involvement in pediatric oncology patients

Sana Farooki  1 , Oluwaseun Olaiya  1 , Lisa Tarbell  1 , Nicholas A Clark  2 , Jennifer S Linebarger  3 , John Stroh  3 , Kelstan Ellis  3 , Karen Lewing  1
Affiliations

A quality improvement project to increase palliative care team involvement in pediatric oncology patients

Sana Farooki et al. Pediatr Blood Cancer. 2021 Feb.

Abstract

Background: Pediatric palliative care (PPC) for oncology patients improves quality of life and the likelihood of goal-concordant care. However, barriers to involvement exist.

Objectives: We aimed to increase days between PPC consult and death for patients with refractory cancer from a baseline median of 13.5 days to ≥30 days between March 2019 and March 2020.

Methods: Outcome measure was days from PPC consult to death; process measure was days from diagnosis to PPC consult. The project team surveyed oncologists to identify barriers. Plan-do-study-act cycles included establishing target diagnoses, offering education, standardizing documentation, and sending reminders.

Results: The 24-month baseline period included 30 patients who died and 25 newly diagnosed patients. The yearlong intervention period included six patients who died and 16 newly diagnosed patients. Interventions improved outcome and process measures. Targeted patients receiving PPC ≥30 days prior to death increased from 43% to 100%; median days from consult to death increased from 13.5 to 159.5. Targeted patients receiving PPC within 30 days of diagnosis increased from 28% to 63%; median days from diagnosis to consult decreased from 221.5 to 14. Of those without PPC consult ≤ 30 days after diagnosis, 17% had template documentation of the rationale.

Conclusion: Interventions utilized met the global aim, outcome, and process measures. Use of QI methodology empowered providers to involve PPC. Poor template use was a barrier to identifying further drivers. Future directions for this project relate to expanding the target list, creating long-term sustainability, formalizing standards, and surveying patients and families.

Keywords: oncology; palliative care; pediatric palliative care; refractory cancer.

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References

REFERENCES

    1. Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). Bethesda, MD: National Institutes of Health, National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program; based on November 2011 SEER data submission, posted to the SEER web site April 2012, updated August 20, 2012.
    1. Wolfe J, Grier HE, Klar N, et al. Symptoms and suffering at the end of life in children with cancer. N Engl J Med. 2000;342(5):326-333.
    1. Hechler T, Blankenburg M, Friedrichsdorf SJ, et al. Parents' perspective on symptoms, quality of life, characteristics of death and end-of-life decisions for children dying from cancer. Klin Padiatr. 2008;220(3):166-174.
    1. Contro N, Larson J, Scofield S, Sourkes B, Cohen H. Family perspectives on the quality of pediatric palliative care. Arch Pediatr Adolesc Med. 2002;156(1):14-19.
    1. von Lutzau P, Otto M, Hechler T, Metzing S, Wolfe J, Zernikow B. Children dying from cancer: parents' perspectives on symptoms, quality of life, characteristics of death, and end-of-life decisions. J Palliat Care. 2012;28(4):274-281.

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