Implementing Pediatric Palliative Care in Vietnam: Initial Experiences and Lessons

Abstract

Context: There remains an enormous unmet need for pediatric palliative care (PPC), especially in low- and middle-income countries (LMICs). Evaluation of existing PPC programs can inform development of emerging programs. In 2017, a PPC program was established at a major children's hospital in Vietnam, a lower-middle-income country where palliative care development is at an early stage.

Objectives: We describe the development and operations of the first PPC program in Vietnam, and evaluate the program's scope and early outcomes.

Methods: We conducted a retrospective cross-sectional study of all patients seen by the PPC inpatient consult service within an 18-month period. Descriptive statistics were used to identify trends in demographics, clinical characteristics, and end-of-life outcomes.

Results: Among 169 children (aged 0 to 15.6 years) who received PPC consultation, the most common diagnoses were cancer, traumatic injury, and congenital syndromes. Patients were referred by 14 different hospital departments. Psychosocial support was the most common PPC intervention (70%), while pain management was provided for 28% of patients. None of the patients with cancer died in the hospital.

Conclusion: By partnering with hospital leadership, creating opportunities for staff education, and adapting to the cultural and geographic setting, the PPC team overcame initial challenges to become a widely utilized, high-volume consult service. The PPC program may have reduced use of chemotherapy and cardiopulmonary resuscitation at end of life. The program's strengths, challenges, and experiences may inform the development of emerging PPC programs in other LMICs.

Keywords: Vietnam; global health; palliative care; palliative care program development; pediatric palliative care.