Study prompts gains in pediatric palliative care
Study prompts gains in pediatric palliative care
Multidisciplinary approach boosts quality of life
Early results from a two-year study on end-of-life care in children with cancer prompted improvement efforts in palliative care at Child ren’s Hospital and Dana-Farber Cancer Institute, both in Boston.
"Based on early results, we developed a palliative care service called PACT, which stands for pediatric advanced care team. It is a multidisciplinary consult service available to children cared for at Dana-Farber and Children’s Hospital," says Joanne Wolfe, MD, an instructor in pediatric oncology at Harvard University and at the Dana-Farber Cancer Institute and Children’s Hospital. Wolfe led research on a two-year study of palliative care for children with cancer; the results were published in the Feb. 3, 2000, issue of The New England Journal of Medicine.
The PACT team, implemented in 1997, is a multidisciplinary group consisting of:
• physicians;
• nurses;
• psychosocial clinicians;
• ethicists;
• chaplains;
• pain team consultants.
"We provide consults, educational efforts, and are developing interventions to improve the quality of life in children with advanced disease," notes Wolfe.
Patients can be referred to PACT at any time. Early involvement with children is encouraged, she says. Providers are asked, "Would you be surprised if the child died in the next year?" If their answer is "no," the child is eligible for PACT.
The team also developed a medication worksheet to guide clinicians on recommending medications that would help patients at home should their conditions change. Generally, the same PACT members follow the patient in both inpatient and outpatient settings.
Having an ethicist on the team proves invaluable, adds Wolfe. "Our ethicist has been critical in developing a comprehensive palliative care plan during [ethics] consults. He has been helpful in educating the PACT about the ethics of end-of-life decision making," she says. Decisions may be needed, for example, regarding withholding fluids and nutrition and determining resuscitation status.
A recent addition to the program is a patient diary, which is still being evaluated in terms of effectiveness. The diary, which the patient shares with PACT members, is designed to improve physician-patient communication around symptoms and quality of life. "For the individual children and families we have served so far, we have seen wonderful improvements in the child’s experience," Wolfe says.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.