Integration of a palliative and terminal care center into a comprehensive pediatric oncology department.
BACKGROUND
The sharp division between curative cancer therapy and palliative care results in the late introduction of palliative care and a high incidence of suffering in children with cancer. We established a Palliative Care Unit (PCU) that is fully integrated with the Pediatric Hematology Oncology Department (PHOD). We wished to explore the impact of such integrative model on patterns of hospitalizations and exposure to palliative care of pediatric oncology patients.


METHODS
Retrospective search of medical records of patients admitted to the PHOD since PCU establishment in 1999, and of children who died from progressive disease between 1990 and 2005 was performed. Differences in clinical and prognostic variables between PCU and non-PCU patients, and differences in location of death before and after PCU establishment were evaluated.


RESULTS
The majority (59%) of patients, who were hospitalized after the PCU establishment, were hospitalized in the PCU, including 49% of the good prognosis patients and 91% of the poor prognosis patients. Poor prognosis patients were hospitalized in the PCU earlier and with higher frequency compared to children with curable disease. After PCU opening there was a significant decline in the percentage of patients who died in the general pediatric ward, hematology-oncology ward, and at home from 40%, 26% and 28% to 4%, 8%, and 16%, respectively.


CONCLUSIONS
Our integrative model results in exposure of the majority of children with cancer to palliative care. For poor prognosis patients, palliative care is introduced early enough to allow gradual transition from symptom control after diagnosis to end of life care.
Golan
Hana
H
Department of Pediatric Hematology-Oncology, Marion and Elie Wiesel Children's Pavilion, Chaim Sheba Medical Center, Tel-Aviv University Sackler School of Medicine, Ramat Gan, Israel. hana.golan@sheba.health.gov.il
Bielorai
Bella
B
Grebler
Dorit
D
Izraeli
Shai
S
Rechavi
Gideon
G
Toren
Amos
A
D000293:Adolescent; D002173:Cancer Care Facilities / Q000458:organization & administration*; D002648:Child; D003657:Decision Making; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data* / Q000639:trends; D006748:Hospital Departments / Q000458:organization & administration; D006760:Hospitalization; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008499:Medical Records; D009369:Neoplasms / Q000451:nursing* / Q000628:therapy; D010166:Palliative Care / Q000592:standards*; D010290:Parents / Q000523:psychology; D010372:Pediatrics; D010820:Physicians / Q000523:psychology; D011379:Prognosis; D011787:Quality of Health Care; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*; D019452:Terminally Ill