title: Differences in end-of-life communication for children with advanced cancer who were referred to a palliative care team.
abstract: BACKGROUND
  There is a general consensus that involving a specialized palliative care team in the care of children with advanced cancer can help optimize end-of-life communication; however, how this compares to standard oncology care is still unknown. We aimed to determine whether there was an association between specialist palliative care involvement and improved end-of-life communication for children with advanced cancer and their families.
  
  
  METHODS
  We administered questionnaires to 75 bereaved parents (response rate 54%). Outcome measures were presence or absence of 11 elements related to end-of-life communication.
  
  
  RESULTS
  Parents were significantly more likely to receive five communication elements if their child was referred to a palliative care team. These elements are: discussion of death and dying with parents by the healthcare team (P<0.01); discussion of death and dying with child by the healthcare team when appropriate (P < 0.01); providing parents with guidance on how to talk to their child about death and dying when appropriate (P < 0.01); preparing parents for medical aspects surrounding death (P = 0.02) and sibling support (P = 0.02). Children were less likely to be referred to a palliative care team if they had a hematologic malignancy.
  
  
  CONCLUSIONS
  Children who receive standard oncology care are at higher risk of not receiving critical communication elements at end of life. Strategies to optimize end-of-life communication for children who are not referred to a palliative care team are needed.
authors.affiliation: Department of Pediatrics, Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Canada.
authors.forename: Alisha
authors.initials: A
authors.lastname: Kassam
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Skiadaresis
authors.affiliation: Department of Pediatrics, Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Alexander
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.|Center for Outcomes and Policy Research Dana-Farber Cancer Institute, Boston, Massachusetts.|Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
mesh_terms: D001293:Attitude to Death; D002648:Child; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000401:mortality* / Q000451:nursing*; D010166:Palliative Care / Q000379:methods*; D010290:Parents / Q000523:psychology*; D010348:Patient Care Team; D012944:Social Support; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*
keywords: end of life; pediatric oncology; supportive care