Paeds Vivas · pain-palliative-and-end-of-life-care
Paediatric palliative care principles and referral — branching viva
Branching viva on the principles and referral of paediatric palliative care: the WHO definition and parallel-care model, the four Together for Short Lives (ACT) categories with worked examples, the Paediatric Palliative Screening Scale (PaPaS), the relationship between the palliative referral and the resuscitation decision, the under-recognised suffering of group 4 children, and bereavement follow-through.
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Opening question
This 6-year-old with relapsed high-risk neuroblastoma has just been diagnosed, and the oncology team plans further intensive treatment. Tell me why you would refer him to the palliative care team today, what the WHO definition of paediatric palliative care is, and why referring only at end of life is the most common error in this field. [1] [5]
References7ShowHide
- [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.PMID 10655532
- [2]Wolfe J, Hammel JF, Edwards KE, et al Easing of suffering in children with cancer at the end of life: is care changing? J Clin Oncol, 2008.PMID 18375901
- [4]Section on Hospice and Palliative Medicine and Committee on Hospital Care Pediatric Palliative Care and Hospice Care Commitments, Guidelines, and Recommendations. Pediatrics, 2013.PMID 28448256
- [5]Himelstein BP Palliative care for infants, children, adolescents, and their families. J Palliat Med, 2006.PMID 16430356
- [8]Bergstraesser E, Paul M, Rufibach K, et al. The Paediatric Palliative Screening Scale: Further validity testing. Palliat Med, 2014.PMID 24280277
- [10]Shaw KL, Brook L, Mpundu-Kaambwa C, et al. The Spectrum of Children's Palliative Care Needs: a classification framework for children with life-limiting or life-threatening conditions. BMJ Support Palliat Care, 2015.PMID 24644200
- [11]Bluebond-Langner M, Beecham E, Candy B, et al Preferred place of death for children and young people with life-limiting and life-threatening conditions: a systematic review of the literature and recommendations for future inquiry and policy. Palliat Med, 2013.PMID 23612958