Exploring the End-of-Life Care of Pediatric Oncology Patients in a Medical Center - 2010~2012 Chart review
Date Issued
2015
Date
2015
Author(s)
Wang, Ya-Lan
Abstract
Background and Purposes: Childhood cancer is one of leading causes of death in children and adolescents. Cancer children received aggressive treatments near the end of life. This study aimed to explore the end-of-life care and the use of palliative care among cancer children in Taiwan, and to explore the correlation between the characteristics of cancer children, the use of palliative care and the end-of-life care. Methods: A retrospective chart review was conducted. All subjects were diagnosed of cancer under 18, and died between January 2010 to December 2012 in a medical center in Taipei. The total valid sample size was 67. Measurement: The data were collected by a self-developed structured form, which included: (1) patient and family characteristics, (2) oncology summary, (3) information of last hospitalization, (4) aggressiveness of cancer care near the end of life, (5) medical use in the last 24 hours of life, (6) CPR status, (7) DNR status, and (8) the use of palliative care. The data were analyzed by the Software SPSS 18.0. Results: In 67 study subjects, 56.7% were male, 16.4% were single child, 56.7% were diagnosed of leukemia/lymphoma. The average age of diagnosis was 8.50±5.23, and the average age of death was 11.75±5.70. Cancer children experienced long-term hospitalization and aggressive treatments near the end of life. 91% were hospitalized more than 14 days in the last 30 days of life. 43.3% were admitted to ICU in the last 30 days of life, and 34.3% were died in ICU. 16.4% received new chemotherapy in the last 30 days of life, and 34.3% received chemotherapy within 14 days before death. 35.8% received inotropic agents in the last 24 hours of life, and 13.4% received cardiac pulmonary resuscitation within 3 days before death. Although the use of palliative care is increasing, the referral timing was still late. In all subjects, 56.7% received hospice consultation before death, and 40.3% received hospice shared care. The average days of first hospice consultation to death was 50.61±54.83 days (median: 36.5 days), and 21% received first hospice consultation within 7 days before death. DNR permits completed 27.85±56.8 days prior to death (median:4.5 days), and 18.3% completed at the same day of death. Patients who were diagnosed of leukemia/lymphoma and died at the age above 12, are more likely to receive aggressive treatments near the end-of-life than other subjects. They were more likely to die in ICU (p<0.05), and were more likely to use ventilators, antibiotics and inotropic agents within the last 24hours of life. Relationship exists between the usage of palliative care and the end-of-life care of cancer children. Patients who had received hospice shared care were less likely to die in the ICU (p<0.01), and had a lower rate of the use of ventilator and inotropic agents within the last 24 hours of life (p<0.01). The DNR orders were completed earlier in the patients received hospice shared care (p<0.01). Conclusions and Nursing Applications: Relationship exists between the usage of palliative care and the end-of-life care of cancer children. Clinical health providers should consult hospice/palliative care team and conduct palliative discussion with patients and family at a proper time, to improve the end-of-life care for cancer children.
Subjects
cancer children
pediatric oncology
childhood cancer
end-of-life care
palliative care
hospice shared care
SDGs
Type
thesis
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