Predictors of location of death for children receiving palliative care
More than one third of all children with cancer in the US die in an institutional setting
More than one third of all children with cancer in the United States die in an institutional setting
In the United States, cancer is the leading cause of death associated with disease in childhood. More than one third of children diagnosed with cancer will die in a hospital setting and a significant number of those die in intensive care. Previous studies have identified that dying in this high acuity environment, which typically features close monitoring and frequent interventions, is often associated with increased suffering at the end of life and a significantly worse response to bereavement by parents.
To determine if there were patient-specific variables that influenced or predicted place of care and place of death, this American retrospective cohort study examined data from 321 paediatric oncology patients who had died while enrolled onto a palliative care service between 2011 and 2015.
The study reported an increased likelihood of death occurring in the paediatric intensive care unit (PICU) for patients diagnosed with haematological malignancies; were treated with haematopoietic stem cell transplant, had anti-cancer therapies in the last month of life or received a late referral to palliative care services (less than 30 days before the date of death). They found that children were less likely to die in the PICU setting and more likely to die at home or at a hospice where an advance directive was documented.
Kaye E, DeMarsh S, Gushue C et al (2018) Predictors of location of death for children with cancer enrolled on a palliative care service. The Oncologist. 23, 12, 1525-1532.