Peer-reviewed article
Early Palliative Care Is Feasible and Acceptable in Pediatric Neuro-Oncology.
Daniels GM, Tefera R, Martinez I, Buckingham SI, Metrock LK et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested whether palliative care can be provided early to children newly diagnosed with high-risk brain tumors. Researchers referred 18 children with serious CNS tumors to palliative care at diagnosis or relapse, aiming to see them within 2 weeks. All children received palliative care, with most seen within 11 days, and families and clinicians reported benefits in symptom management and support. The main barrier was clinician anxiety about introducing palliative care early, despite families welcoming it.
Key points
- All 18 eligible children with high-risk CNS tumors received early palliative care, with median 11 days from diagnosis to first consultation
- Parents and clinicians reported benefits in symptom management, decision-making support, and family support while preserving hope
- Clinicians felt they benefited from partnering in complex care and learning palliative care skills
- Despite positive outcomes, clinician anxiety about introducing early palliative care remained a significant barrier
- Median of 8 palliative care visits were provided per child over the study period
Limitations
This is a small single-center study (18 children) with predominantly non-Hispanic White participants, limiting generalizability to other populations and settings. The study does not include clinical outcome measures (survival, quality of life, symptom control) that would demonstrate the clinical impact of early palliative care.
Abstract
Background Children with central nervous system (CNS) tumors face high morbidity and mortality, yet often do not receive palliative care (PC). There is evidence of the benefit of PC in pediatric oncology, though the ideal timing remains unknown. We aimed to evaluate the feasibility and acceptability of early PC for children with high-risk CNS tumors. Procedures Children at Children's of Alabama with CNS tumors (2019-2022) with high mortality risk (e.g., glioblastoma) were referred to PC at the time of diagnosis/relapse, facilitated by PC and research assistants attending neuro-oncology clinical team meetings. PC aimed to see children within 2 weeks of index event (IE), then as clinically indicated. For feasibility, we assessed time from IE to PC consult and total PC visits. For acceptability, we conducted semi-structured interviews with parents and clinicians about perceptions of early PC. Results Eighteen children (nine female, 14 non-Hispanic White) were eligible. Median IE age was 6 years (interquartile range [IQR] = 2-11 years). All children saw PC; median of 11 days (IQR = 4-20 days) after their IE, with a median of eight (IQR = 4-20) PC visits. Fourteen parents (11 female, nine non-Hispanic White) and nine clinicians (five physicians, four nurse practitioners) were interviewed. Parents and clinicians reported benefits in symptom management, decisional and family support, and preservation of hope. Clinicians benefited from partnering in complex care and learning PC skills. Notably, caregivers appreciated PC involvement, yet clinicians were anxious about introducing PC. Conclusions This study demonstrates the feasibility and acceptability of early PC in pediatric neuro-oncology; however, clinician, but not family, discomfort with early PC remains a barrier.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Early palliative care referral at time of diagnosis or relapse, with goal of initial consultation within 2 weeks, facilitated by palliative care and research assistants attending neuro-oncology team meetings
- Population
- 18 children aged 2-11 years with high-risk CNS tumors (e.g., glioblastoma) at a single children's hospital (2019-2022)
Key finding
Median 11 days from diagnosis/relapse to palliative care consult (IQR 4-20 days), meeting feasibility goal of 2 weeks