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Current Pediatric Reviews

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ISSN (Print): 1573-3963
ISSN (Online): 1875-6336

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Clinical Trial

Palliative Home Visit Intervention and Emergency Admission in Pediatric Cancer Children: A Randomized Controlled Trial

Author(s): Murti Andriastuti*, Pricilia Gunawan Halim, Tati Mulyati, Meidiana Bangun and Dwi Putro Widodo

Volume 20, Issue 2, 2024

Published on: 11 November, 2022

Page: [194 - 199] Pages: 6

DOI: 10.2174/1573396318666220928112910

Price: $65

Abstract

Palliative care model can be carried out at home, in the community, or in long-term home care. Home visits in palliative care have an important role in providing continuity of care and psychosocial support to both the patient and their parents/caretakers. This study is aimed to determine the impact of home visit program to the frequency of emergency room (ER) admissions in children with cancer.

Methods: Randomized controlled trial of 60 pediatric patients with malignancies who were given palliative care (a 3-months home visit) and those who were not was conducted. Patients were children with cancer aged 2-18 years old. Emergency room admissions from the last three months were recorded before patients were enrolled. A two-way communication between a trained health worker and patients with or without their parents were conducted as the intervention. Interventions were given in six sessions (1 session every 2 weeks). During study period, ER admissions were recorded further. Data was analyzed using bivariate analysis, OR calculations were performed.

Results: In the intervention group, 11 children (36.7%) had fewer ER admissions, while 4 (13.3%) had more and 15 children (50%) had constant ER admissions, respectively. Meanwhile, only 2 children (7.7%) were found to have fewer ER admissions in the control group. Others in this group have varying results, 11 children (42.3%) were found to have more admissions to the ER and 13 children (50%) had constant ER admissions. In the intervention group, ER admissions were reduced by 10 visits, while in the control group, the admissions were increased by 16 visits (OR 4.77, 95% CI 1.29-17.65; p = 0.018).

Conclusion: Palliative home visit provides care matched to patient and family needs, trained parents to be skillful in managing child, and enabling avoidance of unnecessary hospitalizations (4.7 times).

Keywords: home visit, emergency admission, palliative, pediatric

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[1]
Hui D, Kim YJ, Park JC, et al. Integration of oncology and palliative care: A systematic review. Oncologist 2015; 20(1): 77-83.
[http://dx.doi.org/10.1634/theoncologist.2014-0312] [PMID: 25480826]
[2]
Zhi WI, Smith TJ. Early integration of palliative care into oncology: Evidence, challenges and barriers. Ann Palliat Med 2015; 4(3): 122-31.
[PMID: 26231808]
[3]
Elnadry J. Home-based palliative care reduces hospital readmissions. JPSM 2017; 53: 428-9.
[4]
Kelley AS, Morrison RS. Palliative care for the seriously ill. N Engl J Med 2015; 373(8): 747-55.
[http://dx.doi.org/10.1056/NEJMra1404684] [PMID: 26287850]
[5]
Dhiliwal S, Muckaden M. Impact of specialist home-based palliative care services in a tertiary oncology set up: A prospective non-randomized observational study. Indian J Palliat Care 2015; 21(1): 28-34.
[http://dx.doi.org/10.4103/0973-1075.150170] [PMID: 25709182]
[6]
Murtagh F. Can palliative care teams relieve some of the pressure on acute services? BMJ 2014; 348: g3693.
[http://dx.doi.org/10.1136/bmj.g3693] [PMID: 24906714]
[7]
Maetens A, Beernaert K, De Schreye R, et al. Impact of palliative home care support on the quality and costs of care at the end of life: A population-level matched cohort study. BMJ Open 2019; 9(1): e025180.
[http://dx.doi.org/10.1136/bmjopen-2018-025180] [PMID: 30670524]
[8]
Paz-Ruiz S, Gomez-Batiste X, Espinosa J, Porta-Sales J, Esperalba J. The costs and savings of a regional public palliative care program: The Catalan experience at 18 years. J Pain Symptom Manage 2009; 38(1): 87-96.
[http://dx.doi.org/10.1016/j.jpainsymman.2009.04.011] [PMID: 19615632]
[9]
Stjernswärd J, Foley KM, Ferris FD. The public health strategy for palliative care. J Pain Symptom Manage 2007; 33(5): 486-93.
[http://dx.doi.org/10.1016/j.jpainsymman.2007.02.016] [PMID: 17482035]
[10]
Rabow M, Kvale E, Barbour L, et al. Moving upstream: A review of the evidence of the impact of outpatient palliative care. J Palliat Med 2013; 16(12): 1540-9.
[http://dx.doi.org/10.1089/jpm.2013.0153] [PMID: 24225013]
[11]
Riolfi M, Buja A, Zanardo C, Marangon CF, Manno P, Baldo V. Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: A retrospective cohort study. Palliat Med 2014; 28(5): 403-11.
[http://dx.doi.org/10.1177/0269216313517283] [PMID: 24367058]
[12]
Cohen J, Deliens L. A public health perspective on end of life care. New York: Oxford University Press 2012.
[http://dx.doi.org/10.1093/acprof:oso/9780199599400.001.0001]
[13]
Chong PH, De Castro Molina JA, Teo K, Tan WS. Paediatric palliative care improves patient outcomes and reduces healthcare costs: Evaluation of a home-based program. BMC Palliat Care 2018; 17(1): 11.
[http://dx.doi.org/10.1186/s12904-017-0267-z] [PMID: 29298714]
[14]
Shepperd S, Gonçalves-Bradley DC, Straus SE, et al. Hospital at home: Home-based end-of-life care. In: Cochrane Database of Systematic Reviews S5. John Wiley & Sons, Ltd 2016.
[http://dx.doi.org/10.1002/14651858.CD009231.pub2]
[15]
Shin SH, Hui D, Chisholm GB, et al. Characteristics and outcomes of patients admitted to the acute palliative care unit from the emergency center. J Pain Symptom Manage 2014; 47(6): 1028-34.
[http://dx.doi.org/10.1016/j.jpainsymman.2013.07.015] [PMID: 24246788]
[16]
Ahn S, Lee YS, Lim KS, Lee JL. Emergency department cancer unit and management of oncologic emergencies: Experience in Asan Medical Center. Support Care Cancer 2012; 20(9): 2205-10.
[http://dx.doi.org/10.1007/s00520-012-1478-8] [PMID: 22555446]
[17]
Basol N. The Integration of palliative care into the emergency department. Turk J Emerg Med 2015; 15(2): 100-7.
[http://dx.doi.org/10.5505/1304.7361.2015.65983] [PMID: 27336074]
[18]
Allo JA, Cuello D, Zhang Y, Reddy SK, Azhar A, Bruera E. Patient home visits: Measuring outcomes of a community model for palliative care education. J Palliat Med 2016; 19(3): 271-8.
[http://dx.doi.org/10.1089/jpm.2015.0275] [PMID: 26652056]
[19]
El Osta B, Bruera E. Models of palliative care delivery. In: Bruera E, Higginson I, von Gunten C, Morita T, Eds. Textbook of Palliative Medicine and Supportive Care. Boca Raton, FL: CRC Press 2015; pp. 275-86.
[20]
Cheng BT, Rost M, De Clercq E, Arnold L, Elger BS, Wangmo T. Palliative care initiation in pediatric oncology patients: A systematic review. Cancer Med 2019; 8(1): 3-12.
[http://dx.doi.org/10.1002/cam4.1907] [PMID: 30525302]

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