Differences in Inpatient Palliative Care Consultation During the Terminal Admission for Pediatric Neuro-Oncology Patients

Abstract

Pediatric neuro-oncology patients have one of the highest mortality rates among all children with cancer. Our study examines the potential relationship between palliative care consultation and intensity of in-hospital care and determines if racial and ethnic differences are associated with palliative care consultations during their terminal admission. Retrospective observational study using the Pediatric Health Information System (PHIS) database with data from U.S. children’s hospitals. PHIS was queried for patients under 18 years of age who received a diagnosis of brain tumor and had their terminal admission between January 1, 2017 and December 31, 2021. Of the 567 patients who fit the inclusion criteria, 359 (63%) patients had an inpatient palliative care consultation during their terminal hospital stay. There were no statistically significant differences seen when comparing palliative care consultation rates among racial groups. When comparing the ethnicity variables, patients in the Hispanic group had approximately a 10% higher rate of palliative care consultations than their non-Hispanic counterpart. Patients with palliative care consultations had a lower percentage of PICU admission (64.9 vs 83.2), mechanical ventilation (51.0 vs 76.0), and TPN use (18.1 vs 25.5) despite having similar lengths of stay. Pediatric neuro-oncology patients who received a palliative care consultation during their terminal hospital stay had lower intensity care (lower rates PICU admission, mechanical ventilation use, and TPN use) despite having similar lengths of stay. This may reflect the enhanced decision-making support for the patients and their families so that they may consider all options. Children facing a terminal illness and their families deserve access to optimal supportive services. This study highlights the importance of integrating palliative care in hospital admissions of terminally ill children with neuro-oncological diagnoses.