Enhancing Early Integration of Pediatric Palliative Care: Evaluating a Clinician-Based Versus Criteria-Based Referral Process in Pediatric Oncology.

BACKGROUND/

OBJECTIVES

Early palliative care referral for new oncologic diagnoses has been widely recognized as integral to comprehensive care, but there exists a paucity of research assessing referral patterns in pediatric oncology. The objective of this study is to review the change in referral patterns at the Children's Hospital of Eastern Ontario (CHEO) before and after a set of referral criteria were implemented for routine consultation of pediatric palliative care (PPC) for all newly diagnosed oncology patients.

METHODS

This was a retrospective single-centre chart review of all patients with a new oncologic diagnosis from 21 October 2017 to 1 January 2024 using information available in the patient's electronic medical record. Data was evaluated for referral patterns and the time from diagnosis to referral to PPC comparing the period before and after referral criteria were initiated (1 July 2019).

RESULTS

A total of 504 chart reviews were completed and 226 patients were referred to PPC. The proportion of patients referred to PPC showed a statistically significant increase from 36.8% to 75.4% after introduction of PPC referral criteria (χ2(1) = 44.98, p < 0.001). The time from diagnosis to referral showed a statistically significant decrease from a median of 267 days (IQR 116-551.5) prior to criteria to 11 days (IQR 4-27) post-criteria (Mann-Whitney U test, p < 0.001). Time to referral decreased significantly across all diagnostic subgroups except for CNS tumours.

CONCLUSIONS

Having referral criteria for consultation to PPC increased the proportion of oncology patients referred to PPC and resulted in a significant decrease in time to referral. These findings suggest that structured referral criteria support earlier integration of pediatric palliative care within oncology programmes.