The Use of Patient-controlled Analgesia for Children Requiring Symptom Management at End of Life: A Scoping Review.

BACKGROUND

Pain is the most common and distressing symptom for children at the end of life, with management challenges causing significant distress for patients and caregivers. Patient-controlled analgesia allows self-administration of preset medication doses for breakthrough pain and has shown benefits in postoperative and chronic pain management. However, its use and effectiveness in pediatric palliative care remain unclear.

OBJECTIVES

To review and synthesize the evidence pertaining to patient-controlled analgesia use for children at the end of life.

REVIEW

METHODS

A scoping review used the Arksey and O'Malley Framework to identify: (1) utilization of patient-controlled analgesia, including patient groups, advantages, and proxy use; (2) implications, safety, side effects, and impact on pain; and (3) child and parental perspectives.

RESULTS

The key finding is a lack of a clearly defined, standardized patient-controlled analgesia policy for use in children at the end of life. Much of the reviewed evidence was organization-dependent, and most related to use for children with a malignant diagnosis.

CONCLUSIONS

Further research is required involving patient-controlled analgesia use with children with a nonmalignant diagnosis, including the perspectives of children and parents. Nurses are integral team members and well-positioned to be developers of policies related to patient-controlled analgesia use in children at the end of life. This is a call to action for nurse clinicians, leaders, researchers, and educators to collaborate to identify and implement an evidence-based, effective policy.