Journal of pain and symptom management · 2026
Underuse of Palliative Medications and Services in Children with Life-Limiting Conditions.
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Levine Hagit, Freud Tamar, Ginati Yotam David, Landau Yuval, Schonmann Yochai, Shvartzman Yahav, Shvartzman Pesach, Peleg Roni
Аннотация
CONTEXT: Children with life-limiting conditions experience substantial pain, depression, and anxiety, yet the real-world use of symptom-directed medications and palliative services in this population is largely uncharacterized.
OBJECTIVES: To examine the use, and potential underuse, of antidepressant and other symptom-directed psychotropic medications, psychological services, and dedicated palliative care services (palliative consultation, hospice referral, and pain consultation) among children with life-limiting conditions.
METHODS: Retrospective population-based cohort study using the electronic medical records of Clalit Health Services, Israel's largest health care organization. Children aged 0-18 years with chronic life-limiting or life-threatening conditions diagnosed between 2000 and 2025 were followed until death or end of follow-up. Medication dispensing, psychiatric and psychological consultations, and palliative care services were compared across age groups and regions.
RESULTS: The cohort included 83,419 children, of whom 3,267 died. In the final year of life, only 18.2% of children who died received benzodiazepines and fewer than 3% received selective serotonin reuptake inhibitors (SSRIs). Psychiatric and psychological consultations reached only 1.8% and 0.6%, respectively; 95.7% received no palliative consultation, and hospice referrals and pain consultations were each provided to 0.2%. SSRI, SNRI, and methylphenidate use rose steeply with age (SSRIs: 0.5% of infants vs. 13.1% of adolescents; p<0.001). Benzodiazepine use was higher in the center and north, whereas palliative consultations were more common in the south and center (p<0.001). Among living children, palliative service use was virtually absent.
CONCLUSION: Children with life-limiting conditions in Israel experience profound, systematic underuse of symptom-directed medications, psychological services, and dedicated palliative care across the entire disease trajectory, demanding urgent policy action.
OBJECTIVES: To examine the use, and potential underuse, of antidepressant and other symptom-directed psychotropic medications, psychological services, and dedicated palliative care services (palliative consultation, hospice referral, and pain consultation) among children with life-limiting conditions.
METHODS: Retrospective population-based cohort study using the electronic medical records of Clalit Health Services, Israel's largest health care organization. Children aged 0-18 years with chronic life-limiting or life-threatening conditions diagnosed between 2000 and 2025 were followed until death or end of follow-up. Medication dispensing, psychiatric and psychological consultations, and palliative care services were compared across age groups and regions.
RESULTS: The cohort included 83,419 children, of whom 3,267 died. In the final year of life, only 18.2% of children who died received benzodiazepines and fewer than 3% received selective serotonin reuptake inhibitors (SSRIs). Psychiatric and psychological consultations reached only 1.8% and 0.6%, respectively; 95.7% received no palliative consultation, and hospice referrals and pain consultations were each provided to 0.2%. SSRI, SNRI, and methylphenidate use rose steeply with age (SSRIs: 0.5% of infants vs. 13.1% of adolescents; p<0.001). Benzodiazepine use was higher in the center and north, whereas palliative consultations were more common in the south and center (p<0.001). Among living children, palliative service use was virtually absent.
CONCLUSION: Children with life-limiting conditions in Israel experience profound, systematic underuse of symptom-directed medications, psychological services, and dedicated palliative care across the entire disease trajectory, demanding urgent policy action.