The Scope of Clinical Practice of Inpatient and Outpatient Pediatric Palliative Care Within Pediatric Oncology.
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BACKGROUND: While pediatric palliative care (PPC) is associated with improved end-of-life (EOL) outcomes for children with cancer, the content of PPC visits leading to these outcomes is not well-understood. This study aims to compare the scope of PPC practice during inpatient and outpatient visits for children with cancer and their families. PROCEDURE: This was a retrospective cohort study of patients 0-27 years with cancer seen by inpatient and/or outpatient PPC within an academic pediatric oncology center between 2017 and 2022. During each PPC visit, documenting clinicians selected the topics, or subdomains, addressed within each domain (Goals of Care, Symptom Management, and Care Coordination). Data were abstracted from the electronic health record, PPC clinic database, and cancer registry. Differences in the frequency of subdomains were analyzed by demographics, location of PPC service, visit type, diagnosis group, proximity to EOL, and billing time. RESULTS: Across 467 PPC recipients, there were 7548 PPC visits. Compared to inpatient visits, outpatient encounters encompassed more subdomains (median of 10 vs. 8, p < 0.001) and were 19 min longer on average. Outpatient visits more commonly addressed goals of care and chronic symptoms (e.g., fatigue, appetite), whereas the use of technology, pain, and common EOL symptoms (e.g., dyspnea, agitation, confusion/delirium) were managed more often in the inpatient setting. CONCLUSIONS: The scope of PPC practice is wide-ranging and distinct between the inpatient and outpatient settings. Many time-intensive topics were addressed more frequently in outpatient visits, while inpatient visits focused on areas related to acute hospitalization. KEY MESSAGE: This retrospective study outlines the distinct content of PPC visits within pediatric oncology across inpatient and outpatient settings. Outpatient visits more commonly addressed goals of care and chronic symptoms, whereas inpatient visits more often addressed the use of technology, pain, and common EOL symptoms.