Implementation of a Pediatric Palliative Care Team for Pediatric Oncology Patients: An Evidence-Based Practice Improvement Project

ABSTRACT

BACKGROUND: Advancements in childhood cancer have increased from 10% to 85% in the past four decades. Nonetheless, these improvements have increased the morbidity and negative effects on healthcare associated quality-of-life, including days spent in the hospital.

LOCAL PROBLEM: The project site did not have a pediatric palliative care team addressing the healthcare associated quality-of-life during cancer treatment. The provision of this service is a priority for the project site and is supported by the psychosocial standards of care for children with cancer and their families, The World Health Organization, American Academy of Pediatrics, and The National Academy of Medicine.

METHODS: This project was guided by the Evidence Based Practice Improvement model. The purpose of the proposed project is to reduce the burden of treatment related effects on pediatric cancer patients and their families by implementing a pediatric palliative care team. The specific aim of the project is to decrease unexpected hospital days by 30% within 3 months of implementation.

INTERVENTIONS: Integration of a pediatric palliative care team composed of a physician and a registered nurse in partnership with the chaplain and social work services was implemented as a concurrent service in the outpatient pediatric oncology clinic. For initial implementation, this service was provided to children diagnosed with Acute Lymphocytic Leukemia.

RESULTS: The implementation of pediatric palliative care for children newly diagnosed with Acute Lymphocytic Leukemia (ALL) reduced unexpected hospital days by 55.24% and unplanned hospital admissions decreased by 26.7%.

CONCLUSIONS: The implementation of a concurrent pediatric palliative care team resulted in a significant reduction in the mean unexpected hospital days, improving the quality of life of children and their families while saving hospital resources. Dissemination of this project's findings, development of an expanded business plan, and extending the program to children with other cancers will promote sustainability of this successful practice change.