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A paediatric palliative care programme in development: trends in referral and location of death
  1. C M Vadeboncoeur1,2,
  2. W M Splinter1,3,
  3. M Rattray1,
  4. D L Johnston4,
  5. L Coulombe1,2
  1. 1Pediatric Palliative Care Outreach Team, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
  2. 2Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
  3. 3Department of Anesthesiology, University of Ottawa, Ottawa, Ontario, Canada
  4. 4Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Christina M Vadeboncoeur, Pediatric Palliative Care Outreach Team, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L2, Canada; vadeboncoeur{at}cheo.on.ca

Abstract

Purpose To describe the formation of a paediatric palliative care programme providing care in hospital, at home or in hospice, ensuring continuity of care where the child and family desire.

Study design Descriptive analysis was performed on referral source, diagnosis and reason for discharge for patients referred to the Palliative Care Team at the Children's Hospital of Eastern Ontario in Ottawa, Ontario, Canada from 1999 to 2007.

Results 341 children were referred. 24% had a neurological condition, 21% had genetic disorders or congenital anomalies, 20% had cancer, 18% had metabolic or neurodegenerative conditions and 17% had another diagnosis. The major sources of referral included paediatricians, neonatologists, oncologists and intensivists. 55% of the children have died. 58% of these died in hospital, 27% at home and 15% in hospice. Of the remaining 152 children, 7% were discharged from the programme after clinical improvement, 4% were moved to another geographic location or an adult centre, 2% were not eligible, 1% declined services and 4% were lost to follow-up. The remaining 90 children continue to be followed-up. In the hospitalised patients who died, the annual referral rate increased from 20% to >50%.

Implications Referral to the palliative care team has increased over time in all diagnostic categories and from all sources. Most children died in hospital; however, a significant number of families chose end-of-life care at home or in a hospice.

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was given by the CHEO Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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