O3209: Symptom Improvement in Children with Serious Illness Who Received Hospital-based Pediatric Palliative Care Services: A Multicenter Analysis

Background: Children hospitalized with serious illness commonly experience multiple distressing symptoms. One of the primary goals of inpatient pediatric palliative care (PPC) services is to prevent and alleviate complex symptoms in patients. Little is known about symptom distress outcomes following inpatient PPC referral.

Methods: Pediatric palliative care teams from 5 hospitals participating in the Pediatric Palliative Care Quality Network collected patient-level data between 2016–2020. Symptom distress scores were reported using a 4-point ordinal scale: 0=none; 1=mild; 2=moderate; and 3=severe for 9 symptoms: pain, anxiety, nausea/vomiting, dyspnea, fatigue, irritability, feeding issues, stooling problems, and voiding issues. Change in symptom distress was assessed from first assessment (T1) to second (T2) and T1 to last assessment (T3). Descriptive statistics were calculated for sample characteristics and symptom score distributions. Wilcoxon signed rank tests were calculated for change in symptom scores.

Results: Of the 1,746 encounters for children with a median age of 6.0 years (interquartile range [IQR] 1-14), 972 (56%) were male and 502/1,671 (30%) had a primary referral diagnosis of solid tumor cancer. Patients received a referral to PPC within 2 days (IQR 1-8, range 0-303) after hospital admission. Median time between T1 and T2 was 1 day (range 1-78), and between T1 and T3 was 7 days (range 0-574). The median number of symptom assessments per PPC visit was 2.0 (IQR 1-5). At T1, clinicians assessed a mean of 3.0 symptoms (SD=1.7, range 1-8). All symptom scores improved by T2 (p <.001) or T3 (p <.001) except for voiding issues (p=0.27, p=0.16, respectively). For the 4 most-distressing symptoms (i.e., largest percentage of moderate to severe scores at T1), improvements were seen in paired comparisons for feeding issues (T1 40% [187/462]; T2 33% [154/462] ;T3 23% [68/297]), fatigue (T1 35% [121/345]; T2 30% [105/345]; T3 18% [35/199]), dyspnea (T1 32% [170/539]; T2 21% [111/539]; T3 17% [58/340]); and pain (T1 25% [149/593]; T2 17% [98/593]; T3 7% 28/381).

Conclusion: Patients referred to PPC experience multiple symptoms and improvement was seen for most symptoms between initial PPC assessment, second assessment, and last assessment. Routine standardized symptom assessment is useful in identifying many sources of distress in children hospitalized with serious illness who receive PPC consultation. Future studies could allow PPC programs to compare outcomes and identify best practices.