9 out of 10 patients who received specialized pediatric palliative care established a preliminary medical plan
Jul 15, 2024
After introducing specialized pediatric palliative care services in hospitals, more severe pediatric and adolescent patients began discussing prior medical plans earlier, a study found. Patients who received this service are expected to be able to contribute to the patient's dignified life through pediatric palliative care, as unnecessary treatment at the end of their lives is reduced and they focus on alleviating pain.
A joint research team led by Professor Kim Min-sun and Integrated Care Center Professor Lee Jung of the Department of Pediatrics and Adolescents at Seoul National University Children's Hospital and Professor Kim Cho-hee of the Department of Nursing at Kangwon National University announced on the 15th the results of a study that analyzed the effectiveness of 'specialized pediatric palliative care" to help relieve the pain of patients and their families at the end of their lives by promoting the establishment of a preliminary medical plan.
Pediatric and adolescent palliative care (hereinafter referred to as pediatric palliative care) is a medical service that provides integrated support to improve the quality of life of children and adolescents with life-threatening diseases and their families. As of 2024, 12 hospitals nationwide, including Seoul National University Children's Hospital, operate a specialized palliative care team composed of various experts such as doctors, nurses, and social workers, and provide advisory pediatric palliative care services.
The main role of specialized pediatric palliative care services is to promote communication between medical staff and patients and families and promote 'Advanced care planning'. Establishing a pre-medical plan refers to the entire process of discussing care goals and intentions to receive medical treatment together with medical staff from the present time to the deterioration of the disease in the future. This is important in that it can alleviate unnecessary pain in end-of-life patients and provide the family with time to prepare for their death.
However, in Korea, there have been no studies yet analyzing the effects of pediatric palliative care on the establishment of prior medical plans.
The research team classified 205 patients under the age of 24 who died at Seoul National University Children's Hospital from 2017 to 2019 according to their use of specialized pediatric palliative care, and compared and analyzed the timing of discussion of prior medical plans and the use of medical care at the end of life (cardiopulmonary resuscitation, ventilator application, etc.).
As a result, the proportions of discussing prior medical plans in the pediatric palliative care group and the non-use group were 94.3% and 64.6%, respectively. In particular, the time when half of the user and non-use groups began discussing was 16 days before the death and the day of the death, respectively. In other words, it was found that the pediatric palliative care group discussed the preliminary medical plan more actively from an earlier time.
In addition, the pediatric palliative care group showed a decrease in aggressive medical use (cardiopulmonary resuscitation, ventilator application, etc.) in the month before death compared to the non-use group, and an increase in the use of painkillers to relieve pain.
The research team explained that specialized pediatric palliative care is playing a role in revitalizing discussions on prior medical plans to focus on alleviating the pain of patients at the end of their lives, and furthermore, to end their lives with dignity.
In addition, compared to before the introduction of specialized pediatric palliative care (2011-2013), discussions on pre-medical plans after the introduction (2017-2019) were confirmed to have become more active. The proportion of patients who died before and after the introduction of pediatric palliative care discussed prior medical plans was 71.5% and 82.4%, respectively.
On the other hand, as a result of statistical analysis, it was found that the discussion of the pre-medical plan began relatively late because it was difficult to predict the prognosis for patients younger than 1 year old. Therefore, the research team explains that it is necessary to develop a specialized process to increase access to specialized pediatric palliative care for infant patients under the age of 1 and their families.
Professor Lee Jung said "This study is significant in that it comprehensively analyzes data on severe pediatric and adolescent patients in Korea, not limited to specific diseases or age groups, and examines the impact of pediatric palliative care services on pre-medical planning."
Professor Kim Min-sun said, "Discussing the establishment of a pre-medical plan with death in mind is a difficult task for pediatric and adolescent patients and their families to suffer considerably. We hope that the professional palliative care team will facilitate discussions on the pre-medical plan and expand pediatric palliative care to make more active decisions centered on the values of pediatric and adolescent patients and their families."
The results of this study were recently published in the international journal 『BMC Palliative Care』.
A joint research team led by Professor Kim Min-sun and Integrated Care Center Professor Lee Jung of the Department of Pediatrics and Adolescents at Seoul National University Children's Hospital and Professor Kim Cho-hee of the Department of Nursing at Kangwon National University announced on the 15th the results of a study that analyzed the effectiveness of 'specialized pediatric palliative care" to help relieve the pain of patients and their families at the end of their lives by promoting the establishment of a preliminary medical plan.
Pediatric and adolescent palliative care (hereinafter referred to as pediatric palliative care) is a medical service that provides integrated support to improve the quality of life of children and adolescents with life-threatening diseases and their families. As of 2024, 12 hospitals nationwide, including Seoul National University Children's Hospital, operate a specialized palliative care team composed of various experts such as doctors, nurses, and social workers, and provide advisory pediatric palliative care services.
The main role of specialized pediatric palliative care services is to promote communication between medical staff and patients and families and promote 'Advanced care planning'. Establishing a pre-medical plan refers to the entire process of discussing care goals and intentions to receive medical treatment together with medical staff from the present time to the deterioration of the disease in the future. This is important in that it can alleviate unnecessary pain in end-of-life patients and provide the family with time to prepare for their death.
However, in Korea, there have been no studies yet analyzing the effects of pediatric palliative care on the establishment of prior medical plans.
The research team classified 205 patients under the age of 24 who died at Seoul National University Children's Hospital from 2017 to 2019 according to their use of specialized pediatric palliative care, and compared and analyzed the timing of discussion of prior medical plans and the use of medical care at the end of life (cardiopulmonary resuscitation, ventilator application, etc.).
As a result, the proportions of discussing prior medical plans in the pediatric palliative care group and the non-use group were 94.3% and 64.6%, respectively. In particular, the time when half of the user and non-use groups began discussing was 16 days before the death and the day of the death, respectively. In other words, it was found that the pediatric palliative care group discussed the preliminary medical plan more actively from an earlier time.
In addition, the pediatric palliative care group showed a decrease in aggressive medical use (cardiopulmonary resuscitation, ventilator application, etc.) in the month before death compared to the non-use group, and an increase in the use of painkillers to relieve pain.
The research team explained that specialized pediatric palliative care is playing a role in revitalizing discussions on prior medical plans to focus on alleviating the pain of patients at the end of their lives, and furthermore, to end their lives with dignity.
In addition, compared to before the introduction of specialized pediatric palliative care (2011-2013), discussions on pre-medical plans after the introduction (2017-2019) were confirmed to have become more active. The proportion of patients who died before and after the introduction of pediatric palliative care discussed prior medical plans was 71.5% and 82.4%, respectively.
On the other hand, as a result of statistical analysis, it was found that the discussion of the pre-medical plan began relatively late because it was difficult to predict the prognosis for patients younger than 1 year old. Therefore, the research team explains that it is necessary to develop a specialized process to increase access to specialized pediatric palliative care for infant patients under the age of 1 and their families.
Professor Lee Jung said "This study is significant in that it comprehensively analyzes data on severe pediatric and adolescent patients in Korea, not limited to specific diseases or age groups, and examines the impact of pediatric palliative care services on pre-medical planning."
Professor Kim Min-sun said, "Discussing the establishment of a pre-medical plan with death in mind is a difficult task for pediatric and adolescent patients and their families to suffer considerably. We hope that the professional palliative care team will facilitate discussions on the pre-medical plan and expand pediatric palliative care to make more active decisions centered on the values of pediatric and adolescent patients and their families."
The results of this study were recently published in the international journal 『BMC Palliative Care』.
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