PEDIATRIC PALLIATIVE CARE

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PEDIATRIC PALLIATIVE CARE

• Hanna Lotocka-Reysner
• 26 November 2004

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PALLIATIVE CARE PRIMARY GOALS

• Provide comfort
• Minimize suffering
• Preserve dignity and integrity of the child and
  the family
• Achieve the best quality of life possible that is
  consistent with patients and family values

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• gt 6500 death among Canadians under age of 20
  (2001)

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Where do children with cancer die?

• Factors influencing palliative care and place of
  death among children with cancer in British
  Columbia

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Children with cancer in BC place of death

• Total 145
• Home 41
• Hospital 66
• Hospice 26
• Other 12

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• 1998
• Total 27
• Home 7
• Hospital 14
• Hospice 1
• Other 5

• 1999
• Total 33
• Home 14
• Hospital 13
• Hospice 4
• Other 2

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• 2000
• Total 27
• Home 8
• Hospital 11
• Hospice 6
• Other 2

• 2001
• Total 31
• Home 5
• Hospital 15
• Hospice 9
• Other 2

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• 2002
• Total 27
• Home 7
• Hospital13
• Hospice 6
• Other 1

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Children with cancer place of death - hospital
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• BRAIN TUMOR 38 patients
• Home 32
• Hospital 42
• Hospice 21
• Other 5

• LEUKEMIA 31 patients
• Home 16
• Hospital 61
• Hospice 20
• Other 3

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• NEUROBLASTOMA 13 patients
• Home 23
• Hospital 54
• Hospice 15
• Other 8

• ES 11 patients
• Home 46
• Hospital 18
• Hospice 36

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• OS 9 patients
• Home 56
• Hospital 22
• Hospice 22

• LYMPHOMA 9 patients
• Home 11
• Hospital 45
• Hospice 22
• Other 22

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Are we meeting our patients and their families
wishes when they enter end of life pathway ?
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• Some families and patients wish to remain in
  hospital. In this case discussion and decisions
  should center on creating an environment that
  meets the needs of the family and patient

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• If the family and/or the patient wishes to
  receive end of life care in their own home and
  required care can be mobilized outside of the
  hospital it should be arranged

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GOALS OF MEDICINE
TO HEAL
TO CURE
PERSON
DISEASE
Investigations Diagnosis Treatment
Wholeness Relationships Quality of life
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STEPS IN PROCESS

• Identify eligible patients
• Communicate effectively
• Understand the illness experience
• Establish prognosis
• Establish goals of care
• Establish advanced illness care plan

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• PEACE it does not mean to be in a place where
  there is no noise, trouble, or hard
• work. It means to be in the midst of all those
  things and still be calm in your heart.
• 
  (Anonymous)

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