BACKGROUND: Early integration of pediatric palliative care (PPC) improves symptom control, communication, and goal-concordant decision-making. Despite these benefits, PPC remains underutilized in many Asian healthcare systems, where referrals are often delayed and most children die in intensive care units (ICUs). METHODS: This retrospective cohort study included children aged 0-18 years who died between 2008 and 2017 at two medical centers in southern Taiwan (n = 294). A shared PPC program was implemented in 2011, embedding palliative specialists within primary care teams. Documentation of do-not-resuscitate (DNR) orders, family meetings, PPC consultations, cardiopulmonary resuscitation (CPR), and place of death were compared across pre-implementation, early post-implementation, and late post-implementation phases. RESULTS: Following implementation, DNR documentation increased from 59.2% to 73.9% (p = .03). Documented family meetings rose from 4.1% to 18.2% (p < .001), and PPC consultations increased from 7.1% to 23.9% (p < .001), suggesting potential improvements in interdisciplinary communication and advance care planning. ICU deaths remained high (87.8%-89.8%), and CPR rates declined but did not reach statistical significance (p = .09). Cancer diagnosis (OR = 7.97, 95% CI 2.71-23.42) and increasing age at diagnosis (OR = 1.12 per year, 95% CI 1.06-1.18) were independently associated with PPC consultation. CONCLUSIONS: Integration of a shared PPC model was associated with improvements in advance care planning and interdisciplinary collaboration. Earlier referral triggers, clinician education, and expansion of community-based PPC services may be important to help reduce high-intensity end-of-life care and better align care delivery with family preferences.
Hung et al. (Mon,) studied this question.