Pediatric Oncology Palliative Care in Atlantic Canada: A Needs Assessment

Background and Objectives: Pediatric palliative care (PPC) is an important part of pediatric oncology care.It improves symptom management, quality of life, and end-of-life care.Despite recommendations for early integration, there are still barriers to providing consistent and equitable PPC, especially in vast rural regions such as Atlantic Canada.This study surveyed regional healthcare workers to better understand the needs, barriers, and opportunities for improving PPC delivery for children with cancer, and to provide practical recommendations to support better integration and access to PPC in those Provinces.Methods: This study used an inductive qualitative approach and a multi-methods design.Healthcare providers affiliated with the Atlantic Provinces Pediatric Hematology Oncology Network (APPHON) were invited to complete a survey exploring their experiences with PPC delivery, including gaps and suggested improvements.Survey responses were analyzed using thematic analysis.Follow-up focus groups with volunteer participants were then conducted to further explore key themes, and this data was also analyzed thematically.Results: Key themes were identified, including role confusion across teams, inconsistent communication and information sharing between provinces, and gaps in education and training.Participants also described challenges with resources and infrastructure, particularly in more rural and underserved areas, as well as unmet psychosocial and mental health needs for patients and families.There was also a clear need for better feedback processes and opportunities for team debriefing.Discussion: Overall, findings highlight variability and fragmentation in PPC delivery across Atlantic Canada.Conclusions: Addressing these gaps will require standardized care pathways, improved communication systems, and stronger collaboration between tertiary and community teams.Enhancing early integration of PPC and expanding education opportunities may help reduce disparities and improve outcomes for children and families.