Development of a Pediatric Palliative Care Roadmap Based on Quality Metrics and Psychosocial Standards of Care

Outcomes 1. Understand currently described pediatric palliative care quality metrics within the context of pediatric oncology psychosocial standards of care.2. Apply pediatric palliative care quality metrics and psychosocial standards of care to their own end of life team processes to facilitate equity and improved communication through the development of their own palliative care roadmaps specific to their local institution. Key Message Focused on pediatric oncology psychosocial standards of care for palliative care, bereavement, and interdisciplinary communication, our team sought to ensure adherence with quality care metrics through the development of a palliative care “roadmap”. Through chart review we identified areas of growth, developed a targeted intervention (roadmap), and continue to modify and evaluate improvement over time. Introduction Focused on pediatric oncology psychosocial standards of care for palliative care, bereavement, and interdisciplinary communication, our pediatric palliative oncology team sought to standardize and ensure adherence with quality care metrics across the continuum of care delivery. Methods Our literature review identified fifteen quality measures to evaluate our current practice. We performed a retrospective chart review focused on end of life (EoL) for all patients who died from progressive disease. By evaluating our current practice gaps compared to quality metrics, we created a multidisciplinary group to draft a “Pediatric Oncology Palliative Care Roadmap” (PCR). The PCR is a physical document that travels in tandem with the patient's treatment roadmap. We chose the term “roadmap” to align ourselves with the oncology team members who reflexively look at treatment roadmaps. The PCR was then distributed to key stakeholders to include inpatient, outpatient, and home-based multidisciplinary teams for feedback. A second draft is currently being trialed in a pilot group of eight patients. Iterative feedback in both informal and formal focus groups are in progress. A more extended chart review to include three additional years is ongoing. Results Preliminary results are based on our first year of chart review, 2022. Twelve patients died due to progressive disease. From this group, we quantified each quality measures. 6(50%) reached EoL in preferred location, 10(83%) were not intubated within last 14 days, 9(75%) referred to hospice, 7(58%) legacy documented, 7(58%) DNR, 11(92%) disclosed nearing EoL, 5(42%) spiritual beliefs documented, 4(33%) EoL date documented, 3(25%) home visit documented, 8(67%) wish documented, and 1(8%) documented tumor donation.10(83%) had at least 5 quality measures documented. Conclusion Based on published metrics and standards we identified areas of growth for our program, developed a customized intervention, and continue to evaluate our improvement over time through the implementation of our PCR. Keywords Interdisciplinary Teamwork / Professionalism; Communication