Pediatric Palliative Care Involvement in Specific Populations

With the goal of improving quality of life through shared decision-making, pain and symptom management, and delineation of goals of care, pediatric palliative care (PPC) is both warranted and beneficial in a variety of clinical settings. However, there are nuances in the operations of the PPC team based on the patient populations with whom they work. As prenatal diagnoses of life-limiting fetal conditions advance, PPC can be utilized in a perinatal setting to prepare a birth plan addressing the goals of care for the neonate and their family. PPC is recognized as necessary among children with congenital heart disease due to risks of early mortality, uncertain disease trajectories, and long-term comorbidities often requiring medical and surgical management. PPC needs in pediatric oncology are unique as medical advancements may allow children to live with—rather than be cured of—cancer. In pediatric neurology, PPC is beneficial in addressing uncertain prognoses, limited life expectancies, and high symptom burden. Children and youth with special health care needs (CYSHCN) are being increasingly recognized as a subpopulation with unique care considerations. Many children in this group benefit greatly from having PPC involved in their care team. Another group recognized as unique in medicine, and in palliative care specifically, is the adolescent and young adult (AYA) population. When these patients face serious illness, their experience is distinct from other pediatric patients and from adult patients. PPC teams take the particular needs of each of these populations and the individuals within them seriously as they work for patient- and family-centered care.