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Home-Based Specialized Pediatric Palliative Care: A Systematic Review and Meta-Analysis

  • Nanna Maria Hammer
    Affiliations
    Copenhagen Palliative Team for Children and Adolescents, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Pernille Envold Bidstrup
    Affiliations
    Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark

    Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
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  • Jesper Brok
    Affiliations
    Department of Paediatric Oncology and Haematology, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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  • Minna Devantier
    Affiliations
    Copenhagen Palliative Team for Children and Adolescents, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Per Sjøgren
    Affiliations
    Section of Palliative Medicine, Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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  • Kjeld Schmiegelow
    Affiliations
    Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Anders Larsen
    Affiliations
    The University Hospitals’ Centre for Health Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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  • Geana Paula Kurita
    Affiliations
    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Section of Palliative Medicine, Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Multidisciplinary Pain Centre, Department of Anaesthesiology, Pain and Respiratory Support, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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  • Author Footnotes
    # Shared last authorship
    Marianne Olsen
    Correspondence
    Corresponding author: Marianne Olsen, Reberbansgade 15, 9000 Aalborg, Denmark
    Footnotes
    # Shared last authorship
    Affiliations
    Copenhagen Palliative Team for Children and Adolescents, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Department of Pediatrics and Adolescent Medicine, Section of Pediatric Hematology and Oncology, Aalborg University Hospital, Aalborg, Denmark
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  • Author Footnotes
    # Shared last authorship
    Hanne Bækgaard Larsen
    Footnotes
    # Shared last authorship
    Affiliations
    Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
    Search for articles by this author
  • Author Footnotes
    # Shared last authorship

      ABSTRACT

      Context

      Although specialized pediatric palliative care (SPPC) teams increasingly provide home-based care, the evidence of its impact has not yet been systematically evaluated.

      Objectives

      To examine the impact of home-based SPPC in children and adolescents with life-limiting conditions, regarding place of death, quality of life and symptom burden.

      Methods

      We searched Medline, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus for studies comparing children and adolescents with life-limiting conditions receiving home-based SPPC with children and adolescents not receiving home-based SPPC, or studies reporting before-and-after measurements. We included studies that reported on place of death, quality of life and/or symptoms. Two authors independently screened the articles, extracted data, and assessed quality. Results were synthesized as a systematic narrative synthesis and meta-analysis, using a random-effects model.

      Results

      We included five studies, which reported on 392 children and adolescents. Meta-analysis showed that receiving home-based SPPC was associated with a more than fourfold increased likelihood of home death (risk ratio 4.64, 95% confidence interval 3.06-7.04; 3 studies; n=296). Most studies reported improved quality of life and reduced symptom burden. The included studies were of low to moderate quality with a high risk of bias.

      Conclusion

      This systematic review suggests that home-based SPPC is associated with increased likelihood of home death, and might be associated with improved quality of life and reduced symptom burden. The small number of studies and an overall high risk of bias, however, makes the overall strength of evidence low.

      Keywords

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