Palliative care referral criteria and application in pediatric illness care: A scoping review.

BACKGROUND: Specialty pediatric palliative care services can help to address unmet care needs for children with complex and serious illness. Current guidelines support the identification of unmet palliative care needs; however, it is unknown how these guidelines or other clinical characteristics influence pediatric palliative care referral in research and practice. AIM: To evaluate the identification and application of palliative care referral criteria in pediatric illness care and research. DESIGN: A scoping review with a content analysis approach to summarize results. DATA SOURCES: Five electronic databases (PubMed, CINAHL, PsycINFO, SCOPUS, and Academic Search Premier) were used to identify peer-reviewed literature published in English between January 2010 and September 2021. RESULTS: We included 37 articles focused on the referral of pediatric patients to palliative care teams. The identified categories of referral criteria were: disease-related; symptom-related; treatment communication; psychosocial, emotional, and spiritual support; acute care needs; end-of-life care needs; care management needs; and self-referrals for pediatric palliative care services. We identified two validated instruments to facilitate palliative care referral and seven articles which described population-specific interventions to improve palliative care access. Nineteen articles implemented a retrospective health record review approach that consistently identified palliative care needs with varying rates of service use. CONCLUSIONS: The literature demonstrates inconsistent methods for identifying and referring children and adolescents with unmet palliative care needs. Prospective cohort studies and clinical trials would inform more consistent pediatric palliative care referral practices. More research is needed on palliative care referral and outcomes in community-focused pediatrics.

Adults' Self-Management of Chronic Cancer and Noncancer Pain in People with and Without Cognitive Impairment: A Concept Analysis.

AIM: To report a concept analysis of adult self-management of chronic pain. BACKGROUND: Self-management of chronic pain has received increasing attention in the clinical research literature. Although with only limited conceptual work. Despite the pervasiveness of pain in adults, there has been a lack of conceptual work to elucidate meaning of adult's self-management of chronic pain. DESIGN: Concept Analysis. METHOD: Rodgers (2000) evolutionary approach of concept analysis was used to systematically analyze 44 articles from different databases. Only 12 articles used the concept of chronic pain self-management. Data were extracted using standardized forms and analyzed using thematic analysis. RESULTS: This concept analysis identified six attributes of adult self-management of chronic pain: (1) multimodal interventions; (2) patient-provider relationship; (3) goal setting; (4) decision making; (5) resource utilization; and (6) chronic pain problem solving.

Over-The-Counter Analgesics: A Meta-Synthesis of Pain Self-Management in Adolescents.

BACKGROUND: The consumption prevalence of OTC medication ranges between 57% and 78% among adolescents in the United States of America; however, the reasons for self-medication with OTC analgesics have not been systematically examined. AIMS: The purpose of this meta-synthesis is to generate new knowledge and theoretical understanding of adolescents' use of over-the-counter (OTC) analgesics. DESIGN: Qualitative meta-ethnography using Noblit and Hare's (1988) approach. SETTINGS: PARTICIPANTS/SUBJECTS: METHODS: We identified qualitative studies in the CINAHL, PubMed, PsycINFO, and ProQuest Dissertation and Thesis databases that addressed OTC analgesic use in adolescents, were published between 2006 and 2018, and were written in English. Themes were extracted from studies meeting inclusion/exclusion criteria and a meta-ethnographic analysis was conducted. RESULTS: Seven studies met inclusion/exclusion criteria. Four themes were identified that described reasons for adolescent use of OTC analgesics for pain management: 1) survival instinct; 2) placebo for stress and anxiety control; 3) accessibility; and 4) consumer socialization. CONCLUSIONS: Findings suggest that OTC analgesic use is common among adolescents to treat pain and other non-medically-indicated conditions, such as stress and anxiety.