Perceptions of specialty palliative care and its role in pediatric stem cell transplant: A multidisciplinary qualitative study.

BACKGROUND: Consultation of specialty palliative care remains uncommon in pediatric stem cell transplant (SCT) despite growing evidence that early integration of palliative care improves outcomes in patients with advanced cancers or undergoing SCT. Little is known about how multidisciplinary pediatric SCT teams perceive palliative care and its role in SCT. PROCEDURE: We conducted semistructured interviews of members of a multi-disciplinary SCT team to understand their perceptions of palliative care, how specialty palliative care is integrated into SCT, and to identify barriers to increased integration. Eligible participants included physicians, nurses, inpatient nurse practitioners, social workers, and child life specialists. Data were analyzed using thematic analysis. RESULTS: Four major themes were identified. First, SCT team members held a favorable perception of the palliative care team. Second, participants desired increased palliative care integration in SCT. Third, participants believed that the palliative care team had insufficient resources to care for the large number of SCT patients, which led to the SCT team limiting palliative care consultation. And, finally, the lack of a standardized palliative care consultation process prevented greater integration of palliative care in SCT. CONCLUSIONS: SCT team members held a favorable perception of palliative care and saw a role for greater palliative care integration throughout the SCT course. We identified modifiable barriers to greater palliative care integration. SCT teams who desire greater palliative care integration may adapt and implement an existing model of palliative care integration in order to improve standardization and increase integration of specialty palliative care in SCT.

Appropriateness of Pediatrics Case Reports Citations.

BACKGROUND: We determined types of peer-reviewed articles that cited Pediatrics case reports and whether citations were "appropriate" or "inappropriate." METHODS: The 20 most highly cited Pediatrics case reports published between January 2011 and April 2016 were identified. All articles referencing these 20 case reports were analyzed for appropriateness of the citation. Appropriate citations referred to the original article specifically as a case report or cited the case report in support of general knowledge. Inappropriate citations used case reports to infer causation, support proof of mechanism, or were deemed irrelevant to claims being supported. Two authors independently coded all citations. RESULTS: These 20 case reports were cited in 479 articles (median: 24 citations per case report). In most articles (83.6%, n = 367), case reports were cited appropriately; in 53.4% (n = 196) of articles, a case report was specifically referred to, and in 46.6% (n = 171) of articles, the case report was used to support general knowledge. For inappropriate citations, in 63.3% (n = 50) of articles, case reports were used to infer causation; in 15.2% (n = 12) of articles, they were used as proof of mechanism of pathogenesis or treatment; and in 21.5% (n = 17) of articles, they were irrelevant. Case reports were most commonly cited in review articles (38.7%, n = 170) and original studies (31%, n = 136). "Original studies" were articles in which authors reported original data, excluding case reports. CONCLUSIONS: These results reveal that most citations of Pediatrics case reports are appropriate.