All ETDs from UAB

Advisory Committee Chair

Huifeng Yun

Advisory Committee Members

Olivia Affuso

Emily E Johnston

Document Type

Thesis

Date of Award

2020

Degree Name by School

Master of Science in Public Health (MSPH) School of Public Health

Abstract

Regional studies show that children dying of cancer receive medically intense end-of-life care but there is limited information about end-of-life care in the Deep South and limited information about hospice and palliative care involvement at EOL. We conducted a retrospective electronic medical record review of children (0-x years) that died of cancer between 2010-20199 who received cancer directed therapy at Children’s of Alabama. We collected patient clinical and sociodemographics factors, including sex, race, and area deprivation index, cancer diagnosis and treatment, palliative care and hospice involvement, location of death, and medical care in the last 30d of life, including chemotherapy use, intubation, and ICU admission. Of 233 patients, median age at death was 11.0 (IQR) and 38% belonged to a racial/ethnic minority. Forty-one percent had a non-CNS solid tumor. Forty-nine percent died in the hospital and 37% received medically intense care in the last 30d of life (intubation, ICU admission, hemodialysis, or CPR). Fifty-eight percent received a palliative care consult, which occurred >30 days before death (early) in 36%. Although palliative care involvement was associated with both more acute care (hospital and ICU) and hospice utilization (61%), children who received early palliative spent less days in the ICU (OR, 95% CI=1.2, 1.0-1.3) and had greater odds of enrolling in hospice (2.6, 1.3-5.0) than those who received late palliative care. Additionally, end-of-life care varied with race/ethnicity and diagnosis. For children who die of cancer in Alabama, care varies significantly by palliative care involvement, diagnosis, and race. It is important to understand whether this variation due to differences in patient and family preferences or systemic factors such as variation in hospice access.

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