Trends in Palliative Care Research 2023; Issue #07

Commentary By:

Arun Ghoshal, Fellow in Palliative Medicine – Princess Margaret Cancer Centre Palliative care physician mostly working in cancer care, interested in research on application of large language models, self-supervised learning or semi-supervised learning in palliative care narratives.

Feature Article

Agrawal, U. S., Sarin, J., Bakhshi, S., & Garg, R. (2023). Challenges and opportunities in providing palliative care  services to children with a life-limiting illness: A systematic review. The National Medical Journal of India, 35(5), 284–289.


The study titled “Challenges and Opportunities in Providing Palliative Care Services to Children with a Life-Limiting Illness: A Systematic Review” by Agrawal, Sarin, Bakhshi, and Garg (2023) explores the unique challenges and potential opportunities in delivering palliative care services to children with life-limiting illnesses. The research aims to address the gaps in understanding and addressing the specific palliative care needs of this population, which has often been neglected in healthcare systems.
The authors conducted a systematic review, employing a rigorous methodology to identify relevant studies on pediatric palliative care. They searched various databases, screened studies based on predetermined inclusion criteria, and included twenty-eight studies for analysis. The selected studies provided insights into the challenges faced by healthcare providers and families while delivering palliative care to children, as well as the potential avenues for improvement.
The review identified several key challenges in pediatric palliative care. Limited awareness among healthcare professionals about pediatric palliative care emerged as a significant barrier. Communication difficulties, ethical considerations, and the need for specialized multidisciplinary teams were also highlighted as challenges. The review also identified opportunities to enhance pediatric palliative care, such as integrating palliative care into routine clinical practice, improving training programs, and promoting research in the field.
Commentary: The systematic review on challenges and opportunities in providing palliative care to children with life-limiting illnesses by Agrawal et al. offers valuable insights into an often-neglected aspect of healthcare. As a healthcare professional, this research resonates with my practice and reinforces the importance of addressing the unique needs of children facing life-limiting illnesses. In addition to recommendations for organizational, patient-focused and policy level changes, this review provided several recommendations to address barriers for health care providers.
One notable finding highlighted in the review is the limited awareness and understanding of pediatric palliative care among many healthcare professionals. This aligns with my own experiences, as I have observed a lack of education and training in pediatric palliative care in many healthcare settings. The authors’ emphasis on the need for specialized training programs is crucial in equipping healthcare providers with the necessary knowledge and skills to deliver compassionate and effective care to children and their families.
Communication emerged as a significant challenge in pediatric palliative care, as it involves delivering sensitive information, involving children in decision-making, and facilitating open dialogue with families. The authors’ recognition of the need for clear communication strategies that consider the developmental stage and individual needs of each child is essential. It reinforces the importance of honing communication skills to ensure families are well-informed, supported, and empowered throughout the palliative care journey.
Ethical considerations play a vital role in pediatric palliative care, particularly in end-of-life decision-making and preserving the child’s dignity. The authors’ identification of ethical challenges highlights the necessity of comprehensive ethical frameworks and guidelines to support healthcare providers, families, and policymakers in navigating these complexities. Ensuring ethical decision-making, while prioritizing the best interests of the child, is essential for providing compassionate and holistic care.
The review’s focus on multidisciplinary teams in pediatric palliative care aligns with the interdisciplinary nature of my practice. The collaboration of healthcare professionals from various disciplines, including physicians, nurses, psychologists, social workers, and chaplains, is crucial in providing comprehensive care that addresses the diverse needs of children and their families. The authors’ emphasis on enhancing access to specialized palliative care teams and promoting collaboration is a valuable reminder of the importance of interprofessional teamwork.
In a broader context, this systemic review serves as a call to action for healthcare systems, policymakers, and researchers to prioritize pediatric palliative care. The authors highlight the need for policy development, resource allocation, and research initiatives focused on addressing the challenges, and improving the quality of care, for children with life-limiting illnesses. By integrating the findings of this review into clinical practice, we can work towards providing equitable and comprehensive palliative care services that meet the specific needs of this vulnerable population.
In conclusion, the systematic review by Agrawal et al. sheds light on the challenges and opportunities in providing palliative care to children with life-limiting illnesses. As a healthcare professional, this review reinforces the need for education, communication skills, ethical frameworks, and interdisciplinary collaboration in pediatric palliative care. By implementing the insights from this systemic review, we can strive towards providing compassionate, person-centered care that enhances the quality of life for children with life-limiting illnesses and their families.

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