Interdisciplinary symptom management in pediatric palliative care: A case report.

Abstract

Objective: Pediatric palliative care (PPC) services strive to prevent and relieve suffering among children, adolescents, and young adults with chronic and/or life-limiting illnesses. The current case report aims to illustrate the methods and effectiveness of an interdisciplinary palliative care team in symptom management of a 19-year-old Mexican American female with complex medical and psychosocial needs, including a history of labor trafficking. The patient, in leukemic remission at time of admission, required close collaboration of subspecialties including Psychology, Pediatric Advanced Care Team, Pain Team, Spiritual Care, and Rehabilitation to comprehensively address total pain. Method: Data were retrospectively extracted from the patient's medical chart, including numerical pain ratings across time, relative hours of monthly service provision by interdisciplinary specialty, and timeline of medical interventions. Results: Results demonstrated a decrease in patient pain scores over time despite progression of physical deterioration and disability. Characterization of service provision revealed flexibility within and across subspecialties as the patient's condition evolved. One year following discharge, the patient was reevaluated by Psychology and demonstrated remarkable physical rehabilitation gains as well as resolution of mood and anxiety concerns (evidenced by subclinical scores on the PHQ-9 and GAD-7). Conclusion: Results demonstrate the effectiveness of psychological, spiritual, and palliative care efforts in tandem with tailored medical intervention to address "total pain" and improve patient outcomes. Influences of cultural practices and spiritual beliefs on pediatric palliative care are highlighted throughout. The relative variance of service provision within and across time points illustrates the flexible and complementary nature of PPC services.