• Meaghann S Weaver, Abby R Rosenberg, Julia Tager, Christopher S Wichman, and Lori Wiener.
• 1 Divisions of Palliative Care and Oncology, Department of Pediatrics, Children's Hospital and Medical Center , Omaha, Nebraska.
• J Palliat Med. 2018 Apr 1; 21 (4): 452-462.

BackgroundLittle is known about the composition, availability, integration, communication, perceived barriers, and work load of pediatric palliative care (PPC) providers serving children and adolescents with cancer.ObjectiveTo summarize the structure and services of programs to better understand successes and gaps in implementing palliative care as a standard of care.MethodsCross-sectional online survey about the palliative care domains determined by the Psychosocial Care of Children with Cancer and Their Families Workgroup.SubjectsA total of 142 surveys were completed with representation from 18 countries and 39 states.ResultsThree-fourths of sites reported having a PPC program available for the pediatric cancer population at their center. Over one-fourth (28%) have been in existence less than five years. Fewer than half of sites (44%) offered 24/7 access to palliative care consultations. Neither hospital-based nor local community hospice services were available for pediatric patients at 24% of responding sites. A specific inpatient PPC unit was available at 8% of sites. Criteria for automatic palliative referrals ("trigger" diagnoses) were reported by 44% respondents. The presence of such "triggers" increased the likelihood of palliative principle introduction 3.41 times (p < 0.003). Six percent of respondents perceived pediatric oncology patients and their families "always" were introduced to palliative care concepts and 17% reported children and families "always" received communication about palliative principles. The most prevalent barriers to palliative care were at the provider level.DiscussionChildren and adolescents with cancer do not yet receive concurrent palliative care as a universal standard.

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