Precision in Pediatric Palliative Care: Looking Ahead to the Next Twenty-Five Years

Key Message: An interdisciplinary panel of pediatric palliative care (PPC) clinician-researchers will reflect on the history of the field, explain why realizing precision in our practice remains challenging, and explore why it is essential moving forward. We will then engage participants with the World Cafe method to develop a precision-focused PPC agenda.

Abstract: An interdisciplinary panel of pediatric palliative care (PPC) clinician-researchers including one of the early leaders in the field will begin by reflecting on the history of the field over the last 25 years and making a case for focusing on precision in PPC in the next quarter century. Since its inception, PPC has evolved alongside medical technologies and curative therapies, becoming an essential medical subspecialty. Eighty percent of children’s hospitals now have PPC programs [1], and PPC often plays a critical role in helping medical teams, patients, and families discern when and how to use powerful medical innovations [2]. Yet variability in our own practice remains a barrier to realizing the highest quality PPC.

Panelists will argue that in our current era of precision medicine, PPC, too, must integrate precision. We must shift from what began as broadly supportive care to more specific, nuanced interventions. With attention to precision, we have the potential to transform processes and outcomes of complex communication and medical decision-making; resilience and coping; symptom-related distress; high-quality end-of-life care; and family-focused bereavement support. Our field’s most potent contributions depend on commitment to clinical precision grounded in rigorous research [3].

Next, we will use the World Cafe method [4] to engage participants in co-designing an agenda for achieving precision in PPC clinical practice and research. We will ask where we hope for PPC to be in 2050 and brainstorm around three big picture questions: (1) What does precision look like in PPC?, (2) What is the optimal timing and ‘dose’ of PPC?, and (3) How do we approach implementation of precision PPC? By the end of the session, we will aim to have an outline for a working paper detailing the concept of precision in PPC and an agenda for realizing it over the coming decades.

References: 1. Weaver MS, Shostrom VK, Kaye EC, Keegan A, Lindley LC. Palliative Care Programs in Children’s Hospitals. Pediatrics. 2022;150(4). doi:10.1542/peds.2022-057872
2. Porter AS, Freitas JE, Frechette EM, Wolfe J, Snaman JM. A tool for guiding goal-concordant medical recommendations in paediatric serious illness. BMJ Support Palliat Care. 2023;13(4):472-474. doi:10.1136/SPCARE-2023-004434
3. Sedhom R, Shulman LN, Parikh RB. Precision Palliative Care as a Pragmatic Solution for a Care Delivery Problem. J Clin Oncol Off J Am Soc Clin Oncol. 2023;41(16):2888-2892. doi:10.1200/JCO.22.02532
4. Recchia V, Dodaro A, De Marco E, Zizza A. A critical look to community wisdom: Applying the World Café method to health promotion and prevention. Int J Health Plann Manage. 2022;37 Suppl 1:220-242. doi:10.1002/hpm.3594