Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life: A National Study.
Radion Svynarenko, Lora Humphrey Beebe, Lisa C Lindley
PMID 34483331WHAT IT FOUND
Four patterns of mental health diagnoses were found among children dying in hospice.
One group averaged 4.0 mental or behavioral health conditions and 28.8 medications. Nurses should expect detailed mental health assessment and medication review.
Key findings
01The analysis identified a four-class model of mental or behavioral health diagnoses among 6,195 children.
02Class 3, Physiology, represented 43.4% of the sample; 65.5% of its children were younger than 5, 54.7% had physical health comorbidities, and 47.3% were dependent on technology.
03Class 4, Mood, Behavior, and Anxiety, averaged 4.0 mental or behavioral health comorbidities and 28.8 medications at once.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective analysis of Medicaid claims, not a randomised trial, so it cannot show that any treatment caused a better outcome. Diagnoses came from ICD-9-CM billing codes, not DSM diagnoses or clinical assessment. The data were from 2011 to 2013 and used ICD-9 codes. The sample was limited to children enrolled in Medicaid and did not include children with only private insurance. The study could not separate medications for physical health from medications for mental health. The four-class model was chosen by statistical fit measures, but some fit checks did not support the class solution.
Declared interests
The article reports NIH extramural research support. The authors stated nothing to disclose.
The easy way to misread this
Do not read the medication averages as evidence that more medications are needed at end of life. The study counted prescriptions in Medicaid claims but did not separate psychiatric from physical medications or measure comfort, so it cannot say whether those medications helped.