Pediatric End-of-Life Care in Rural America: A Systematic Review.
Whitney Stone, Jessica Keim-Malpass, Melanie J Cozad and 2 others
PMID 34963329WHAT IT FOUND
Rural pediatric hospice care in the US faced barriers from provider shortages, pharmacy gaps, and admission policies.
Telehealth and pediatric training were described as helpful, and geographic studies identified unmet need.
Key findings
01The main barriers were hospice policies excluding children, few pediatric providers, and limited pediatric-trained staff or pharmacy resources.
02Telehealth and pediatric-specific training were reported as facilitators: telehealth was acceptable to children, hospice nurses, and caregivers, and training improved enrollment in pediatric hospice care.
03Geographic analyses identified rural hotspots where children dying with advanced cancer or serious life-limiting illness needed pediatric hospice care.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 9 studies were included, and all were rated level III quality B, so the review describes patterns rather than proving what works. The studies came from a small number of states, and most were conducted in the South, so the findings may not apply to other rural areas. The search was limited to English-language, US peer-reviewed original research published between January 1, 2011 and January 31, 2021, and it excluded reviews and other article types, so relevant work could have been missed. The authors acknowledge possible bias in identifying themes and interpreting conclusions, although they used independent screening, extraction, and consensus discussion. The review analysed studies, not individual patients, so it cannot provide a combined patient count or patient-level outcomes.
Declared interests
The supplied text does not report funding or conflict-of-interest declarations.
The easy way to misread this
Do not conclude that telehealth or pediatric training reliably improves rural pediatric hospice care. The review includes only 9 level III studies, and the telehealth and training findings come from studies of acceptability and enrollment, not tested interventions.