Disparities in intensity of treatment at end‐of‐life among children according to the underlying cause of death

Abstract

Aim
To compare indicators of high intensity treatment at end‐of‐life (HI‐EOL) among children according to causes of death.

Methods
We conducted a nationwide registry study in Denmark among 938 children of 1‐17 years of age who died from natural causes from 2006 to 2016. We identified and compared indicators of HI‐EOL within the last month of life across diagnoses. Indicators were hospital admissions, days in hospital, intensive care unit admission, mechanical ventilation, and hospital death.

Results
Proportions of each indicator of HI‐EOL ranged from 27% to 75%. The most common indicators were hospital death (75%) and ICU admission (39%). Compared to children with solid tumours, children with non‐cancerous conditions had an adjusted odds ratio of 3.5 (95% CI 2.1‐5.9) of having ≥3 indicators of HI‐EOL within the last month of life and children with haematological cancer had an odds ratio of 11.8 (95% CI 6.1‐23.0).

Conclusion
The underlying diagnosis was strongly associated with HI‐EOL. Children who died from solid tumours experienced substantially less intensive treatment than both children with haematological cancer and non‐cancerous conditions did. Across non‐cancerous diagnoses, the intensity of treatment appeared consistent, which may indicate, that the awareness of palliative care is higher among oncologists than within other paediatric fields.

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