(824) Pediatric Palliative Care and Language Differences at End-of-Life Care

Sunday, February 23, 2025

11:00am – 12:00pm Eastern Time

Location: Connections Central - RST 05

First Author(s)

Margaret Yang, MD (she/her/hers)

New York City, New York, United States

Co-Author(s)

JH

Joanne Hojsak, MD

Professor of Pediatrics, Pediatric Critical Care Attending Physician
Mount Sinai School of Medicine
New York City, New York, United States
BL

Boran Li, MD

Assistant Professor of Pediatrics, Pediatric Critical Care and Cardiology Attending Physician
Mount Sinai Kravis Children's Hospital
New York City, New York, United States

Introduction: The goal of palliative care is to improve the quality of life for both patients and caregivers facing challenges associated with serious illness. Palliative care can be introduced at any time, and it is associated with improved outcomes, reduced caregiver stress, and decreased end-of-life symptom burden. The relationship between pediatric palliative care involvement in end-of-life care and language differences is not well described. The purpose of this study is to evaluate for differences in time to palliative care consultation (PCC) between primarily English- and non-English-speaking patients and to assess for associations between PCC, past medical history and length of stay.

Methods: This is a retrospective study of patients who were admitted and died in an urban children’s hospital between January 1, 2011 to December 31, 2023, with age range from 0 to 22 years. We excluded patients who died within 4 hours after admission, are wards of the state, and patients whose medical records were confidential. We performed a search query in EPIC and manual chart review. Statistical analysis included survival models using log-rank, Cox regression, multiple linear and logistic regression.

Results: Among 264 patients, 195 (73.9%) patients preferred English, 69 (26.1%) preferred a language other than English, and a total of 108 (40.9%) patients received PCC. The most common languages were English (73.9%) followed by Spanish (15.9%), Arabic (1.9%) and Bengali (1.9%). Compared to English speakers, non-English speakers did not experience a delay in time to first PCC in the first 50 days of hospitalization (p=0.013) and about 70% more non-English speakers received their first PCC compared to English speakers at any given time (hazard ratio [HR] 1.71 [95% CI 1.08-2.70], p=0.021). Compared to patients with no past medical history, patients with cardiac history (HR 0.49 [0.24-1.03], p=0.014) or prematurity (HR 0.42 [0.10-1.87], p=0.032) were more likely to receive PCC, adjusting for language preference.

Conclusions: There was no significant delay in time to PCC between English and non-English-speaking patients and conversely, non-English speakers were more likely to receive PCC. This unexpected discrepancy between preferred language and PCC has not previously been described and will require further investigation.