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Completed

NCT Number: NCT04236180

Effectiveness of Specialised Paediatric Palliative Care

This study evaluates the effectiveness of an existing Specialised Paediatric Palliative Care programme and reports on its potential to improve patient-, family-, health professionals-, and healthcare-related outcomes. Data will be compared between an intervention and a comparison group.

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Key information

Age range

Up to 18 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Cantonal Children's Hospital, Aarau, Switzerland

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About this study

The number of children and adolescents living with life-limiting conditions and potentially in need for specialised paediatric palliative care (SPPC) is rising. As a highly complex subfield of palliative care, paediatric palliative care focuses on the support and involvement of the entire family, and on the impact not only at the patient level, but also at the family and health systems level. Ideally, a specialised multiprofessional team fills the complex healthcare needs of children and their families. A consultative care model might be well-suited to address each family's most important needs. The question, however, of how SPPC is beneficial for whom and under what circumstances remain largely unanswered as validation of innovative care programmes in controlled studies is lacking.

This study's overall target is to evaluate the effectiveness of SPPC and to report on its potential to improve patient-, family-, health professional-, and healthcare-related outcomes. The primary objective is to explore how SPPC influences the quality of life (QOL) of caregivers, i.e. parents. Secondary objectives are to explore how SPPC influences the QOL of patients including their symptom severity and distress as well as the QOL of their siblings and of healthcare professionals not specialised in PPC. Further objectives are to determine whether the provision of SPPC reduces the utilisation of healthcare resources and direct and indirect health-related costs for families, and to evaluate implementation outcomes such as adoption, i.e., the uptake of SPPC.

This interventional multi-centre study will apply a hybrid design to determine the clinical effectiveness (comparative effectiveness research) of an existing SPPC programme, while gathering information on its delivery and potential implementation in a real-life situation.

This study will be conducted in compliance with the protocol, the current version of the Declaration of Helsinki, the ICH-GCP as well as all national legal and regulatory requirements.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Children suffering from a life-limiting condition and potentially in need of SPPC, their parents and siblings as applicable will be eligible to enter the study, along with all HCP involved in their care at all study sites. The potential need for SPPC is defined per indication criteria based on the Zurich SPPC programme's guidelines:

  • Increase in (unplanned) hospital admissions during the last months
  • Medical adverse events from which the child is not recovering completelyIncreasing symptom burden
  • Unsatisfactory response to treatments
  • Conflicting treatment goals
  • Estimated life expectancy less than 6-12 months
  • Patient's/parents' wish for PC support

Inclusion criteria

  • Children, aged 0-18 years, suffering from a life-limiting condition of various origins and potentially in need of SPPC (for Zurich, additionally enrolment in the SPPC programme)
  • Parents (mothers and fathers) of included children
  • Siblings, aged >8 years, of included families
  • All health care professionals involved in the care of included families
  • Proficiency in French or German language
  • Signed Informed Consent after being informed

Exclusion criteria

  • Neonates with medical complications due to prematurity and/or birth complications and treated in a neonatal intensive care unit
  • Children with an estimated life expectancy of <48 hours

Treatment and study plan

Specialised Paediatric Palliative Care (SPPC)

Other

All services provided to children/families by a member of the multiprofessional SPPC team in Zurich according to local guidelines will be considered as study intervention. This includes direct consultation of the patient/family, as well as patient-/family-related consultation of the frontline care team. Bereavement support is considered an integrated part of SPPC and after the death of a child, follow-up bereavement support is routinely offered at the individual or group level as appropriate for parents and siblings.

Primary outcomes

  1. Change in Caregiver QOL - QOLLTI-F Questionnaire

    Time frame: Up to day 330 after study entry

    Longitudinal assessment of self-reported caregiver (parental) Quality of Life (QOL) using the QOLLTI-F (Quality of Life in Life Threatening Illness - Family Carer Version) questionnaire.

Secondary outcomes

  1. Change in Child's QOL - DISABKIDS Chronic Generic Measure (DCGM-37) Questionnaire

    Time frame: Up to day 330 after study entry

    Longitudinal assessment of child's Quality of Life using the DCGM-37 DISABKIDS questionnaire.

  2. Change in child's symptoms - Memorial Symptom Assessment Scale (MSAS) Questionnaire

    Time frame: Up to day 330 after study entry

    Longitudinal assessment of child's symptoms by using the Memorial Symptom Assessment Scale (MSAS) questionnaire. MSAS assesses severity, frequency and distress for symptom evaluation using separate 4 or 5 point Likert scales. Higher values are associated with higher symptom burden.

  3. Change in Siblings QOL - KIDSSCREEN-27 Questionnaire

    Time frame: Up to day 630 after study entry

    Longitudinal assessment of sibling's health related Quality of Life using the KIDSSCREEN-27 questionnaire.

  4. Professional's QOL (ProQOL) Questionnaire

    Time frame: Cross-sectional at the end of study year 1

    Assessing self-reported healthcare professional's Quality of Life using the ProQOL questionnaire.

  5. Professional's QOL (ProQOL) Questionnaire

    Time frame: Cross-sectional at the end of study year 2

    Assessing self-reported healthcare professional's Quality of Life using the ProQOL questionnaire.

  6. Chang in grief - "Würzburger Trauerinventar (WüTi)" Questionnaire

    Time frame: Up to 1 year after the child's death

    Longitudinal assessment of parental grief processes using the "Würzburger Trauerinventar (WüTi)" questionnaire.

  7. Change in parental QOL during bereavement - WHOQOL-BREF Questionnaire

    Time frame: Up to 1 year after the child's death

    Longitudinal assessment of parental Quality of Life during bereavement using the WHO Quality of Life-BREF questionnaire.

Other outcomes

  1. Number of hospital admissions as assessed longitudinally via chart review

    Time frame: Up to day 330 after study entry

    Number of admissions including number of emergency and/or outpatient consultations and number of admissions to a pediatric palliative care unit. Routine data, chart review, longitudinally during the child's palliative care phase.

  2. Number of resuscitations

    Time frame: Up to day 330 after study entry

    Routine data, chart review, continuously during the child's palliative care phase.

  3. Number of invasive procedures

    Time frame: Up to day 330 after study entry

    E.g. surgery and imaging requiring sedation. Routine data, chart review, continuously during the child's palliative care phase.

  4. Length of Stay (LOS)

    Time frame: Up to day 330 after study entry

    Total length of hospital stay per admission. Routine data, chart review, continuously during the child's palliative care phase.

  5. Number of days receiving professional community home care services

    Time frame: Up to day 330 after study entry

    Routine data, chart review, continuously during the child's palliative care phase.

  6. Place of Death

    Time frame: Place of death will be recorded, if the patient dies within 1 year after study enrollment.

    (Hospital, Home, Hospice, Other) Data extraction from routine data/cart reviews at time of death.

  7. Effective costs charged and paid for by formal payers

    Time frame: Up to day 630 after study entry

    Cost estimations based on resource utilization combined with publicly available sources or retrieved from payers for each family who consented.

  8. Family household expenditures

    Time frame: after 1 year or at child's death; 1 year after the child's death

    Direct and indirect household expenditures. Household data obtained using questionnaires.

  9. SPPC - Paediatric Palliative Screening Scale (PaPas-Scale) Questionnaire

    Time frame: For each patient at baseline (study enrollment), through study completion, ca. 2 years.

    Identification of patients in need of specialised paediatric palliative care using the Paediatric Palliative Screening Scale (PaPas-Scale) questionnaire. Higher scores indicate a higher need for paediatric palliative care.

  10. Sense of coherence (SOC) Questionnaire

    Time frame: For each family at baseline (study enrollment), through study completion, ca. 2 years.

    Assessment of self-reported Family Sense of Coherence with the FSOC questionnaire.

  11. Family hardiness (FH) Questionnaire

    Time frame: For each family at baseline (study enrollment), through study completion, ca. 2 years.

    Assessing the internal strengths and cooperativeness, the resourcefulness and willingness to learn and the sense of having control over life circumstances by using the Family Hardiness Index (FHI) questionnaire.

Sponsors and collaborators

Lead sponsor

University Children's Hospital, Zurich

Other

Collaborators

  • Cantonal Hospital of Aarau, Switzerland
  • Insel Gruppe AG, University Hospital Bern
  • University Children's Hospital Basel
  • University of Basel

Registry information

Official study title

Specialised Paediatric Palliative Care: Assessing Family, Healthcare Professionals and Health System Outcomes in a Multi-site Context of Various Care Settings

Acronym: SPhAERA

Important dates

Study start
2019
Primary completion
2023
Study completion
2023
First posted
Jan 22, 2020
Registry last updated
Dec 15, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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