Distress Screening and Pediatric Palliative Care Referral: A Retrospective Case–Control Study in Supportive Cancer Care Delivery

Abstract

Background/Objectives: Pediatric palliative care (PPC) reduces distressing symptoms and improves quality of life for children with cancer and their caregivers. This study assesses whether patient and caregiver distress is associated with PPC referral. Utilizing screening tools to identify families experiencing high distress could lead to earlier access to PPC. Methods: A retrospective case–control study compared children with cancer referred to a PPC clinic at a large pediatric cancer center in the United States from 2019 to 2021 to a matched sample of nonreferred patients. Distress scores and emotional, practical, family/social, and spiritual concerns were routinely measured for patients and caregivers using the Pediatric Distress Thermometer (Peds DT). Conditional logistic regression was utilized to assess the association between PPC referral and (1) high Peds DT scores and (2) Peds DT domains. Van Elteren test was used to compare overall Peds DT scores between the cohorts. Results: PPC-referred patients ( n = 135) were matched to 257 nonreferred patients. Patients ever reporting high distress had higher odds of PPC referral (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.05–3.39). Median Peds DT scores did not differ for patients (1.36 vs. 1.44; p = 0.29) or caregivers (2.52 vs. 2.48; p = 0.30). Caregivers reporting family/social concerns had lower odds of PPC referral (OR 0.56, 95% CI 0.33–0.97). Conclusion: Patients reporting high distress had higher odds of PPC referral. Caregiver DT scores were not associated with PPC referral. High patient distress scores could serve as a screening criterion for PPC referral. Further research could evaluate the impact PPC has on patient and caregiver distress.

The authors' abstract, as published at the source. Journal of Palliative Medicine, 2026 · DOI ↗