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J Palliat Med. 2019 Apr;22(4):464-467. doi: 10.1089/jpm.2018.0301. Epub 2018 Dec 4.

Homeward Bound: A Case Series of Cross-Cultural Care at End of Life, Enhanced by Pediatric Palliative Transport.

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1 Division of General Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, Minnesota.
2 ComPASS Care Team, Mayo Clinic , Rochester, Minnesota.
3 Division of Pediatric Critical Care Medicine, Mayo Clinic , Rochester, Minnesota.
4 Division of Neonatal Medicine, Mayo Clinic , Rochester, Minnesota.


For most families, the preferred location of death for their child is home, yet most children still die in the hospital. Many children with life-threatening and life-limiting illness are medically dependent on technology, and palliative transport can serve as a bridge from the intensive care unit to the family's home to achieve family-centered goals of care. Palliative transport may also present an opportunity to prioritize cultural care and rituals at end of life which cannot be provided in the hospital. We describe a case series of pediatric patients from communities espousing markedly diverse cross-cultural values and limited financial resources. Specific cultural considerations at end of life for these children included optimizing the presence of the shared community or tribe, the centrality of healing rituals, and varied attitudes toward withdrawal of life-sustaining medical treatment. By addressing each of these components, we were able to coordinate palliative transport to enhance cross-cultural care and meaning at end of life for children with life-limiting illness.


Amish; Hutterite; Native American; cross-cultural; palliative care; palliative transport


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