Table 3.

Methods of pediatric symptom assessment.

Assessment	Strengths	Weaknesses	Application to PPC
Patient-reported outcomes (PROs)	Can be adapted to a number of electronic interfaces, including EMR and direct-to-clinician reports Variety of choices for different symptoms, HRQOL measures Valid and reliable measures for pediatric research studies Can be fed back to clinical team for improved symptom management	Long forms can be time-consuming Need to consider child self-report vs proxy report PROs lacking for non-malignant conditions and within pediatric research Limitation of PROs in patients at end-of life, or who are non-verbal	Can be incorporated prior to and within symptom management visits PROs can be completed at home, with hospice providers and sent to hospital-based team Allows for multi-site research studies
Online tools (e.g., KLIK, PediQUEST, MyQuality) [5,80,81,83,86]	Utilize a variety of PROs Applicable in research and clinical settings Surveys prior to physician appointments increased psychosocial discussions Improves parent and clinician satisfaction	Initial investment into development and technology Need for interface between electronic assessments and EMR	Allows families to choose the measures of importance Easier communication with busy clinicians Feasible for children with advanced disease
Mobile apps	Can be used by parent, child or both allowing inter-relationship analysis across a variety of symptoms Direct reporting to clinicians Ability to provide targeted interventions focusing on non-pharmacologic therapies	Measures within apps vary, making it hard for clinicians to understand results or compare across apps Availability only on some operating systems (e.g., Apple (Apple Inc., Cupertino, CA, USA) vs Android (Google, Mountain View, CA, USA))	Teaches and enhances patient coping skills Ability to teach mindfulness, guided imagery, and breathing techniques Applicable for research on pain, fatigue, etc.
Therapeutic toys	Promote social, emotional development Can reduce pain, stress, fear Mixed-media capability with toy and mobile app Engaged children who can assist in design ideas	Can be expensive to acquire for hospitals or patients/parents Toys must meet many hospital safety and compliance regulations Few options available	Utilized as distraction for procedures Engages a patient’s senses of smell, touch Children can use toys to communicate emotions and feelings
Interdisciplinary Pediatric Palliative Care team	Ease of assessment in inpatient and outpatient settings Benefit of multiple member assessment (physician, nursing, social work, chaplain, child life) Data supporting improved patient/family outcomes	Less feasible when patients are home Increased personnel and time needed Not available at all pediatric centers	Provides human connection for families Have ability to combine with any other strategy Provides medical opinion and puts treatment plan in place

EMR: electronic medical record, HRQOL: health-related quality of life.