Variation in receipt of opioids by pediatric oncology patients who died in children's hospitals

Background Opioids are a cornerstone of palliation of pain. We sought to assess variation in opioid prescription during the last week of life among a cohort of pediatric oncology patients who died while hospitalized. Procedure We used detailed hospital administrative data from the Pediatric Health Information System (PHIS) regarding 1,466 subjects 0–24 years of age who were treated at 33 hospitals between 2001 and 2005. Results Among the 1,466 subjects hospitalized at the time of their death, 56% received opioids every day during the hospitalized portion of their last week of life, while 44% did not. This proportion varied substantially across hospitals (range 0–90.5%). After multivariate adjustment for individual-level characteristics, the hospital-level effect on the odds of continuous prescription of opioids during the hospitalized portion of the last 7 days of life continued to vary significantly among hospitals, accounting for 10.5% of the variance in the receipt of daily opioid (P