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Ivéus K, Eklund R, Kreicbergs U, Lövgren M. Family bonding as a result of the family talk intervention in pediatric oncology: Siblings' experiences. Pediatr Blood Cancer 2022; 69:e29517. [PMID: 34971075 DOI: 10.1002/pbc.29517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childhood cancer affects the whole family. Illness-related stressors increase the risk for poor family communication, affecting the family's well-being. Siblings describe worry and poor illness-related information. As there are few evaluated family interventions in pediatric oncology, this study aimed to pilot-test a family-centered intervention, the family talk intervention (FTI), in pediatric oncology. This paper examined the feasibility in terms of acceptability from the siblings' perspectives. METHODS This study derives from a pilot study of 26 families including 37 siblings recruited from one pediatric oncology center. Standard FTI comprises six meetings with the family, led by two interventionists, with the main goal to facilitate family communication on illness-related topics (e.g., prognosis, the invisibility of healthy siblings). This paper focuses on interview and survey data from siblings after participation in FTI. The study is registered at ClinicalTrials.gov (Identifier NCT03650530). RESULTS The siblings, aged 6 to 24 years, stated that the interventionists made the meetings feel like a safe environment and that it was a relief for the siblings to talk. They reported that FTI helped the family talk openly about illness-related topics, which they felt led to increased family understanding and improved relationships. The siblings described that FTI also helped them with their school situation. The majority of the siblings reported that FTI came at the right time and involved an appropriate number of meetings. CONCLUSION According to the siblings, the timing, content, and structure of FTI were appropriate. FTI showed benefits for both the siblings and each family as a whole.
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Affiliation(s)
- Kerstin Ivéus
- Lilla Erstagården Children's and Youth Hospice, Ersta Hospital, Stockholm, Sweden
| | - Rakel Eklund
- National Centre for Disaster Psychiatry, Department of Medical Science, Uppsala University, Uppsala, Sweden.,Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Pediatric Oncology and Hematology, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Childhood Cancer Research Unit, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Advanced Pediatric Home Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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2
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Yamaji N, Suzuki D, Suto M, Sasayama K, Ota E. Communication tools used in cancer communication with children: a scoping review protocol. BMJ Open 2022; 12:e056403. [PMID: 35197351 PMCID: PMC8867319 DOI: 10.1136/bmjopen-2021-056403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Despite the potential benefits of effective communication, telling children about cancer, unpredictable and life-threatening conditions is challenging. This study aimed to summarise the communication tools used in cancer communication among children with cancer, caregivers and healthcare professionals. METHODS AND ANALYSIS We will conduct a scoping review following the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews checklist. We will search PubMed (including MEDLINE), Embase, CENTRAL, PsycINFO and CINAHL. We will include the qualitative and quantitative studies that reported the communication tools that tell a child diagnosed with cancer about the cancer-related information. We will summarise the communication tools and the impacts of the tools. ETHICS AND DISSEMINATION Formal ethical approval is not required, as primary data will not be collected in this study. The findings of this study will be disseminated through the presentation at the conference and publication in a peer-reviewed journal.
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Affiliation(s)
- Noyuri Yamaji
- Department of Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Japan
| | - Daichi Suzuki
- Department of Nursing, Kanagawa Institute of Technology, Atsugi, Japan
| | - Maiko Suto
- Department of Health Policy, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Kiriko Sasayama
- Department of Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Japan
| | - Erika Ota
- Department of Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Japan
- The Tokyo Foundation for Policy Research, Minato-ku, Japan
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3
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Martinez I, Hoppmann A, Perna S, Byrd P, Wolfe J, Aye J, Johnston EE. To Disclose or Not to Disclose: A Case Highlighting the Challenge of Conflicts in Pediatric Disclosure. J Pain Symptom Manage 2021; 61:211-215. [PMID: 32890630 PMCID: PMC8097844 DOI: 10.1016/j.jpainsymman.2020.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Isaac Martinez
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anna Hoppmann
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sam Perna
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Byrd
- Pastoral Care Department, Children's of Alabama, Birmingham, Alabama, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jamie Aye
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily E Johnston
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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4
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Lövgren M, Udo C, Alvariza A, Kreicbergs U. Much is left unspoken: Self-reports from families in pediatric oncology. Pediatr Blood Cancer 2020; 67:e28735. [PMID: 32975361 DOI: 10.1002/pbc.28735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Communication about illness-related subjects is complex and difficult. To support entire families in pediatric oncology, health care professionals need to know what family members think, but leave unspoken. The aim of this study was to explore how families in pediatric oncology experienced illness-related information and communication with professionals and within the family. PROCEDURE A cross-sectional web survey was used. Families were recruited from one pediatric oncology center in Sweden, 2-3 months after diagnosis. One hundred eighteen family members (ill children, siblings, and parents) representing 27 families filled out age-adapted surveys. RESULTS Eighty-six percent of the parents and 71% of the siblings reported that they had not received enough or any information about how the cancer and its treatment could affect the child's psychological health. The families reported that they did not dare ask professionals questions about psychosocial issues and future-related subjects. Nor did they talk with one another, even though 55% of the parents and 24% of the children wanted to reveal more about how they felt to someone in the family. The parents reported the lowest family communication, and few families had all members reporting the same perception of family communication. CONCLUSIONS Much is still left unspoken in pediatric oncology and the needs of the families are prominent. Assessments of each family member's needs might form a basis for professionals to give each person adequate information and family support. An increased awareness in families about family members' different needs might lead to mutual understanding.
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Affiliation(s)
- Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
| | - Camilla Udo
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,School of Education, Health and Society, Dalarna University College, Falun, Sweden.,Center for Clinical Research Dalarna, Falun, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
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5
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Stein A, Dalton L, Rapa E, Bluebond-Langner M, Hanington L, Stein KF, Ziebland S, Rochat T, Harrop E, Kelly B, Bland R. Communication with children and adolescents about the diagnosis of their own life-threatening condition. Lancet 2019; 393:1150-1163. [PMID: 30894271 DOI: 10.1016/s0140-6736(18)33201-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 01/10/2023]
Abstract
When a child is diagnosed with a life-threatening condition, one of the most challenging tasks facing health-care professionals is how to communicate this to the child, and to their parents or caregivers. Evidence-based guidelines are urgently needed for all health-care settings, from tertiary referral centres in high-income countries to resource limited environments in low-income and middle-income countries, where rates of child mortality are high. We place this Review in the context of children's developing understanding of illness and death. We review the effect of communication on children's emotional, behavioural, and social functioning, as well as treatment adherence, disease progression, and wider family relationships. We consider the factors that influence the process of communication and the preferences of children, families, and health-care professionals about how to convey the diagnosis. Critically, the barriers and challenges to effective communication are explored. Finally, we outline principles for communicating with children, parents, and caregivers, generated from a workshop of international experts.
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Affiliation(s)
- Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Louise Dalton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Myra Bluebond-Langner
- The Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lucy Hanington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tamsen Rochat
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Human Sciences Research Council, Johannesburg, South Africa
| | - Emily Harrop
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Helen & Douglas House, Oxford, UK
| | - Brenda Kelly
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Bland
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Institute of Health and Wellbeing, Glasgow, UK; University of Glasgow and Royal Hospital for Children, Glasgow, UK
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6
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Brand McCarthy SR, Kang TI, Mack JW. Inclusion of children in the initial conversation about their cancer diagnosis: impact on parent experiences of the communication process. Support Care Cancer 2019; 27:1319-1324. [PMID: 30675664 DOI: 10.1007/s00520-019-4653-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/15/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Including children in medical conversations is considered the standard of care for children with cancer. However, previous qualitative research has raised concerns about how the child's presence impacts the parent's communication experience. The current study examines the frequency and impact of child presence during a serious medical conversation on the parent's communication experience in pediatric oncology. METHODS Three hundred sixty parents of children newly diagnosed with cancer completed questionnaires assessing the child's presence during the initial conversation with the oncologist about diagnosis and treatment and parental communication experiences. Primary oncologists completed a survey question about the child's prognosis. RESULTS Sixty-one percent of children were present during the initial conversation, with lowest rates among children aged 3-6 (44%) and 7-12 (44%). Child presence was not associated with parents' reports that they received prognostic information (p = 0.20), high-quality information (p = 0.19), or high-quality communication about the child's cancer (p = 1.0). DISCUSSION The parent's communication experience is not diminished by the choice to include the child. Given the bioethical imperative to include children in conversations about serious illness whenever possible, this concern should not be used to exclude children, but rather to give parents additional time of their own when needed to fully process decisions.
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Affiliation(s)
- Sarah R Brand McCarthy
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Tammy I Kang
- Section of Pediatric Palliative Care, Texas Children's Hospital, Houston, TX, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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7
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Pyke-Grimm KA, Franck LS, Patterson Kelly K, Halpern-Felsher B, Goldsby RE, Kleiman A, Rehm RS. Treatment Decision-Making Involvement in Adolescents and Young Adults With Cancer. Oncol Nurs Forum 2019; 46:E22-E37. [PMID: 30547960 DOI: 10.1188/19.onf.e22-e37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Involvement in treatment decision making (TDM) is considered a key element of patient- and family-centered care and positively affects outcomes. However, for adolescents and young adults (AYAs) with cancer, little is known about the current state of knowledge about their perspective on and involvement in TDM or the factors influencing AYAs' TDM involvement. LITERATURE SEARCH Integrative review focused on AYAs aged 15-21 years, their involvement in TDM, and factors influencing their involvement using the MEDLINE®, PsycINFO®, CINAHL®, and Web of Science databases. DATA EVALUATION 4,047 articles were identified; 21 met inclusion criteria. SYNTHESIS Five factors were identified. IMPLICATIONS FOR RESEARCH Research is needed to understand AYAs' preferences for TDM, the type and degree of their involvement, and the interactions between factors that contribute to or impede TDM.
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Affiliation(s)
| | | | | | | | | | - Ari Kleiman
- UCSF Medical Center Institute for Nursing Excellence
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8
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Mant J, Kirby A, Cox KJ, Burke A. Children's experiences of being diagnosed with cancer at the early stages of treatment; an interpretive phenomenological analysis. Clin Child Psychol Psychiatry 2019; 24:3-18. [PMID: 30145911 DOI: 10.1177/1359104518788400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Being given a diagnosis of cancer is a significant and highly distressing event for both children and their families, but little research has been done to explore and understand children's feelings. This study aims to understand from the child's perspective what it feels like to be told you have cancer, with the hope that increased understanding can lead to improved communication and support for children and families. The study uses qualitative methodology. Six children aged 8-12 years with a new diagnosis of cancer took part in two semi-structured interviews at least one week apart. The interviews were conducted using the draw and write technique. The results were analysed using interpretative phenomenological analysis. The report describes the five super-ordinate themes that were identified; initially I felt shocked and scared, chemo is an awful thing, please talk to me; the more I know the better I feel, I will accept treatment and quickly get used to it because I know I will get better and, finally, my family are vital. Implications for clinical practice are discussed. The report highlights the research limitations and areas for future studies.
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Affiliation(s)
- Jill Mant
- 1 Department of Paediatrics, Scarborough General Hospital, UK
| | - Angela Kirby
- 2 Department of Paediatric Oncology and Haematology, Addenbrooke's Hospital, UK
| | - Kathy J Cox
- 3 School of Psychology, University of Plymouth, UK
| | - Amos Burke
- 2 Department of Paediatric Oncology and Haematology, Addenbrooke's Hospital, UK
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9
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Abstract
PURPOSE OF REVIEW Pediatric palliative oncology (PPO) is an emerging field that integrates the principles of palliative care early into the illness trajectory of children with cancer. PPO providers work with interdisciplinary clinicians to provide optimal medical and psychosocial care to children with cancer and their families. Ongoing advances in the field of pediatric oncology, including new treatment options for progressive cancers, necessitate the early integration of palliative care tenets including holistic care, high-quality communication, and assessment and management of refractory symptoms. RECENT FINDINGS Research in this emerging field has expanded dramatically over the past several years. This review will focus on advancements within several key areas of the field, specifically regarding investigation of the communication needs and preferences of patients and families, exploration of educational initiatives and interventions to teach PPO principles to clinicians, study of patient-reported and parent-reported tools to better assess and manage refractory symptoms, and development of novel models to integrate palliative care within pediatric oncology. SUMMARY Research findings in the field of PPO, concurrent with advances in the treatment of pediatric cancer, may help improve survival and quality of life for children with cancer.
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10
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Kaye EC, Snaman JM, Johnson L, Levine D, Powell B, Love A, Smith J, Ehrentraut JH, Lyman J, Cunningham M, Baker JN. Communication with Children with Cancer and Their Families Throughout the Illness Journey and at the End of Life. PALLIATIVE CARE IN PEDIATRIC ONCOLOGY 2018. [DOI: 10.1007/978-3-319-61391-8_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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11
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Kelly KP, Mowbray C, Pyke-Grimm K, Hinds PS. Identifying a conceptual shift in child and adolescent-reported treatment decision making: "Having a say, as I need at this time". Pediatr Blood Cancer 2017; 64. [PMID: 28221731 DOI: 10.1002/pbc.26262] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/03/2016] [Accepted: 08/22/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Professional organizations and governments recommend child and adolescent involvement in cancer treatment decision making (TDM) despite minimal evidence that children prefer involvement, how best to include them, and the result of doing so. PROCEDURE Using descriptive qualitative research methods, we interviewed 20 children ages 9-17 years about their TDM preferences and experiences. We shifted our conceptualizations as findings emerged about how children with cancer viewed their decisional experiences. Results from constant comparative analysis of participant interviews yielded a new construct, "Having a say, as I need at this time" ('Having a Say'), which focuses more broadly on child communication preferences and the dynamism of those preferences. Ten additional interviews confirmed 'Having a Say' results. RESULTS Children's contextually related 'Having a Say' preferences ranged from not wanting to hear information at this time, to being included in treatment discussions, to choosing a treatment option. Children reported both positive and negative effects of being involved (or not) in treatment discussions as they preferred. Children's preferences assumed the presence and involvement of their parents and doctors. Illness conditions (e.g., stage of treatment; symptom distress) informed child communication preferences more so than the child's age. CONCLUSIONS The 'Having a Say' construct challenges the dominant shared TDM paradigm, which presumes it is best to involve children in their treatment decisions. 'Having a Say' is both a developmental and conceptual fit for children that can inform future research to develop and test clinical care approaches to meet child and adolescent communication needs.
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Affiliation(s)
- Katherine Patterson Kelly
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Washington, District of Columbia
| | - Catriona Mowbray
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia
| | - Kimberly Pyke-Grimm
- Center for Nursing Excellence, Bass Center for Childhood Cancer and Blood Diseases, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Washington, District of Columbia.,Department of Nursing Research and Quality Outcomes, Center for Translational Science, Children's National Health System, Department of Pediatrics, George Washington University, Washington, District of Columbia
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12
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Sisk BA, Bluebond-Langner M, Wiener L, Mack J, Wolfe J. Prognostic Disclosures to Children: A Historical Perspective. Pediatrics 2016; 138:peds.2016-1278. [PMID: 27561728 PMCID: PMC5005028 DOI: 10.1542/peds.2016-1278] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/24/2022] Open
Abstract
Prognostic disclosure to children has perpetually challenged clinicians and parents. In this article, we review the historical literature on prognostic disclosure to children in the United States using cancer as an illness model. Before 1948, there was virtually no literature focused on prognostic disclosure to children. As articles began to be published in the 1950s and 1960s, many clinicians and researchers initially recommended a "protective" approach to disclosure, where children were shielded from the harms of bad news. We identified 4 main arguments in the literature at this time supporting this "protective" approach. By the late 1960s, however, a growing number of clinicians and researchers were recommending a more "open" approach, where children were included in discussions of diagnosis, which at the time was often synonymous with a terminal prognosis. Four different arguments in the literature were used at this time supporting this "open" approach. Then, by the late 1980s, the recommended approach to prognostic disclosure in pediatrics shifted largely from "never tell" to "always tell." In recent years, however, there has been a growing appreciation for the complexity of prognostic disclosure in pediatrics. Current understanding of pediatric disclosure does not lead to simple "black-and-white" recommendations for disclosure practices. As with most difficult questions, we are left to balance competing factors on a case-by-case basis. We highlight 4 categories of current considerations related to prognostic disclosure in pediatrics, and we offer several approaches to prognostic disclosure for clinicians who care for these young patients and their families.
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Affiliation(s)
- Bryan A. Sisk
- Department of Pediatrics, St Louis Children’s Hospital, St. Louis, Missouri
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children’s Palliative Care, Institute of Child Health, University College London, London, England
| | - Lori Wiener
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, Maryland
| | - Jennifer Mack
- Departments of Pediatric Oncology and Division of Population Sciences, and,Division of Pediatric Hematology/Oncology, and
| | - Joanne Wolfe
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; and,Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
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13
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El Malla H, Steineck G, Ylitalo Helm N, Wilderäng U, El Sayed Elborai Y, Elshami M, Kreicbergs U. Cancer disclosure-account from a pediatric oncology ward in Egypt. Psychooncology 2016; 26:679-685. [PMID: 27362448 DOI: 10.1002/pon.4207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 06/20/2016] [Accepted: 06/24/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Informing the child about his/her diagnosis and treatment plan is essential; research has shown that it is related to the patient's quality of life and adherence to medication. METHODS For 7 months during 2008 (February to September), 2 study-specific questionnaires were constructed and administered to 304 parents of children diagnosed with cancer at the Children's Cancer Hospital Egypt. RESULTS Among the 313 eligible parents of children diagnosed with cancer, 304 (97%) answered the first questionnaire and 281 (92%) answered the second questionnaire. We found that nearly three-quarters (72%) of the parents had their child's cancer diagnosis communicated by the physician. Among the 72%, the rate of the children present with the parent or parents during the disease disclosure conversation was 39% (n = 85/219). The majority of the children were in the age group 5-18 years (55%). CONCLUSIONS Our findings indicate that cancer disclosure at the Children's Cancer Hospital is to a certain degree common; yet even when disclosure does take place, it is mainly in the absence of the child. Moreover, the information provided during the conversation may not be fully comprehended by the parent or the child because of the physician's misleading use of terms when disclosing the disease. Therefore, better practice should be developed for disease disclosure, and proper communication should be established between the patients and the provider; patient autonomy should also have an influence in the clinical practice.
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Affiliation(s)
- Hanan El Malla
- Division of Clinical Cancer Epidemiology, Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Steineck
- Division of Clinical Cancer Epidemiology, Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Ylitalo Helm
- Division of Clinical Cancer Epidemiology, Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ulrica Wilderäng
- Division of Clinical Cancer Epidemiology, Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yasser El Sayed Elborai
- Children's Cancer Hospital Egypt, Cairo, Egypt.,Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.,National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Ulrika Kreicbergs
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Sophiahemmet University, Stockholm, Sweden.,Department of Nursing, Ersta Sköndal University College, Stockholm, Sweden
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14
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Holm KE, Patterson JM, Gurney JG. Parental Involvement and Family-Centered Care in the Diagnostic and Treatment Phases of Childhood Cancer: Results from a Qualitative Study. J Pediatr Oncol Nurs 2016; 20:301-13. [PMID: 14738162 DOI: 10.1177/1043454203254984] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Few research studies have addressed the ways parents participate in their childs medical care, particularly in relation to the cancer experience. The purpose of this study was to explore parents descriptions of their participation in medical care for their children with cancer. For this study, seven focus groups were conducted with 45 parents of 26 children who had completed cancer treatment at least one year prior, and who were still alive. Data were coded using thematic analysis procedures. It was found that parents emphasized their role as advocates during the diagnosis and treatment phases, by informing themselves about their childrens medical conditions, making medical care decisions, limiting the actions of medical professionals, and affirming and supporting medical professionals. These results emphasize the need to employ a family-centered approach in cancer care medical settings, by fostering and supporting the active inclusion of parents in their child’s treatment and management.
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Affiliation(s)
- Kristen E Holm
- Department of Family Social Science, University of Minnesota, St. Paul, USA
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15
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Badarau DO, Wangmo T, Ruhe KM, Miron I, Colita A, Dragomir M, Schildmann J, Elger BS. Parents' Challenges and Physicians' Tasks in Disclosing Cancer to Children. A Qualitative Interview Study and Reflections on Professional Duties in Pediatric Oncology. Pediatr Blood Cancer 2015. [PMID: 26207515 DOI: 10.1002/pbc.25680] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Professional guidelines encourage physicians to provide children with as much information regarding their health as deemed developmentally and emotionally appropriate. However, empirical research indicates that in clinical practice, an open discussion with children about cancer is often lacking. This study explores impeding factors to and possible strategies for open communication of cancer diagnosis to children from the perspectives of parents and physicians. PROCEDURE Semi-structured interviews were conducted with 18 parents of children with cancer and 10 treating oncologists. The patient sample was obtained from three pediatric units in Romania. Interviews were transcribed verbatim and interpreted using thematic analysis. Inductive open-coding procedures identified participants' accounts regarding their experiences with cancer diagnosis and treatment. Final themes were selected by grouping codes that formed a pattern in the data. RESULTS An interplay of mainly three different factors-information overload and emotional turmoil, lack of knowledge and skills for disclosing the diagnosis, and assumptions about burdening the child when discussing cancer-restricted parent-patient communication and subsequently affected physician-patient exchanges. Oncologists recommended open communication at diagnosis, but left the final decision to the parents. They adapted their communication style with patients to parents' preference. CONCLUSIONS Although physicians need to respect the wishes of children's legal representatives, they also have a duty to promote patients' best interests. We recommend that physicians employ a proactive stance in ensuring that children with cancer are appropriately informed about their diagnosis. In case of parents' arduous objections to full disclosure, an ethical consultation should be considered.
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Affiliation(s)
- Domnita O Badarau
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Katharina M Ruhe
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Ingrid Miron
- Department of Pediatric Oncology, St. Mary Emergency Hospital, Iasi, Romania
| | - Anca Colita
- Department of Pediatric Hemato-oncology & Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Monica Dragomir
- Department of Pediatric Oncology, Prof. Dr. Al. Trestioreanu Oncology Institute, Bucharest, Romania
| | - Jan Schildmann
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Coyne I, Amory A, Gibson F, Kiernan G. Information-sharing between healthcare professionals, parents and children with cancer: more than a matter of information exchange. Eur J Cancer Care (Engl) 2015; 25:141-56. [DOI: 10.1111/ecc.12411] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- I. Coyne
- School of Nursing & Midwifery; Trinity College Dublin; Dublin Ireland
| | - A. Amory
- School of Nursing & Midwifery; Trinity College Dublin; Dublin Ireland
| | - F. Gibson
- Children and Young People's Cancer Care; Great Ormond Street Hospital for Children NHS Foundation Trust; London
- School of Health and Social Care; Department of Children's Nursing; London South Bank University; London UK
| | - G. Kiernan
- School of Nursing & Human Sciences; Dublin City University; Dublin Ireland
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17
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Sato I, Higuchi A, Yanagisawa T, Mukasa A, Ida K, Sawamura Y, Sugiyama K, Saito N, Kumabe T, Terasaki M, Nishikawa R, Ishida Y, Kamibeppu K. Parent’s Perceived Provision of Information Regarding Diagnosis to Children with Brain Tumors. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.55048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Wiener L, Viola A, Koretski J, Perper ED, Patenaude AF. Pediatric psycho-oncology care: standards, guidelines, and consensus reports. Psychooncology 2014; 24:204-11. [PMID: 24906202 DOI: 10.1002/pon.3589] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/04/2014] [Accepted: 05/07/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to identify existing guidelines, standards, or consensus-based reports for psychosocial care of children with cancer and their families. PURPOSE Psychosocial standards of care for children with cancer can systematize the approach to care and create a replicable model that can be utilized in pediatric hospitals around the world. Determining gaps in existing standards in pediatric psycho-oncology can guide development of useful evidence-based and consensus-based standards. METHODS The MEDLINE and PubMed databases were searched by investigators at two major pediatric oncology centers for existing guidelines, consensus-based reports, or standards for psychosocial care of patients with pediatric cancer and their families published in peer-reviewed journals in English between 1980 and 2013. RESULTS We located 27 articles about psychosocial care that met inclusion criteria: 5 set forth standards, 19 were guidelines, and 3 were consensus-based reports. None was sufficiently up to date, comprehensive, specific enough, or evidence- or consensus-based to serve as a current standard for psychosocial care for children with cancer and their families. CONCLUSION Despite calls by a number of international pediatric oncology and psycho-oncology professional organizations about the urgency of addressing the psychosocial needs of the child with cancer to reduce suffering, there remains a need for development of a widely acceptable, evidence-based and consensus-based, comprehensive standard of care to guide provision of essential psychosocial services to all patients with pediatric cancer.
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19
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Kaye E, Mack JW. Parent perceptions of the quality of information received about a child's cancer. Pediatr Blood Cancer 2013; 60:1896-901. [PMID: 23775852 DOI: 10.1002/pbc.24652] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 05/21/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Parents' perceptions of the quality of information communicated by their child's oncologist about the child's cancer are not well understood. PROCEDURE We conducted a cross-sectional survey of 194 parents of children with cancer (response rate 70%), treated at the Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Mass, and the children's physicians. Parents were asked to report the quality of information received about the child's cancer in several domains. RESULTS Most parents reported that information about their child's cancer had been excellent (49%) or good (41%) overall, and ratings were similar for information about diagnosis (P = 0.62) and treatment (P = 0.59). Fewer parents felt they received high quality information about how cancer treatment is working (P < 0.001), likelihood of cure (P < 0.001), what the diagnosis means for the future (P < 0.001), and whether there is a cause for the child's cancer (P < 0.001). In multivariable models, parents were more likely to consider information of high quality when they also rated physician communication style highly. The accuracy of their knowledge on likelihood of cure and the child's future limitations, however, was not associated with quality ratings. CONCLUSIONS Although parents feel that they have received high quality cancer information overall, parents feel they receive lower quality information about issues relating to the child's future. Yet quality ratings are not associated with their actual knowledge. Parent perceptions of quality represent one, but not the only, facet of communication quality.
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Affiliation(s)
- Erica Kaye
- Department of Medicine, Boston Children's Hospital, Boston, Mass
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20
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Kelly KP, Pyke-Grimm K, Stewart JL, Hinds PS. Hypothesis generation for childhood cancer communication research: results of a secondary analysis. West J Nurs Res 2013; 36:512-33. [PMID: 24159058 DOI: 10.1177/0193945913507487] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Secondary analysis of existing qualitative datasets offers an opportunity to efficiently use these difficult-to-collect data to generate hypotheses for future research and expand understanding of the phenomena under study. We conducted a retrospective interpretation of two qualitative datasets regarding childhood cancer treatment decision making to elaborate themes regarding parents' cancer communication (information sharing and involvement of their children in treatment decision making) that were not fully developed in the original analyses. We identified broad variability in parents' cancer communication that was not entirely dependent upon the age of their ill child. We were able to generate multiple hypotheses to help guide our future research.
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Singer S, Gianinazzi ME, Hohn A, Kuehni CE, Michel G. General practitioner involvement in follow-up of childhood cancer survivors: a systematic review. Pediatr Blood Cancer 2013; 60:1565-73. [PMID: 23813795 DOI: 10.1002/pbc.24586] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 03/29/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND An increasing number of childhood cancer survivors need long-term follow-up care. Different models address this problem, including that of follow-up by general practitioners (GP). We describe models that involve GPs in follow-up for childhood cancer survivors, their advantages and disadvantages, clinics that employ these models, and the elements essential to high-quality, GP-led follow-up care. PROCEDURE We searched four databases (PubMed [including Medline], Embase, Cochrane, and CINAHL) without language restrictions. RESULTS We found 26 publications, which explicitly mentioned GP-led follow-up. Two models were commonly described: GP-only, and shared care between GP and pediatric oncology or late effects clinic. The shared care model appears to have advantages over GP-only follow-up. We found four clinics using models of GP-led follow-up, described in five papers. We identified well-organized transition, treatment summary, survivorship care plan, education of GPs and guidelines as necessary components of successful follow-up. CONCLUSION Scarcity of literature necessitated a review rather than a meta-analysis. More research on the outcomes of GP-led care is necessary to confirm the model for follow-up of childhood cancer survivors in the long term. However, with the necessary elements in place, the model of GP-led follow-up, and shared care in particular, holds promise.
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Affiliation(s)
- Sarah Singer
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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22
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Abstract
Advancing pediatric palliative care is desperately needed to support the physical, emotional, cultural, spiritual, and psychosocial needs of children and families who live with life-threatening illnesses. Although educational resources and standards of practice related to this topic have been developed, dissemination and implementation of programs have been slow to progress. The purpose of this case study is to present the lived experiences of an adolescent with leukemia and his family to illustrate how health care providers may benefit from receiving enhanced palliative and end-of-life care education.
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23
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Selove R, Kroll T, Coppes M, Cheng Y. Psychosocial services in the first 30 days after diagnosis: results of a web-based survey of Children's Oncology Group (COG) member institutions. Pediatr Blood Cancer 2012; 58:435-40. [PMID: 21755591 DOI: 10.1002/pbc.23235] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 05/18/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study examines what proportion of families of recently diagnosed pediatric cancer patients are offered recommended psychosocial services, and if that proportion is linked to size of institution or number of psychosocial staff. PROCEDURES A web-based survey was offered to all institutions belonging to the Children's Oncology Group (COG). RESULTS Respondents from 127/212 (=59.9%) COG institutions provided information about percentage of families offered specific services within the first 30 days after diagnosis, and barriers to providing such services, as well as information about other factors that might affect their ability to provide psychosocial care. All sites reported that ≥50% of families are offered 21 of the 27 services investigated in this study. Over half of respondents (n=290) indicated that inadequate funding for staff (72%) and families' time constraints (63%) were barriers to providing psychosocial care. There was a positive relationship between the total number of psychosocial staff and the number of new patients seen annually (Pearson correlation=0.3409, P-value < 0.0004), but not between the total number of psychosocial staff and specific services offered. Most sites do not use validated assessment tools or evidence-based psychosocial interventions. CONCLUSIONS While some version of most recommended psychosocial services are offered across COG institutions, evidence-based psychosocial services are offered at only 11% of sites. Advances in psychosocial outcomes in pediatric oncology could be accelerated by multi-site collaboration, use of standardized assessment tools, and evidence-based interventions.
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Affiliation(s)
- Rebecca Selove
- Centerstone Research Institute, 44 Vantage Way, Nashville, TN 37228, USA.
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24
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Docherty SL, Thaxton C, Allison C, Barfield RC, Tamburro RF. The nursing dimension of providing palliative care to children and adolescents with cancer. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2012; 6:75-88. [PMID: 23641169 PMCID: PMC3620813 DOI: 10.4137/cmped.s8208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Palliative care for children and adolescents with cancer includes interventions that focus on the relief of suffering, optimization of function, and improvement of quality of life at any and all stages of disease. This care is most effectively provided by a multidisciplinary team. Nurses perform an integral role on that team by identifying symptoms, providing care coordination, and assuring clear communication. Several basic tenets appear essential to the provision of optimal palliative care. First, palliative care should be administered concurrently with curative therapy beginning at diagnosis and assuming a more significant role at end of life. This treatment approach, recommended by many medical societies, has been associated with numerous benefits including longer survival. Second, realistic, objective goals of care must be developed. A clear understanding of the prognosis by the patient, family, and all members of the medical team is essential to the development of these goals. The pediatric oncology nurse is pivotal in developing these goals and assuring that they are adhered to across all specialties. Third, effective therapies to prevent and relieve the symptoms of suffering must be provided. This can only be accomplished with accurate and repeated assessments. The pediatric oncology nurse is vital in providing these assessments and must possess a working knowledge of the most common symptoms associated with suffering. With a basic understanding of these palliative care principles and competency in the core skills required for this care, the pediatric oncology nurse will optimize quality of life for children and adolescents with cancer.
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Affiliation(s)
- Sharron L Docherty
- Duke University, School of Nursing, Pennsylvania State University College of Medicine, Departments of Pediatrics and Public Health Sciences
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25
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Zwaanswijk M, Tates K, van Dulmen S, Hoogerbrugge PM, Kamps WA, Beishuizen A, Bensing JM. Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences. Psychooncology 2011; 20:269-77. [DOI: 10.1002/pon.1721] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Abstract
An 11-year old Asian-Indian boy was recently discovered to have acute myelogenous leukemia. The pediatric hematologist-oncologist arranged a meeting to inform the parents about the diagnosis, prognosis and treatment. The physician planned to include the child in this process. However, the child's father, a computer programmer, made a request that his son should not be informed about the diagnosis of leukemia. The father asked that his son should be told that he has a severe infection and will require intensive treatment. The oncologist then informed the father that, as a physician, she has the responsibility to truthfully disclose the diagnosis to a patient, and she insisted on informing the child about the leukemia in an open and truthful manner.
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27
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Spinetta JJ, Jankovic M, Masera G, Ablin AR, Barr RD, Ben Arush MW, D'Angio GJ, Van Dongen-Melman J, Eden T, Epelman C, Martins AG, Greenberg ML, Kosmidis HV, Oppenheim D, Zeltzer PM. Optimal care for the child with cancer: A summary statement from the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology. Pediatr Blood Cancer 2009; 52:904-7. [PMID: 19142992 DOI: 10.1002/pbc.21863] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since its foundation in 1991, the SIOP Working Committee on Psychosocial Issues in Paediatric Oncology1 has developed and published 12 sets of Guidelines for health-care professionals treating children with cancer and their families. Those elements considered essential in the process of cure and care of children with cancer are summarized in this document as a formal statement, developed at the 2007 SIOP annual meeting in Mumbai. Elaboration of the concepts with detailed strategies for practice can be found in the referenced guidelines [1-12] and in a companion publication [13]. This article is a summary of what practitioners considered critical elements in the optimal care of the child with cancer, with the goal of stimulating a broader application of these elements throughout the SIOP membership.
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Affiliation(s)
- John J Spinetta
- Department of Psychology, San Diego State University, San Diego, California, USA
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28
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Quinn GP, Vadaparampil ST. Fertility preservation and adolescent/young adult cancer patients: physician communication challenges. J Adolesc Health 2009; 44:394-400. [PMID: 19306799 DOI: 10.1016/j.jadohealth.2008.08.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 08/20/2008] [Accepted: 08/27/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE The doctor-parent-adolescent triad is a unique communication challenge, particularly in the area of fertility preservation for adolescents with cancer. This paper provides a preliminary exploration into the barriers experienced by physicians in discussing cancer related fertility issues with patients aged 12-18. METHODS This study used a subset of the data from qualitative interviews with pediatric oncologists. RESULTS The majority of physicians agreed that fertility preservation conversations were awkward because of limited options and resources for the technology as well as the existence of a fine line between establishing a sense of trust between doctor and patient, while not excluding parents. CONCLUSIONS Healthcare providers need training on how and when to broach fertility issues with patients, emphasizing open communication and early disclosure.
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Affiliation(s)
- Gwendolyn P Quinn
- University of South Florida, College of Medicine, Department of Oncologic Sciences, Tampa, Florida 33647, USA.
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29
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Tates K, Zwaanswijk M, Otten R, van Dulmen S, Hoogerbrugge PM, Kamps WA, Bensing JM. Online focus groups as a tool to collect data in hard-to-include populations: examples from paediatric oncology. BMC Med Res Methodol 2009; 9:15. [PMID: 19257883 PMCID: PMC2653071 DOI: 10.1186/1471-2288-9-15] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 03/03/2009] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this article is to describe and evaluate the methodology of online focus group discussions within the setting of paediatric oncology. Methods Qualitative study consisting of separate moderated asynchronous online discussion groups with 7 paediatric cancer patients (aged 8–17), 11 parents, and 18 survivors of childhood cancer (aged 8–17 at diagnosis). Results All three participant groups could be actively engaged over a one-week period. Respondents highly valued the flexibility and convenience of logging in at their own time and place to join the discussion. Adolescent patients and survivors emphasized that the anonymity experienced made them feel comfortable to express their views in detail. The findings indicate a strong preference for online group discussions across all participant groups. Conclusion The findings show that online focus group methodology is a feasible tool for collecting qualitative data within the setting of paediatric oncology, and may offer new opportunities to collect data in other hard-to-include populations. The evaluations seem to indicate that the online group discussions have given participants an opportunity to articulate their experiences and views in a way they might not have done in a traditional group discussion.
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Affiliation(s)
- Kiek Tates
- NIVEL (Netherlands Institute for Health Services Research), BN Utrecht, The Netherlands.
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30
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Seitz DCM, Besier T, Goldbeck L. Psychosocial interventions for adolescent cancer patients: a systematic review of the literature. Psychooncology 2008; 18:683-90. [DOI: 10.1002/pon.1473] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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31
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Abstract
BACKGROUND Finding out that your child has cancer is a devastating experience. How this information is communicated can have a lasting impression on parents receiving the news. The purpose of this study was to assess how well parents recall discussing the diagnosis of cancer and to summarize suggestions for improvement. METHODS A questionnaire was developed with input from several parents of children previously diagnosed with cancer. All parents of children <18 years of age with a diagnosis of cancer who were >1 month post-diagnosis at our children's hospital were asked to participate. The patient sample was identified through the in- and outpatient clinics from June to August 2006. RESULTS One-hundred sixteen parents (mothers and fathers) completed the questionnaire, with only two parents refusing (1.7%). The moment of disclosure of the diagnosis was remembered vividly in 77%, well in 20%, and somewhat, vaguely or not at all in 1% each. Parental reaction to the disclosure was viewed as a positive experience 79% of the time and a negative experience 21% of the time. Parents also provided a number of suggestions for future disclosure. CONCLUSIONS The majority of parents recall receiving the diagnosis and the discussions that ensued about their child's diagnosis of cancer. Most parents were satisfied with their experience with receiving the diagnosis. Suggestions for improvement can be incorporated into future educational indicatives for front line healthcare providers to improve communication of sensitive diagnoses with parents.
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Affiliation(s)
- Torrey M Parker
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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32
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Abstract
An 11-year old Asian-Indian boy was recently discovered to have acute myelogenous leukemia. The pediatric hematologist-oncologist arranged a meeting to inform the parents about the diagnosis, prognosis and treatment. The physician planned to include the child in this process. However, the child's father, a computer programmer, made a request that his son should not be informed about the diagnosis of leukemia. The father asked that his son should be told that he has a severe infection and will require intensive treatment. The oncologist then informed the father that, as a physician, she has the responsibility to truthfully disclose the diagnosis to a patient, and she insisted on informing the child about the leukemia in an open and truthful manner.
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Rivero-Vergne A, Berrios R, Romero I. Cultural aspects of the Puerto Rican cancer experience: the mother as the main protagonist. QUALITATIVE HEALTH RESEARCH 2008; 18:811-820. [PMID: 18503022 DOI: 10.1177/1049732308318505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pediatric cancer survivors are a growing group whose needs extend to multiple contexts and systems. Most studies dealing with the emotional sequelae of childhood cancer have neglected patients' and parents' perspectives. Few have dealt with issues faced by the treatment team. Our research constitutes the first attempt to gather a collective view of such experience in Puerto Rico. Using a phenomenological approach, in-depth interviews were conducted with acute lymphoblastic leukemia (ALL) patients, their mothers, and their oncology treatment team (18) at a children's hospital in Puerto Rico. Analysis followed the model proposed by Strauss and Corbin. In this article, findings directly associated with the cultural aspects of the Puerto Rican cancer experience are presented, including the mother's role--devotion and abandonment; the father's role--masculine vulnerability; and the family paradox. Mothers' protagonism was the central theme that emerged from these three categories.
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Affiliation(s)
- Alicia Rivero-Vergne
- Department of Psychology, Inter American University of Puerto Rico, San Juan, Puerto Rico.
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Abstract
Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-threatening conditions and their families. To achieve this goal, the individuals working in this field need to: clearly define the population served; better understand the needs of children with life-threatening conditions and their families; develop an approach that will be appropriate across different communities; provide care that responds adequately to suffering; advance strategies that support caregivers and health-care providers; and promote needed change by cultivating educational programmes. Despite these challenges, advances in paediatric palliative care have been achieved in a short period of time; we expect far greater progress as the field becomes more formalised and research networks are established.
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Affiliation(s)
- Stephen Liben
- The Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
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35
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Zieber S, Friebert S. Pediatric cancer care: special issues in ethical decision making. Cancer Treat Res 2008; 140:93-115. [PMID: 18283772 DOI: 10.1007/978-0-387-73639-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Sarah Zieber
- Vanderbilt Children's Hospital, Department of Pediatrics, Nashville, TN 37232-6310, USA
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36
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Zwaanswijk M, Tates K, van Dulmen S, Hoogerbrugge PM, Kamps WA, Bensing JM. Young patients', parents', and survivors' communication preferences in paediatric oncology: results of online focus groups. BMC Pediatr 2007; 7:35. [PMID: 17996108 PMCID: PMC2206018 DOI: 10.1186/1471-2431-7-35] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 11/09/2007] [Indexed: 12/24/2022] Open
Abstract
Background Guidelines in paediatric oncology encourage health care providers to share relevant information with young patients and parents to enable their active participation in decision making. It is not clear to what extent this mirrors patients' and parents' preferences. This study investigated communication preferences of childhood cancer patients, parents, and survivors of childhood cancer. Methods Communication preferences were examined by means of online focus groups. Seven patients (aged 8–17), 11 parents, and 18 survivors (aged 8–17 at diagnosis) participated. Recruitment took place by consecutive inclusion in two Dutch university oncological wards. Questions concerned preferences regarding interpersonal relationships, information exchange and participation in decision making. Results Participants expressed detailed and multi-faceted views regarding their needs and preferences in communication in paediatric oncology. They agreed on the importance of several interpersonal and informational aspects of communication, such as honesty, support, and the need to be fully informed. Participants generally preferred a collaborative role in medical decision making. Differences in views were found regarding the desirability of the patient's presence during consultations. Patients differed in their satisfaction with their parents' role as managers of the communication. Conclusion Young patients' preferences mainly concur with current guidelines of providing them with medical information and enabling their participation in medical decision making. Still, some variation in preferences was found, which faces health care providers with the task of balancing between the sometimes conflicting preferences of young cancer patients and their parents.
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Affiliation(s)
- Marieke Zwaanswijk
- NIVEL, Netherlands Institute for Health Services Research, P,O, Box 1568, 3500 BN Utrecht, The Netherlands.
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Baker JN, Barfield R, Hinds PS, Kane JR. A process to facilitate decision making in pediatric stem cell transplantation: the individualized care planning and coordination model. Biol Blood Marrow Transplant 2007; 13:245-54. [PMID: 17317576 DOI: 10.1016/j.bbmt.2006.11.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 11/13/2006] [Indexed: 11/24/2022]
Abstract
Providers of care for children undergoing stem cell transplantation (SCT) skillfully combine the roles of scientist and clinician. As scientists, they apply scientific methods and disease theory in the creation and testing of new therapies and in the careful observation and exploration of treatment outcomes. As clinicians, they are capable of intuitively delivering care in a patient- and family-centered context of meaning and life values. The specialty of SCT has inherent aspects that make treatment decision making complex and potentially contentious. Having a strategy ready to implement in advance or at the time when treatment decisions need to be made will facilitate and enhance the decision making process for both the health care team and family members. Here we introduce the individualized care planning and coordination (ICPC) model as a practical approach to facilitate ethical and effective decision making in pediatric SCT settings. The ICPC is a 3-step model comprising (1) relationship--understanding the illness experience from the perspective of the patient and family, sharing relevant information, and assessing ongoing needs; (2) negotiation--prognosticating, establishing goals of care, and discussing treatment options; and (3) plan--generating a comprehensive plan of care that includes life and medical plans. Based on a foundation of a care of competence, empathy, compassion, communication, and quality, the ICPC model aims to diminish contentious family-staff interactions that can lead to mistrust and help guide treatment decision making. The ICPC model enhances communication among patients, families, and clinicians by revealing patient and family values and medical and quality-of-life priorities before reaching or even during critical decision points in the transplantation process.
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Affiliation(s)
- Justin N Baker
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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Abstract
With improvements in therapy for childhood cancer, the expectation that most childhood cancer patients will survive and enter adulthood is a reality. There is clear evidence that survivors are at risk for adverse health-related long-term sequelae associated with their cancer and its treatment, requiring appropriate health care resources. What is less clear is how this health care should optimally be delivered. We review the functional and operational needs for long-term follow-up for childhood cancer survivors and present alternatives for models of care. Programs for childhood cancer survivors should provide mechanisms for monitoring and management of late effects, as well as support and advocacy for addressing psychosocial issues, health education, and assistance with financial concerns. Access to research is an important component as clinical care and research are integrally related. A multidisciplinary model that provides continuity of care throughout the disease course is optimal, providing transitions from acute anti-neoplastic therapy to follow-up and primary care, as well as from pediatric care to adult-oriented care. There is no single best model of care for all childhood cancer survivors. In evaluating different models, considerations include available resources as well as the particular cancer population being served. Not all survivors require the same level of services and the service level requirement for individual patients may change with time. As outcome research progresses for childhood cancer survivors, methodological issues of optimal health care delivery for this population deserve to be the subject of such research.
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39
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Abstract
The treatment and management of chronic conditions during adolescence pose specific issues that need to be appropriately handled by health professionals. In this paper, questions related to disclosure of the diagnosis, the management of adherence to therapy, the need for an interdisciplinary network approach, lifestyles' anticipatory guidance and prevention, and the transition into an adult healthcare setting are reviewed. Special areas such as the issue of life threatening diseases and the ethical aspects of the treatment of chronic conditions are also discussed.
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Affiliation(s)
- P-A Michaud
- Unité Multidisciplinaire pour la Santé des Adolescents, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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40
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Affiliation(s)
- D Caprino
- Department of Pediatric Hematology and Oncology, G. Gaslini Scientific Children's Hospital, Genoa, Italy.
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41
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Affiliation(s)
- Jack E Burkhalter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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Masera G, Beltrame F, Corbetta A, Fraschini D, Adamoli L, Jankovic M, Spinetta JJ. Audiotaping communication of the diagnosis of childhood leukemia: parents' evaluation. J Pediatr Hematol Oncol 2003; 25:368-71. [PMID: 12759622 DOI: 10.1097/00043426-200305000-00004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate how parents viewed the authors' practice of audiotaping the initial communication of the leukemia diagnosis and of the complete program of care, including the prognosis. METHODS From January 1997 through December 1998, at the end of the formal communication interview, parents were asked to evaluate the audiotaping by filling out a questionnaire concerning the procedure. RESULTS Sixty-three parents of children with leukemia participated. CONCLUSIONS The authors' use of audiotapes was strongly supported by the parents as a supplementary intervention and has become a routine procedure.
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Affiliation(s)
- Giuseppe Masera
- Clinica Pediatrica dell' Università di Milano-Bicocca, Azienda Ospedaliera San Gerardo, Monza, Italy.
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43
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Spinetta JJ, Masera G, Jankovic M, Oppenheim D, Martins AG, Ben Arush MW, van Dongen-Melman J, Epelman C, Medin G, Pekkanen K, Eden T. Valid informed consent and participative decision-making in children with cancer and their parents: a report of the SIOP Working Committee on psychosocial issues in pediatric oncology. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 40:244-6. [PMID: 12555253 DOI: 10.1002/mpo.10262] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the tenth official document of the SIOP Working Committee on psychosocial issues in pediatric oncology, instituted in 1991. It is addressed to the pediatric oncology community. Children clearly have a right to participate in medical decisions regarding their own treatment, based on the developmental level of the child. The objective of these guidelines is to encourage physicians to share with the child developmentally relevant medical information specific to that particular child's health status, in the context of the child's own culture, so that he or she can actively participate in the decision-making process regarding his or her own health. These guidelines, geared toward this objective, discuss the child's right to medical information, the parents' legal responsibility for but not exclusive right over the child's health, and ways of encouraging the younger child's active participation in his or her own health care at an age-appropriate level of understanding. For adolescents, there should be a full and legally mandated power to make their own decisions regarding medical treatment.
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Affiliation(s)
- John J Spinetta
- Department of Psychology, San Diego State University, San Diego, California, USA
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44
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Abstract
This study reviews the common long-term sequalae of childhood cancer and its therapy. It discusses the clinical and research challenges posed by such late effects. The authors address related topics of late effects research and clinical care, methodological issues, barriers and directions for the future.
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Affiliation(s)
- Debra L Friedman
- Division of Pediatric Hematology/Oncology, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle 98117, USA.
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45
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Abstract
Research has indicated that information and social support may have helped children and adolescents with cancer to cope with their illness and lead normal lives. However, recent researchers have reported that youths with cancer express a clear interest in receiving more information and social support. This study reviewed research on information and social support for children and adolescents with cancer to understand their needs. Young patients with cancer showed high uncertainty about cancer. Besides, adolescents with cancer were more in conflict with their parents than healthy youths. Discussions on future plans or death are difficult for young people with cancer. They also are frequently absent from school over time. Moreover, they want to make healthy friends. To fulfill the needs of these youths, nurses should be aware not only of individualized information and social support, but also of these factors from an ecologic perspective. Further qualitative research is required to identify the needs of youths with cancer and resolve these issues.
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Affiliation(s)
- A Ishibashi
- Oita University of Nursing and Health Sciences, School of Nursing, Japan
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Mattson M, Roberts F. Overcoming truth telling as an obstacle to initiating safer sex: clients and health practitioners planning deception during HIV test counseling. HEALTH COMMUNICATION 2001; 13:343-362. [PMID: 11771801 DOI: 10.1207/s15327027hc1304_01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article considers how deception, as a strategy for handling delicate interpersonal situations, is raised and responded to during HIV pretest counseling sessions. Two cases are presented in which clients (CLs) formulate extrarelational sexual encounters as potential obstacles to initiating safer sex practices with long-term relational partners (because reinitiating safer sex with such partners would entail admission of the extrarelational encounters). Close analysis of spoken interaction reveals that CLs display their resistance to initiating safer sex by animating, through hypothetical dialogue, their long-term partners' requests for explanation of the disruption in their usual intimate behaviors; health practitioners attempt to overcome this obstacle of "truth telling" by suggesting deception in its place. This study extends current understandings of the formulation and planning of deceptive messages in the course of actual health promotion interactions. The implications of this investigation suggest that deception may pose a viable, albeit controversial, option when promoting disease prevention behaviors, especially in delicate interpersonal interactions such as not wanting to admit an extrarelational affair.
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Affiliation(s)
- M Mattson
- Department of Communication, Purdue University, West Lafayette, IN 49707-1366, USA.
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47
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[In Process Citation]. Arch Pediatr 2000; 7 Suppl 2:181s-182s. [PMID: 10904701 DOI: 10.1016/s0929-693x(00)80028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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Masera G, Spinetta JJ, Jankovic M, Ablin AR, Buchwall I, Van Dongen-Melman J, Eden T, Epelman C, Green DM, Kosmidis HV, Yoheved S, Martins AG, Mor W, Oppenheim D, Petrilli AS, Schuler D, Topf R, Wilbur JR, Chesler MA. Guidelines for a therapeutic alliance between families and staff: a report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology. MEDICAL AND PEDIATRIC ONCOLOGY 1998; 30:183-6. [PMID: 9434830 DOI: 10.1002/(sici)1096-911x(199803)30:3<183::aid-mpo12>3.0.co;2-o] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This, the fifth official document of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology, develops another important topic: the Therapeutic Alliance between families and staff. This is addressed to the Pediatric Oncology Community as Guidelines that could be followed. Every parent, medical staff member, and psychosocial professional involved in the care of the child should be responsible for cooperating in the child's best interest. Everyone must work together toward the common goal of curing the cancer and minimizing its medical and psychosocial side-effects.
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Affiliation(s)
- G Masera
- Clinica Pediatrica dell'Università di Milano, Ospedale San Gerardo, Monza, Italy
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49
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Masera G, Jankovic M, Adamoli L, Corbetta A, Fraschini D, Lia R, Collino L, Locati A, Pertici S, Bissi R, Bertolini M, Verga G, Spinetta JJ. The psychosocial program for childhood leukemia in Monza, Italy. Ann N Y Acad Sci 1997; 824:210-20. [PMID: 9382446 DOI: 10.1111/j.1749-6632.1997.tb46224.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- G Masera
- Clinica Pediatrica, Università di Milano, Ospedale San Gerardo, Italy
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