Parent perceptions of pediatric oncology care during the COVID-19 pandemic: An Australian study

Psychological Experiences of Parents of Pediatric Cancer Patients during and after COVID-19 Pandemic

BACKGROUND

Family members dealing with the devastating impact of a cancer diagnosis are now facing even greater vulnerability due to the COVID-19 pandemic. Alongside the already overwhelming trauma, they must also bear the distressing burden of the infection risks. The purpose of this study was to examine and explore the effects in parents of pediatric cancer patients two years after the start of the COVID-19 pandemic to compare these data with the previous data.

METHODS

We conducted a single-center prospective observational study, enrolling 75 parents of 42 pediatric oncology patients. Four questionnaires (IES-R; PSS; STAI-Y and PedsQL) were given to the parents 2 years after the first evaluation.

RESULTS

The bivariate matrix of correlation found a strong significant positive correlation between IES-R and PSS scores (r = 0.526, p < 0.001) as in T1. Stress symptoms (t = 0.00, p < 0.001) and levels of anxiety (trait) (t = 0.32, p < 0.001) remained unchanged; anxiety state levels appeared to have increased (t = 0.425, p < 0.001); there was a significant decrease in the PedsQL tot (t = 5.25, p < 0.001).

CONCLUSIONS

The COVID-19 pandemic has influenced the levels of stress and anxiety of parents and the quality of life of patients, also correlating with the traumatic impact of the diagnosis.

The Psychosocial Impact of the COVID-19 Pandemic on Families of Youth of Color: A Prospective Cohort Study

OBJECTIVE

Prospectively examine racial and ethnic disparities in exposure to COVID-19-related stressors and their impact on families.

METHODS

A racially, ethnically, and socioeconomically diverse cohort of caregivers of youth (n = 1,581) representative of the population served by a pediatric healthcare system completed the COVID-19 Exposure and Family Impact Scales in Oct/Nov 2020 and March/April 2021. Linear mixed-effects models were used to examine exposure to COVID-19-related events (Exposure), impact of the pandemic on family functioning and well-being (Impact), and child and parent distress (Distress) across time and as a function of race and ethnicity, adjusting for other sociodemographic variables.

RESULTS

Exposure and Distress increased over time for all participants. After adjusting for sociodemographic factors, caregivers of Black and Hispanic youth reported greater Exposure than caregivers of White youth and caregivers of Black youth had a greater increase in Exposure over time than caregivers of White youth. Caregivers of White youth reported greater Impact than caregivers of Black and Other race youth.

CONCLUSIONS

Exposure to and impact of the COVID-19 pandemic on family psychosocial functioning varied by race and ethnicity. Although exposure to COVID-19-related events was greater among Hispanic and non-Hispanic Black families, those of marginalized races reported less family impact than non-Hispanic White families, suggesting resiliency to the pandemic. Research should examine such responses to public health crises in communities of color, with a focus on understanding protective factors. These findings suggest the importance of culturally tailored interventions and policies that support universal psychosocial screenings during times of public health crises.

Variation in parental experiences with their child's hospitalization over the COVID-19 pandemic

BACKGROUND

Hospitals and healthcare workers have been greatly impacted by the COVID-19 pandemic. The potential impacts upon the patient experience have been less documented, particularly in the pediatric setting. Our aim was to examine how parental experiences with their child's hospitalization varied during the COVID-19 pandemic at two children's hospitals in Alberta, Canada.

METHODS

A random sample of parents were surveyed within six weeks of their child's discharge from Alberta's two children's hospitals. Surveys were administered using the Alberta Pediatric Inpatient Experiences Survey (APIES) - a validated instrument used to assess parental experiences during their child's hospitalization. Surveys were linked with administrative inpatient records. Three cohorts were created based on hospital discharge date: Pre-COVID (Pre: April 2019 to March 2020), COVID year one (C1: April 2020 to March 2021), and COVID year two (C2: April 2021 to March 2022). We examined 48 survey questions, including four overall rating scales. Survey responses were Likert scales. These were transformed to normalized scores from 0 (worst) to 100 (best). Differences between cohorts were assessed using ANOVA and the post-hoc Tukey test.

RESULTS

A total of 3,611 surveys (1,314 Pre; 997 C1; 1,300 C2) were completed over the three-year period. Five questions showed differences between the Pre and C1 periods, six showed differences between Pre and C2, and 13 showed differences between C1 and C2. Among these questions, scores pre-COVID were lower than COVID year one, while results in COVID year two were lower than pre-COVID and COVID year one. Thirty-one survey questions showed no statistical differences between the three time periods. For the overall ratings, only hospital rating showed a difference in any of the periods (91.4 C1 vs. 90.2 C2). Overall ratings of doctors, nurses, and recommendation of the hospital to others showed no differences.

CONCLUSION

This study showed that the experiences of parents during the first year of the COVID-19 pandemic were mildly better or comparable to historical results. This changed over the following year, where lower scores were reported on 13 questions.

The Psychosocial Impact of the COVID-19 Pandemic on Families of Children With Cancer in the Low-income Setting

The coronavirus disease 2019 (COVID-19) pandemic has had a profound effect on families' psychosocial well-being worldwide. This study aimed to investigate the pandemic's impact on families of children with cancer in a low-income setting in Syria. The study conducted a cross-sectional survey of 50 families of children with cancer receiving treatment at a nongovernmental organization-based pediatric oncology unit in Syria. The survey used the Corona Anxiety Scale (CAS) to assess the pandemic's impact on families' anxiety, and other items to evaluate the financial toxicity of the strict measures implemented during the pandemic's first months. The study's results revealed that the COVID-19 pandemic significantly negatively impacted the psychosocial well-being of families of children with cancer in Syria. Specifically, 22% of families reported a major increase in anxiety levels (CAS of >9), and the majority of families (84%) reported excessive indirect financial costs, including travel and living expenses. The study emphasizes the significant social and psychological impact of the COVID-19 pandemic on families of children with cancer in Syria, highlighting the need for additional psychosocial interventions to mitigate future global health crises or pandemics' impact on this vulnerable population. The interventions should prioritize promoting resilience and adaptive coping strategies.

Trend in the admissions of patients with non-COVID-19 respiratory symptoms during COVID-19 pandemic and its impact on hospital finances in surabaya, Indonesia

Background

COVID-19 cases surge, it has a crucial impact on healthcare systems, with rapidly increasing demand for healthcare resources in hospitals and intensive care units (ICUs) in Indonesia and worldwide. It is necessary to quantify the extent to which the effects of the COVID-19 pandemic on the hospital admissions, and clinical and financial outcomes of patients with non-COVID-19 respiratory symptoms.

Objective

To determine whether the COVID-19 pandemic changed the hospitalisation of child and adult patients with non-COVID-19 respiratory conditions and whether these changes affected the patient's disease condition, clinical outcomes, and hospital finances.

Methods

A retrospective cohort study was conducted from May 1, 2018 (before the COVID-19 pandemic) until December 31, 2021. Total sampling was done to compare hospital admission of patients with non-COVID-19 respiratory symptoms before versus during the COVID-19 pandemic. The results were analyzed using SPSS 26.0 and SmartPLS.v.3.2.9.

Results

There was a reduction in hospitalisations for respiratory disorders unrelated to COVID-19 during the pandemic by 55.3% in children and 47.8% in adult patients. During the pandemic, the average hospital revenue per patient of child and adult patients increased significantly, but the profit per patient decreased. Pathway analysis showed that in children, the COVID-19 Pandemic changed disease severity and complexity (β = 0.132, P < 0.001), as well as clinical outcomes (β = 0.029, P < 0.05). In adults, the COVID-19 pandemic improves disease severity and complexity (β = -0.020, P < 0.001), as well as clinical outcomes (β = -0.013, P < 0.001). COVID-19 pandemic increases care charges (in children with β = 0.135, P < 0.001; and in the adult patients with β = 0.110, P < 0.001), worsens hospital financial outcomes relating to child (β = -0.093, P < 0.001) and adult patient (β = -0.073, P < 0.001). In adult patients, seasonal variations moderate the impact of the COVID-19 pandemic on improving disease conditions (β = -0.032, P=<0.001). The child structural model effectively predicted clinical outcomes (Q² = 0.215) and financial outcomes (Q² = 0.462). The adult structural model effectively predicted clinical outcomes (Q² = 0.06) and financial outcomes (Q² = 0.472).

Conclusion

The conclusions are that the number of non-COVID respiratory patients decreased during the COVID-19 pandemic (47.8% in adult patients, 55.3% in child patients). Disease severity and complexity increased in child patients but decreased in adult patient. Costs of care and insurance payments increased. Since the insurance payments did not increase as much as the cost of care, hospital profit decreased.

Ethical challenges faced by healthcare workers in pediatric oncology care during the COVID-19 pandemic in Australia

OBJECTIVE

This qualitative study examined ethical challenges reported by healthcare professionals (HCPs) working in a large Australian pediatric oncology center during a period of strict COVID-19 restrictions.

METHODS

We conducted semi-structured interviews with 21 HCPs who provided pediatric cancer care during the pandemic in 2020, during strict lockdown periods. Interviews examined the difficulties they faced, as well as their own ethical evaluation of the impact of COVID-19 policies on oncology care. Data were analyzed using inductive content analysis and thematic analysis.

RESULTS

HCPs faced several challenges, primarily originating from hospital restrictions, which led to changes in usual clinical practices. These challenges included delivering care with personal protective equipment (PPE), the impact of a one-parent visitation policy, changes in psychosocial and allied health services, and COVID-19 swabbing policies. Overall, there was consensus from participants that hospital restrictions were justified and, while difficult, HCPs simply had to provide the best care possible given the circumstances. However, participants described decreased capacity to deliver holistic patient care and, in some instances, a tendency to avoid ethical reflection. Lastly, there was a consistent theme of shame and sense of responsibility underlying some participants' anxiety around inadvertently transmitting COVID-19 to immunocompromised patients.

CONCLUSION

Our findings show that many staff felt unease at the disruptions in patient care due to COVID-19 restrictions. Some HCPs indicated a degree of moral distress, with a possibility of moral injury among some HCPs. A focus on ethical recovery could assist in preventing any ongoing difficulties among HCPs because of their experiences.

Differences in Stakeholders' Perception of the Impact of COVID-19 on Clinical Care and Decision-Making

Background: Pandemics are related to changes in clinical management. Factors that are associated with individual perceptions of related risks and decision-making processes focused on prevention and vaccination, but perceptions of other healthcare consequences are less investigated. Different perceptions of patients, nurses, and physicians on consequences regarding clinical management, decisional criteria, and burden were compared. Study Design: Cross-sectional OnCoVID questionnaire studies. Methods: Data that involved 1231 patients, physicians, and nurses from 11 German institutions that were actively involved in clinical treatment or decision-making in oncology or psychiatry were collected. Multivariate statistical approaches were used to analyze the stakeholder comparisons. Results: A total of 29.2% of professionals reported extensive changes in workload. Professionals in psychiatry returned severe impact of pandemic on all major aspects of their clinical care, but less changes were reported in oncology (p < 0.001). Both patient groups reported much lower recognition of treatment modifications and consequences for their own care. Decisional and pandemic burden was intensively attributed from professionals towards patients, but less in the opposite direction. Conclusions: All of the groups share concerns about the impact of the COVID-19 pandemic on healthcare management and clinical processes, but to very different extent. The perception of changes is dissociated in projection towards other stakeholders. Specific awareness should avoid the dissociated impact perception between patients and professionals potentially resulting in impaired shared decision-making.

Parental Factors Contribute to Childhood Cancer Abandonment Treatment During COVID-19

Factors influence a person’s health seeking behavior related to abandonment rate on pediatric oncology treatment during this pandemic is unknown. The aim is to identify factors influencing abandonment rates in early pandemic. This was a cross-sectional studies during early pandemic and analyze factors in parents whose children had treatment for malignancy contribute to their children’s abandonment treatment rate through guided interview using questionnaire. The characteristic related significantly with treatment abandonment is maternal education. It is found that patients whose mother had education less than secondary school was 1.315 (CI 1.013-1.707) having risk experience abandonment treatment. Parental perception related to impact of COVID-19 was significantly related to treatment abandonment rate with RR 0.202 (CI 0.86-0.471). Patients whose parents have positive perception how abandonment treatment affect their child outcome, believe that doctor has taken step to prevent COVID-19 transmission during treatment, and receive information about COVID-19, having less risk being abandonment treatment.