1
|
Sinnathamby A, Lee LY, Ng GMC. " Why Are we Giving up on my Brother?"-The Unmet Needs of the Adolescent Facing End-of-Life Care in a Sibling. J Palliat Med 2024. [PMID: 38905128 DOI: 10.1089/jpm.2023.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Abstract
Adolescence is a challenging time at baseline, and a sibling receiving end-of-life care can alter an adolescent's life irrevocably. It is imperative for the medical team to understand the unique needs and perspectives of such an adolescent sibling. This in turn facilitates the anticipation of an adolescent's grief response, and allows for parents to be appropriately guided. However, more can be done to evaluate the needs of adolescent siblings and improve their support. This can be through establishing a validated needs-based questionnaire, empowering families and the multidisciplinary team to engage siblings, and diverting resources toward culturally sensitive support groups for siblings with critical illness. A framework to involve key players in the adolescent's circle is presented.
Collapse
Affiliation(s)
- Annushkha Sinnathamby
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Division of Palliative Care, National University Cancer Institute, Singapore, Singapore
| | - Le Ye Lee
- Foundation Healthcare Holdings, Singapore, Singapore
| | | |
Collapse
|
2
|
Nilsson S, Öhlén J, Nyblom S, Ozanne A, Stenmarker M, Larsdotter C. Place of death among children from 0 to 17 years of age: A population-based study from Sweden. Acta Paediatr 2024. [PMID: 38819101 DOI: 10.1111/apa.17308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
AIM The aim of this study is to contribute to the development of paediatric palliative care by investigating, on a population basis, where children in Sweden died, from 2013 to 2019. A particular focus was on comparing two groups: children who died during their first year of life with children who died at 1-17 years of age. METHODS We hypothesised that there might be variations in place of death between the defined groups. Utilising national registry data, descriptive statistics were used to assess the distribution and variations in the place of death. Logistic regression analyses were conducted to ascertain the impact of associated factors. RESULTS Most children died in hospitals (74.7%). The hypothesis postulating divergences in the place of death between age groups was not substantiated. Sex and birthplace showed no significant differences in home deaths. Deaths due to malignancies had a relatively high likelihood of occurring at home (39.0%). For perinatal diagnoses, the incidence of home deaths was relatively low (1.5%). CONCLUSION Children who received support from a specialist palliative service in their own homes were notably less likely to die in a hospital setting compared to those who did not receive such support. An unplanned hospital visit increased the likelihood of hospital death.
Collapse
Affiliation(s)
- Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stina Nyblom
- Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margaretha Stenmarker
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics, Region Jönköping County, Jönköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Cecilia Larsdotter
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| |
Collapse
|
3
|
Schwartz-Attias I, Ash S, Ofir R, Ben Gal Y, Broitman M, Saeb M, Hornik-Lurie T. Gaps in pediatric oncologic end of life care as recounted by the bereaved parents in Isarel. J Pediatr Nurs 2024; 75:187-195. [PMID: 38163422 DOI: 10.1016/j.pedn.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/23/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE This study investigated parents' perception of their needs and those of their children with cancer at the end-of-life period, including unmet needs and their expectations regarding providers. DESIGN AND METHODS This cross-sectional study involved 26 parents recruited from three pediatric hematology-oncology wards in Israel who completed demographic and medical questionnaires of the child, and a parental needs questionnaire based on The Needs Assessment of Family Caregivers-Cancer questionnaire, following the death of their child. FINDINGS Parents expressed needs related to medical care, including pain management, decision-making, and finding optimal treatment options for their children. The most prominent unmet needs were financial and psychological factors, of which, paying for medical expenses and helping their child adjust to the end of their life received the highest mean scores. There were notable gaps between desired and actual support from service providers, particularly in relation to emotional aspects. While over half of the parents believed the psychosocial team should assist with their child's emotional distress, this need was not adequately fulfilled. Some parents also expressed a desire for better emotional support during the end-of-life period. CONCLUSIONS The study emphasizes the importance of understanding parents' needs and perspectives during this challenging time. The identified gaps in support can be attributed to parental roles, the struggle with losing hope, communication barriers between care teams and parents, among others. PRACTICE IMPLICATIONS By gaining insight into these needs and perceptions, care teams can enhance the provision of palliative care and optimize the distribution of responsibilities within the team.
Collapse
Affiliation(s)
- Irit Schwartz-Attias
- Meir Academic Nursing School, Meir Medical Center, Clalit Health Services, Israel.
| | - Shifra Ash
- Rambam Health Care Campus, Department of Pediatric Hematology-Oncology, Haifa, Israel; Technion- Israel Institute of Technology, Haifa, Israel..
| | - Ruti Ofir
- Rambam Health Care Campus, Department of Pediatric Hematology-Oncology, Haifa, Israel.
| | - Yael Ben Gal
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
| | - Marcela Broitman
- Tel Aviv Sourasky Medical Center, Department of Pediatric Hematology-Oncology, Tel Aviv, Israel.
| | - Mona Saeb
- Rambam Health Care Campus, Department of Pediatric Hematology-Oncology, Haifa, Israel.
| | | |
Collapse
|
4
|
Betke M, Stiel S, Schwabe S. Bereavement Counsellors' Experiences Supporting the Families of Deceased Children Within a German Bereavement Network- A Qualitative Interview Study. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241233329. [PMID: 38358305 DOI: 10.1177/00302228241233329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background: The "Bereavement Network Lower Saxony" (BNLS) provides professional bereavement support to families grieving for a child. The present study aimed at exploring the experiences of BNLS bereavement counsellors in providing bereavement support to affected families. Methods: 12 semi-structured qualitative interviews were conducted with bereavement counsellors of the BNLS between June and August 2022. Interviews were recorded, transcribed and analysed using qualitative content analysis, according to Mayring (2010). Results: Bereavement counsellors perceived that grief could be experienced very differently, and thus bereavement support must always be based on the individual needs and resources of bereaved family members. Bereavement counsellors appreciated exchange within the network and supervision to cope with emotional load that arises from compassion for those affected. Conclusions: Bereavement support within a network structure may improve the accessibility of individual support and enable exchange between counsellors, thus ensuring better bereavement support. Public outreach and strategic partnerships with clinics may amplify the positive impact of this support service.
Collapse
Affiliation(s)
- Merle Betke
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Sven Schwabe
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| |
Collapse
|
5
|
Brouwer MA, Bas-Douw BC, Leget CJW, Engel M, Teunissen SCCM, Kars MC. Barriers to the spiritual care of parents taking care of their child with a life-limiting condition at home. Eur J Pediatr 2024; 183:629-637. [PMID: 37950793 PMCID: PMC10912281 DOI: 10.1007/s00431-023-05314-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/13/2023]
Abstract
The changes that parents face when caring for a child with a life-limiting condition at home can affect them on a spiritual level. Yet, indications remain that parents do not feel supported when dealing with spiritual issues related to caring for a severely ill child. This paper explores, from the perspectives of bereaved parents, chaplains, grief counselors, and primary health care providers, the barriers to supporting the spiritual needs of parents. We conducted a qualitative focus group study from a constructivist point with chaplains/grief counselors, primary care professionals, and bereaved parents. All groups participated in two consecutive focus group sessions. Data were thematically analyzed. Six chaplains/grief counselors, 6 care professionals, and 5 parents participated. We identified six barriers: (1) There were difficulties in identifying and communicating spiritual care needs. (2) The action-oriented approach to health care hinders the identification of spiritual care needs. (3) There is an existing prejudice that spiritual care needs are by nature confrontational or difficult to address. (4) Spiritual support is not structurally embedded in palliative care. (5) There is a lack of knowledge and misconceptions about existing support. (6) Seeking out spiritual support is seen as too demanding. CONCLUSION Parents of children with life-limiting conditions face existential challenges. However, care needs are often not identified, and existing support is not recognized as such. The main challenge is to provide care professionals and parents with the tools and terminology that suit existing care needs. WHAT IS KNOWN • Spiritual care needs are an important aspect of pediatric palliative care. • Parents of children with life-limiting conditions feel unsupported when dealing with spiritual questions. WHAT IS NEW • Parents and professionals mention barriers that hinder spiritual support for parents. • There is a disconnect between existing support and the care needs that parents have.
Collapse
Affiliation(s)
- Marije A Brouwer
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Barbara C Bas-Douw
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Carlo J W Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Marijanne Engel
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| |
Collapse
|
6
|
Reshetnikov A, Gevandova M, Prisyazhnaya N, Vyatkina N. The Role of Parents in Their Child's Cancer Diagnosis, Treatment, Rehabilitation, and Socialization. Indian J Pediatr 2024; 91:30-34. [PMID: 36424520 DOI: 10.1007/s12098-022-04387-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/31/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the role of parents (family) as participants in their child's cancer diagnosis, treatment, and rehabilitation. METHODS This survey research was carried out by the Institute of Social Sciences, I.M. Sechenov First Moscow State Medical University (Sechenov University) in 2019-2020. The survey involved 237 parents of children with cancer admitted to oncological clinics of the North Caucasus Federal District. More than half of parents (54.9%) took their child to a pediatrician because of the unusual and strange symptoms. The overwhelming majority of respondents (99.1%) admitted stress and shock on hearing the cancer diagnosis. Besides emotional issues, they reported financial problems (55.3%), and a change in lifestyle (38.4%). RESULTS During the treatment period, parents sought financial and organizational support from medical institutions (49.4%), as well as charitable and public organizations (40.5%). At the end of treatment, almost half of the respondents (48.9%) applied for rehabilitation services. CONCLUSION Parents play one of the key roles in their child's cancer journey. They provide the child with basic psychological support and care, and they search for resources to enable treatment and rehabilitation. Parents help their child re-enter and return to a normal life (schooling, communication with friends, etc.) after going through cancer.
Collapse
Affiliation(s)
- Andrey Reshetnikov
- Institute of Social Sciences, I.M. Sechenov First Moscow State Medical University (Sechenov University), Rossolimo St., 11/2, Moscow, 119021, Russian Federation.
| | - Margarita Gevandova
- Department of Biology, Stavropol State Medical University, Stavropol, Russian Federation
| | - Nadezhda Prisyazhnaya
- Institute of Social Sciences, I.M. Sechenov First Moscow State Medical University (Sechenov University), Rossolimo St., 11/2, Moscow, 119021, Russian Federation
| | - Nadezhda Vyatkina
- Institute of Social Sciences, I.M. Sechenov First Moscow State Medical University (Sechenov University), Rossolimo St., 11/2, Moscow, 119021, Russian Federation
| |
Collapse
|
7
|
Mahoney AB, Akard TF, Cowfer BA, Dietrich MS, Newton JL, Gilmer MJ. Impact of Animal-Assisted Interaction on Anxiety in Children With Advanced Cancer and Their Caregivers. J Palliat Med 2024; 27:75-82. [PMID: 37751186 PMCID: PMC10790544 DOI: 10.1089/jpm.2023.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 09/27/2023] Open
Abstract
Background: Pediatric patients with advanced cancer and their caregivers have unique psychosocial needs. Anxiety often worsens throughout treatment for both patients and parents, and, if undertreated, can cause suffering. Animal-assisted interaction (AAI) incorporates animals into patient care in a structured manner for the purpose of therapeutic benefit. Objective: To evaluate feasibility of incorporating AAI into patient care and to assess AAI effectiveness in decreasing patient and caregiver anxiety in pediatric patients with advanced cancer, defined by relapsed or refractory disease. Design: Randomized controlled study. Setting/Subjects: Participants were children (n = 19) and parents (n = 21) who were randomized to AAI group or usual care (UC) group. Measures: Participants completed weekly measures to assess anxiety, including the 20-question State-Trait Anxiety Inventory (STAI). Results: Our results demonstrated feasibility of the use of AAI in children with advanced cancer. While they did not reveal a significant difference in anxiety scores over the four sessions in either group, parents randomized to the AAI group had lower STAI State subscores at initial visit in comparison to the UC group. The difference in initial STAI State anxiety scores for caregivers may indicate a positive effect of AAI in reducing anxiety surrounding appointments through anticipation of seeing a therapy dog. Conclusion: Further research is needed to determine the effectiveness of AAI in pediatric patients with advanced cancer and their caregivers, but results are promising that participation in AAI may lessen caregiver anxiety. Clinical Trial Registration Number is: NCT03765099.
Collapse
Affiliation(s)
- Anne Byrd Mahoney
- Department of Pediatric Hematology/Oncology, Vanderbilt University Medical Center and Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Terrah Foster Akard
- Family Care Community, Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | - Brittany A. Cowfer
- Division of Hospice and Palliative Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Mary S. Dietrich
- Family Care Community, Vanderbilt University School of Nursing, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Mary Jo Gilmer
- Family Care Community, Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| |
Collapse
|
8
|
Hansson H, Björk M, Santacroce SJ, Raunkiaer M. End-of-life palliative home care for children with cancer: A qualitative study on parents' experiences. Scand J Caring Sci 2023; 37:917-926. [PMID: 35072276 DOI: 10.1111/scs.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/16/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is insufficient knowledge available about the impact of paediatric palliative care at home on meeting family needs and ensuring the highest quality of care for the dying child. The aim of this study was to elucidate parents' experiences of how and why home-based paediatric palliative care impacted the entire family during their child's final phase of life. METHODS The study used a qualitative design. Semi-structured interviews were conducted with the bereaved parents of children who had received palliative care at home from a paediatric cancer hospital department programme that was based on collaboration with community nurses and the paediatric palliative care service. The interviews were transcribed verbatim, and qualitative content analysis was applied. The Ecocultural theory was used to explain the findings. RESULTS Three main themes emerged: (1) involvement enabling a sense of control and coping, (2) sustaining participation in everyday family life routines and (3) making room for presence and comfort during and after the end-of-life trajectory. CONCLUSION End-of-life palliative care at home can enable parents and other family members to maintain a sense of control, presence and semblance of everyday life. It contributes to managing and alleviating the burden and distress during the last phase of the child's life and during bereavement. We suggest that healthcare professionals support family members in participation and daily life routines and activities during a child's EOL care, as it affects the well-being of the entire family.
Collapse
Affiliation(s)
- Helena Hansson
- Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet and Associate Professor at Copenhagen University, Copenhagen, Denmark
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Maria Björk
- CHILD Research Group at the Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Sheila Judge Santacroce
- Beerstecher-Blackwell Distinguished Scholar at School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mette Raunkiaer
- Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, University of Southern Denmark, Nyborg, Denmark
| |
Collapse
|
9
|
Neefjes V. Parental Ethical Decision Making and Implications for Advance Care Planning: A Systematic Review and Secondary Analysis of Qualitative Literature from England and Wales, Germany, and the Netherlands. J Palliat Med 2023; 26:1728-1743. [PMID: 37262127 DOI: 10.1089/jpm.2022.0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Background: Clinicians and parents are expected to make medical treatment decisions in the child's best interests. To reach their decisions, clinicians typically apply a principled approach outlined by Beauchamp and Childress. How parents make ethical decisions is an under-researched area. A possible model for parental decision making is the Ethics of Care (EoC) theory. Ethical decision making within this framework aims to preserve the caring relationship. What is right or wrong depends on the circumstances at the time. Objective: To identify the parental ethical values and determine whether parental decision making is consistent with EoC, a systematic review and secondary analysis of qualitative research from England and Wales, the Netherlands, and Germany was performed. As part of a larger project investigating conflicts between parents and clinicians about children's medical treatment, the choice of countries was determined by differences in litigation. Methods: Eight databases were searched for articles published between 2010 and 2020 reporting on at least one medical treatment decision made by parents of a child with any life-limiting condition and analyzed using reflexive thematic analysis. Twelve included articles directly addressing advance care planning (ACP) were reanalyzed to investigate whether this specific decision parents are increasingly being asked to make is also consistent with EoC. Results: Forty-three articles were included. Parents use the same 6 ethical values which, consistent with EoC, are mostly in the context of their relationship with the child. All values contributed to the previously identified theme of "being a good parent/person." Analysis of parental decision making in ACP confirmed consistency with EoC. Conclusion: The parental decision-making process is consistent with EoC. That parental decisions aim to maintain the caring relationship and are dependent on the circumstances at the time has implications for parental decision making in ACP and should be reflected in future policies.
Collapse
Affiliation(s)
- Veronica Neefjes
- Center for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
10
|
Nogueira AJ, Ribeiro MT. A psychological experience assessment protocol of parent caregivers in paediatric palliative care. Ann Med 2023; 55:2268093. [PMID: 38010855 PMCID: PMC10836293 DOI: 10.1080/07853890.2023.2268093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/02/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Paediatric Palliative Care (PPC) has undergone rapid growth in Portugal, where there are over 7800 children with life-limiting conditions. This is a complex experience for families due to the ongoing threat and vulnerability caused by the emergence of an illness, and therefore several studies have tended to focus on the adaptation of parent caregivers. The aim of the present study is to present a psychological experience assessment protocol of parents in PPC. Methods: It consists of a socio-demographic and clinical questionnaire and a semi-structured interview based on an incomplete narrative deriving from the Unwanted Guest Metaphor. Results: On the basis of the latter, 10 dimensions of the experience in the parental subsystem were explored through parents' own perspective, namely: confrontation with the diagnosis; representation of the illness; emotional impact; day-to-day challenges; family impact; resources and social support; coping strategies; posttraumatic growth; representation of the sick child; and future perspectives. Discussion: The protocol can be used in person or remotely and its application enables the identification of specific needs and the establishment of psychotherapeutic goals and strategies for each family, thus enhancing their well-being and resilience, from an eco-systemic perspective. Conclusions: The protocol is presented in detail and its importance in the context of research and systemic intervention in PPC is discussed.
Collapse
Affiliation(s)
- Alexandra Jóni Nogueira
- CICPSI, Faculty of Psychology, University of Lisbon, Alameda da Universidade, Lisboa, Portugal
| | - Maria Teresa Ribeiro
- CICPSI, Faculty of Psychology, University of Lisbon, Alameda da Universidade, Lisboa, Portugal
| |
Collapse
|
11
|
Engel M, Brouwer MA, Jansen N, Leget C, Teunissen SCCM, Kars MC. The spiritual dimension of parenting a child with a life-limiting or life-threatening condition: A mixed-methods systematic review. Palliat Med 2023; 37:1303-1325. [PMID: 37461310 PMCID: PMC10548770 DOI: 10.1177/02692163231186173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Spirituality refers to the dynamic dimension of human life that relates to the way that persons experience meaning, purpose, and transcendence. The complex task of parenting a child with a life-limiting condition may raise existential questions, which are easily overlooked by healthcare professionals. AIM We explored how the spiritual dimension becomes manifest in parents of children in pediatric palliative care. DESIGN A mixed-methods systematic review was conducted, registered in Prospero (2021 CRD42021285318). DATA SOURCES PubMed, CINAHL, Embase, PsycInfo, and Cochrane were searched for articles published between January 1, 2015 and January 1, 2023. We included original empirical studies that reported on spirituality of parents of seriously ill children, from parents' perspectives. RESULTS Sixty-three studies were included: 22 North-American, 19 Asian, 13 European, 9 other. Studies varied in defining spirituality. We identified five different aspects of spirituality: religion, hope, parental identity, personal development, and feeling connected with others. All aspects could function as source of spirituality or cause of spiritual concern. Sources of spirituality helped parents to give meaning to their experiences and made them feel supported. However, parents also reported struggling with spiritual concerns. Several parents highlighted their need for professional support. CONCLUSIONS Although studies vary in defining spirituality, reports on spirituality focus on how parents connect to their faith, others, and themselves as parents. Healthcare professionals can support parents by paying attention to the spiritual process parents are going through. More research is needed into how healthcare professionals can support parents of seriously ill children in this process.
Collapse
Affiliation(s)
- Marijanne Engel
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije A Brouwer
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nienke Jansen
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Carlo Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia CCM Teunissen
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
12
|
Moreira-Dias PL, Franco LF, Bonelli MA, Ferreira EAL, Wernet M. Searching for human connection to transcend symbolisms in pediatric palliative care. Rev Bras Enferm 2023; 76:e20220476. [PMID: 37377316 DOI: 10.1590/0034-7167-2022-0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/16/2022] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES to present a theoretical model for the interactional context of health professionals and families of children and adolescents under palliative care. METHODS qualitative study based on the theoretical frameworks of Grounded Theory and Symbolic Interactionism. Ten palliative care professionals took part in this study through semi-structured interviews employing snowball technique from 2020 to 2021. RESULTS the comparative data analysis resulted in the theoretical model "Searching for human connection to transcend symbolisms in pediatric palliative care". It reveals symbolic elements that substantiate the construction of a collaborative context integrating two phenomena: "Overcoming boundaries and intertwining paths" and "Embracing suffering to weave meaningful experiences". Symbolisms in palliative care guide the behavior of families and professionals, which makes them the key factor to be managed. FINAL CONSIDERATIONS symbolisms and suffering continually integrate the interactional experience of professionals. Empathy and compassion are fundamental elements to enable their connection with families.
Collapse
Affiliation(s)
| | | | | | | | - Monika Wernet
- Universidade Federal de São Carlos. São Carlos, São Paulo, Brazil
| |
Collapse
|
13
|
Nogueira AJ, Ribeiro MT. "The Key Is to Value Every Little Achievement": A Qualitative Study of the Psychological Experience of Parent Caregivers in Paediatric Palliative Care. Clin Pract 2023; 13:670-683. [PMID: 37366931 DOI: 10.3390/clinpract13030062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
In Europe, Portugal has been identified as the country with the most rapid evolution of paediatric palliative care provision, which is a highly complex experience for families. The present descriptive-exploratory study seeks to contribute to the understanding of the psychological experience of life-limiting conditions in parent caregivers. A total of 14 families completed a sociodemographic and clinical data sheet and answered a structured online interview based on an incomplete narrative resulting from the Unwanted Guest Metaphor. A thematic analysis of the various narratives was performed through an inductive-deductive process. The results provide a holistic view of 10 essential dimensions in the parental psychological experience and contribute to the design of intervention methodologies in an eco-systemic approach. The importance of clear communication with health professionals, an awareness of the unpredictability of the disease, the desire for more self-care, the difficulty in understanding their children's needs and the threat implicit in everyday life are some of the main findings. This research emphasizes the importance of having opportunities of emotional expression and psychoeducation about anxiety' management, enhancing the perception of positive characteristics in children with palliative needs and creating time for the couple. The study has some limitations, such as the small sample size, and suggests that further research should explore the father's experience.
Collapse
|
14
|
Constantinou G, Cook EJ, Tolliday E, Randhawa G. 'A team around the child' professionals' experiences of unmet needs, access and expectations in children's palliative care services, a phenomenological study in the UK. J Child Health Care 2023:13674935221147716. [PMID: 36946427 DOI: 10.1177/13674935221147716] [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] [Indexed: 03/23/2023]
Abstract
This study aims to understand the experiences of professionals involved in caring for families of children with life-limiting illnesses to ascertain unmet needs, access issues and expectations of services.A phenomenological approach comprising semi-structured interviews with professionals from various services was used. Interviews that happened between July and November 2018 were audio-recorded, transcribed verbatim and thematically analysed based on descriptive phenomenology.In total, 29 interviews were conducted. Findings showed how essential collaborative working was for becoming a team around the child. Barriers to this include complex working relationships, overprotectiveness of families, roles and responsibilities and use of independent care records. The pressures of waiting times and the impact of staffing shortages affected the experiences of providing care. The reality of meeting families' expectations was shaped by family networking, online research and previous services resistance, which was influential in more challenging interactions. Expectations of care were also impacted by misunderstandings and anxieties surrounding access to services. Overall, professionals were concerned about families being used as a bottomless caring resource and stressed the need for short breaks to alleviate parents.Interventions that educate families and professionals on these services and how they can benefit the child and family would be well received.
Collapse
Affiliation(s)
- Georgina Constantinou
- Institute for Health Research, 5195University of Bedfordshire, UK
- Centre for Maternal and Child Health Research, School of Health Sciences, 4895City University of London, London, UK
| | - Erica J Cook
- Department of Psychology, 5195University of Bedfordshire, UK
| | | | - Gurch Randhawa
- Institute for Health Research, 5195University of Bedfordshire, UK
| |
Collapse
|
15
|
Fisher V, Fraser L, Taylor J. Experiences of fathers of children with a life-limiting condition: a systematic review and qualitative synthesis. BMJ Support Palliat Care 2023; 13:15-26. [PMID: 34140322 PMCID: PMC9985706 DOI: 10.1136/bmjspcare-2021-003019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/28/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Children with a life-limiting condition often require extensive and complex care, much of which is provided by their parents at home. There is a growing body of research that aims to understand the experiences of these parents, but the majority of this research is from mothers' perspectives, meaning that fathers' experiences are not well understood. OBJECTIVES To identify and synthesise findings from existing qualitative studies that have explored the experiences of fathers of children with a life-limiting condition. METHODS A systematic review of qualitative research was conducted using thematic synthesis. Searches were conducted in MEDLINE, CINAHL, EMBASE, PsycINFO and Social Science Citation Index. RESULTS Findings from 30 studies were included, representing the experiences of 576 fathers of children with a range of diagnoses including cancer, cystic fibrosis, genetic and neurological conditions. Themes detailed fathers' experiences of uncertainty and shock around the time of their child's diagnosis, their accounts of a 'new normal', difficulties in discussing their emotions, forming relationships with and seeking support from professionals and working fathers' role conflicts. They discussed the life-changing nature of their child's diagnosis, an event that affected all aspects of their lives from everyday activities, to their relationships, spirituality, values and ambitions. CONCLUSIONS Fathers experience many difficulties in response to their child's diagnosis and ongoing treatment. Findings highlight the need for healthcare professionals to recognise individual family dynamics and the evolving role of the father. Fathers' responses are not widely understood, and research that directly addresses their own well-being is warranted.
Collapse
|
16
|
Gundry A, Elvidge N, Donovan L, Bunker K, Herbert A, Bradford N. Parent and Provider Perspectives of a Hospital-Based Bereavement Support Program in Pediatric Palliative Care. J Pain Symptom Manage 2023; 65:388-399.e9. [PMID: 36775110 DOI: 10.1016/j.jpainsymman.2023.02.002] [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: 12/09/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
CONTEXT Bereavement is an individuated, nuanced experience, and its expression is different for each parent who has cared for a dying child. Evidence highlights support is valuable to navigate this loss. OBJECTIVES To evaluate a Bereavement Support Program from the perspectives of both families and service providers. METHODS A cross-sectional study design explored the experiences and perspectives of the benefits of various program components. Respondents were asked about accessing program components, their expectations, and parents were asked to rate the impact of program components on their grief on a scale from one, (no impact) to 100 (positive impact). Space for free text was provided throughout for additional feedback. SETTING/ PARTICIPANTS The survey was distributed through mailing lists of parents known to the service, referring service providers, and advertised in the program newsletter. RESULTS One hundred two respondents completed the survey and provided detailed comments about their experiences. Most interactions and program components were reported helpful by both parents and service providers. Parents (N = 60) reported a positive impact on grief across all program components (median impact on grief range 81-98, Interquartile range 68.5-99). There were, however, a considerable number of respondents who were unaware of some components. CONCLUSION Bereavement care to navigate the devastating loss of a child is of paramount importance and can offer significant and beneficial resources for families. Findings have supported service development in a major tertiary paediatric hospital facilitating improved access for families, particularly for those in regional and rural locations.
Collapse
Affiliation(s)
- Alyson Gundry
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia.
| | - Norah Elvidge
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Leigh Donovan
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Kristy Bunker
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Anthony Herbert
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Natalie Bradford
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia
| |
Collapse
|
17
|
Du N, Wu Y, Xiong S, Ji H, Huang L, Guo W, Zeng C. Current situation and influencing factors of disease uncertainty in parents of children with Sturge‒Weber syndrome: a retrospective study. BMC Pediatr 2023; 23:64. [PMID: 36750798 PMCID: PMC9903547 DOI: 10.1186/s12887-023-03857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Sturge Weber syndrome (SWS), can cause extensive capillary malformations on the face, head, trunk, and other parts of the body, and the eyes can also suffer optic nerve injury. Secondary glaucoma can cause blindness, which has the characteristics of a relatively hidden onset and unclear pathogenesis. The treatment of SWS secondary glaucoma has always been difficult, and due to the characteristics of the disease, there is uncertainty about the long-term efficacy and safety of various treatment methods for such patients. METHODS A total of 105 parents of children with SWS completed a self-designed general information questionnaire, a generalized anxiety questionnaire (GAD-7), a patient health questionnaire (PHQ-2), a stress perception scale (PSS-4), a simple coping scale (SCSQ) and a disease-uncertainty scale (PPUS). RESULTS The total uncertainty score of parents of children with SWS was 79.07 ± 13.24, and the average item score was 2.82 ± 0.47. Multiple linear regression analysis revealed that anxiety and simple coping were the main influencing factors of disease uncertainty among parents of children with SWS (P < 0.05). CONCLUSIONS Parents of children with SWS exhibit a high level of disease uncertainty. Medical staff should pay attention to the source of parents' disease uncertainty and provide targeted interventions, which are of great importance in reducing parents' disease uncertainty.
Collapse
Affiliation(s)
- Na Du
- Department of Nursing, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200011 China
| | - Yue Wu
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200011 China
| | - Shanshan Xiong
- Department of Nursing, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200011 China
| | - Hong Ji
- Department of Nursing, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200011 China
| | - Lulu Huang
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200011 China
| | - Wenyi Guo
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200011 China
| | - Changjuan Zeng
- Department of Nursing, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011 China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, 200011 China
- Shanghai JiaoTong University School of Nursing, Shanghai, 200025 China
| |
Collapse
|
18
|
Hirata M, Kobayashi K. Experiences with the end-of-life decision-making process in children with cancer, their parents, and healthcare professionals: A systematic review and meta-ethnography. J Pediatr Nurs 2022; 69:e45-e64. [PMID: 36586777 DOI: 10.1016/j.pedn.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Decision-making during the end-of-life (EOL) phase for children with cancer is extremely difficult for parents. We synthesized the qualitative experiences of children with cancer, parents, and healthcare professionals (HCPs), and their social interactions during the EOL decision-making process in the pediatric oncology setting. METHODS Meta-ethnography was used to conduct a systematic review and meta-synthesis. We searched four online databases to identify original studies published in English and Japanese and examined 21 relevant studies. Two Japanese reviewers discussed the differences/relationships and included studies that synthesized the translated qualitative findings. A conceptual model of social interactions was created. RESULTS We identified four themes regarding children's, parents', and HCPs' experiences: hope and confrontation with the child's death, guidance and support during uncertainty, awareness of being protected and having hope, and mutual unspoken integration of values. CONCLUSIONS These themes evince the experiences of children, parents, and HCPs during the EOL decision-making process and suggests a complex three-way social interaction model. While considering such distinctive social interactions during a child's EOL, this study revealed the sharing of prudent information and psychosocial support by HCPs. The findings indicate that hope and uncertainty are key elements for effectively understanding the experiences of children and parents and that EOL decision-making should not be rushed but should be supported by leaving room for uncertainty and acknowledging parents' emotional needs and fostering new hope. Further research into how hope can be further supported in situations that are rife with uncertainty is needed.
Collapse
Affiliation(s)
- Mika Hirata
- Department of Nursing, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama 343-8540, Japan.
| | - Kyoko Kobayashi
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
| |
Collapse
|
19
|
Shattnawi KK, Qananbeh FS, Khater W. The experiences of mothers of children with hydrocephalus in Jordan: A phenomenological study. J Pediatr Nurs 2022; 69:e127-e135. [PMID: 36586776 DOI: 10.1016/j.pedn.2022.12.026] [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: 06/15/2022] [Revised: 12/24/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Available literature showed that mothers of children with hydrocephalus experience many challenges. Studies that described mothers' experiences in caring for their children with hydrocephalus are limited. Understanding the mothers' experiences and challenges is essential and may enable the provision of increased knowledge and support for these mothers. AIM The aim of this study was to explore the lived experiences of Jordanian mothers of children with hydrocephalus. METHODOLOGY A phenomenological descriptive approach was applied in this study, using semi-structured interviews with a purposive sample of 10 mothers of children with hydrocephalus. Transcribed interviews were analyzed using thematic approach. RESULT Three main themes that explored the mothers' experiences emerged from the data analysis process. The first theme was the impact of living with a child with hydrocephalus. Four subthemes comprise this theme; namely the mothers' initial response, overwhelming responsibilities, social withdrawal, and adapting: loving the baby and growing stronger. The second theme was related to the support system. Two subthemes compose this theme; the role of husband, and social support. The last theme was related to feelings of uncertainty. Two subthemes constitute this theme; concerns about the child's future and considering abortion as a solution. CONCLUSION The mothers in this study were found to have experienced many intense feelings and to have faced many stressors and difficulties associated with the different stages of their child's illness. This study provides evidence that could be used to develop guidelines to support mothers of children with hydrocephalus.
Collapse
Affiliation(s)
- Khulood Kayed Shattnawi
- Maternal & Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box (3030), Irbid 22110, Jordan.
| | - Fatima Said Qananbeh
- Maternal & Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Wejdan Khater
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid 22110, Jordan.
| |
Collapse
|
20
|
Oakley S, Dunbar H, de Vries K. Parent-led strategies supporting personal well-being when caring for a child with a life-limiting condition: A scoping review. J Child Health Care 2022; 26:648-667. [PMID: 34372722 DOI: 10.1177/13674935211026122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objectives of this review were to identify strategies initiated by parents of children with life-limiting conditions to support their own well-being at home and to describe the impact of these strategies on parental well-being. A systematic scoping review was performed using PRISMA-ScR guidelines, identifying 15 relevant studies that fit the inclusion and exclusion criteria. There were no studies that specifically assessed how parents support their own well-being; however, the 15 identified studies did provide pertinent data secondary to the primary aims of each study. This resulted in the identification of 14 parent-initiated strategies which were grouped thematically into 4 categories: (i) social experience and peer support, (ii) information and management techniques, (iii) reframed perspectives and (iv) prioritising own needs. Overall, there was some evidence of parents initiating specific, individualised and useful strategies to supporting their well-being. Notably lacking was any empirical evaluation as to the effectiveness of these strategies and the wider factors associated with them. Further research is required to assess how parents support their personal well-being in daily life and how these strategies can be implemented alongside service-initiated support to ensure full parental well-being.
Collapse
Affiliation(s)
- Sarah Oakley
- Leicester School of Nursing and Midwifery, 4487De Montfort University, Leicester, UK
| | - Helena Dunbar
- Leicester School of Nursing and Midwifery, 4487De Montfort University, Leicester, UK
| | - Kay de Vries
- Leicester School of Nursing and Midwifery, 4487De Montfort University, Leicester, UK
| |
Collapse
|
21
|
Donovan LA, Slater PJ, Delaney AM, Baggio SJ, Herbert AR. Building capability in paediatric palliative care and enhancing education through the voice of parents: the Quality of Care Collaborative Australia. Palliat Care Soc Pract 2022; 16:26323524221128835. [PMID: 36225949 PMCID: PMC9549082 DOI: 10.1177/26323524221128835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The greater proportion of children with a life-limiting condition (LLC) and
their families want to remain at home as much as possible. Building
capability in paediatric palliative care (PPC) for generalist health and
social care professionals in nonmetropolitan regions through the Quality of
Care Collaborative Australia (QuoCCA) has improved access to palliative care
for families, regardless of where they live. Aim: To understand the experience of families whose child has received specialist
PPC, to ensure future service capability development is informed by lived
experience. Design: A retrospective, descriptive study in which parents participated in a
semi-structured telephone interview guided by Discovery Interview
methodology. Inductive thematic analysis identified the major learnings from
participants. Participants: Parents caring for a child referred to the specialist PPC service, who
received a pop-up visit and whose child is stable or who are more than 6
months bereaved. Results: Eleven parents (n = 9 mothers; n = 2
fathers) of children with an LLC (n = 5) or whose child had
died (n = 6) participated in an interview. The overarching
themes and subthemes were as follows: (1) burden of suffering, in which
parents described grieving for the life once anticipated, confronting many
life transitions and seeking quality of life for their child and (2)
umbrella of support, in which parents built partnerships with professional
support, activated a network of care around their family and sought
responses to their whole family’s needs. Conclusion: Parents caring for a child with an LLC described significant personal,
familial, social and existential adjustments. This study integrates a
relational learning approach with QuoCCA education grounded in the
relationships between children, families and professionals. Learning from
lived experience in PPC education enhances the preparedness of generalist
health and social care professionals to join a child and their family
throughout their various life transitions and facilitates the goal to remain
at home within their community for as long as possible. Education in PPC is
an imperative component of service models, enabling regional services to
gain confidence and capability in the context of a dying child and their
family, empowered and informed through the voice of the family. Plain Language Summary Enhancing palliative care for children through education informed by
the experience of families It is often the wish of many children/young people with a life-limiting
condition to stay at home with their families as much as possible. It is
important that specialist palliative care services provide training and
mentoring to the family’s local care professionals to support the delivery
of good care, particularly those in rural and remote areas. This article aims to integrate the lived experience of families with
palliative care education, so that the education reflects and addresses the
needs that they express. Parents were interviewed by telephone using a method called Discovery
Interviews. This is an open interview process, guided by a spine that
describes the main points of palliative care. Parents can openly talk about
their experience, focusing on the areas that are important to them.
Interviews were studied by four researchers, and emerging themes were
discussed and summarised. The study included parents whose child/young person was receiving support
from specialist palliative care and bereaved parents whose child had died
more than 6 months ago. In total, eleven parents (nine mothers and two
fathers) were interviewed, five participants had children currently
receiving palliative care and six were bereaved. The overarching themes were as follows: Burden of suffering, in which parents described grieving for the life they
had expected, confronting transitions and seeking good quality of life for
their child. Umbrella of support, in which parents built partnerships with care teams and
activated a network of care to address the needs of their whole family. This study allowed the families’ perspectives to be integrated into the
palliative care education of care professionals in the family’s local area.
The lived experience of families prepared care professionals to support
families with the care of their child/young person, allowing them to remain
at home as long as possible.
Collapse
Affiliation(s)
- Leigh A. Donovan
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane, QLD,
AustraliaCollaboraide Consultancy, Minjerribah, QLD, Australia
| | | | - Angela M. Delaney
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane, QLD,
Australia
| | - Sarah J. Baggio
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane, QLD,
Australia
| | - Anthony R. Herbert
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane,
Queensland, AustraliaCentre for Children’s Health Research, Queensland
University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
22
|
Shattnawi KK, Younis BJ, Omran SM. Neonatal Nurses' Perceptions and Needs of End-of-Life Care Practice: A Jordanian Qualitative Study. J Hosp Palliat Nurs 2022; 24:00129191-990000000-00036. [PMID: 36166218 DOI: 10.1097/njh.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
End-of-life (EOL) care for newborns is challenging and requires well-prepared nurses to provide the best care for the dying baby and to prepare and support parents during such a difficult experience. This study aimed to explore Jordanian neonatal intensive care unit nurses' perceptions and needs regarding the provision of EOL care. This study used an exploratory descriptive qualitative approach and was conducted among a sample of 12 Jordanian neonatal intensive care unit nurses. Semistructured interviews were conducted to allow the nurses to describe their personal experiences and express their needs related to the provision of EOL care. Two main themes and 6 subthemes emerged from the analysis process. Main themes were (1) the challenges related to the provision of EOL care, and (2) nurses' needs: what matters most. The findings of this study shed light on neonatal care unit nurses' experiences and needs related to the provision of EOL care. The results of this study may be used to develop EOL care guidelines, programs, and protocols to be applied in intensive care units.
Collapse
|
23
|
Strojek K, Wójtowicz D, Kowalska J. Assessment of the Emotional State of Parents of Children Starting the Vojta Therapy in the Context of the Physical Activity-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10691. [PMID: 36078406 PMCID: PMC9517770 DOI: 10.3390/ijerph191710691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
The aim of the study was to assess the emotional state of parents at the moment of starting therapy for their children using the Vojta method in the context of the physical activity undertaken by the parents. The study involved 68 parents (37 mothers and 31 fathers) of children with central coordination disorders (CCD) presenting for consultation and therapy using the Vojta method. The authors' questionnaires, the Perceived Stress Scale (PSS-10), the State-Trait Anxiety Inventory (STAI), the Patient Health Questionnaire (PHQ-9), the Satisfaction With Life Scale (SWLS), and the Inventory to Measure Coping Strategies with Stress (Mini-COPE) were used. As many as 84% of mothers and 77% of fathers presented high level of perceived stress. Comparative analysis showed a statistically significant difference in anxiety and life satisfaction between the groups of mothers and fathers studied. Taking declared physical activity into account, there was a statistically significant difference in stress and anxiety in the mothers' group and a statistically significant difference in mood and life satisfaction in the fathers' group. Promoting physical activity among parents of children with CCD can be helpful in maintaining better psycho-physical conditions and can also be a good tool in combating stress in difficult situations, such as the illness and therapy of a child.
Collapse
|
24
|
Najafi K, Shirinabadi Farahani A, Rassouli M, Alavi Majd H, Karami M. Emotional upheaval, the essence of anticipatory grief in mothers of children with life threatening illnesses: a qualitative study. BMC Psychol 2022; 10:196. [PMID: 35953867 PMCID: PMC9366755 DOI: 10.1186/s40359-022-00904-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Life-threatening illnesses in childhood are considered a crisis for the whole family, especially for the mother, which leads to experiencing different degrees of grief and emotional-behavioral problems.
Objective The present study is conducted with the aim of explaining the concept of anticipatory grief from the perspective of the mothers of the children with life-threatening illnesses. Methods This qualitative study is part of a sequential exploratory research for model development in the field of anticipatory grief, which was conducted using conventional content analysis method. The data were collected through in-depth semi-structured interviews with 19 mothers of the children with life-threatening illnesses living in Shiraz and Tehran, who were selected through purposive sampling with maximum variation. When data saturation were achieved, the data were codified by MAXQDA-10 software and analyzed using Graneheim and Lundman’s approach. Findings Data analysis resulted in the identification of 8 subcategories including shock, irritability, fear of losing, feeling guilty, uncertainty, hopelessness, loneliness and isolation, and mourning without a coffin, all forming the major theme emotional upheaval. Discussion and conclusion As the result of being in a situation of imminent and possible loss of her child, the mother experiences different responses of sadness and sorrow and suffers the consequences the core of which is consisted of emotional upheaval. Therefore, by explaining the behaviors related to anticipatory grief, efficient and effective interventions can be designed to improve coping among this group of mothers.
Collapse
Affiliation(s)
- Kazem Najafi
- Student Research Committee, Departmant of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Shirinabadi Farahani
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Rassouli
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Karami
- Student Research Committee, Departmant of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
25
|
Correia ME, Melo T, Nobre J. Grieving Experiences of Parents with Children in End-of-Life Care—A Qualitative Review Protocol. NURSING REPORTS 2022; 12:426-430. [PMID: 35894031 PMCID: PMC9326657 DOI: 10.3390/nursrep12030041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Parents that accompany their children in end-of-life care until death go through a devastating, complex and vulnerable situation, which is experienced in a unique way and with individual needs, given the specificity of the palliative care setting in which it occurs. This qualitative review aims to identify and synthesize the best evidence available on the grieving experiences of parents with children in end-of-life care in a palliative care setting. This qualitative review protocol is according to the review method proposed by the Joanna Briggs Institute. The results will enable us to identify how parents of children in end-of-life care in a palliative care setting experience their grieving process. This review will broaden the horizon of understanding of the specificities of the grieving experience of parents who have accompanied their children in end-of-life care until their death in a palliative care setting and promote research in this context. The results of the review will also allow the construction of an “end-of-life grieving script”, with the aim of identifying one’s individuality in the grieving process. This protocol is registered at Open Science Framework.
Collapse
Affiliation(s)
- Maria Eduarda Correia
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1990-096 Lisboa, Portugal
- Health School, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal;
- Correspondence:
| | - Tânia Melo
- Paediatric Hospital of the Centro Hospitalar e Universitário de Coimbra, 3000-602 Coimbra, Portugal;
- Nursing School of Coimbra, 3000-232 Coimbra, Portugal
| | - Joana Nobre
- Health School, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal;
- VALORIZA—Research Centre for Endogenous Resource Valorization, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal
- Nursing Research Unit for South and Islands (NURSE’IN), 2914-503 Setubal, Portugal
| |
Collapse
|
26
|
Effendy C, Uligraff DK, Sari SH, Angraini F, Chandra L. Experiences of family caregivers of children with cancer while receiving home-based pediatric palliative care in Indonesia: a qualitative study. BMC Palliat Care 2022; 21:104. [PMID: 35668398 PMCID: PMC9171947 DOI: 10.1186/s12904-022-00986-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for children living with life-threatening and life-limiting illnesses can be challenging. Parents' roles as the main caregivers can be complex with extensive responsibilities. The experiences of family caregivers can provide key insights into the provision of home-based Pediatric Palliative Care (PPC) for seriously ill children. This study is aimed at exploring the experiences of family caregivers of children diagnosed with cancer while receiving home-based PPC. METHODS This was a qualitative study. This study used semi-structured interviews which were audio-recorded with family caregivers of twelve children diagnosed with cancer who had received home-based PPC. The interviews were transcribed verbatim. The data were analyzed using qualitative content analysis. The reporting of the study was based on the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS Three main themes emerged: (1) The implementation of home-based PPC; (2) The benefits of home-based PPC; and (3) The family caregivers' hopes of the home-based PPC service and their impressions of home-based PPC. The implementation of home-based PPC described the experiences of family caregivers in receiving home-based PPC provided by nurses with particular attention to the bio-psychosocial-spiritual aspects. Family caregivers experienced several benefits from the home-based PCC service, where holistic care was provided for both the patient and the family. Family caregivers shared their hopes prior to receiving support from competent health care professionals to care for their sick child at home and improve the child's quality of life. They confirmed that these hopes were fulfilled through the home-based PPC service delivered by Rachel House. CONCLUSIONS Home-based PPC provides several benefits with a positive impact for both the children diagnosed with cancer as well as their families. Nurses involved in the home-based PPC service provide holistic care with a family-centered approach. We believe that children with terminal illnesses and their families need and deserve home-based PPC during difficult times.
Collapse
Affiliation(s)
- Christantie Effendy
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas, Gadjah Mada, Yogyakarta, Indonesia.
| | | | | | | | | |
Collapse
|
27
|
Santini A, Avagnina I, Marinetto A, De Tommasi V, Lazzarin P, Perilongo G, Benini F. The Intervention Areas of the Psychologist in Pediatric Palliative Care: A Retrospective Analysis. Front Psychol 2022; 13:858812. [PMID: 35391957 PMCID: PMC8980523 DOI: 10.3389/fpsyg.2022.858812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Infants, children and adolescents with life-limiting and life-threatening disease need long-term care that may change according to disease's natural history. With the primary goal of quality of life, the psychologist of pediatric palliative care (PPC) network deals with a large variety of issues. Little consideration has been given to the variety of intervention areas of psychology in PPC that concern the whole life span of the patient and family. The PPC network is composed by a multidisciplinary team of palliative care specialists that intervenes at home, in the hospital and in every place where the patient is living. The network coordinates different public health services to respond to clinical, psychosocial and spiritual needs. In these scenarios, the psychological need is not a single event but a moment inserted in the complexity of the child's needs. This retrospective monocentric project consists of an analysis of characteristics of psychological interventions in our PPC service. The time frame taken into consideration is 2019-2020, analyzing the clinical records of 186 patients of Pediatric Palliative Care and Pain Service of Veneto Region (Italy). The areas that emerged in the analysis show how the intervention of the psychologist in PPC does not concern only end-of-life, but a series of topics that are significant for the family to guarantee psycho-social wellbeing oriented toward the best quality of life. In conclusion, these different topics highlight the complexity of the child and family experience. This variety must be taken into consideration, the psychologist must increase holistic support with a dedicated skills curriculum.
Collapse
Affiliation(s)
- Anna Santini
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Irene Avagnina
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Anna Marinetto
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Valentina De Tommasi
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Pierina Lazzarin
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Giorgio Perilongo
- Department of Women’s and Children’s Health, School of Medicine, University of Padua, Padua, Italy
| | - Franca Benini
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| |
Collapse
|
28
|
Knochel K, Zaimovic V, Gatzweiler B, Hein KK, Heitkamp N, Monz A, Reimann D, Borasio GD, Führer M. Participatory Development of a Modular Advance Care Planning Program in Pediatric Palliative Care (MAPPS). J Pain Symptom Manage 2022; 63:189-198. [PMID: 34597758 DOI: 10.1016/j.jpainsymman.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Decision-making in pediatric palliative care concerns mainly children without decision-making capacity. It has to balance the child's best interests, parental responsibility and the impact on the family system. OBJECTIVES Advance care planning (ACP) supports decision making about future medical care. A consistent pediatric approach is still missing. This study aimed at developing a pediatric ACP program (pedACP) meeting specific needs of children, parents and professionals. METHODS Bereaved parents of children with life-limiting conditions and professionals involved in pedACP participated. Employing the technique of constellation analysis, they collaboratively assigned content, actors, tools and warning notes about pedACP along a timeline. The researchers analyzed, systematized and translated these results into a pedACP program draft, which was revised by the participants. RESULTS The participants' overall focus was on the children's quality of life and an individualized interdisciplinary communication process along the disease trajectory. The program was conceptualized in modular design with fixed modules at the beginning (to build a trustful relationship and frame the process) and at the end (to summarize results and prepare implementation). The main discussions are structured in flexible modules (About the child, Emergencies, Disease-specific scenarios and End of life care). General themes cover timing, communication, engaging children and structural issues. The participants appreciated the program's comprehensiveness and flexibility. CONCLUSION Parents and professionals combined their perspectives on reflecting goals of care and the complexity of pedACP. They perceived the resulting modular program as suitable for meeting the individual needs of patients, families and professional stakeholders.
Collapse
Affiliation(s)
- Kathrin Knochel
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Vedrana Zaimovic
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Birga Gatzweiler
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Kerstin K Hein
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Nari Heitkamp
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Anna Monz
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Daniel Reimann
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service (G.D.B.), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Monika Führer
- Center for Pediatric Palliative Care (K.K., V.Z., B.G., K.K.H., N.H., A.M., D.R., M.F.), Dr von Hauner Children's Hospital, University of Munich, Munich, Germany.
| |
Collapse
|
29
|
Leite RC, Ribeiro CA, Cunha MLDR, Maia EBS, Ben LWD, Almeida FDA. Busca de qualidade e segurança no cuidado ao filho: interações familiares com profissionais de Home Care. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo compreender a vivência do cuidador familiar de crianças/adolescentes assistidos pela equipe multiprofissional em Home Care. Método estudo qualitativo, tendo o Interacionismo Simbólico como referencial teórico, realizado com nove famílias de crianças/adolescentes em internação domiciliar, atendidas em uma empresa de Home Care localizada em São Paulo. Os dados foram coletados entre abril e outubro de 2017, por meio de entrevistas semiestruturadas, e submetidos à análise qualitativa de conteúdo convencional. Resultados as subcategorias Vivendo em constante estado de alerta e Dando um passo à frente para garantir um cuidado seguro e qualificado evidenciaram que os familiares ressignificam o cuidado, mostrando-se alertas, no sentido de redirecionar suas ações para prover uma assistência idealizada. Conclusão o Home Care exige dos familiares o enfrentamento de novos desafios e difíceis adaptações, além da preocupação com a segurança e qualidade do atendimento, levando-os a desenvolverem estratégias para lidar com a situação. Implicações para a prática os discursos dos familiares sinalizam a urgência da inserção da temática do cuidado pediátrico em Home Care nas pautas de debates e discussões acadêmicas, e seu desdobramento em investimentos por parte de gestores e serviços de atendimento domiciliar, a fim de garantir uma assistência segura à criança/adolescente e sua família.
Collapse
|
30
|
Carr K, Hasson F, McIlfatrick S, Downing J. Parents' experiences of initiation of paediatric advance care planning discussions: a qualitative study. Eur J Pediatr 2022; 181:1185-1196. [PMID: 34783898 PMCID: PMC8897342 DOI: 10.1007/s00431-021-04314-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
Advance care planning enables parents to discuss their goal and wishes for the future treatment and care of their life-limited or life-threatened child. Whilst research has identified the barriers clinicians face to initiate such discussions, the views of the parents have received scant attention. This qualitative study, using reflexive thematic analysis, aimed to explore parents' experience of the initiation of their child's advance care planning discussions, to help provide an understanding to inform future practice. Single interviews were undertaken with 17 non-bereaved and bereaved parents. Parents reported they had engaged with future thinking but needed time before initiating this with clinicians. They identified the need for a trusted professional and time for private, thorough, non-judgemental discussion without feeling clinicians were 'giving up'. Parents reported that advance care planning discussions were not always aligned to the dynamics of family life. They felt that health professionals were responsible for initiating advance planning conversations according to the families' individual requirements. There was an apparent lack of standardised protocols to assist paediatric advance care planning discussion initiation.Conclusion: Initiating advance care planning is a complicated process that needs to be tailored to the specific parent and child situation. Health professionals need to appreciate that parents are key contributors to initiate engagement with advance care planning discussions but that they also require support and care, recognising this may facilitate the building of trust, identified as a key corner stone, of paediatric advance care planning initiation and engagement. What is Known: • In paediatric palliative care, parents are challenged with wanting to sustain hope whilst thinking and planning for their child's end of life. Paediatric advance care planning discussions are often delayed or avoided and triggered by physical deterioration. What is New: • Previous relationship with HCP not essential but parental trust of the HCP is fundamental to Paediatric advance care planning initiation engagement. To build mutual trust health professionals' approach needs to be professional, respectful and empathetic to the parent and child's situation. • Subtle paediatric advance care planning parent initiation preparation by HCP is often unnoticed by parents but may be the crux of empowering parents to initiate advance care planning conversations themselves as they need to feel a sense of regaining control before planning ahead.
Collapse
Affiliation(s)
- Karen Carr
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road , Newtownabbey, BT37 0QB, UK.
| | - Felicity Hasson
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road , Newtownabbey, BT37 0QB UK
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road , Newtownabbey, BT37 0QB UK
| | - Julia Downing
- International Children’s Palliative Care Network, Bristol, UK ,Makerere University Uganda, Kampala, Uganda
| |
Collapse
|
31
|
Bergstraesser E, Thienprayoon R, Brook LA, Fraser LK, Hynson JL, Rosenberg AR, Snaman JM, Weaver MS, Widger K, Zernikow B, Jones CA, Schlögl M. Top Ten Tips Palliative Care Clinicians Should Know About Prognostication in Children. J Palliat Med 2021; 24:1725-1731. [PMID: 34726519 DOI: 10.1089/jpm.2021.0439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pediatric palliative care (PPC) is different from palliative care (PC) for adults. However, conceptualizing PPC remains cumbersome due to the high heterogeneity of often rare diseases, the high diversity of disease trajectories, and the particular difficulty to predict the future of an individual, severely ill child. This article aims to provide an overview and critical reflection of different aspects of prognostication in children with PC needs. This includes different diseases from neurology to oncology, from the unborn baby to the young adult, new approaches in treatment, advance care planning, and, most important, communication with the affected child as well as parents.
Collapse
Affiliation(s)
- Eva Bergstraesser
- Department of Pediatric Palliative Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Rachel Thienprayoon
- Division of Palliative Care, Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lynda A Brook
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Lorna K Fraser
- Martin House Research Centre, University of York, Heslington, United Kingdom
| | - Jenny L Hynson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Abby R Rosenberg
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, Washington, USA
| | - Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA.,National Center for Ethics in Healthcare, Washington, DC, USA
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, Univeristy of Toronto, Toronto, Ontario, Canada.,Pediatric Advanced Care Team, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Boris Zernikow
- Pediatric Palliative Care Centre, Children's and Adolescents' Hospital Datteln, Germany.,Department of Children's Pain Therapy and Pediatric Palliative Care, Datteln, Germany.,Faculty of Health-School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mathias Schlögl
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland.,Universtiy Clinic for Acute Geriatric Care, City Hospital Waid Zurich, Zurich, Switzerland
| |
Collapse
|
32
|
van Westrhenen A, de Lange WFM, Hagebeuk EEO, Lazeron RHC, Thijs RD, Kars MC. Parental experiences and perspectives on the value of seizure detection while caring for a child with epilepsy: A qualitative study. Epilepsy Behav 2021; 124:108323. [PMID: 34598099 DOI: 10.1016/j.yebeh.2021.108323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Caring for a child with epilepsy has a significant impact on parental quality of life. Seizure unpredictability and complications, including sudden unexpected death in epilepsy (SUDEP), may cause high parental stress and increased anxiety. Nocturnal supervision with seizure detection devices may lower SUDEP risk and decrease parental burden of seizure monitoring, but little is known about their added value in family homes. METHODS We conducted semi-structured in-depth interviews with parents of children with refractory epilepsy participating in the PROMISE trial (NCT03909984) to explore the value of seizure detection in the daily care of their child. Children were aged 4-16 years, treated at a tertiary epilepsy center, had at least one nocturnal major motor seizure per week, and used a wearable seizure detection device (NightWatch) for two months at home. Data were analyzed using inductive thematic analysis. RESULTS Twenty three parents of nineteen children with refractory epilepsy were interviewed. All parents expressed their fear of missing a large seizure and the possible consequences of not intervening in time. Some parents felt the threat of child loss during every seizure, while others thought about it from time to time. The fear could fluctuate over time, mainly associated with fluctuations of seizure frequency. Most parents described how they developed a protective behavior, driven by this fear. The way parents handled the care of their child and experienced the burden of care influenced their perceptions on the added value of NightWatch. The experienced value of NightWatch depended on the amount of assurance it could offer to reduce their fear and the associated protective behavior as well as their resilience to handle the potential extra burden of care, due to false alarms or technical problems. CONCLUSION Healthcare professionals and device companies should be aware of parental protective behavior and the high parental burden of care and develop tailored strategies to optimize seizure detection device care.
Collapse
Affiliation(s)
- Anouk van Westrhenen
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, The Netherlands; Department of Neurology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | - Wendela F M de Lange
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Eveline E O Hagebeuk
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, The Netherlands.
| | - Richard H C Lazeron
- Academic Center of Epileptology Kempenhaeghe, Heeze, The Netherlands; Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, The Netherlands; Department of Neurology, Leiden University Medical Center (LUMC), Leiden, The Netherlands; UCL Queen Square Institute of Neurology, London, United Kingdom.
| | - Marijke C Kars
- Center of Expertise in Palliative Care, Julius Center Research Program Cancer, University Medical Center Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
33
|
Erdim NK, Koyuncu Z, Keleş H, Durcan G, Kadak MT, Doğangün B, Celkan T. Impact of having a sibling with cancer or type I diabetes mellitus on psychopathology and self-conscious emotions in adolescents: a comparative study including controls. Support Care Cancer 2021; 30:635-645. [PMID: 34363110 DOI: 10.1007/s00520-021-06456-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND OBJECTIVE: Having a child diagnosed with cancer is stressful for the whole family and may cause significant psychological impact on parents and siblings. Chronic, life-altering diseases may also have similar effects in siblings due to the daily life changes in the family to accommodate the child with chronic disease. We investigated the impact of having a sibling with cancer or type 1 diabetes mellitus (T1DM) on the psychological features of adolescents, with particular focus on self-conscious emotions such as guilt and shame-which are associated with the development of psychopathologies. METHOD Sixty-four children who were siblings of patients diagnosed with cancer (CS group), 54 children who were siblings of patients diagnosed with T1DM (DMS group), and 200 adolescents with siblings who did not have any chronic disease (control group) were included in the study. The CS group was also divided into two subgroups with respect to cancer type (leukemia and non-leukemia). Feelings of guilt and shame were evaluated via the Test of Self-Consciousness Affect for Adolescents (TOSCA-A). The Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory (STAI) were used to determine the levels of depression and anxiety symptoms. Comparisons between groups were performed and within-group directional relationships between scores were analyzed. RESULTS Guilt scores were significantly higher in CSs than controls (p = 0.009), and the guilt scores of CSs and DMSs were similar (p = 0.508). Other subdimension scores obtained from the TOSCA-A and the CDI and STAI scores were similar in all three groups. In the CS group, externalization scores of siblings with leukemia were significantly higher than that of siblings with non-leukemia cancer. Although shame scores were similar in the CS, DMS, and control groups, shame scores were found to be positively correlated with CDI and STAI total scores in each group (p < 0.05 for all), whereas guilt scores did not demonstrate any significant correlations. CONCLUSION Our results support prior studies in showing that CSs feel a greater level of guilt compared to adolescents without disease-stricken siblings, whereas, interestingly, CSs and DMSs were found to experience similar levels of guilt. Despite lack of significant increase in the CS and DMS groups, shame levels were positively correlated with depression and anxiety scores in all groups, but the lower correlation coefficients for the CS group indicate the presence of other factors influencing this relationship. We believe our results warrant the need for future studies evaluating the needs of the siblings of children with other chronic diseases, preferably with longitudinal follow-up to determine situations associated with need for psychosocial support.
Collapse
Affiliation(s)
| | - Zehra Koyuncu
- Department of Child and Adolescent Psychiatry, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa Street No: 53, Cerrahpasa, Fatih/Istanbul, 34098, Turkey.
| | | | - Gizem Durcan
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital of Psychiatry, Istanbul, Turkey
| | - Muhammed Tayyib Kadak
- Department of Child and Adolescent Psychiatry, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa Street No: 53, Cerrahpasa, Fatih/Istanbul, 34098, Turkey
| | - Burak Doğangün
- Department of Child and Adolescent Psychiatry, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Kocamustafapasa Street No: 53, Cerrahpasa, Fatih/Istanbul, 34098, Turkey
| | - Tiraje Celkan
- Department of Pediatric Hematology and Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
34
|
Mariyana R, Betriana F. "I Checked Her While She was Sleeping Just to make Sure She was Still Alive": A Qualitative Study of Parents and Caregivers of Children with Chronic Disease in Indonesia. J Pediatr Nurs 2021; 59:e7-e12. [PMID: 33546965 DOI: 10.1016/j.pedn.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Caring for children with chronic disease is a stressful and challenging experience for parents and caregivers. This study aimed to describe the experiences of parents and caregivers who cared for children with chronic disease. DESIGN AND METHODS A descriptive qualitative study was conducted through face-to-face interview in West Sumatra, Indonesia. Sampling was continued until saturation was achieved, resulting in eleven parents and caregiver who met the inclusion criteria. Data were collected from March to May 2019 and were analyzed through content analysis. Trustworthiness of this study was established following the criteria of credibility, transferability, confirmability, and dependability. RESULTS Findings revealed three categories, namely expressions of care, efforts of care, and ways of accepting the situations. Parents expressed their feeling through crying, denial, guilt, and fear of loss. Efforts of care were reflected from trying traditional healing, following health care workers recommendations, and striving to be good parents. Ways of accepting the situations were derived from motivating oneself, looking for support, and surrendering. CONCLUSIONS Parents and caregivers of children with chronic disease expressed various feelings and expressions since the first time they knew the diagnoses until they continued to care for their children at home and started life adjustment. The main points of concern and psycho-emotional burden on the family-care provider were identified as anticipatory grief, which occurred when the parents and caregiver realized that death maybe close after they knew the diagnoses. Another concern was regarding the appropriate way to care for the children at home, which was mostly provided by the mother. PRACTICE IMPLICATIONS Psychological and social support should be given to parents who have children with chronic disease, especially from peer groups with other parents of children with the same conditions. Health care providers are suggested to provide caregivers with information regarding continuing care for their children at home and involve the father in planning family-centered care.
Collapse
Affiliation(s)
- Rina Mariyana
- Department of Nursing, Fort de Kock University, Bukittinggi, Indonesia
| | - Feni Betriana
- Department of Nursing, Fort de Kock University, Bukittinggi, Indonesia.
| |
Collapse
|
35
|
Kochen EM, Boelen PA, Teunissen SCCM, Jenken F, de Jonge RR, Grootenhuis MA, Kars MC. Health Care Professionals' Experiences With Preloss Care in Pediatrics: Goals, Strategies, Obstacles, and Facilitators. J Pain Symptom Manage 2021; 62:107-116. [PMID: 33186732 DOI: 10.1016/j.jpainsymman.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Although parents experience grief when confronted with their child's deterioration and imminent death, most bereavement care is focused on supporting parents after child loss. Insight into intentions and strategies of the health care professionals (HCPs) in preloss care during the end of life is still lacking. OBJECTIVES To create a starting point for improvement of preloss care, this study explores HCPs' experiences with providing support aimed at parental feelings of grief during the child's end of life. METHODS Exploratory qualitative research using individual semistructured interviews with clinicians in pediatrics and neonatology in hospital and homecare settings. Data were thematically analyzed by a multidisciplinary team. RESULTS Nineteen HCPs participated. HCPs tried to ensure that parents could reflect on the care received as concordant to their preferences and were not hindered in their bereavement as a consequence of their professional actions. Strategies included maximizing parental presence, enabling parental involvement in decision making, and ensuring a dignified death. While using these strategies, HCPs faced several difficulties: uncertainty about the illness course, unpredictability of parental grief responses, and being affected themselves by the child's imminent death. It helped HCPs to develop a bond with parents, find comfort with colleagues, and making joint decisions with colleagues. CONCLUSION HCPs strive to improve parental coping after the child's death, yet apply strategies that positively influence parental preparedness and well-being during the end of life as well. Individual HCPs are left with many uncertainties. A more robust approach based on theory, evidence, and training is needed to improve preloss care in pediatrics.
Collapse
Affiliation(s)
- Eline M Kochen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floor Jenken
- Department Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roos R de Jonge
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Department of Psycho-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | |
Collapse
|
36
|
Baumann F, Hebert S, Rascher W, Woelfle J, Gravou-Apostolatou C. Clinical Characteristics of the End-of-Life Phase in Children with Life-Limiting Diseases: Retrospective Study from a Single Center for Pediatric Palliative Care. CHILDREN-BASEL 2021; 8:children8060523. [PMID: 34205278 PMCID: PMC8235017 DOI: 10.3390/children8060523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
Background: Data on the end-of-life phase of children receiving palliative care are limited. The purpose of this study is to investigate the spectrum of symptoms of terminally ill children, adolescents, and young adults, depending on their underlying disease. Methods: Findings are based on a 4.5-year retrospective study of 89 children who received palliative care before they died, investigating the symptomatology of the last two weeks before death. Results: In this study, the most common clinical symptomatology present in children undergoing end-of-life care includes pain, shortness of breath, anxiety, nausea, and constipation. Out of 89 patients included in this study, 47% suffered from an oncological disease. Oncological patients had a significantly higher symptom burden at the end of life (p < 0.05) compared to other groups, and the intensity of symptoms increased as the underlying disease progressed. The likelihood of experiencing pain and nausea/vomiting was also significantly higher in oncological patients (p = 0.016). Conclusions: We found that the underlying disease is associated with marked differences in the respective leading clinical symptom. Therefore, related to these differences, symptom management has to be adjusted according to the underlying disease, since the underlying disorder seems to exert an influence on the severity of symptoms and thereby on the modality and choice of treatment. This study is intended to aid underlying disease-specific symptom management at the end-of-life care for children, adolescents, and young adults, with a specific focus on end-of-life care in a home environment.
Collapse
Affiliation(s)
| | | | | | - Joachim Woelfle
- Correspondence: ; Tel.: +49-9131-85-33118 or +49-9131-85-33113
| | | |
Collapse
|
37
|
Boles JC, Jones MT. Legacy perceptions and interventions for adults and children receiving palliative care: A systematic review. Palliat Med 2021; 35:529-551. [PMID: 33487090 DOI: 10.1177/0269216321989565] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Legacy has been invoked as a means for strengthening human attachments, continuing bonds, and ensuring that individuals will be remembered; however, little is known about the spectrum of approaches to, outcomes associated with, and best practices for legacy interventions. AIM To systematically review research on legacy perceptions and interventions in pediatric and adult palliative care recipients. DESIGN A systematic mixed studies review synthesizing quantitative, qualitative, and mixed-methods study findings using PRISMA guidelines. DATA SOURCES PubMed, PsycINFO, and CINAHL databases were searched on October 1, 2020. GRADE criteria were used to assess quality of quantitative reports, and the Johns Hopkins Evidence Level and Quality Guide was used to rate qualitative, mixed methods, and review articles. Data were synthesized using integrative thematic analysis. RESULTS The 67 studies reviewed describe a variety of legacy perceptions and interventions with adult and pediatric patients receiving palliative care. Statistically significant improvements in various dimensions of wellbeing are documented, with significant reduction in incidence and symptoms of depression in adults. Studies highlight the utility, feasibility, and perceived benefits of legacy interventions according to adult patients and their caregivers, and parents/caregivers of pediatric patients. CONCLUSIONS Though future research with high-quality, experimental designs is needed, the positive outcomes associated with legacy interventions are documented in adult patient populations; additionally, the application of legacy interventions for children with serious illnesses receiving palliative care is reasonable based on the existing body of evidence. A consistent and operational concept of legacy is still needed for future research and practice.
Collapse
Affiliation(s)
- Jessika C Boles
- Child Life Department, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Maile T Jones
- Child Life Department, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| |
Collapse
|
38
|
Darlington A, Randall D, Leppard L, Koh M. Palliative and end of life care for a child: Understanding parents' coping strategies. Acta Paediatr 2021; 110:673-681. [PMID: 32564398 DOI: 10.1111/apa.15429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022]
Abstract
AIM Understanding of coping strategies that parents use before the death of their child is crucial and will enable us to best provide support. The current study aimed to explore parents' coping strategies, and map these onto an existing theoretical framework. METHODS Bereaved parents and parents of a child with a life-limiting/threatening condition were interviewed to investigate coping strategies, recruited through Intensive Care Units (2 Neonatal, 2 Paediatric, 1 Paediatric Cardiac) and a children's hospice. Analysis focused on coping strategies and mapping these onto the framework. RESULTS 24 parents of 20 children were interviewed and identified. Parents use a variety of coping strategies (n = 25) such as humour, staying positive, advocating and staying strong for others, expressing emotions and preparing, while also living life to the full, supported by others. The themes were successfully mapped onto the theoretical framework, which focuses on the constructs of approach and avoidance, as well as coping for self and others. CONCLUSION The findings have provided a detailed account of the breadth and depth of coping strategies parents use, including those classed as avoidance. The strategies were successfully mapped onto the theoretical framework. Future research should investigate changes over times, and associations to negative long-term outcomes.
Collapse
Affiliation(s)
| | - Duncan Randall
- School of Health Sciences University of Southampton Southampton UK
| | - Lisa Leppard
- Neonatal Intensive Care Unit University Hospital Southampton Southampton UK
| | - Michelle Koh
- University Hospital SouthamptonNaomi House Hospice Southampton UK
| |
Collapse
|
39
|
Postavaru GI, Swaby H, Swaby R. A meta-ethnographic study of fathers' experiences of caring for a child with a life-limiting illness. Palliat Med 2021; 35:261-279. [PMID: 33339475 PMCID: PMC7897781 DOI: 10.1177/0269216320979153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a growing body of qualitative studies examining parents' experiences of caring for a child with a life-limiting condition, coinciding with recent evidence that indicates an increasing incidence of paediatric life-limiting conditions. However, research focusing on fathers' needs remains sparse and is often diluted among a predominant 'mother's voice', raising questions about whether practices in clinical settings meet fathers' needs. AIM To provide an in-depth assembly of the current state of knowledge around fathers' experiences of caring for their children diagnosed with life-limiting conditions and understand the implications for healthcare services and policies. DESIGN A meta-ethnography was conducted to synthesise findings from existing qualitative studies exploring fathers' experiences of caring. DATA SOURCES Four electronic databases (PubMed, PsycINFO, CINAHL and Science Direct) were searched up until April 2020. Qualitative studies exploring fathers' care experience and published in English language were included. The Critical Appraisal Skills Programme (CASP) checklist was employed for study quality appraisal. No temporal limits were used. RESULTS Sixty-three studies met the inclusion criteria. Thirty life-limiting conditions were included. Based on responses from 496 fathers, a conceptual model was developed which translates key experiences within the fathers' caregiving journeys. The overarching concepts identified were: the paradox of support, challenges in the caring process, 'nobody thinks of men', impact on family life and the fall of the curtain: an irrevocably altered world. These and associated sub-concepts are discussed, with recommendations for future research and practice provided. CONCLUSION The findings indicate the value of a family-oriented approach to develop psychosocial interventions and support channels for fathers, thus empowering them whilst reducing the care-giving burden on the family unit.
Collapse
Affiliation(s)
| | | | - Rabbi Swaby
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
40
|
Fahner J, Rietjens J, van der Heide A, Milota M, van Delden J, Kars M. Evaluation showed that stakeholders valued the support provided by the Implementing Pediatric Advance Care Planning Toolkit. Acta Paediatr 2021; 110:237-246. [PMID: 32434275 PMCID: PMC7818164 DOI: 10.1111/apa.15370] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 01/22/2023]
Abstract
AIM This study described the development, and pilot evaluation, of the Implementing Pediatric Advance Care Planning Toolkit (IMPACT). METHODS Key elements of paediatric advance care planning (ACP) were defined using a systematic review, a survey of 168 paediatricians and qualitative studies of 13 children with life-limiting conditions, 20 parents and 18 paediatricians. Participants were purposively recruited from six Dutch university hospitals during September 2016 and November 2018. Key elements were translated into intervention components guided by theory. The acceptability of the content was evaluated by a qualitative pilot study during February and September 2019. This focused on 27 children with life-limiting conditions from hospitals, a hospice and home care, together with 41 parents, 11 physicians and seven nurses who cared for them. RESULTS IMPACT provided a holistic, caring approach to ACP, gave children a voice and cared for their parents. It provided information on ACP for families and clinicians, manuals to structure ACP conversations and training for clinicians in communication skills and supportive attitudes. The 53 pilot study participants felt that IMPACT was appropriate for paediatric ACP. CONCLUSION IMPACT was an appropriate intervention that supported a holistic approach towards paediatric ACP, focused on the child's perspective and provided care for their parents.
Collapse
Affiliation(s)
- Jurrianne Fahner
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Judith Rietjens
- Department of Public HealthErasmus Medical CenterRotterdamthe Netherlands
| | | | - Megan Milota
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Johannes van Delden
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Marijke Kars
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| |
Collapse
|
41
|
Verberne LM, Fahner JC, Sondaal SFV, Schouten–van Meeteren AYN, de Kruiff CC, van Delden JJM, Kars MC. Anticipating the future of the child and family in pediatric palliative care: a qualitative study into the perspectives of parents and healthcare professionals. Eur J Pediatr 2021; 180:949-957. [PMID: 33030601 PMCID: PMC7886816 DOI: 10.1007/s00431-020-03824-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Abstract
Preparing for future scenarios in pediatric palliative care is perceived as complex and challenging by both families and healthcare professionals. This interpretative qualitative study using thematic analysis aims to explore how parents and healthcare professionals anticipate the future of the child and family in pediatric palliative care. Single and repeated interviews were undertaken with 42 parents and 35 healthcare professionals of 24 children, receiving palliative care. Anticipating the future was seen in three forms: goal-directed conversations, anticipated care, and guidance on the job. Goal-directed conversations were initiated by either parents or healthcare professionals to ensure others could align with their perspective regarding the future. Anticipated care meant healthcare professionals or parents organized practical care arrangements for future scenarios with or without informing each other. Guidance on the job was a form of short-term anticipation, whereby healthcare professionals guide parents ad hoc through difficult situations.Conclusion: Anticipating the future of the child and family is mainly focused on achievement of individual care goals of both families and healthcare professionals, practical arrangements in advance, and short-term anticipation when a child deteriorates. A more open approach early in disease trajectories exploring perspectives on the future could allow parents to anticipate more gradually and to integrate their preferences into the care of their child. What is Known: • Anticipating the future in pediatric palliative care occurs infrequently and too late. What is New: • Healthcare professionals and parents use different strategies to anticipate the future of children receiving palliative care, both intentionally and unwittingly. Strategies to anticipate the future are goal-directed conversations, anticipated care, and guidance on the job. • Parents and healthcare professionals are engaged to a limited extent in ongoing explorative conversations that support shared decision-making regarding future care and treatment.
Collapse
Affiliation(s)
- Lisa M. Verberne
- Department of pediatrics, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | - Jurrianne C. Fahner
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Stephanie F. V. Sondaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | | | - Chris C. de Kruiff
- Emma Children’s Hospital, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Johannes J. M. van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Marijke C. Kars
- Center of Expertise Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| |
Collapse
|
42
|
Bogetz JF, Trowbridge A, Kingsley J, Taylor M, Rosenberg AR, Barton KS. "It's My Job to Love Him": Parenting Adolescents and Young Adults With Advanced Cancer. Pediatrics 2020; 146:peds.2020-006353. [PMID: 33234665 DOI: 10.1542/peds.2020-006353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Parents of adolescents and young adults (AYAs) with serious illness experience enormous stress as they navigate their child's illness. In this study, we aimed to elucidate AYA parental perspectives on the advanced cancer experience, including what parents find challenging and their sources of strength. METHODS Parents of AYAs aged 14 to 24 years old being treated for recurrent or refractory advanced cancer at a large academic center completed demographic surveys and 1:1 semi-structured interviews between December 2017 and July 2018. Conventional content analysis was used by 2 coders to analyze transcriptions, with a third reviewer adjudicating. Thematic networks analysis was then used to extrapolate basic and organizing themes. RESULTS A total of 22 parents participated. The majority were female, non-Hispanic, and married; 23% (n = 5) were from racial minority groups. We identified 3 organizing themes related to navigating parents' experiences: (1) what we do to love our child, (2) what challenges us, and (3) how we keep our heart focused on what matters most. Despite substantial uncertainty about their child's future, parents endorsed growth and gratitude as they focused on the ways they showed love for their child during this difficult time. CONCLUSIONS Parents of AYAs with advanced cancer experience many parenting challenges, elucidating some of the vulnerabilities and magnifying the sources of strength among parents of children transitioning to adulthood during serious illness. This research has important implications for how we build programs that support and sustain parents' well-being during their child's serious illness.
Collapse
Affiliation(s)
- Jori F Bogetz
- Seattle Children's Hospital, Seattle, Washington; .,School of Medicine, University of Washington, Seattle, Washington.,Palliative Care and Resilience Laboratory, Seattle Children's Research Institute, Seattle, Washington; and
| | - Amy Trowbridge
- Seattle Children's Hospital, Seattle, Washington.,School of Medicine, University of Washington, Seattle, Washington.,Palliative Care and Resilience Laboratory, Seattle Children's Research Institute, Seattle, Washington; and
| | - Jenny Kingsley
- Seattle Children's Hospital, Seattle, Washington.,School of Medicine, University of Washington, Seattle, Washington.,Palliative Care and Resilience Laboratory, Seattle Children's Research Institute, Seattle, Washington; and.,Keck School of Medicine, Los Angeles, California
| | - Mallory Taylor
- Seattle Children's Hospital, Seattle, Washington.,School of Medicine, University of Washington, Seattle, Washington.,Palliative Care and Resilience Laboratory, Seattle Children's Research Institute, Seattle, Washington; and
| | - Abby R Rosenberg
- Seattle Children's Hospital, Seattle, Washington.,School of Medicine, University of Washington, Seattle, Washington.,Palliative Care and Resilience Laboratory, Seattle Children's Research Institute, Seattle, Washington; and
| | - Krysta S Barton
- Seattle Children's Hospital, Seattle, Washington.,Palliative Care and Resilience Laboratory, Seattle Children's Research Institute, Seattle, Washington; and
| |
Collapse
|
43
|
Lin CJ, Cheng YI, Garvie PA, D’Angelo LJ, Wang J, Lyon ME. The Effect of FAmily-CEntered (FACE ®) Pediatric Advanced Care Planning Intervention on Family Anxiety: A Randomized Controlled Clinical Trial for Adolescents With HIV and Their Families. JOURNAL OF FAMILY NURSING 2020; 26:315-326. [PMID: 33283612 PMCID: PMC8015181 DOI: 10.1177/1074840720964093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Clinicians fear pediatric advance care planning (pACP) for adolescents is too distressing for families. Multisite longitudinal randomized controlled trial of adolescents with HIV tested the effect of FAmily-CEntered (FACE®) pACP intervention on families' anxiety and depression. One hundred five adolescent/family dyads were randomized to FACE® (n = 54 dyads) or control (n = 51 dyads). Families were 90% African American, 37% HIV-positive, and 22% less than high school educated. Families reported lower anxiety 3 months post-FACE® intervention than control (β = -4.71, 95% confidence interval [CI] = [-8.20, -1.23], p = .008). Male family members were less anxious than female family members (β = -4.55, 95% CI = [-6.96, -2.138], p ≤ .001). Family members living with HIV reported greater depressive symptoms than HIV-uninfected families (β = 3.32, 95% CI = [0.254, 6.38], p = .034). Clinicians can be assured this structured, facilitated FACE® pACP model minimized family anxiety without increasing depressive symptoms. Adolescent/family dyads should be invited to have access to, and provision of, evidence-based pACP as part of patient-centered/family-supported care in the HIV continuum of care.
Collapse
Affiliation(s)
| | - Yao I. Cheng
- Children’s National Hospital & Center for Translational Research, Washington, DC, USA
| | | | | | - Jichuan Wang
- Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, DC, USA
| | - Maureen E. Lyon
- Children’s National Hospital & Center for Translational Research, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, DC, USA
- Children’s National Research Institute, Washington, DC, USA
| | | |
Collapse
|
44
|
Winger A, Kvarme LG, Løyland B, Kristiansen C, Helseth S, Ravn IH. Family experiences with palliative care for children at home: a systematic literature review. BMC Palliat Care 2020; 19:165. [PMID: 33099303 PMCID: PMC7585197 DOI: 10.1186/s12904-020-00672-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/15/2020] [Indexed: 01/29/2023] Open
Abstract
Background The main goal of pediatric palliative care (PPC) is to improve or maintain the best possible quality of life (QoL) for the child and their family. PPC can be provided in community health centres, within the specialist health care service and/or in the child’s home. Home is often the preferred place for families, and recommendations state that, whenever possible, the family home should be the centre of care for the child. The aim of this study is to systematically review the experiences and needs of families with children receiving palliative care at home. Methods We conducted a systematic review and searched the peer-reviewed databases CINAHL, Embase, PsycInfo and MEDLINE for articles published between January 2000 and October 2019. We included 23 studies emphasising the experience of family members when their child (0–18 years) received palliative care at home. We used a thematic analysis to identify relevant themes in the literature, and synthesised the findings from the different studies. Results The review represents the experiences of the families of almost 300 children with life-limiting (LL) and life-threatening (LT) conditions receiving palliative care at home. In general, the children’s mothers are interviewed, and seldom the sick children themselves or their siblings. Most families preferred staying at home since it made it easier to maintain a normal family life, was less stressful for the sick child, and meant that siblings could still attend school and be with friends. Families experienced a range of challenges due to the coordination of care, including a lack of support and adequately skilled staff with appropriate experience. Respite care was needed in order to cope with everyday life. Some studies were not specific concerning the place of care, and some relevant papers may have been omitted. Conclusions Families receiving PPC need organised, individualised support from a skilled PPC team. Respite care is necessary in order to manage a demanding home-care situation and parents need support for siblings. Privacy to be a family is a need, and many families need financial support. Future studies should focus on PPC at home in the perspectives of sick children and their siblings.
Collapse
Affiliation(s)
- Anette Winger
- Oslo Metropolitan University (OsloMet), P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway.
| | - Lisbeth Gravdal Kvarme
- Oslo Metropolitan University (OsloMet), P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway
| | - Borghild Løyland
- Oslo Metropolitan University (OsloMet), P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway
| | | | - Sølvi Helseth
- Oslo Metropolitan University (OsloMet), P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway
| | - Ingrid H Ravn
- Oslo Metropolitan University (OsloMet), P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway
| |
Collapse
|
45
|
Bowers AP, Bradford N, Chan RJ, Herbert A, Yates P. Analysis of health administration data to inform health service planning for paediatric palliative care. BMJ Support Palliat Care 2020; 12:e671-e679. [PMID: 33051310 DOI: 10.1136/bmjspcare-2020-002449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/27/2020] [Accepted: 09/15/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Health service planning in paediatric palliative care is complex, with the diverse geographical and demographic characteristics adding to the challenge of developing services across different nations. Accurate and reliable data are essential to inform effective, efficient and equitable health services. AIM To quantify health service usage by children and young people aged 0-21 years with a life-limiting condition admitted to hospital and health service facilities in Queensland, Australia during the 2011 and 2016 calendar years, and describe the clinical and demographic characteristics associated with health services usage. DESIGN Retrospective health administrative data linkage of clinical and demographic information with hospital admissions was extracted using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification (ICD-10-AM) diagnostic codes. Data were analysed using descriptive statistics. SETTING/PARTICIPANTS Individuals aged 0-21 years with a life-limiting condition admitted to a Queensland Public Hospital and Health Service or private hospital. RESULTS Hospital admissions increased from 17 955 in 2011 to 23 273 in 2016, an increase of 5318 (29.6%). The greatest percentage increase in admissions were for those aged 16-18 years (58.1%, n=1050), and those with non-oncological conditions (36.2%, n=4256). The greatest number of admissions by ICD-10-AM chapter for 2011 and 2016 were by individuals with neoplasms (6174, 34.4% and 7206, 31.0% respectively). Overall, the number of admissions by Indigenous children and young people increased by 70.2% (n=838). CONCLUSIONS Administrative data are useful to describe clinical and demographic characteristics and quantify health service usage. Available data suggest a growing demand for health services by children eligible for palliative care that will require an appropriate response from health service planners.
Collapse
Affiliation(s)
- Alison Pauline Bowers
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia .,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Centre for Children's Health Research, Queensland University of Technology (QUT), South Brisbane, Queensland, Australia
| | - Natalie Bradford
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Centre for Children's Health Research, Queensland University of Technology (QUT), South Brisbane, Queensland, Australia
| | - Raymond Javan Chan
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Anthony Herbert
- Paediatric Palliative Care, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Patsy Yates
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Centre for Children's Health Research, Queensland University of Technology (QUT), South Brisbane, Queensland, Australia
| |
Collapse
|
46
|
Clancy M, Taylor J, Bradbury-Jones C, Phillimore J. A systematic review exploring palliative care for families who are forced migrants. J Adv Nurs 2020; 76:2872-2884. [PMID: 32865848 DOI: 10.1111/jan.14509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/09/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
AIMS To explore the palliative care experiences of forced migrant children, families, and healthcare professionals (HCPs) highlighting successes, challenges, and associated practice implications. DESIGN Systematic literature review. DATA SOURCES The following search engines were searched from 2008 - 2018: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health, MEDLINE, Embase, ProQuest, Scopus, Psycinfo, and Web of Science. Extensive reference and citation checking were also conducted. REVIEW METHODS Systematic review followed PRISMA guidelines with prepared PROSPERO registered protocol #CRD42019129200. English language qualitative, quantitative, or mixed methods studies were eligible for inclusion. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). RESULTS Eighteen studies (reported in 20 articles) met the final inclusion criteria. Most focused on challenges to care provision. Thematic analysis following methods proposed by Braun and Clarke was undertaken. Five themes were identified: (a) divergence of beliefs and expectations; (b) communication; (c) navigating healthcare systems; (d) burdens and coping strategies; and (e) training and knowledge. A compassionate, collaborative approach with mutual respect crossed themes and was linked to high-quality care. CONCLUSION Forced migrant families have multiple needs including physical and emotional support and help in navigating complex systems. Professional interpreters can ease communication barriers when resourced appropriately. Individualized care is crucial to addressing the intricate mosaic of culture such families present. A cultural sensitivity/insensitivity framework is presented that may help guide future interactions and priorities for those working in children's palliative care. IMPACT This systematic review explored the international experiences of palliative care for forced migrant families. The findings highlight the plight of families who experience multiple traumas and increased levels of grief and loss through their migration experiences and when caring for a child with a life-limiting condition. This research has potential to have an impact on professionals working with culturally diverse families in all palliative care settings.
Collapse
Affiliation(s)
- Marie Clancy
- School of Nursing, University of Birmingham, Birmingham, UK.,School of Social Policy, Sociology and Criminology, University of Birmingham, Birmingham, UK.,School of Nursing and Midwifery, Birmingham City University, Birmingham, UK
| | - Julie Taylor
- School of Nursing, University of Birmingham, Birmingham, UK.,Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Jenny Phillimore
- School of Social Policy, Sociology and Criminology, University of Birmingham, Birmingham, UK
| |
Collapse
|
47
|
Fahner JC, Thölking TW, Rietjens JAC, van der Heide A, van Delden JJM, Kars MC. Towards advance care planning in pediatrics: a qualitative study on envisioning the future as parents of a seriously ill child. Eur J Pediatr 2020; 179:1461-1468. [PMID: 32193658 PMCID: PMC7413894 DOI: 10.1007/s00431-020-03627-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/16/2020] [Accepted: 02/27/2020] [Indexed: 12/03/2022]
Abstract
Advance care planning enables parents to discuss goals and preferences for future care and treatment of their seriously ill child. Although clinicians report parental factors as common barriers for advance care planning, parental views on reflecting on their child's future have had limited exploration. A clear understanding of their perspectives might help clinicians to implement advance care planning tailored to parental needs. This interpretive qualitative study using thematic analysis aims to identify how parents envision the future when caring for their seriously ill child. Single interviews and two focus groups were attended by 20 parents of 17 seriously ill children. Parents reported to focus on the near future of their child. However, their actions and deeper thoughts showed perspectives towards a further future. Future perspectives initial focused on practical, disease-related themes, but more existential elaborations, reflecting underlying life values, were also identified. Parents needed acknowledgement of their challenging situation, care tasks, and expertise as a precondition for sharing their deepest thoughts regarding the future of their child.Conclusion: When envisioning the future of their seriously ill child, parents tend to stay in the near future, whereas they value the opportunity to share further thoughts within a compassionate relationship with clinicians. What is Known: • Parents prefer open and honest information about their child's illness and prognosis and they value the concept of advance care planning, while they emphasize the need for an individualized approach. • Health care professionals see parental factors like unease and emotional burden as key barriers for advance care planning. What is New: • When envisioning the future of their seriously ill child, parents tended to stay close to the near future initially, with a focus on disease-related, practical themes. Ongoing conversations uncovered deeper, value-based elaborations towards the future. To engage parents in advance care planning, the future needs to be discussed in relation to the present and the past. • There is "no sharing without caring". Parents who felt cared for and acknowledged in their challenging context by clinicians, were open to share their perspectives on the future of their seriously ill child. To share deeper motives and values underlying goals and preferences for future care and treatment, parents need a stimulating attitude of listening and encouragement from clinicians to express their feelings.
Collapse
Affiliation(s)
- Jurrianne C. Fahner
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, Medical Humanities, University Medical Center Utrecht, Internal mail no Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Thessa W. Thölking
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, Medical Humanities, University Medical Center Utrecht, Internal mail no Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Judith A. C. Rietjens
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Agnes van der Heide
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Johannes J. M. van Delden
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, Medical Humanities, University Medical Center Utrecht, Internal mail no Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marijke C. Kars
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, Medical Humanities, University Medical Center Utrecht, Internal mail no Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| |
Collapse
|
48
|
Boyden JY, Hill DL, Carroll KW, Morrison WE, Miller VA, Feudtner C. The Association of Perceived Social Support with Anxiety over Time in Parents of Children with Serious Illnesses. J Palliat Med 2019; 23:527-534. [PMID: 31697175 DOI: 10.1089/jpm.2019.0387] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Parenting a child with a serious life-threatening illness (SLTI) may impact parents' mental health. The protective association of social support with anxiety over time following an acute medical event has not been empirically tested in a sample of parents of children with oncologic and nononcologic serious illnesses. Objective: To test the potential association of perceived social support with anxiety in parents of children with SLTIs over time. Design: Prospective cohort study. Setting/Subjects: Two hundred parents of 158 children in the Decision Making in Serious Pediatric Illness study, conducted at the Children's Hospital of Philadelphia. Measurements: Parental anxiety and perceived social support were assessed using the Hospital Anxiety and Depression Scale (HADS) and the Social Provisions Scale (SPS). We performed bivariate linear regressions to test cross-sectional and longitudinal associations between the SPS and anxiety scores at baseline, 12 months, and 24 months. Results: The average SPS total and subscale scores decreased significantly from baseline to 12 months, and increased from 12 to 24 months. The average HADS-Anxiety scores decreased significantly from baseline to 12 months, and remained stable at 24 months. Cross-sectionally, total SPS scores were negatively associated with anxiety scores at each time point. Longitudinally, SPS scores were associated with anxiety scores, although this association weakened in adjusted modeling. Conclusions: Over a two-year period, higher levels of perceived social support were associated with lower levels of anxiety in parents of seriously ill children. Clinicians and researchers should work to optimize social support for families to improve parental mental health outcomes.
Collapse
Affiliation(s)
- Jackelyn Y Boyden
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas L Hill
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen W Carroll
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wynne E Morrison
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|