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Franklin P, Arber A, Ream E. Priorities for enhancing nurses' and social workers' competence and confidence in helping families support dependent children through parental death. A classic-Delphi survey. BMC Palliat Care 2024; 23:122. [PMID: 38760809 PMCID: PMC11102151 DOI: 10.1186/s12904-024-01452-0] [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] [Received: 05/29/2023] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Annually, approximately five per cent of dependent children - aged under eighteen years - in the United Kingdom (UK), experience parental death. Nurses and social workers caring for parents with life-limiting illnesses, including cancer, help families support their children. However, these professionals have been found to lack confidence and competence in fulfilling this role. METHODS We conducted three rounds of a classic-Delphi survey to identify and measure a panel of topic experts' consensus on the priorities and issues for nurses and social workers when supporting families and children through parental death. The Delphi survey was conducted with a panel of UK topic experts (n=43) including lead health and social care professionals (n=30), parents bereaved of a partner whilst parenting dependent children (n=6), academics (n=4) and bereaved young adults (n=3). RESULTS Ninety per cent (n=18/20) of the issues for nurses and social workers and all (7/7) of the priorities rated and ordered in the survey achieved consensus. Key priorities were 1) training in opening conversations with families about dependent children, 2) training and support for nurses and social workers to manage their own and others' emotions arising from conversations with parents about children's needs regarding parental death, and 3) increasing nurses' and social workers' knowledge of sources of information to support families before the death of a parent. CONCLUSION We identified priorities for UK nurses and social workers. Further research is needed to identify which of these nurses and social workers would benefit most from support, and how any resultant interventions could enhance confidence and competence in helping families to support children through parental death.
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Affiliation(s)
- Penny Franklin
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, England, GU2 7YH, UK.
- Department of Pastoral and Spiritual Care, Royal Devon University Healthcare NHS Foundation Trust, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, England, EX2 5DW, UK.
| | - Anne Arber
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, England, GU2 7YH, UK
| | - Emma Ream
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, England, GU2 7YH, UK
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Sheehan S, Hanna JR, Drury A, McCance T, Semple CJ, O'Neill C. A Systematic Review of Educational Interventions to Equip Health and Social Care Professionals to Promote End-of-Life Supportive Care when a Parent with Dependent Children is Dying with Cancer. Semin Oncol Nurs 2023; 39:151474. [PMID: 37481410 DOI: 10.1016/j.soncn.2023.151474] [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] [Received: 06/09/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES This systematic review aimed to determine the content, mode of delivery, assessment, and outcomes of educational interventions to equip health and social care professionals when delivering end of life supportive care for parents dying with cancer who have dependent children. DATA SOURCES A mixed-methods systematic review was undertaken. Six electronic database were searched from their inception until September 2023 (Medline OVID, CINAHL, EMBASE, PsycINFO, Web of Science, and ERIC), supplemented by citation chaining, grey literature searches using Google Advanced Search and relevant professional bodies. Quality assessment was conducted independently by two researchers on the included studies. A convergent integrated approach was utilised for data synthesis. CONCLUSION The review identified two educational interventions; highlighting a dearth of training opportunities to equip health and social care professionals to provide supportive care to families when a parent is at end of life with cancer. Despite health and social care professionals reported need and desire for upskilling in this area of clinical practice, there is a severe lack of evidence-based educational interventions. It is imperative that effective educational interventions are made accessible to professionals. IMPLICATIONS FOR NURSING PRACTICE There is an imminent need for robust educational interventions to be developed, as health and social care professionals often lack the knowledge, skills and confidence on how best to support families when a parent of dependent children is at end of life. Health and social care professionals engagement with high-quality, evidence-based and theory-driven educational interventions has the potential to impact professionals' provision of family-centred cancer care at end of life. This could lead to better mental and physical outcomes for the whole family at end of life and in bereavement.
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Affiliation(s)
- Sarah Sheehan
- Research Assistant, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Jeffrey R Hanna
- Research Associate, Institute of Nursing and Health Research, School of Nursing and Paramedic Science, Ulster University, Belfast, Northern Ireland
| | - Amanda Drury
- Associate Professor in General Nursing, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Tanya McCance
- The Mona Grey Professor of Nursing Research & Development, Institute of Nursing and Health Research, School of Nursing and Paramedic Science, Ulster University, Belfast, Northern Ireland
| | - Cherith J Semple
- Professor in Clinical Cancer Nursing, Institute of Nursing and Health Research, Ulster University / Cancer Services, South Eastern Health and Social Care Trust, Belfast, Northern Ireland
| | - Carla O'Neill
- Assistant Professor in Nursing, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
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Drury A, Dowling M, Diez de Los Rios de la Serna C, Erdem S, Aroyo V, Wiseman T, Bağçivan G. Advanced breast cancer education for cancer nurses: A systematic review. NURSE EDUCATION TODAY 2022; 117:105477. [PMID: 35908406 DOI: 10.1016/j.nedt.2022.105477] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Access to comprehensive, integrated, multidisciplinary care is one of the most urgent and actionable recommendations of the Advanced Breast Cancer Global Alliance. However, access to specialist breast care units, and specialist breast cancer nurses is variable, influenced by access to specialist education and role recognition. To date, there has not been a synthesis of evidence regarding educational programmes related to advanced breast cancer education for nurses. OBJECTIVES The aim of this review was to determine the content, mode of delivery, assessment and outcomes of education programmes related to advanced breast cancer for nurses. REVIEW METHODS A systematic review was undertaken, according to the Joanna Briggs Institute's mixed methods review methodology. DATA SOURCES MEDLINE, PUBMED, CINAHL, Scopus, PsycInfo, Joanna Briggs Institute, Web of Science and grey literature sources were systematically searched. Eleven publications met the inclusion criteria. Data relating to programme content, mode of delivery, assessment and outcomes were extracted and analysed. RESULTS This review identifies a limited number of educational programmes within this specialist area of nursing practice. Shortcomings in the development, implementation and evaluation of advanced breast cancer education programmes included limited use of educational standards, theoretical frameworks and patient and public involvement to inform programme development. Evaluation of education programmes related to advanced breast cancer relied predominantly on self-reported learning, with limited consideration of the impacts of education on service delivery, patient experience or quality of care. CONCLUSIONS Future development of advanced breast cancer education programmes must consider the alignment of programme content and learning outcomes with existing educational and competency standards. Evaluation of educational programmes in this field must endeavour to enhance rigour of methods, incorporating standardised questionnaires, and multiple methods and sources of data to evaluate the broader impacts of advanced breast cancer education for nurses.
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Affiliation(s)
- Amanda Drury
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Celia Diez de Los Rios de la Serna
- School of Nursing, Faculty of Medicine and Health Sciences, Bellvitge Campus, Barcelona University, Feixa Llarga, 08907-L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
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Navigating Difficult Conversations with Children When Parents are Ill: How Medical Family Therapists Can Assist. CONTEMPORARY FAMILY THERAPY 2022. [DOI: 10.1007/s10591-021-09628-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Steiner V, Joubert L, Shlonsky A, Morris A. Hospital Parenting Support for Adults with Incurable End-Stage Cancer: Multidisciplinary Health Professional Perspectives. HEALTH & SOCIAL WORK 2021; 46:289-298. [PMID: 34648638 DOI: 10.1093/hsw/hlab024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/18/2020] [Accepted: 07/30/2020] [Indexed: 06/13/2023]
Abstract
Patients with incurable end-stage cancer (IESC) who are parenting minor-age children often experience parenting-related distress. Parenting concerns are not always addressed as part of routine hospital-based psychosocial care. Currently, there is a lack multidisciplinary health professional (HP) perspectives in this area. An exploratory study of hospital-based HP perspectives of adult patients' and coparents' parenting experiences, support needs, and parenting supportive care practice was conducted. Twelve multidisciplinary HPs from one Australian tertiary hospital participated in a semistructured focus group and interviews. Data were audio recorded, transcribed, and analyzed using thematic analysis. Results showed HPs were cognizant of patients' and coparents' diverse parenting support needs and experiences and other aspects that comprise best practice. However, multilevel organization, HP, and patient/coparent barriers impeded optimal practice. Barriers included a nonsystemized approach to screening patients' parenting status and parenting support needs, inadequate resources, limited professional support, hospital environment, and parent psychosocial factors. This article provides feasible options for addressing practice barriers. Reviewing what factors influence optimal parenting focus from interdisciplinary HP perspectives helped identify potential strategies that could influence a shift from medical-focused care to more holistic family-focused patient care.
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Addressing the needs of parents with advanced cancer: Attitudes, practice behaviors, and training experiences of oncology social workers. Palliat Support Care 2020; 19:329-334. [PMID: 32985404 DOI: 10.1017/s1478951520001005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Advanced cancer patients who are parents of minor children experience heightened psychosocial distress. Oncology social workers (OSWs) are essential providers of psychosocial support to parents with advanced cancer. Yet, little is known about the experiences and approaches of OSWs in addressing these patients' unique needs. The purpose of this study was to characterize the attitudes, practice behaviors, and training experiences of OSWs who provide psychosocial care for advanced cancer patients with minor children. METHOD Forty-one OSWs participated in a cross-sectional survey addressing multiple facets of their psychosocial care for parents with advanced cancer. The five assessed domains of psychosocial support were communication support, emotional support, household support, illness and treatment decision-making support, and end-of-life planning. RESULTS Participants reported greatest confidence in counseling patients on communication with children about illness and providing support to co-parents about parenting concerns. OSWs reported less confidence in counseling parents on end-of-life issues and assisting families with non-traditional household structures. The majority of participants reported needing more time in their clinical practice to sufficiently address parents' psychosocial needs. Nearly 90% of participants were interested in receiving further training on the care of parents with advanced cancer. SIGNIFICANCE OF RESULTS To improve the care of parents with advanced cancer, it is critical to understand how the psychosocial oncology workforce perceives its clinical practice needs. Study findings suggest an opportunity for enhanced training, particularly with respect to end-of-life needs and in response to the changing household structure of American families.
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Steiner V, Joubert L, Shlonsky A, Hocking A. Australian Hospital-Based Parenting Support for Adults with Incurable End-Stage Cancer: Parent Perspectives. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:172-190. [PMID: 33300474 DOI: 10.1080/26408066.2019.1705957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Parenting support needs of patients diagnosed with incurable end-stage cancer (IESC) with young families are not addressed as part of routine hospital health care. Their support needs and experiences of hospital-based parenting support are largely unknown. The study aims to explore hospital-based parenting support delivery from patient and co-parent perspectives in context to their parenting experience and support needs. Exploratory, prospective, cross-sectional qualitative design. Semi-structured in-depth interviews with eight adult patients with IESC and four co-parents purposively recruited from a tertiary hospital in Melbourne, Australia. Findings were thematically analyzed. Parents desire support with challenging multidimensional parenting issues. Organization, health professionals (HP), and parental-based factors hinder and facilitate optimal service provision. Responsibility rests with HP to initiate parenting support. Interdisciplinary family-focused support offered throughout IESC health-care journey is key. Patient-centered family-focused support is warranted. Surmountable challenges lie with management and HPs to address barriers affecting optimal service delivery.
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Affiliation(s)
- Vera Steiner
- Department of Social Work, University of Melbourne, Parkville, VIC, Australia
| | - Lynette Joubert
- Department of Social Work, University of Melbourne, Parkville, VIC, Australia
| | - Aron Shlonsky
- Department of Social Work, Monash University, Caulfield East, VIC, Australia
| | - Alison Hocking
- Department of Social Work, University of Melbourne, Parkville, VIC, Australia
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O'Neill C, O'Neill CS, Semple C. Children Navigating Parental Cancer: Outcomes of a Psychosocial Intervention. Compr Child Adolesc Nurs 2019; 43:111-127. [PMID: 30875484 DOI: 10.1080/24694193.2019.1582727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Research has evidenced a marked increase in the prevalence of cancer among younger people with up to one in five, parenting children under the age of 18 years of age. When a parent is diagnosed with cancer they experience fears and anxieties as they attempt to simultaneously manage their role as a parent, with the illness experience. Parents have expressed difficulties in knowing how to communicate appropriately with their children throughout the illness trajectory as they are primarily focused on protecting or shielding their children from knowledge of the illness. Understandably parents may become overwhelmed with significant parental stress impacting on their psychological well-being. This subsequently affects the well-being of the entire family unit, coupled with changes to routines, roles, and responsibilities. This study was carried out to examine how a group psychosocial intervention Children's Lives Include Moments of Bravery (CLIMB®) helped young children to navigate parental cancer. A qualitative research design utilizing focus group methodology, artwork and individual interviews was used to generate data from 19 participants (parents, children, and health-care professionals). Three key themes emerged from the data, navigating the diagnosis, navigating emotions and changed routines, creating spaces to talk about cancer. The findings evidenced that attending CLIMB® was a positive experience for both children and parents. It gave the children the language and opportunity to express their fears and worries. CLIMB® equipped them with tools and skills to both express and manage their negative emotions, life skills that could be transferred to other challenging life events. All techniques that created spaces to talk and appeared to have a reassuring effect on the children. The parents appreciated the professional support that the structured intervention offered to them and helped them communicate more openly with their children. Creating spaces to talk about cancer reduces mistrust and tension between parents and children, when parental cancer occurs, and hopefully minimizes future psychological and social problems.
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Affiliation(s)
- Carla O'Neill
- Lecturer/Assistant Professor of Nursing, University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Catherine S O'Neill
- Board Member, Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland , Dublin, Ireland
| | - Cherith Semple
- Reader in Clinical Cancer Nursing, Ulster University/South Eastern Health and Social Care Trust, School of Nursing, Ulster University , Newtownabbey, Northern Ireland
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Dencker A, Murray SA, Mason B, Rix BA, Bøge P, Tjørnhøj-Thomsen T. Disrupted biographies and balancing identities: A qualitative study of cancer patients' communication with healthcare professionals about dependent children. Eur J Cancer Care (Engl) 2019; 28:e12991. [PMID: 30628750 DOI: 10.1111/ecc.12991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 11/05/2018] [Accepted: 12/16/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE About 14% of cancer patients live with dependent children. Healthcare professionals are well placed to help patients support their children as part of a patient-centred practice. Children tend to appreciate open communication during the course of illness, but patients often find this difficult. However, research is unclear about patients' preferences and their willingness to talk with healthcare professionals about their dependent children. METHODS We conducted 15 in-depth interviews with patients from haematological (N = 11) and gynaecological oncology (N = 4). The interviews and subsequent analysis focused on patients' communicative preferences, taking the theoretical framework of "biographical disruption" as a starting point and using Jenkins' concept of identity as a social, relational and dynamic process. RESULTS We identified two overall identities at stake for seriously ill patients with parental responsibility: "patient identity" and "parent identity." As "patients," patients were ambivalent about relating to their children, but as "parents" they wanted healthcare professionals to talk about their children. CONCLUSION In order to be patient-centred, clinicians should, we suggest, acknowledge that patients have these conflicting perspectives and identities, which surface at various times and situations throughout their illness trajectories. Research is needed to further explore these findings in different illness groups and cultures.
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Affiliation(s)
- Annemarie Dencker
- Patient Support, The Danish Cancer Society, Copenhagen, Denmark.,National Institute of Public Health, Research Programme on Health Promotion and Prevention, University of Southern Denmark, Copenhagen, Denmark
| | - Scott A Murray
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK
| | - Bruce Mason
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK
| | | | - Per Bøge
- Patient Support, The Danish Cancer Society, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, Research Programme on Health Promotion and Prevention, University of Southern Denmark, Copenhagen, Denmark
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10
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Franklin P, Arber A, Reed L, Ream E. Health and social care professionals' experiences of supporting parents and their dependent children during, and following, the death of a parent: A qualitative review and thematic synthesis. Palliat Med 2019; 33:49-65. [PMID: 30371147 DOI: 10.1177/0269216318803494] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Children need to be prepared for the death of a parent and supported afterwards. Parents seek support from health and social care professionals to prepare their children. Support is not always forthcoming. AIM: To systematically identify, analyse and synthesise literature reporting of the experiences of health and social care professionals when supporting parents and children during, and following, the death of a parent. DESIGN: A systematically constructed qualitative review and thematic synthesis. Registered on Prospero (CRD42017076345). DATA SOURCES: MEDLINE, CINAHL, Embase, PsycINFO, PsycARTICLES and PROSPERO, searched from January 1996 to July 2018 for qualitative studies in English, containing verbatim reporting of health and social care professionals' experiences of supporting parents and children during, and following, the death of a parent. Qualitative data were appraised using a modified Critical Appraisal Skills Programme qualitative appraisal checklist. RESULTS: The search yielded 15,758 articles. Of which, 15 met the inclusion criteria. A total of 13 included professionals' experiences of supporting parents and children before parental death. Two included experiences of supporting surviving parents and children afterwards. Three analytical themes identified as follows: (1) aspiring to deliver family-focussed care, (2) health and social care professionals' behaviours and emotions and (3) improving connections with parents and children. Connecting empathically with parents and children to prepare and support children entails significant emotional labour. Professionals seek to enhance their confidence to connect. CONCLUSION: Professionals struggle to connect empathically with parents and their children to prepare and to support children when a parent is dying and afterwards. Awareness of professionals' needs would enable provision of appropriate support for parents and children.
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Affiliation(s)
- Penny Franklin
- 1 School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Anne Arber
- 1 School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Liz Reed
- 2 Princess Alice Hospice, Esher, UK
| | - Emma Ream
- 1 School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Holland C, Hocking A, Joubert L, McDermott F, Niski MD, Thomson Salo F, Quinn MA. My Kite Will Fly: Improving Communication and Understanding in Young Children When a Mother Is Diagnosed with Life-Threatening Gynecological Cancer. J Palliat Med 2018; 21:78-84. [DOI: 10.1089/jpm.2017.0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cynthia Holland
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Alison Hocking
- Social Work and Cultural Diversity, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Cancer Experience Research, Peter MacCallum Centre, Parkville, Victoria, Australia
| | - Lynette Joubert
- Department of Social Work, Faculty of Medicine, Dentristry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Fiona McDermott
- Department of Social Work, Faculty of Medicine Nursing and Health Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Marcus D. Niski
- My Kite Will Fly Research Project, The Writing Practice, Melbourne, Victoria, Australia
| | - Frances Thomson Salo
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael A. Quinn
- International Gynecologic Cancer Society (IGCS), Louisville, Kentucky
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12
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Dencker A, Kristiansen M, Rix BA, Bøge P, Tjørnhøj-Thomsen T. Contextualisation of patient-centred care: A comparative qualitative study of healthcare professionals' approaches to communicating with seriously ill patients about their dependent children. Eur J Cancer Care (Engl) 2017; 27. [PMID: 29114990 DOI: 10.1111/ecc.12792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
Patients' family relations play an important part in the provision of patient-centred cancer care, not least when healthcare professionals encounter seriously ill patients with dependent children. Little is known about how children are perceived and dealt with in clinical encounters. In this qualitative comparative study, we explore the influence of medical contexts in three Danish hospital wards, haematology, oncological gynaecology and neuro-intensive care, on communication with patients about their children. In exploring the degree to which the inclusion of children in clinical encounters is dependent on context, we took a comparative approach based on fieldwork in wards either exclusively focusing on cancer treatment or partially involved in critical phases of cancer treatment. We conducted 49 semi-structured, in-depth interviews with doctors and nurses, and 27 days of participant observation. The thematic analysis was based on Bateson's conceptualisation of communication. We found that healthcare professionals' approach to children in clinical encounters and the ways in which children were positioned on each ward were influenced by aspects specific to the ward, including the diagnosis and treatments that related specifically to the patient. Our findings suggest the need to explore further the influence of medical contexts on the inclusion of children in patient communication.
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Affiliation(s)
- A Dencker
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - M Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - B A Rix
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark
| | - P Bøge
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark
| | - T Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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13
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Park EM, Deal AM, Yopp JM, Edwards T, Wilson DJ, Hanson LC, Rosenstein DL. End-of-life experiences of mothers with advanced cancer: perspectives of widowed fathers. BMJ Support Palliat Care 2016; 6:437-444. [PMID: 26685117 PMCID: PMC5293732 DOI: 10.1136/bmjspcare-2015-000976] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/12/2015] [Accepted: 11/25/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Despite the importance of parenting-related responsibilities for adult patients with terminal illnesses who have dependent children, little is known about the psychological concerns of dying parents and their families at the end of life (EOL). The aim of this study was to elicit widowed fathers' perspectives on how parental status may have influenced the EOL experiences of mothers with advanced cancer. SUBJECTS 344 men identified themselves through an open-access educational website as widowed fathers who had lost a spouse to cancer and were raising dependent children. METHODS Participants completed a web-based survey about their wife's EOL experience and cancer history, and their own depression (Center for Epidemiologic Studies Depression Scale, CES-D) and bereavement (Texas Revised Inventory of Grief, TRIG) symptoms. Descriptive statistics, Fisher's exact tests, and linear regression modelling were used to evaluate relationships between variables. RESULTS According to fathers, 38% of mothers had not said goodbye to their children before death and 26% were not at all 'at peace with dying.' Ninety per cent of widowed fathers reported that their spouse was worried about the strain on their children at the EOL. Fathers who reported clearer prognostic communication between wife and physician had lower CES-D and TRIG scores. CONCLUSIONS To improve EOL care for seriously ill patients and their families, we must understand the concerns of parents with dependent children. These data underscore the importance of parenting-related worries in this population and the need for additional clinical and research programmes devoted to addressing these issues.
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Affiliation(s)
- Eliza M Park
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC (USA)
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina, Chapel Hill, NC (USA)
| | - Justin M Yopp
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC (USA)
| | - Teresa Edwards
- H. W. Odum Institute for Research in Social Science, University of North Carolina at Chapel Hill, Chapel Hill, NC (USA)
| | - Douglas J Wilson
- Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina, Chapel Hill, NC (USA)
| | - Laura C Hanson
- Division of Geriatric Medicine and Palliative Care Program, Department of Medicine, University of North Carolina, Chapel Hill, NC (USA)
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC (USA)
- Department of Medicine, University of North Carolina, Chapel Hill, NC (USA)
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14
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How to support teenagers who are losing a parent to cancer: Bereaved young adults' advice to healthcare professionals—A nationwide survey. Palliat Support Care 2016; 15:313-319. [DOI: 10.1017/s1478951516000730] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:The loss of a parent to cancer is considered one of the most traumatic events a teenager can experience. Studies have shown that teenagers, from the time of diagnosis, are already extremely worried about the consequences of a parent's cancer but tend to be left to manage these concerns on their own. The present study aimed to explore young adults' advice to healthcare professionals on how to support teenagers who are losing a parent to cancer.Methods:This work derives from a Swedish nationwide survey and employs a qualitative approach with a descriptive/interpretive design to obtain answers to an open-ended question concerning advice to healthcare professionals. Of the 851 eligible young adults who had lost a parent to cancer when they were 13–16 years of age within the previous 6 to 9 years, 622 participated in our survey (response rate = 73%). Of these 622 young adults, 481 responded to the open-ended question about what advice to give healthcare professionals.Results:Four themes emerged: (1) to be seen and acknowledged; (2) to understand and prepare for illness, treatment, and the impending death; (3) to spend time with the ill parent, and (4) to receive support tailored to the individual teenager's needs.Significance of Results:This nationwide study contributes hands-on suggestions to healthcare staff regarding attitudes, communication, and support from the perspective of young adults who, in their teenage years, lost a parent to cancer. Teenagers may feel better supported during a parent's illness if healthcare professionals take this manageable advice forward into practice and see each teenager as individuals; explain the disease, its treatments, and consequences; encourage teenagers to spend time with their ill parent; and recommend sources of support.
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Grant L, Sangha A, Lister S, Wiseman T. Cancer and the family: assessment, communication and brief interventions—the development of an educational programme for healthcare professionals when a parent has cancer. BMJ Support Palliat Care 2016; 6:493-499. [DOI: 10.1136/bmjspcare-2015-001006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 06/13/2016] [Accepted: 07/25/2016] [Indexed: 11/03/2022]
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Clipsham L, Islam Z, Faull C. Experiences of hospice inpatient nurses in supporting children before the death of a parent. Int J Palliat Nurs 2016; 21:453-9. [PMID: 26412276 DOI: 10.12968/ijpn.2015.21.9.453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The need for pre-bereavement support for children facing the death of a parent is well recognised but how this is done by hospice ward nurses in practice is not well known. METHOD To explore the experiences of hospice ward nurses' identification of the support needs of children under 18 years old facing the death of a parent, and the impact on hospice nurses when involved in providing this support. DESIGN Semi-structured individual interviews with hospice nurses working on a single UK inpatient unit were audio-taped and analysed using thematic analysis to produce themes and subthemes. RESULTS Nurses were highly reflective, discussing their personal experiences, and identified potential enablers and barriers to providing support. Child and family factors were identified as influencing identification of support needs. CONCLUSION Multiple factors influencing provision of support emerged. Formal training and readily available resources would support hospice nurses working with children.
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Affiliation(s)
- Laura Clipsham
- Consultant in Palliative Medicine, University Hospitals of Leicester
| | | | - Christina Faull
- Consultant in Palliative Medicine, both at LOROS Hospice Care for Leicester, Leicestershire and Rutland
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Abstract
BACKGROUND Parental cancer is a stressful experience for young people, constituting a potential threat to physical and mental health and normative development. Currently, there is insufficient information describing the sources and nature of this distress during advanced parental cancer, especially concerning families with adolescent children. AIM To address the significant gap in the literature by providing the adolescent's perspective on the impact of their parent's advanced cancer on their lives. DESIGN This qualitative study involved single-occasion, semi-structured elicitation interviews with adolescents whose parents were diagnosed with advanced stage cancer. SETTING/PARTICIPANTS The study sample consisted of seven adolescents from six families, five females and two males ranging in age from 11 to 15 years (mean = 13.6 years, standard deviation = 1.4 years). The ill parents consisted of four females and two males diagnosed with Stage IV cancer. RESULTS The core construct that organized study results was Weaving a Normal Life with Cancer which involved five major domains: feeling the weight of the world on my shoulders; cancer changes everything; confronting or getting away from the cancer; talking about it; and cancer was a positive for me … it taught me. CONCLUSION Study findings shed light on how adolescents self-manage their parent's advanced cancer and work to delimit the illness even as they are aware of its constant presence. Future research and intervention studies are needed to support and add to the adolescents' self-management strategies to weave a normal life for themselves while in the throes of the cancer's uncertainty and challenges with family communication.
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Krauel K, Simon A, Krause-Hebecker N, Czimbalmos A, Bottomley A, Flechtner H. When a parent has cancer: challenges to patients, their families and health providers. Expert Rev Pharmacoecon Outcomes Res 2013; 12:795-808. [PMID: 23252360 DOI: 10.1586/erp.12.62] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
At least 14% of cancer patients live with minor children. Being a parent with cancer has far-reaching consequences for individual treatment decision-making and quality of life in patients and their families. Even though the majority of children and adolescents do not show clinically relevant symptoms of psychopathology, worries about the survival of the parent and the future development of the family are present, and experienced as distressing, in most children. Open communication by parents and clinicians has been found to be of major importance for children and adolescents in adjusting to parental cancer. Support for parents with cancer on relevant parenting issues, starting in the diagnostic phase, should be acknowledged as an important facet of cancer care to reduce the psychosocial burden for cancer patients and their families.
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Affiliation(s)
- Kerstin Krauel
- Department of Child and Adolescent Psychiatry, University of Magdeburg, Magdeburg, Germany
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Semple C, McCaughan E. Family life when a parent is diagnosed with cancer: impact of a psychosocial intervention for young children. Eur J Cancer Care (Engl) 2012; 22:219-31. [DOI: 10.1111/ecc.12018] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2012] [Indexed: 11/28/2022]
Affiliation(s)
- C.J. Semple
- South Eastern Health and Social Care Trust; Ulster Hospital; Belfast; N Ireland; UK
| | - E. McCaughan
- Institute of Nursing Research; University of Ulster; Coleraine; Co. Londonderry; N Ireland; UK
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van de Bovenkamp HM, Trappenburg MJ. Comparative review of family-professional communication: what mental health care can learn from oncology and nursing home care. Int J Ment Health Nurs 2012; 21:366-85. [PMID: 22510087 DOI: 10.1111/j.1447-0349.2011.00798.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Because family members take on caring tasks and also suffer as a consequence of the illness of the patient, communication between health-care professionals and family members of the patient is important. This review compares communication practices between these two parties in three different parts of health care: oncology, nursing home care, and mental health care. It shows that there are important differences between sectors. Mental health stands out because contacts between family members and professionals are considered problematic due to the autonomy and confidentiality of the patient. The article explores several explanations for this, and, by comparing the three health sectors, distils lessons to improve the relationship between family members and health-care professionals.
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Ernst J, Götze H, Krauel K, Romer G, Bergelt C, Flechtner HH, Herzog W, Lehmkuhl U, Keller M, Brähler E, von Klitzing K. Psychological distress in cancer patients with underage children: gender-specific differences. Psychooncology 2012; 22:823-8. [DOI: 10.1002/pon.3070] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 02/14/2012] [Accepted: 02/24/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Jochen Ernst
- Department of Medical Psychology and Medical Sociology; University of Leipzig; Germany
| | - Heide Götze
- Department of Medical Psychology and Medical Sociology; University of Leipzig; Germany
| | - Kerstin Krauel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics; Otto-von-Guericke University; Magdeburg; Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry and Psychotherapy; Hamburg-Eppendorf University Medical Centre; Hamburg; Germany
| | - Corinna Bergelt
- Institute of Medical Psychology; Hamburg-Eppendorf University Medical Centre; Germany
| | - Hans-Henning Flechtner
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics; Otto-von-Guericke University; Magdeburg; Germany
| | - Wolfgang Herzog
- Department of Psychosomatic and General Clinical Medicine; University Medical Centre Heidelberg; Germany
| | - Ulrike Lehmkuhl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité University Medical Centre; Berlin; Germany
| | - Monika Keller
- Department of Psychosomatic and General Clinical Medicine; University Medical Centre Heidelberg; Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology; University of Leipzig; Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics; University Medical Centre Leipzig; Germany
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Wenzel J, Shaha M, Klimmek R, Krumm S. Working through grief and loss: oncology nurses' perspectives on professional bereavement. Oncol Nurs Forum 2011; 38:E272-82. [PMID: 21708522 DOI: 10.1188/11.onf.e272-e282] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE/OBJECTIVES To determine facilitators and barriers to managing patient loss from the combined perspectives of oncology nurses and to extract essential components of a supportive intervention. RESEARCH APPROACH Qualitative, descriptive. SETTING The comprehensive National Cancer Institute-designated cancer center of a mid-Atlantic university teaching hospital. PARTICIPANTS 34 nurses from inpatient and outpatient adult and pediatric oncology units. METHODOLOGIC APPROACH Focus groups were held with oncology staff nurses to identify challenges regarding work-related bereavement, current support for managing grief and loss, and how to support interpersonal functioning and resiliency. MAIN RESEARCH VARIABLES Work-related bereavement, bereavement support, and interventions and management strategies for bereavement and loss. FINDINGS Two primary themes emerged: dimensions of work-related loss and working through bereavement. Participants also provided many concrete suggestions for the creation of a supportive self-care environment. CONCLUSIONS Support issues were numerous, multilevel, and varied. However, addressing those concerns can improve job satisfaction and decrease compassion fatigue. The findings lay the foundation for appropriate interventions to assist nurses in managing those situations. INTERPRETATION Administrators, managers, and individuals interested in furthering the multifaceted goals of oncology care, including nurses themselves, are challenged to create and maintain mutually supportive environments for providing optimal care to patients and families.
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Affiliation(s)
- Jennifer Wenzel
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
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Abstract
AbstractObjective:Diagnosis of a parent's cancer has a profound influence on the parent, the children and the child–parent relationship, and puts all family members at risk for psychological distress. This article describes the development and the first attempts at implementation of an intervention aimed at helping people cope with difficulties arising from being both parents and cancer patients.Methods:Based on themes discussed in focus groups with parents coping with cancer and with professionals in the field, a four-module psychological intervention was developed. The modules are: Telling and Sharing, Children’ Responses, Routine and Changes, and Learning and Awareness as a Parent. The techniques used are mainly psycho-educational and cognitive–behavioral.Results:Preliminary experience showed this intervention to be more feasible as a one-day workshop than as a four-session intervention. Parents who participated in two workshops reported it to be helpful in empowering them as parents and in imparting learning tools for identifying their children's needs, as well as for communicating with their children.Significance of results:Intervention tailored specifically for parents coping with cancer can be relevant for their special needs. Research is needed to establish the effectiveness of this intervention.
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Turner J, Clavarino A, Butow P, Yates P, Hargraves M, Connors V, Hausmann S. Enhancing the capacity of oncology nurses to provide supportive care for parents with advanced cancer: Evaluation of an educational intervention. Eur J Cancer 2009; 45:1798-806. [DOI: 10.1016/j.ejca.2009.02.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 02/24/2009] [Accepted: 02/26/2009] [Indexed: 11/29/2022]
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Kelly BJ, Turner J. Depression in advanced physical illness: diagnostic and treatment issues. Med J Aust 2009; 190:S90-3. [PMID: 19351301 DOI: 10.5694/j.1326-5377.2009.tb02478.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 10/09/2008] [Indexed: 11/17/2022]
Abstract
Assessing and managing depression and other forms of psychological distress in patients with advanced physical illness (such as advanced cancer) can be complex clinical tasks. Assessment of distress is complicated by the contribution of the physical disease and side effects of its treatment to symptoms. Clinical evidence has indentified factors that increase vulnerability to experiencing distress and interventions that can improve wellbeing in patients with serious physical illness, yet there are significant gaps in current practice and challenges for health professionals in addressing the core emotional concerns of patients with advanced physical illness. The 2003 publication Clinical practice guidelines for the psychosocial care of adults with cancer provides evidence-based recommendations for providing psychosocial care. Implementing existing guidelines, including systematic assessment of risk and adapting interventions to reflect the precise needs of patients, requires strategies to help clinicians in the emotional dimensions of this caring role.
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Affiliation(s)
- Brian J Kelly
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW, Australia.
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