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Agerskov H, Thiesson HC, Schultz H, Pedersen BD. Relationships and dynamics in families with a child with a kidney transplant-A study of parents' everyday life experiences. J Ren Care 2024; 50:151-158. [PMID: 36949556 DOI: 10.1111/jorc.12465] [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: 06/26/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Paediatric kidney transplantation is often the best choice of treatment for kidney failure with replacement therapy and represents an important change in the child's well-being. There are, however, still a number of challenges in addition to the parental role. The magnitude of intensive parental caregiving and support required by children with a kidney transplant could be disruptive to family relationships and dynamics. OBJECTIVE To explore the experiences of family relationships and dynamics among parents of a child with a kidney transplant. DESIGN An explorative study using a qualitative method. PARTICIPANTS Twelve parents (seven mothers and five fathers) of seven children with a kidney transplant were included. APPROACH A phenomenological-hermeneutic approach was applied. METHOD Semistructured, individual interviews were conducted. The data were analysed using Ricoeur's theory of interpretation on three levels: naïve reading, structural analysis and critical interpretation and discussion. FINDINGS Three themes were generated: Emotions during ups and downs in everyday life; Balancing different needs among children; and Opportunities and having consideration in the family. CONCLUSION Relationships between parents that are based on mutual emotional support are significant and essential during periods of severe illness in a child. Parents who are alone or emotionally marked by their child's disease history feel vulnerable and struggle to overcome challenges. Different health situations among siblings lead to challenges in bringing up the children and emotional dilemmas among parents that impact family dynamics. Resilience in parents is a shifting phenomenon that can influence how they deal with family relationships and dynamics.
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Affiliation(s)
- Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Family Focused Health Care Research Centre, University of Southern Denmark, Odense C, Denmark
| | - Helle C Thiesson
- Department of Nephrology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Helen Schultz
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Surgical Department, Odense University Hospital, Odense C, Denmark
| | - Birthe D Pedersen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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De Bruyne E, Eloot S, Willem L, Van Hoeck K, Walle JV, Raes A, Van Biesen W, Goubert L, Van Hoecke E, Snauwaert E. Mental health and professional outcomes in parents of children with chronic kidney disease. Pediatr Nephrol 2024:10.1007/s00467-024-06372-y. [PMID: 38653885 DOI: 10.1007/s00467-024-06372-y] [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: 12/08/2023] [Revised: 03/08/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND This study evaluated parenting stress, anxiety, and depression symptoms and their associated factors in parents of children with chronic kidney disease (CKD). METHODS This cross-sectional study compared parents of patients with CKD (0-18 years) with a matched control group of parents of healthy children. Both groups completed the Parenting Stress Index - Short Form, the Hospital Anxiety and Depression Scale, and a sociodemographic questionnaire. RESULTS The study group consisted of 45 parents (median age 39; 32 mothers) of CKD patients (median age 8; 36% female). Nearly 75% of children had CKD stages 2, 3, or 4, and 44.5% had congenital anomaly of the kidney and urinary tract. Five children (11%) were on dialysis, and 4 (9%) had a functioning kidney graft. Compared with parents of healthy children, more stress and anxiety symptoms were reported. Since the CKD diagnosis, 47% of parents perceived a deterioration of their own health, and 40% reduced work on a structural basis. Higher levels of stress, anxiety, and depression symptoms were associated with a more negative perception of own health, and more child medical comorbidities and school absence. CONCLUSIONS This study showed higher levels of parenting stress and anxiety symptoms in parents of children with CKD compared with parents of healthy children. This was associated with a less positive perception of their own health, especially if the child had more medical comorbidities or more absence from school. Psychosocial interventions to reduce the parental burden should be integrated in the standard care of pediatric nephrology departments.
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Affiliation(s)
- Elke De Bruyne
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium.
| | - Sunny Eloot
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Lore Willem
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium
| | - Koen Van Hoeck
- Department of Pediatric Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eline Van Hoecke
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
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De Bruyne E, Willem L, Van Hoeck K, Reynaert S, Vankerckhove S, Adams B, Leroi S, Collard L, Michaux A, Godefroid N, Mekahli D, Knops N, Eloot S, Raes A, Walle JV, Van Hoecke E, Snauwaert E, Levtchenko E. Illness-related parental stress and quality of life in children with kidney diseases. Pediatr Nephrol 2023; 38:2719-2731. [PMID: 36929385 DOI: 10.1007/s00467-023-05911-3] [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: 08/25/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND This cross-sectional study investigated quality of life (QoL) and illness-related parental stress in children with kidney diseases by (1) comparing mean levels of these two variables between several kidney disease categories; (2) exploring correlations between QoL and parental stress; and (3) describing which disease category reports lowest QoL and highest parental stress. METHODS We included 295 patients with a kidney disease (0-18 years) and their parents, followed at 6 reference centers for pediatric nephrology. Children's QoL was assessed by the PedsQL™ 4.0 Generic Core Scales, and illness-related stress by the Pediatric Inventory for Parents. All patients were divided into 5 kidney disease categories according to the multidisciplinary care program criteria prescribed by the Belgian authorities: (1) structural kidney diseases, (2) tubulopathies and metabolic diseases, (3) nephrotic syndrome, (4) acquired diseases with proteinuria and hypertension, and (5) kidney transplantation. RESULTS Child self-reports showed no differences in QoL between kidney disease categories, in contrast to parent proxy reports. Parents of transplant patients reported lower QoL in their child and more parental stress compared with the 4 non-transplant categories. QoL and parental stress were negatively correlated. Lowest QoL and highest parental stress scores were mainly found in transplant patients. CONCLUSIONS This study showed lower QoL and higher parental stress in pediatric transplant patients compared with non-transplants, based on parent reports. Higher parental stress is associated with worse QoL in the child. These results highlight the importance of multidisciplinary care for children with kidney diseases, with special attention to transplant patients and their parents. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Elke De Bruyne
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium.
| | - Lore Willem
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium.
| | - Koen Van Hoeck
- Department of Pediatric Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Sarah Reynaert
- Department of Pediatric Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Sylvie Vankerckhove
- Department of Pediatric Nephrology, Queen Fabiola Children's University Hospital Brussels, Brussels, Belgium
| | - Brigitte Adams
- Department of Pediatric Nephrology, Queen Fabiola Children's University Hospital Brussels, Brussels, Belgium
| | - Stéphanie Leroi
- Department of Pediatric Nephrology, CHC-MontLégia, Health Group CHC Liège, Liege, Belgium
| | - Laure Collard
- Department of Pediatric Nephrology, CHC-MontLégia, Health Group CHC Liège, Liege, Belgium
| | - Aline Michaux
- Department of Pediatric Nephrology, Saint-Luc Brussels University Hospital, Brussels, Belgium
| | - Nathalie Godefroid
- Department of Pediatric Nephrology, Saint-Luc Brussels University Hospital, Brussels, Belgium
| | - Djalila Mekahli
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium
| | - Noël Knops
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium
| | - Sunny Eloot
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Eline Van Hoecke
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Evelien Snauwaert
- Department of Pediatric Nephrology & Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Elena Levtchenko
- Department of Child Nephrology and Organ Transplantation, Leuven University Hospital, Louvain, Belgium
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Smith KA, Widger K, Arbour-Nicitopoulos KP, Gibson BE. The Sensory Experience of Waiting for Parents of Children Awaiting Transplant: A Narrative Ethnography. QUALITATIVE HEALTH RESEARCH 2023:10497323231182892. [PMID: 37328281 DOI: 10.1177/10497323231182892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Despite the senses being a valuable source of knowledge, little research has explored the sensory process of medical experiences. This narrative ethnographic study investigated how the senses shaped parents' experiences of waiting for their child to receive a solid organ, stem cell, or bone marrow transplant. Six parents from four different families primarily participated in sensory interviews as well as observations that explored the question: How do parents experience waiting using the five senses? Our narrative analysis suggested that parents' bodies stored sense memories, and they re-experienced stories of waiting through the senses and 'felt realities'. In addition, the senses transported families back to the emotional experience of waiting, which highlighted the longevity of waiting after receiving a transplant. We discuss how the senses provide important information about the body, waiting experiences, and the environmental contexts that mediate waiting. Findings contribute to theoretical and methodological work exploring how bodies are implicated in producing narratives.
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Affiliation(s)
- Kristina A Smith
- Ethics Services, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Jesse MT, Gartrelle K, Bruschwein H, Hug G, LeTarte B, Lerret S, Dew MA. Non-pharmacological interventions engaging organ transplant caregivers: A systematic review. Clin Transplant 2022; 36:e14611. [PMID: 35143701 DOI: 10.1111/ctr.14611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
Lay-caregivers in organ transplantation (to candidates, recipients, and donors) are essential to pre- and post-operative care, but report significant caregiving-related stressors. This review aims to summarize studies testing non-pharmacological interventions aimed at improving organ transplant caregiver-reported outcomes. METHODS In accordance with PRISMA, we conducted a systematic review (searched PubMed, Embase, Cochrane Central, PsycInfo, and CINAHL, no start-date restriction through 7/1/2021). Quality of comparative studies assessed by ROBS-2 or ROBINS. RESULTS Twelve studies met inclusion. Study designs, interventions, and outcomes varied. Sample sizes were small across caregivers to adult (nine studies, five with caregiver samples ns≤50) and pediatric patients (three studies, caregiver samples ns≤16). Study designs included seven single-arm interventions, two pre-post with comparison cohorts, and three randomized-controlled trials. Eight studies included transplant-specific education as the intervention, an interventional component, or as the comparison group. Outcomes included transplant specific knowledge, mental health, and intervention acceptability. Of the nine pre-post caregiver assessments and/or comparison groups, four studies demonstrated no statistically significant intervention effects. CONCLUSION Few interventions addressing the needs of organ transplant caregivers have been empirically evaluated. Existing interventions were well-received by caregivers. Given complexities of care in transplantation, research is needed evaluating interventions using rigorous trial methodology with adequate samples. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michelle T Jesse
- Transplant Institute, Henry Ford Health System, Detroit, MI.,Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI.,Academic Internal Medicine, Henry Ford Health System, Detroit, MI
| | | | - Heather Bruschwein
- Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Gina Hug
- Sladen Library, Henry Ford Health System, Detroit, MI
| | | | - Stacee Lerret
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
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Agerskov H, Thiesson HC, Pedersen BD. Parenting a child with a kidney transplant-A study of everyday life experiences. J Ren Care 2022; 49:134-143. [PMID: 35106917 DOI: 10.1111/jorc.12410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kidney transplantation in children shows excellent long-term outcomes. However, parents feel responsible for ensuring that their child adheres to complex medical interventions. The dual role - as both parent and medical caregiver - gives rise to fatigue, stress, and emotional pain. Parental and family functioning are critically important to a child's disease course, development and well-being. OBJECTIVE To explore the experiences and perspectives of mothers and fathers of children with a kidney transplant. DESIGN An explorative study using a qualitative method. PARTICIPANTS Twelve parents (seven mothers and five fathers) of seven children with a kidney transplant. APPROACH A qualitative exploratory study taking a phenomenological-hermeneutic approach. METHOD Semi-structured individual interviews were conducted. The data were analysed using Ricoeur's theory of narrative and interpretation on three levels: naïve reading, structural analysis, and critical interpretation and discussion. FINDINGS Four themes were generated: Kidney transplantation as a turning point, the importance of a close collaboration with health care professionals, being the child's voice, and managing the dual role as a parent, and medical caregiver in everyday life. CONCLUSION Child kidney transplantation led to a transformation in the child, on the physical, mental, and social levels; however, the child was still in need of special attention and support. Problems with the kidney graft functioning resulted in frustration and disappointment in parents. Teamwork between a child's parents became evident, in coping with the dual role as a parent and medical caregiver. Parents aimed to maintain a clear structure related to medication and disease-related treatment. A close and trustful relationship and collaboration with health care professionals were significant and included listening to the voice of the child.
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Affiliation(s)
- Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Family Focused Health Care Research Center, University of Southern Denmark, Odense, Denmark
| | - Helle C Thiesson
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Birthe D Pedersen
- Department of Clinical Research, University of Southern Denmark, University of Southern Denmark, Odense, Denmark
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McLoughlin A, Wilson C, Swords L. Parents' Experiences of Their Child's Solid-Organ Transplant: A Meta-Ethnography of Qualitative Studies. J Pediatr Psychol 2021; 47:279-291. [PMID: 34664643 DOI: 10.1093/jpepsy/jsab108] [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: 04/08/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this paper was to conduct a systematic review and meta-ethnography of qualitative studies examining the experiences of parents adjusting to life after the solid organ transplant (SOT) of their child. METHODS A systematic review of the literature was conducted to identify qualitative studies that examined this topic. The search retrieved 4,964 studies to review against inclusion criteria. A total of 21 studies were included in the meta-ethnography. A reciprocal translation was conducted to compare themes identified in each study. A line of argument synthesis was then conducted in order to integrate the similarities and differences between all of the studies into a new interpretative context. RESULTS The synthesis identified four themes: (a) adjusting to life after transplant, (b) factors that facilitate adjustment, (c) factors that disrupt adjustment, and (d) changes caused by transplant. As a result of the synthesis, a new interpretation of parents' experiences of adjusting to life after the SOT of their child was constructed. A summary figure is presented. CONCLUSION This review found that while parents may struggle to adapt to life post-transplant and the demands of caring for their child, the experience can also result in the development of new skills, a new appreciation for life, and viewing the self in a more positive manner. A better understanding of parental experiences will promote the development of more effective interventions for the adjustment of parents and families to post-transplant life.
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Applebaum AJ, Panjwani AA, Buda K, O'Toole MS, Hoyt MA, Garcia A, Fresco DM, Mennin DS. Emotion regulation therapy for cancer caregivers-an open trial of a mechanism-targeted approach to addressing caregiver distress. Transl Behav Med 2021; 10:413-422. [PMID: 30395306 DOI: 10.1093/tbm/iby104] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Informal caregivers (ICs) are integral to care provided to patients facing life-threatening or incurable illnesses. This responsibility causes considerable burden, as approximately one half of ICs report clinically significant symptoms of depression and/or anxiety that persist when left untreated. Psychosocial interventions containing efficacious treatment principles (e.g., cognitive behavior therapy [CBT]) show disappointing results in reducing anxiety and depression in ICs. This may reflect failure of these interventions to specifically target crucial mechanisms underlying the central feature of distress caused by the patient's illness-notably, perseverative negative thinking (PNT). Emotion Regulation Therapy (ERT) is an efficacious CBT developed to explicitly target mechanisms underlying PNT and the emotional concomitants that arise in response to stressful situations. This open trial was conducted to evaluate the acceptability and initial efficacy of ERT adapted to the experience of cancer ICs (ERT-C). Thirty-one ICs provided informed consent and completed eight weekly individual sessions of ERT-C. Participants completed self-report measures of depression and anxiety symptoms, PNT, emotion regulation deficits, and caregiver burden before and after treatment. ERT-C was well tolerated as indicated by 22 treatment completers and feedback provided in exit interviews. ICs demonstrated reduced depression and anxiety symptoms, PNT, and emotion regulation deficits with moderate to large effect sizes (Hedge's g range: 0.36-0.92). Notably, caregiver burden was not reduced but ICs expressed more ability to confront caregiving-related challenges. Findings offer promising but preliminary support for ERT-C as a conceptual model and treatment modality for distressed cancer ICs.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kara Buda
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mia S O'Toole
- Department of Psychology & Behavioral Sciences, Aarhus, Denmark
| | | | - Adam Garcia
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David M Fresco
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Douglas S Mennin
- Department of Psychology, Teachers College, Columbia, New York, NY
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Mantulak A, Cadell S. Mothers' Experience of Post-Traumatic Growth in Pediatric Kidney Transplantation. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2018; 14:110-123. [PMID: 29482461 DOI: 10.1080/15524256.2018.1437587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parenting a child with chronic kidney disease has a profound impact on the parental caregivers across social, emotional, and physical functioning. As the survival rates for children with chronic kidney disease increase, the demands on parents caring for these children intensify. The aim of this study was to understand the lived experience of being a mother of a child who has undergone kidney transplantation. Seven mothers caring for children with chronic kidney disease in Ontario, Canada participated in in-depth interviews that were analyzed according to the principles of hermeneutic phenomenology. The present study presents the findings concerning post-traumatic growth: personal strength, new possibilities, enhanced relationships, appreciation of life and spiritual change. Recognizing positive aspects of stressful situations and the potential for growth can impact the practice of social workers and other health-care professionals. Ultimately the assistance that is provided to parent caregivers can be improved with a better understanding of the whole experience.
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Affiliation(s)
- Andrew Mantulak
- a School of Social Work , King's University College , London , Ontario , Canada
| | - Susan Cadell
- b School of Social Work , Renison University College - University of Waterloo , Waterloo , Ontario , Canada
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