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Peláez Cantero MJ, Morales Asencio JM, Navarro Marchena L, Velázquez González MDR, Sánchez Echàniz J, Rubio Ortega L, Martino Alba R. End of life in patients under the care of paediatric palliative care teams. Multicentre observational study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 96:394-401. [DOI: 10.1016/j.anpede.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
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2
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Jestico ECL, Schutz SE, Finlay TMD, Appleton JV. How 'significant others' may support parents with decision-making about their child's cancer care: An integrative literature review. J Clin Nurs 2022; 32:1821-1840. [PMID: 35040523 DOI: 10.1111/jocn.16220] [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: 09/30/2021] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
AIM To synthesise what is known from current international evidence about how parents are supported by significant others when they are faced with making decisions about their child's cancer care. BACKGROUND Parents are faced with making challenging decisions when their child has cancer and may benefit from support. Whilst previous research has comprehensively explored how healthcare professionals can offer support, little attention has been given to how support may be informally provided from a parent's network of significant others. METHOD An integrative literature review was undertaken and reported following the ENTREQ framework. Literature was identified from comprehensive database searching across four relevant databases (CINAHL, PubMed, PsychINFO and British Nursing Database) and hand-searching reference lists of retrieved studies. Studies that met the inclusion criteria were critically appraised and then analysed using the Constant Comparative Analysis method. RESULTS Twenty-six articles were included in the review. Two overarching themes were identified. Theme 1-Dimensions of Decision-Making support-included three sub-themes: informational, emotional and instrumental mechanisms of support. Theme 2-Expectations of Decision-Making support-identified that parents' expectations of their own role, and the role of their significant others, affected how decision-making was supported. CONCLUSIONS Parents may seek and receive support from various significant members of their network, but there is a fine line between supportive and unsupportive behaviours. RELEVANCE TO CLINICAL PRACTICE Each family's unique personal, social and cultural context strongly impacts on their support needs, and nurses and other healthcare professionals should be mindful of how parents may access support from their significant others. Further in-depth research around this area would contribute important knowledge around parents' support needs.
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Affiliation(s)
| | - Susan E Schutz
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Teresa M D Finlay
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Jane V Appleton
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
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Peláez Cantero MJ, Morales Asencio JM, Navarro Marchena L, Velázquez González MDR, Sánchez Echàniz J, Rubio Ortega L, Martino Alba R. [End of life in patients under the care of paediatric palliative care teams. Multicentre observational study]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00222-8. [PMID: 34303629 DOI: 10.1016/j.anpedi.2021.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Around 2000 children and adolescents die each year in Spain, however, we know little about the particularities of deaths in paediatrics. The purpose of this study is to document the characteristics of patients who die in the care of paediatric palliative care teams in Spain. PATIENTS AND METHODS Retrospective, descriptive, multicentre study. Fourteen teams from all over the country participated. RESULTS Data were obtained from 164 patients. In most cases the underlying disease stemmed from oncological, neurological or neuromuscular processes. The median age at death was 6.9 years (RIC 11.2). The median follow-up time by the team was 0.3 years (RIC 0.8 years). The most frequent symptoms in the last week of life were dyspnoea, pain, increased secretions and sleep disorders. The median number of drugs administered to each patient one week prior to death was 6 (RIC 4). The place of death for 95 of the patients (57.9%) was hospital while 67 (40.9%) died at home. CONCLUSIONS There was a wide age range of patients and they had substantial exposure to polypharmacy. The follow-up time shows that patients have late access to palliative care programmes. An effort should be made to introduce this care earlier rather than relegating it to the end of life. In Spain there is an unequal distribution of resources and not all teams can provide care at home. The place of death should be interpreted with caution.
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Affiliation(s)
- Maria José Peláez Cantero
- Unidad de Crónicos complejos y Cuidados Paliativos pediátricos, Hospital Regional Universitario, Materno-Infantil de Málaga, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, España.
| | - Jose Miguel Morales Asencio
- Facultad de Ciencias de la Salud, Universidad de Málaga, Instituto de Investigación biomédica de Málaga (IBIMA), Málaga, España
| | - Lucia Navarro Marchena
- Servicio de Atención Paliativa y Paciente Crónico Complejo, Hospital Sant Joan de Déu, Barcelona, España
| | | | - Jesús Sánchez Echàniz
- Equipo de Cuidados Paliativos pediátricos domiciliarios, Hospital Universitario de Cruces, Bilbao, España
| | - Laura Rubio Ortega
- Unidad de hospitalización a domicilio pediatrica, Servicio de Pediatría, Hospital general universitario de Alicante, Alicante, España
| | - Ricardo Martino Alba
- Unidad de Atención Integral Paliativa Pediátrica, Hospital Infantil Universitario Niño Jesús, Madrid, España
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Papadatou D, Kalliani V, Karakosta E, Liakopoulou P, Bluebond-Langner M. Home or hospital as the place of end-of-life care and death: A grounded theory study of parents' decision-making. Palliat Med 2021; 35:219-230. [PMID: 33307990 PMCID: PMC7797614 DOI: 10.1177/0269216320967547] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND While several studies have examined 'what' families want with regard to the place of a child's end-of-life care and death, few have explored 'how' parents reach a decision. AIMS (1) to develop a model explaining how parents of a child with a life-threatening illness in Greece decide about the place of end-of-life care and death; (2) to identify the factors affecting decision-making; (3) to consider the implications for clinical practice. DESIGN Grounded theory study of bereaved parents using semi-structured open-ended interviews following Strauss and Corbin's principles of data collection and analysis. SETTING/PARTICIPANTS Semi-structured interviews with 36 bereaved parents of 22 children who died at home (n = 9) or in a paediatric hospital (n = 13) in Athens, Greece. RESULTS (1) Decisions regarding place of care and death were reached in one of four ways: consensus, accommodation, imposition of professional decisions on parents or imposition of parents' decisions without including professionals. (2) Six factors were identified as affecting decisions: awareness of dying, perceived parental caregiving competence, perceived professional competence, parents' view of symptom management, timing of decision-making, and being a 'good parent'. (3) Decisions were clear-cut or shifting. Few parents did not engage in decisions. CONCLUSION Parents' decisions about place of end-of-life care and death are affected by personal, interpersonal, timing and disease-related factors. Parents are best supported in decision-making when information is presented clearly and honestly with recognition of what acting as 'good parents' means to them, and opportunities to enhance their caregiving competence to care for their child at home, if they choose so.
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Affiliation(s)
- Danai Papadatou
- Faculty of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Kalliani
- "Merimna" Society for the Care of Children and Families Facing Illness and Death, Athens, Greece
| | - Eleni Karakosta
- "Merimna" Society for the Care of Children and Families Facing Illness and Death, Athens, Greece
| | - Panagiota Liakopoulou
- "Merimna" Society for the Care of Children and Families Facing Illness and Death, Athens, Greece
| | - Myra Bluebond-Langner
- UCL-School of Life and Medical Sciences, Faculty of Population Health Sciences Great Ormond Street Institute of Child Health, Population, Policy and Practice Research and Teaching Department, Louis Dundas Centre for Children's Palliative Care, UK
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Widger KA, Wilkins K. What are the Key Components of Quality Perinatal and Pediatric End-of-Life Care? A Literature Review. J Palliat Care 2019. [DOI: 10.1177/082585970402000207] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kimberley A Widger
- Pediatric Palliative Care Service, IWK Health Centre, Halifax, Nova Scotia
| | - Krista Wilkins
- Evidence-Based Nursing Program, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
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Affiliation(s)
- Stephen Liben
- Palliative Care Program, Montreal Children's Hospital, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Ann Goldman
- Palliative Care, Department of Haematology and Oncology, Great Ormond Street Children's Hospital, London, UK
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Zernikow B, Szybalski K, Hübner-Möhler B, Wager J, Paulussen M, Lassay L, Jorch N, Weber C, Schneider DT, Janßen G, Oommen PT, Kuhlen M, Brune T, Wieland R, Schündeln M, Kremens B, Längler A, Prokop A, Kiener R, Niehues T, Rose M, Baumann-Köhler M, Pöppelmann M, Thorer H, Irnich M, Sinha K, Wolfe J, Schmidt P. Specialized pediatric palliative care services for children dying from cancer: A repeated cohort study on the developments of symptom management and quality of care over a 10-year period. Palliat Med 2019; 33:381-391. [PMID: 30537890 DOI: 10.1177/0269216318818022] [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: 11/17/2022]
Abstract
Background: About one quarter of children affected with cancer die. For children and their families, the end-of-life period is highly distressing. Aim: This study focused on how end-of-life care in pediatric cancer patients changed over a period of 10 years and if changes in pediatric palliative care structures were associated with quality of care. Design: Over a 10-year period, all pediatric oncology departments in one German federal state were invited to participate in a repeated cross-sectional cohort study at three time-points (2005, 2010, 2015). Departments invited parents whose children died due to cancer 5 years earlier to participate. Identical semi-structured interviews were conducted with each cohort by the Survey of Caring for Children with Cancer. In addition, departments provided information on their pediatric palliative care infrastructure. Participants: In total, 124 families participated; 73% of interviews were conducted with mothers, 18% with fathers, and 9% with both parents. Results: Parents’ perception of symptom occurrence, symptom burden, and effectiveness of symptom-related treatment remained stable over the 10-year period. Over time, the availability of pediatric palliative care ( p < 0.001) as well as quality and satisfaction ratings of care ( p < 0.001) increased significantly. A growing number of children received specialized pediatric palliative care at home during the end-of-life period ( p = 0.009). Along with this development, more families had the chance to plan the location of death ( p = 0.003), and more children died at the preferred location ( p = 0.001). Conclusion: Advances in the availability of pediatric palliative care were associated with improvement in some aspects of quality of care (e.g. location of death) while other aspects, such as effectiveness of symptom management, remained unchanged. Further research is required to determine whether additional improvement in structural quality may increase the effectiveness of symptom management.
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Affiliation(s)
- Boris Zernikow
- 1 Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,2 Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
| | - Katharina Szybalski
- 1 Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,2 Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
| | - Bettina Hübner-Möhler
- 1 Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,2 Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
| | - Julia Wager
- 1 Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,2 Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
| | - Michael Paulussen
- 3 Children's and Adolescents' Hospital Datteln and Department of Pediatrics, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
| | - Lisa Lassay
- 4 University Hospital Aachen, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, RWTH Aachen University, Aachen, Germany
| | - Norbert Jorch
- 5 Department of Pediatrics, Protestant Hospital Bielefeld, Bielefeld, Germany
| | - Carola Weber
- 6 Department of Pediatric Oncology, Hematology and Immunology, University Hospital Bonn, Bonn, Germany
| | - Dominik T Schneider
- 7 Division of Pediatric Hematology and Oncology, Department of Pediatrics, Hospital Dortmund, Dortmund, Germany
| | - Gisela Janßen
- 8 Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Prasad T Oommen
- 8 Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michaela Kuhlen
- 8 Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Brune
- 9 Department of Pediatrics, Hospital Lippe-Detmold, Detmold, Germany
| | - Regina Wieland
- 10 Hematology/Oncology, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Michael Schündeln
- 10 Hematology/Oncology, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Bernhard Kremens
- 10 Hematology/Oncology, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Alfred Längler
- 11 Gemeinschaftskrankenhaus Herdecke and Integrative Pediatrics, School of Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Aram Prokop
- 12 Department of Pediatric Hematology/Oncology, Children's Hospital Köln, Köln, Germany
| | - Rita Kiener
- 13 Department of Paediatric Oncology and Hematology, Policlinic for Children and Adolescents, University Hospital Köln, Köln, Germany
| | - Tim Niehues
- 14 Centre for Pediatrics and Adolescent Medicine, HELIOS Hospital Krefeld, Krefeld, Germany
| | - Martina Rose
- 15 Department for Children and Adolescents, Johannes Wesling Hospital Minden, Bochum University, Minden, Germany
| | - Margit Baumann-Köhler
- 16 Department of Paediatric Hematology and Oncology, Policlinic for Children and Adolescents, University Hospital Münster, Münster, Germany
| | - Monika Pöppelmann
- 16 Department of Paediatric Hematology and Oncology, Policlinic for Children and Adolescents, University Hospital Münster, Münster, Germany
| | - Heike Thorer
- 16 Department of Paediatric Hematology and Oncology, Policlinic for Children and Adolescents, University Hospital Münster, Münster, Germany
| | - Martin Irnich
- 17 Department of Paediatric Hematology and Oncology, Asklepios Hospital Sankt Augustin GmbH, Sankt Augustin, Germany
| | - Kumar Sinha
- 18 Department of Pediatrics, Helios Medical Centre, Witten-Herdecke University, Wuppertal, Germany
| | - Joanne Wolfe
- 19 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pia Schmidt
- 1 Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,2 Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
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8
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von Lützau P, Otto M, Hechler T, Metzing S, Wolfe J, Zernikow B. Children Dying from Cancer: Parents’ Perspectives on Symptoms, Quality of Life, Characteristics of Death, and End-of-Life Decisions. J Palliat Care 2018. [DOI: 10.1177/082585971202800406] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we investigated the experience of children who died of cancer, as perceived by their parents. All the pediatric oncology departments in one German federal state were contacted and asked to invite parents who had lost a child to cancer in the period 2005–2006 to participate. Those parents who accepted were interviewed by means of a semi-structured questionnaire. In the participating 16 departments, 158 children died in 2005–2006. Parents of 48 children (38.3 percent) agreed to participate and were interviewed. Nearly all of the children had suffered from at least one distressing symptom. Pain and fatigue occurred most frequently. Symptoms were successfully treated over 65 percent of the time. In all, 64 percent of the children received home care services; 50 percent died at home, and only 10 percent in the ICU. Results suggest that some progress has been made in pediatric palliative care. To further improve end-of-life care for children with cancer, it is also necessary to evaluate parents’ perspectives on structures for pediatric palliative care delivery.
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Affiliation(s)
- Pia von Lützau
- P von Lützau (corresponding author): Pediatric Palliative Care Centre and German Pediatric Pain Centre, Children's and Adolescents’ Hospital, Datteln and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health — School of Medicine, Dr. Friedrich Steiner Strasse 5, 45711 Datteln, Germany
| | - Michael Otto
- M Otto, T Hechler, B Zernikow: Pediatric Palliative Care Centre and German Pediatric Pain Centre, Children's and Adolescents’ Hospital, Datteln and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health — School of Medicine, Datteln, Germany
| | - Tanja Hechler
- M Otto, T Hechler, B Zernikow: Pediatric Palliative Care Centre and German Pediatric Pain Centre, Children's and Adolescents’ Hospital, Datteln and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health — School of Medicine, Datteln, Germany
| | - Sabine Metzing
- M Otto, T Hechler, B Zernikow: Pediatric Palliative Care Centre and German Pediatric Pain Centre, Children's and Adolescents’ Hospital, Datteln and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health — School of Medicine, Datteln, Germany
| | - Joanne Wolfe
- S Metzing: Witten/Herdecke University, Faculty of Health — School of Nursing Science, Witten, Germany
| | - Boris Zernikow
- J Wolfe: Harvard Medical School, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts, USA
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9
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Jankovic M, Van Dongen-Melman JE, Vasilatou-Kosmidis H, Jenney ME. Improving the Quality of Life for Children with Cancer. TUMORI JOURNAL 2018; 85:273-9. [PMID: 10587031 DOI: 10.1177/030089169908500412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are now more than one million new cases of cancer every year in the European Community (EC) including the children to whom particular needs should be addressed. Besides the disease-free survival other outcomes reflecting the impact of treatment on the patient and their families must also be assessed and include their physical, psychological and social functioning throughout their care: during therapy, after completion of treatment or, for some, in the terminal phase of their illness. To provide optimal care and thus improve the quality of life for these children needs: a) an appropriately structured Paediatric Cancer Unit; b) well trained and permanent staff members: comprising doctors, nurses, psychologists, social workers and other health care professionals; c) facilities such as a specific out-patient clinic, a hospital school, a residence for parents; d) a well defined programme for the terminally ill children; e) a well defined programme for controlling the late effects of therapy.
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Affiliation(s)
- M Jankovic
- Department of Pediatrics, Ospedale San Gerardo, Monza, Italy
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10
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Barrera M, D'Agostino NM, Schneiderman G, Tallett S, Spencer L, Jovcevska V. Patterns of Parental Bereavement following the Loss of a Child and Related Factors. OMEGA-JOURNAL OF DEATH AND DYING 2016; 55:145-67. [DOI: 10.2190/om.55.2.d] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigated the patterns of parental bereavement in 20 parents who have lost a child to cancer, congenital heart disease, meningitis, or drowning in the last 19 months, using semi-structured interviews and standardized questionnaires of depression and grief. Qualitative content analysis of interviews identified three bereavement patterns: The majority of parents (65%) presented uncomplicated, Integrated Grief, five mothers were Consumed by Grief, and one mother and one father expressed Minimal Grief. Quotes from parents exemplified these patterns. Parental gender, symptoms of depression, and pre-death relationship between parents and their deceased child differentially related to these patterns. Having surviving children, social support, and being active appeared to help to integrate grief into daily life. These findings illustrate differential patterns of parental bereavement and related factors, information that has important implications for identifying at-risk parents for complicated bereavement.
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Affiliation(s)
- Maru Barrera
- Hospital for Sick Children and University of Toronto
| | | | | | - Susan Tallett
- Hospital for Sick Children and University of Toronto
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12
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Pousset G, Bilsen J, Cohen J, Addington-Hall J, Miccinesi G, Onwuteaka-Philipsen B, Kaasa S, Mortier F, Deliens L. Deaths of children occurring at home in six European countries. Child Care Health Dev 2010; 36:375-84. [PMID: 19961493 DOI: 10.1111/j.1365-2214.2009.01028.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Until now there have been no population-based European data available regarding place of death of children. This study aimed to compare proportions of home death for all children and for children dying from complex chronic conditions (CCC) in six European countries and to investigate related socio-demographic and clinical factors. METHODS Data were collected from the death certificates of all deceased children aged 1-17 years in Belgium, the Netherlands, Norway, England, Wales (2003) and Italy (2002). Gender, cause and place of death (home vs. outside home) and socio-demographic factors (socio-economic status, degree of urbanization and number of hospital beds in the area) were included in the analyses. Data were analysed using frequencies and multivariate logistic regression. RESULTS In total 3328 deaths were included in the analyses; 1037 (31.2%) related to CCC. The proportion of home deaths varied between 19.6% in Italy and 28.6% in the Netherlands and was higher for children dying from CCC in all the countries studied, varying between 21.7% in Italy and 50% in the Netherlands. Among children dying from CCC, home death was more likely for cancer patients and those aged over 10 years. After controlling for potentially related clinical and socio-demographic factors, differences in the proportion of home deaths between countries remained significant, with higher proportions in Belgium and the Netherlands as compared with Italy. CONCLUSIONS Although home deaths comprise a substantial proportion of all deaths of children with CCCs, variation among disease categories and across countries suggest that considerable potential still exists for further improvements in facilitating end-of-life care in the home for those children and families who desire to be in this location.
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Affiliation(s)
- G Pousset
- Bioethics Institute Ghent, Ghent University, Ghent, Belgium.
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13
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A Solution-Focused Intervention with a Youth in a Domestic Violence Situation: Longitudinal Evidence. CONTEMPORARY FAMILY THERAPY 2008. [DOI: 10.1007/s10591-008-9067-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Abstract
Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-threatening conditions and their families. To achieve this goal, the individuals working in this field need to: clearly define the population served; better understand the needs of children with life-threatening conditions and their families; develop an approach that will be appropriate across different communities; provide care that responds adequately to suffering; advance strategies that support caregivers and health-care providers; and promote needed change by cultivating educational programmes. Despite these challenges, advances in paediatric palliative care have been achieved in a short period of time; we expect far greater progress as the field becomes more formalised and research networks are established.
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Affiliation(s)
- Stephen Liben
- The Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
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15
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Wijngaards-de Meij L, Stroebe M, Stroebe W, Schut H, Van den Bout J, Van Der Heijden PGM, Dijkstra I. The impact of circumstances surrounding the death of a child on parents' grief. DEATH STUDIES 2008; 32:237-252. [PMID: 18705169 DOI: 10.1080/07481180701881263] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A longitudinal study was conducted among bereaved parents to examine the relationship between the circumstances surrounding the death of their child and psychological adjustment. Two hundred nineteen couples participated at 6, 13, and 20 months post-loss. Examination was made of two categories of factors: those that were determined by the particular death circumstances (e.g., whether the parent was present at the death) versus those over which parents themselves could have influence (e.g., choice of cremation or burial). Results indicated that some but not all factors were related to adjustment over time. Importantly, the feeling of having said goodbye to the child and presenting the body for viewing at home were associated with lower levels of the parents' grief. Implications for supporting bereaved parents are discussed.
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Affiliation(s)
- Leoniek Wijngaards-de Meij
- Department of Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands.
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Monterosso L, Kristjanson LJ, Aoun S, Phillips MB. Supportive and palliative care needs of families of children with life-threatening illnesses in Western Australia: evidence to guide the development of a palliative care service. Palliat Med 2007; 21:689-96. [PMID: 18073255 DOI: 10.1177/0269216307083032] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To obtain feedback from families of children receiving palliative and supportive care about their care needs in hospital and in community settings. DESIGN A two-phase combined quantitative and qualitative study. SETTING Western Australia. PARTICIPANTS 134 parents and 20 service providers. RESULTS Analysis indicated the concept of palliative care is poorly understood by health professionals and by parents. Many families are affected emotionally, financially and physically by the burden of caring for children with life threatening or chronic conditions requiring complex care at home. Parents indicated the need for clear and honest information about their child's condition and prognosis throughout the trajectory of illness and perceived this had been lacking. Families required financial and practical assistance with providing care from their children at home. Parents also wanted more practical resources and information to assist with the management of their child's nutrition and pain, as well as support for their other children. The level of respite (in home and residential) was perceived to be insufficient and inequitable. Parents also required access to, and advice from, multidisciplinary health professionals when caring for their child at home. There was a perceived lack of coordination between community services and the hospital. CONCLUSION Education of health professionals and parents regarding the concepts and introduction of palliative and supportive care is required. Care for children and their families should be coordinated by a multidisciplinary team in consultation with children and their families, and linked and integrated with the treating hospital in collaboration with community services. More inclusive criteria are required for community services including practical aids and respite care.
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Affiliation(s)
- Leanne Monterosso
- Division of Health Sciences, Curtin University, Perth, Western Australia.
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Surkan PJ, Dickman PW, Steineck G, Onelöv E, Kreicbergs U. Home care of a child dying of a malignancy and parental awareness of a child's impending death. Palliat Med 2006; 20:161-9. [PMID: 16764220 DOI: 10.1191/0269216306pm1139oa] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this population-based study, we found that parents who are aware that their child will die from a malignancy are more likely to care for their child at home during the child's last month of life compared to parents who are not aware. End-of-life home care was comparable to hospital care for satisfactory pain relief, access to pain relief and access to medications for other physical symptoms. Using an anonymous postal questionnaire, we obtained information from 449 parents in Sweden who had lost a child due to a malignancy between 1992 and 1997, 4 to 9 years before participating in our study. The prevalence of dying at home and being cared for at home during the last month of life was 23.7% when parents realized intellectually more than 1 month in advance that the child would die (versus 12% who did not), 28.7% for parents who sensed that the child was aware of his or her imminent death (versus 7.8% who did not sense this) and 21.9% for those who received information that the child's illness was incurable (versus 9.4% who did not receive the information). Prevalence of children's unrelieved pain was 11.6% for those receiving home care and 15.3% for those receiving care outside the home.
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Affiliation(s)
- Pamela J Surkan
- Department of Oncology and Pathology, Karolinska Hospital, Stockholm, Sweden.
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Davies R. Mothers' stories of loss: their need to be with their dying child and their child's body after death. J Child Health Care 2005; 9:288-300. [PMID: 16275666 DOI: 10.1177/1367493505056482] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children die every year in the UK from a range of life-limiting conditions. The majority will die in hospital as only a minority die at home or in children's hospices. There is a paucity of research exploring the experiences of mothers whose children die in these settings. Although the need for them to be in a caring and supportive environment seems self-evident, this qualitative study finds that not all provide this. Interviews with 10 mothers enabled comparisons to be made between care and support received in hospital, at home and in a children's hospice. Their stories identified their need for time, space and privacy with their dying child and their child's body after death. Also, that memories of these events continued to affect them, giving further support to new theoretical understandings of parental grief which suggest that parents maintain continuing bonds with their dead child by preserving memories and recollections of their life and death.
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Affiliation(s)
- Ruth Davies
- Centre for Child Health, University of Wales.
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Drew D, Goodenough B, Maurice L, Foreman T, Willis L. Parental grieving after a child dies from cancer: is stress from stem cell transplant a factor? Int J Palliat Nurs 2005; 11:266-73. [PMID: 16010222 DOI: 10.12968/ijpn.2005.11.6.18293] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM to investigate psychological distress, family functioning and complicated grieving in parents whose child had died from cancer, and as a function of whether: (a) the deceased child had also received stem cell transplant (SCT) any time during curative treatment; and (b) the place of the child's death (home or hospital). DESIGN a cross-sectional case-match design. SAMPLE Fifty-six Australian bereaved parents in two groups: 28 whose child had also received SCT, matched with 28 (on deceased patient variables) whose child had not received SCT. RESULTS parents in the 'SCT group' (n = 28) reported relatively higher levels of depression, anxiety and stress, and - for those whose child had also died in hospital - a greater likelihood of meeting the criteria for traumatic grief than those parents whose deceased child had not received SCT. There were no significant group differences in family functioning. CONCLUSION routine psychosocial screening, especially for families undergoing SCT, may contribute usefully to a proactive model of palliative care in identifying parents at risk for complicated bereavement outcomes.
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Affiliation(s)
- Donna Drew
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, New South Wales, Australia
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20
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Goodenough B, Drew D, Higgins S, Trethewie S. Bereavement outcomes for parents who lose a child to cancer: Are place of death and sex of parent associated with differences in psychological functioning? Psychooncology 2004; 13:779-91. [PMID: 15386640 DOI: 10.1002/pon.795] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Despite increasing cure rates, cancer is a leading cause of non-accidental death in childhood. Models of psychosocial care in pediatric cancer may therefore need to address bereavement planning for a 'minority group' of parents (approximately 25%) for whom cure of their child is not possible. This study addresses a gap in knowledge concerning long-term bereavement and psychological outcomes for parents, as a function of the sex of the parent and the place of the child's death: home versus hospital. Fifty Australian parents (25 father-mother dyads), whose child had died at least 1 year prior to study participation, independently completed measures of psychological functioning (depression, anxiety and stress), family functioning, and pathological grieving (separation distress, and traumatic distress). The results showed some support for a hypothesized interaction between place of death and sex of parent. Fathers reported significantly higher levels of depression, anxiety and stress when the child died in hospital rather than at home. By way of contrast, differences for mothers as function of place of death were not reflected in psychological outcomes but were more closely tied to symptoms of pathological grieving. The findings are discussed with respect to the needs for services for surviving adult family members, especially for fathers who may have an enhanced psychological vulnerability after the death of a child in hospital rather than at home.
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Affiliation(s)
- Belinda Goodenough
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, NSW, Australia.
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Papadatou D, Martinson IM, Chung PM. Caring for dying children: a comparative study of nurses' experiences in Greece and Hong Kong. Cancer Nurs 2001; 24:402-12. [PMID: 11605711 DOI: 10.1097/00002820-200110000-00013] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this transcultural descriptive study was to explore the subjective experiences of 63 oncology and critical care nurses who provide care to dying children in Greece and Hong Kong. Semistructured interviews were conducted with 39 Greek and 24 Chinese nurses who described their experiences and responses to the dying process and death of children. The data were analyzed qualitatively and quantitatively, and nurses' responses were compared for their work setting (oncology versus critical care) and their ethnic background (Greek versus Chinese). Findings revealed that most nurses experience a sense of helplessness when caring for a dying patient and difficulties in their communication with the child and parents during the terminal phase of the disease. The large majority acknowledge that the impending or actual death of a patient elicits a grieving process, which is characterized by a fluctuation between experiencing and avoiding loss and grief. Greek and Chinese nurses differ in their expression of their grief and how they attribute meaning to childhood death. Despite the suffering caused by multiple deaths, nurses report significant rewards from caring for chronically and acutely ill children, and the majority are satisfied with their job, despite the difficulties they encounter, in both countries, mostly as a result of shortage in personnel and cooperation problems with physicians.
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Affiliation(s)
- D Papadatou
- School of Nursing, University of Athens, Greece.
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Davies B, Deveau E, deVeber B, Howell D, Martinson I, Papadatou D, Pask E, Stevens M. Experiences of mothers in five countries whose child died of cancer. Cancer Nurs 1998; 21:301-11. [PMID: 9775480 DOI: 10.1097/00002820-199810000-00001] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although increasing attention is being focused on the emotional aspects of caring for dying children and their families, few research reports concentrate on the experiences of mothers, particularly in different countries. This article describes the findings of an exploratory, descriptive study that investigated the experiences of mothers from five different countries who each had a child die from cancer in the past 6 months. Principal investigators, members of the International Work Group on Death, Dying, and Bereavement, conducted semistructured interviews with 21 mothers in their own countries. No culturally related differences were noted among mothers, and the mothers' recall of their experiences are more similar than different. All mothers, irrespective of country, described similar reactions to the diagnosis, management of the end-stage illness, and challenge of coping with bereavement. Lessons learned from this project provide suggestions for future research across countries.
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Affiliation(s)
- B Davies
- School of Nursing, University of British Columbia, Vancouver, Canada
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