Correlates of control in pediatric cancer patients and their families

Exploring key elements of approaches that support childrens' preferences during painful and stressful medical procedures: A scoping review

PROBLEM

Children undergoing medical procedures can experience pain and distress. While numerous interventions exist to mitigate pain and distress, the ability to individualize the intervention to suit the needs and preferences of individual children is emerging as an important aspect of providing family-centered care and shared decision making. To date, the approaches for supporting children to express their preferences have not been systematically identified and described. A scoping review was conducted to identify such approaches and to describe the elements that are included in them.

ELIGIBILITY CRITERIA

Studies that (a) described approaches with the aim to support children to express their coping preferences during medical procedures; (b) included the option for children to choose coping interventions; (c) included a child (1--18 years).

SAMPLE

Searches were conducted in December 2019 and November 2020 in the following databases: Cinahl, Embase, PubMed and Psycinfo.

RESULTS

Thirteen studies were identified that included six distinct approaches. Four important key elements were identified: 1) Aid to express preferences or choice, 2) Information Provision, 3) Assessment of feelings/emotions, 4) Feedback/Reflection and Reward.

CONCLUSIONS

Identified approaches incorporate components of shared decision-making to support children in expressing their preferences during medical procedures and treatments.

IMPLICATIONS

Children undergoing medical procedures can be supported in expressing their coping needs and preferences by using components of shared decision-making.

Navigating Decisional Discord: The Pediatrician's Role When Child and Parents Disagree

From the time when children enter the preteen years onward, pediatric medical decision-making can entail a complex interaction between child, parents, and pediatrician. When the child and parents disagree regarding medical decisions, the pediatrician has the challenging task of guiding the family to a final decision. Unresolved discord can affect family cohesiveness, patient adherence, and patient self-management. In this article, we outline 3 models for the pediatrician's role in the setting of decisional discord: deference, advocative, and arbitrative. In the deference model, the pediatrician prioritizes parental decision-making authority. In the advocative model, the pediatrician advocates for the child's preference in decision-making so long as the child's decision is medically reasonable. In the arbitrative model, the pediatrician works to resolve the conflict in a balanced fashion. Although each model has advantages and disadvantages, the arbitrative model should serve as the initial model in nearly all settings. The arbitrative model is likely to reach the most beneficial decision in a manner that maintains family cohesiveness by respecting the authority of parents and the developing autonomy of children. We also highlight, however, occasions when the deference or advocative models may be more appropriate. Physicians should keep all 3 models available in their professional toolkit and develop the wisdom to deploy the right model for each particular clinical situation.

The experiences of Hong Kong Chinese parents of children with acute lymphocytic leukemia

The purpose of this study was to explore the experiences of Chinese parents of children diagnosed with acute lymphocytic leukemia (ALL). Respondents consisted of a convenience sample of nine mothers and eight fathers. Data were collected through in-depth interviews and were scheduled to coincide with the disease trajectory, and were analyzed using the matrix system described by Miles and Huberman. Major categories identified include parental reactions, methods used by the parents to disclose the child's diagnosis to others, changes in the family routine, and the preferred sources of parental support. Implications for health professionals include a need for thorough psychosocial assessment of the affected children, parents, and siblings. Limitations of the study and recommendations for future research are also discussed.

Comparison of Chinese and Caucasian families caregiving to children with cancer at home: Part I

This 1-year, longitudinal comparative study of Chinese and Caucasian family caregiving for a child with cancer is reported in two parts. Part I describes data obtained from the initial interviews at diagnosis with Chinese and Caucasian families. Interviews revealed that Chinese families use supplemental care methods, Chinese families have fewer resources and are more isolated; Caucasian families emphasize emotional care; and family emotional coping patterns differed between the two groups. Measures of functional status of the child, the impact of the child's illness on the family, the symptomatic responses of the parents to the child's illness, and patterns of caregiving were also analyzed over the first year after diagnosis. There were no statistical differences between ethnic groups. General health was lower for the children with cancer than for chronically ill children. Part II reports on the results from the two following interviews during the first year after diagnosis.

Common themes and ethnic differences in family caregiving the first year after diagnosis of childhood cancer: Part II

Chinese immigrant and North American white family caregiving for a child with cancer was compared in a 1-year study. This second of a two-part report describes interview results after first remission and at 1-year postdiagnosis. (The first part reported results of the initial interview and family function, symptom and caregiving inventories administered at diagnosis and at first remission). In follow-up interviews, the ill child remained the family priority in both groups, with sequelae for siblings and parents. All children were physically well cared for, with strict adherence to Western medical protocols. Cultural differences and immigrant status contributed to lower verbal expression of distress, more isolation, and lower attention to emotional distress for the Chinese. Caregiving emphases were dietary for the Chinese; emotional for the Caucasians. Differences over time in family caregiving and coping were determined by demands of care and evolving expertise. Care inclusive routines were established by most families by the second interview, in spite of extent of continued difficulties. Emotional care demands, concern for needs of siblings, and marital conflict increased over time. At 1 year, all families complained of emotional and physical fatigue and the need to adapt to a tentative future with their child.

Coping with HIV disease among seropositive women: psychosocial correlates

With HIV becoming more of a chronic illness, and with a shift in the demographics of the HIV pandemic to women, it is important to understand which psychosocial factors relate to positive coping behaviors in HIV-infected women. Additionally, socioeconomic factors have frequently confounded the interpretation of results of many other studies of stress and coping in HIV-infected individuals. In the present study, 58 HIV-infected women were assessed. These women were generally well-educated, employed women and therefore did not suffer from socioeconomic factors associated with inner city living, commercial sex work, or drug use. We performed a discriminant function analysis to determine which of five psychosocial variables could discriminate between those who strongly self-identified with each of three coping styles from those with low self-identification. The three coping styles included an active, problem solving style, a hopeless, given-up style, and a stoic style. Different patterns of psychosocial variables discriminated between those who strongly identified with a coping style from those who did not. For fighting spirit, the best combination of predictors (loadings > .25) were: strong social support, lower loneliness, depression, and anger, and a belief in a chance locus of control. The best combination of predictors for identification with a helpless coping style were: loneliness, depression, and anger, lower social support and less belief in a chance locus of control. Stronger identification with a stoic coping style were belief in a chance locus of control and lower social support, loneliness, and anger. Results of the study point to areas of psychosocial functioning which need to be strengthened or diminished in order to maintain effective coping for HIV-infected women and enhance their quality of life.

Informed consent in children and adolescents: age, maturation and psychological state

PURPOSE

The purpose of this investigation was to examine the relationship of understanding of research participation to anxiety, control, and stage of cognitive development.

METHODS

Participants included 44 boys and girls ages 7 to 20 years. All were inpatients for the first time in pediatric units of a research hospital. Twenty participants were admitted for experimental treatment of pediatric cancers and 24 were admitted for a 3-week treatment of extreme obesity. An interview was conducted to assess 12 elements of knowledge of research participation of a medical protocol. The interview was coded for: 1) knowledge of research participation score, 2) weighted knowledge of participation in research score (based on physician ratings of what was most-to-least important for children and adolescents to know), and 3) global control (perceived control over life, illness and treatment). A measure of anxiety and one Piagetian task to measure stage of cognitive development also were administered.

RESULTS

Pearson correlations, significant at p < or = .05, were as follows: knowledge of participation in research and global control, (r = .40) and weighted knowledge of participation in research score and global control (r = .38). Hierarchical regression showed that the best predictors of knowledge of research participation or the weighted knowledge of research participation score was global control alone or an interaction of global control with anxiety.

CONCLUSIONS

Emotional factors were more frequently related to understanding of research participation than age or cognitive development. Providing medical environments that decrease anxiety and increase control may enhance children's and adolescent's understanding of the research process.

Transition to adult health care for adolescents and young adults with cancer

As the prognosis for children and adolescents with cancer improves, we must reconsider how we will provide care to the adolescents and young adults who have survived these conditions. On the premise that the global needs of adults are best served by health care obtained in the adult health-care system, the case is made for transition from pediatric to adult-oriented health care for adolescents and young adults with cancer. The benefits of transition, barriers to implementation, and models of care are discussed.

The effects of group therapy on adolescents with cancer

The value of group therapy for adolescents with cancer has not been well documented. This quasi-experimental and descriptive study was completed to determine the effects of participation in a support group on measures of psychosocial functioning of adolescents with cancer and to describe the process and content of such a group. Seven control and seven experimental subjects were tested prior to beginning the group and again following its completion. Descriptive data were obtained from a process log of the sessions and from participant evaluations. Descriptive findings suggest that the group may have had therapeutic value for the participants by helping them cope with such stresses as over-protective parents and isolation from peers. Empirical findings showed no significant differences on any measures of psychosocial functioning. Results of the study implied that adolescents with cancer may benefit from having a specific time to discuss concerns. However, further study is needed with a larger sample and improved methodology in order to support this finding empirically.