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Broden EG, Boyden JY, Keller S, James R, Mooney-Doyle K. Who, What, Where, and How? The State of Family Science in Pediatric Palliative Care. J Pain Symptom Manage 2024:S0885-3924(24)00844-3. [PMID: 38992396 DOI: 10.1016/j.jpainsymman.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
CONTEXT Families are vital providers and recipients of pediatric palliative care (PPC) services. Understanding the scope and nature of evidence at the intersection of family science and PPC research is necessary to develop family-focused interventions that enhance child and family health. OBJECTIVES Explore and describe the family-level impact of pediatric serious illness. METHODS We conducted a librarian-assisted scoping review using Arskey and O'Malley's approach. We searched PubMed, Scopus, CINAHL, and EMBASE databases for empirical publications from 2016 to 2021 that focused on families navigating serious pediatric illness published in English. Two reviewers assessed eligibility, with discrepancies resolved by a third. We used Covidence and REDCap for data management and extraction. RESULTS We screened 10,983 abstracts; 309 abstracts were included in full text screening. The final group of 52 citations was analyzed by the entire team. Most research was conducted in Western Europe and North America. The perspectives of parents of children with cancer were most frequently described; voices of seriously ill youth and their siblings were less often presented. Most of the research was descriptive qualitative, followed by descriptive quantitative. Few studies were mixed methods, inferential, or interpretive. Studies most often described parent, youth, and family experience with illness and less often explored family processes and relationships. Irrespective of the approach (i.e., qualitative, quantitative), few studies focused on families as the analytic unit or used family-level analysis techniques. Study participants were usually from local dominant populations and less often from historically marginalized communities. CONCLUSION The robust, descriptive, and individual-level evidence describing family impact of serious pediatric illness provides a solid foundation for future research priorities. Stronger integration of family techniques and diverse family voices in pediatric palliative care research can clarify family processes, illuminate structural barriers, and inform interventions that are responsive to family needs. These steps will enhance the education, policy, and clinical provision of PPC to all who would benefit, thereby advancing health equity for children living with serious illness and their families.
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Affiliation(s)
- Elizabeth G Broden
- Yale National Clinician Scholars Program (E.G.B.), Yale University, New Haven, CT; School of Public Health (E.G.B.), Yale University, New Haven, CT.
| | - Jackelyn Y Boyden
- Department of Family and Community Health (J.Y.B.), School of Nursing, University of Pennsylvania, Philadelphia, PA; Division of General Pediatrics (J.Y.B.), Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan Keller
- Research Library (S.K.M.), Children's National Hospital, Washington, DC
| | - Richard James
- Nemours Children's Health (R.J.M.), Wilmington, DE; Fontan Outcomes Network
| | - Kim Mooney-Doyle
- Department of Family and Community Health (K.M-D.), School of Nursing, University of Maryland, Baltimore, MD
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Patterson V, Olsavsky A, Garcia D, Sutherland-Foggio M, Vannatta K, Prussien KV, Bemis H, Compas BE, Gerhardt CA. Impact of sociodemographic factors, stress, and communication on health-related quality of life in survivors of pediatric cancer. Pediatr Blood Cancer 2024; 71:e31001. [PMID: 38644596 PMCID: PMC11373611 DOI: 10.1002/pbc.31001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND While most research has largely focused on medical risks associated with reduced health-related quality of life (HRQOL) in survivors, sociodemographic and family factors may also play a role. Thus, we longitudinally examined sociodemographic factors and family factors associated with survivor HRQOL, including adolescent's cancer-specific stress, mother's general stress, and mother-adolescent communication. METHODS Mothers (N = 80) and survivors (ages 10-23, N = 50) were assessed 5 years following initial diagnosis. Mothers completed measures regarding sociodemographic background adolescent's cancer-specific stress, mother's general stress, mother-adolescent communication, and adolescent HRQOL. Survivors also reported on their own HRQOL. Two hierarchical multiple regressions examined predictors of (a) mother's report of adolescent HRQOL, and (b) survivor's self-report of HRQOL. RESULTS The final model predicting mother-reported adolescent HRQOL was significant, F(5,74) = 21.18, p < .001, and explained 59% of the variance in HRQoL. Significant predictors included adolescent stress (β = -.37, p < .001), mothers' stress (β = -.42, p < .001), and communication (β = .19, p = .03). The final model predicting survivor-reported HRQOL was also significant, F(5,44) = 5.16, p < .01 and explained 24% of the variance in HRQOL. Significant predictors included adolescent stress (β = -.37, p = .01) and communication (β = -.31, p = .04). Sociodemographic factors were not a significant predictor of HRQOL in any model. CONCLUSION Family stress and communication offer potential points of intervention to improve HRQOL of pediatric cancer survivors from mother and survivor perspectives. While additional research is needed, healthcare professionals should encourage stress management and strong mother-child communication to enhance survivors' long-term HRQOL. Such interventions may be complimentary to efforts targeting the known sociodemographic factors that often affect health.
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Affiliation(s)
- Valdeoso Patterson
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
| | - Anna Olsavsky
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dana Garcia
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
| | - Kemar V Prussien
- Vanderbilt University, Nashville, Tennessee, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Bemis
- Vanderbilt University, Nashville, Tennessee, USA
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
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Son H, Kim N. Therapeutic Parent-Child Communication and Health Outcomes in the Childhood Cancer Context: A Scoping Review. Cancers (Basel) 2024; 16:2152. [PMID: 38893270 PMCID: PMC11172360 DOI: 10.3390/cancers16112152] [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: 04/23/2024] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Family communication has been thought to be an important area to support children's adjustment to a cancer diagnosis. However, the characteristics of therapeutic parent-child communication that contribute to better patient outcomes and the specific patient health outcomes have been less explored. This current review explored the characteristics of therapeutic parent-child communication and its physical and psychological health outcomes. A total of 5034 articles were initially identified, and only 10 articles remained for inclusion in this review after application of the exclusion criteria. Most studies used a cross-sectional design and measured verbal communication characteristics and its psychological outcomes, but no physical outcomes. The characteristics of therapeutic verbal communication (openness, maternal validation, quality of information shared, etc.) and nonverbal communication (eye contact, close physical distance, and acknowledging behaviors) were identified. The psychological health outcomes included less distress, a lower level of PTSS, less internalizing and externalizing of symptoms, increased levels of social emotional competencies, better peer relationships, and more cooperation during the procedure at the individual level. Increased family cohesion and family adaptation were family-level outcomes. Longitudinal studies are needed to identify what qualities of communication predict better psychological outcomes so that interventions can be developed and tested. In addition, physical outcomes should be evaluated.
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Affiliation(s)
- Heeyeon Son
- College of Nursing, University of Tennessee, 1412 Circle Drive, Knoxville, TN 37996, USA
| | - Nani Kim
- School of Nursing, The University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
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Zapf H, Boettcher J, Haukeland Y, Orm S, Coslar S, Fjermestad K. A systematic review of the association between parent-child communication and adolescent mental health. JCPP ADVANCES 2024; 4:e12205. [PMID: 38827979 PMCID: PMC11143954 DOI: 10.1002/jcv2.12205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/05/2023] [Indexed: 06/05/2024] Open
Abstract
Background This systematic review addresses how adolescent-rated parent-child communication (PCC) quality is related to adolescent mental health. Methods We performed a systematic literature search in Medline and APA PsycInfo, including peer-reviewed quantitative studies examining associations between adolescent-rated dyadic PCC quality and general as well as specific measures of adolescent mental health. Qualitative and case studies were excluded, as were studies reporting only parent-rated communication quality or instruments assessing other constructs than dyadic PCC. We screened 5314 articles, of which 37 were included in the review. We assessed study quality with the Mixed Methods Appraisal Tool. Results We synthesized the findings in a table and narratively, reporting the main outcomes organized according to mental health constructs. The included studies were mainly cross-sectional. The results showed that adolescent-rated PCC quality is negatively associated with mental health constructs, demonstrating small to large effects across different mental health constructs and populations. The associations were found for general mental health and specific domains, including depression, anxiety, psychosis, suicidal ideation, post-traumatic stress symptoms, and addictive internet use/gaming. Conclusions The findings demonstrate that PCC is a relevant variable to consider in assessing adolescent mental health and preventive efforts. Limitations include the exclusive focus on adolescent-reported PCC questionnaires since parent- and observer-rated instruments may lead to different results. Also, PCC is related to other constructs, such as dyadic relationships, that were not included in this review. We conclude that PCC is a relevant variable to consider in mental health research. Our findings suggest that PCC may be considered in mental health practice, both in terms of assessing its quality and potentially by tailoring interventions to enhance PCC. These may represent a mean to promote adolescent mental health.
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Affiliation(s)
- Holger Zapf
- Department of Child and Adolescent Psychiatry, Psychotherapy and PsychosomaticsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychotherapy and PsychosomaticsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | | | - Stian Orm
- Division Mental Health CareInnlandet Hospital TrustOsloNorway
- Frambu Resource Centre for Rare DisordersOsloNorway
| | - Sarah Coslar
- Faculty of Behavioral and Social SciencesUniversity of GroningenGroningenThe Netherlands
| | - Krister Fjermestad
- Frambu Resource Centre for Rare DisordersOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
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Huang HM, Yeh TC, Lee TY. Taiwanese fathers' experiences of caring for their children during childhood cancer treatment. Eur J Oncol Nurs 2024; 69:102543. [PMID: 38457933 DOI: 10.1016/j.ejon.2024.102543] [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: 12/23/2022] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE Parents must manage their own stress and help their child with cancer during the treatment process, both physically and emotionally. With the increased involvement of fathers in caring for the family, how fathers adjust to the stress and play a role in care responsibilities is unknown. This study aimed to explore the fathers' experiences of caring for their ill child during the cancer diagnosis and treatment process. METHOD This study adopted a qualitative descriptive design and conducted in-depth interviews with 21 fathers with a diagnosed child recruited from a northern Taiwan medical center. Data were managed and analysed using content analysis. RESULTS Two main categories in the Taiwanese fathers' experiences of caring for their ill child during the cancer diagnosis and treatment process emerged: 1) the maintainer of family stability, and 2) thoughts and value adjustment. Each main category consists of 3-4 generic categories. They make the necessary adjustments between work and family, actively participate in caring for the entire family, and redefine family values. They convey information about the illness to their children, pay attention to the physical and psychological development of the child with cancer, and cherish the time spent together as a family. CONCLUSIONS During the cancer treatment process, fathers play the roles of the protector and maintainer of family stability and adjust their attitudes and thoughts toward the family members and family life. Healthcare professionals can offer the fathers comprehensive support and improve the family's overall well-being during this demanding period.
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Affiliation(s)
- Hsiu-Mei Huang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Ting-Chi Yeh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children's Hospital and Mackay Medical College, Taipei, Taiwan
| | - Tzu-Ying Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan.
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Zapf H, Boettcher J, Haukeland Y, Orm S, Coslar S, Wiegand-Grefe S, Fjermestad K. A Systematic Review of Parent-Child Communication Measures: Instruments and Their Psychometric Properties. Clin Child Fam Psychol Rev 2023; 26:121-142. [PMID: 36166179 PMCID: PMC9879831 DOI: 10.1007/s10567-022-00414-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 02/02/2023]
Abstract
Parent-child communication represents an important variable in clinical child and family psychology due to its association with a variety of psychosocial outcomes. To give an overview of instruments designed to measure the quality of parent-child communication from the child's (8-21 years) perspective and to assess the psychometric quality of these instruments, we performed a systematic literature search in Medline and PsycInfo (last: February 25, 2022). Peer-reviewed journal articles published in English with a child-rated instrument measuring the quality of parent-child communication were included. Initial screening for eligibility and inclusion, subsequent data extraction, and quality assessment were conducted by couples of review team members. Based on the screening of 5115 articles, 106 studies reported in 126 papers were included. We identified 12 parent-child communication instruments across the studies. The Parent-Adolescent Communication Scale (PACS) was used in 75% of the studies. On average, the evidence for psychometric quality of the instruments was low. Few instruments were used in clinical and at-risk samples. Several instruments are available to rate parent-child communication from the child's perspective. However, their psychometric evidence is limited and the theoretical foundation is largely undocumented. This review has limitations with regard to selection criteria and language bias.Registration PROSPERO: CRD42021255264.
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Affiliation(s)
- Holger Zapf
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | | - Stian Orm
- Division Mental Health Care, Innlandet Hospital Trust, Brumunddal, Norway
| | - Sarah Coslar
- Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Son H, Miller LE. Family Communication About Cancer in Korea: A Dyadic Analysis of Parent-Adolescent Conversation. Glob Qual Nurs Res 2023; 10:23333936231199999. [PMID: 37790199 PMCID: PMC10542324 DOI: 10.1177/23333936231199999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023] Open
Abstract
Parent-adolescent communication is important in the context of childhood cancer. However, we know little about the communication experiences between Korean adolescents and their parents. Here, we conducted a secondary analysis of interview data from a qualitative descriptive study to explore Korean parent-adolescent communication experiences as a unit. Specifically, our dyadic analysis of individual interviews with seven Korean adolescents with cancer and at least one parent included inductive analysis at the individual level and cross-analysis to generate themes. The main theme was "Experience the same thing, but see it differently," along three subthemes: (1) different expectations for parent-adolescent communication, (2) different views on communication challenges, and (3) limited sharing and no progress in the conversation. Overall, our findings provide insights into different communication expectations and preferences between Korean adolescents and parents, and reasons for communication challenges, while emphasizing the individualized assessment of parent-adolescent communication between them.
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8
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Zhen B, Yao B, Zhou X. How does parent-child communication affects posttraumatic stress disorder and growth in adolescents during the COVID-19 pandemic? The mediating roles of self-compassion and disclosure. J Affect Disord 2022; 306:1-8. [PMID: 35301037 PMCID: PMC8920085 DOI: 10.1016/j.jad.2022.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/14/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Research suggests that family factors play an important role in adolescent posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). Parent-child communication has attracted particular attention. However, it remains unclear whether parent-child communication affects PTSD and PTG via unique or shared underlying mechanisms. The study aim was to examine the effect of parent-child communication on PTSD and PTG via self-compassion and self-disclosure. METHODS Self-report questionnaires were administered to 683 adolescents during the COVID-19 pandemic. RESULTS Open parent-child communication was positively associated with PTG and negatively associated with PTSD via two 1-step indirect paths of self-compassion and self-disclosure, and by one 2-step indirect path of self-compassion to self-disclosure. Problematic parent-child communication was negatively associated with PTG and positively associated with PTSD via two 1-step indirect paths of self-compassion and self-disclosure. LIMITATIONS First, pandemics differ from other disasters, generalizing these findings to other traumatized populations must be cautious. Then, this was a cross-sectional study, so longitudinal effects could not be examined and causal relationships cannot be confirmed. CONCLUSIONS Different types of parent-child communication have different influencing mechanisms on PTSD and PTG. Therefore, distinct intervention strategies are needed targeted to these two psychological reactions.
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Affiliation(s)
- Baohua Zhen
- College of Educational Science, Anhui Normal University, Wuhu 241000, China
| | - Benxian Yao
- College of Educational Science, Anhui Normal University, Wuhu 241000, China; Department of Psychology, Hefei Normal University, Hefei 238076, China.
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China.
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van Driessche A, Gilissen J, De Vleminck A, Kars M, Fahner J, van der Werff ten Bosch J, Deliens L, Cohen J, Beernaert K. The BOOST paediatric advance care planning intervention for adolescents with cancer and their parents: development, acceptability and feasibility. BMC Pediatr 2022; 22:210. [PMID: 35428281 PMCID: PMC9010242 DOI: 10.1186/s12887-022-03247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Although advance care planning (ACP) has been widely recommended to support patient and family engagement in understanding the patient’s values, preferences and goals of care, there are only a few models in paediatric oncology that capture ACP as a process of behaviour change. We aimed to develop and test the acceptability and feasibility of BOOST pACP (Benefits of Obtaining Ownership Systematically Together in paediatric Advance Care Planning) – an intervention to improve ACP in adolescents with cancer, their parents and paediatric oncologists. Methods Several methods informed the intervention development process: 1) Problem identification: interviews with 11 healthcare professionals working in paediatric oncology; 2) Identification of evidence: literature review of existing pACP tools and barriers and facilitators in performing pACP; 3) Logic model and 4) Intervention design: collaborative expert meetings with researchers and professionals in pACP; 5a) Acceptability test of the materials: interviews with nine healthcare professionals, four adolescents and young adults with cancer and six parents; 5b) Feasibility test of core intervention components with three families, including interviews about their experiences. Results The BOOST pACP intervention was iteratively developed and adapted, based on feedback from families, healthcare professionals, and pACP experts (e.g., components were changed, deleted, and added; formulation of themes and associated questions were amended to enhance acceptability). The core components of the BOOST pACP intervention include: four ACP conversation sessions with the adolescent and/or parent(s) provided by a trained facilitator, structured by interactive conversation cards covering different ACP themes, followed by a transfer of information from the intervention facilitator to the paediatric oncologist. Core intervention components were deemed feasible by all participating families. Conclusion The BOOST pACP intervention was developed by close involvement of both adolescent patients and their parents, healthcare professionals and pACP experts. The final intervention and supporting materials are considered appropriate and feasible. Its effectiveness in improving parent-adolescent communication on ACP themes is currently being tested in a multi-centre randomised controlled trial. Researchers aiming to develop a complex psychosocial intervention for a vulnerable target group could use the step-by-step approach described in this paper. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03247-9.
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Orm S, Haukeland YB, Vatne T, Fjermestad K. Measuring family communication in pediatric nursing: Psychometric properties of the Parent-Child Communication Scale - Child Report (PCCS-CR). J Pediatr Nurs 2022; 62:78-83. [PMID: 34799202 DOI: 10.1016/j.pedn.2021.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/16/2021] [Accepted: 10/31/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Communication quality is an essential indicator of family functioning and represents an important outcome after pediatric nursing interventions. However, few well-documented child-report questionnaires for family communication exist. We aimed to document the psychometric properties of a previously developed child-rated family communication scale for use in pediatric nursing. DESIGN AND METHODS We examined the Parent-Child Communication Scale - Child Report (PCCS-CR) in terms of factor structure, convergent validity against the Experiences in Close Relationships-Relationship Structures scale (ECR-RS), and known-groups validity between a sample of siblings of children with pediatric health conditions and controls. The sample comprised 101 siblings of children with a pediatric health condition and 44 controls (M age = 11.5 years, SD = 2.2). RESULTS We confirmed a two-factor structure of the PCCS-CR. One factor is communication from the child to the parent, labelled child communication (e.g., "I discuss problems with my parents") and the other is communication from the parent to the child, labelled parent communication (e.g., "My parent is a good listener"). Convergent validity of the PCCS-CR was demonstrated through correlations with ECR-RS (r = -0.73 to -0.22, p ≤ .05). Further, construct validity through differences between families with and without a child with a pediatric health condition was demonstrated (g = 0.36-0.83, p ≤ .052). CONCLUSION The PCCS-CR appears to be a psychometrically sound measure of parent-child communication from the child's point of view. PRACTICAL IMPLICATIONS The PCCS-CR can be administered in pediatric nursing care and can be used to target and measure the outcomes of interventions aimed at enhancing family functioning.
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Affiliation(s)
- Stian Orm
- Department of Psychology, University of Oslo, Norway; Department of Mental Health Care, Innlandet Hospital Trust, Norway.
| | | | - Torun Vatne
- Frambu Resource Center for Rare Disorders, Norway
| | - Krister Fjermestad
- Department of Psychology, University of Oslo, Norway; Frambu Resource Center for Rare Disorders, Norway
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Kenney AE, Bedoya SZ, Gerhardt CA, Young-Saleme T, Wiener L. End of life communication among caregivers of children with cancer: A qualitative approach to understanding support desired by families. Palliat Support Care 2021; 19:715-722. [PMID: 33641691 PMCID: PMC8408277 DOI: 10.1017/s1478951521000067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Clinicians and parents are encouraged to have open and honest communication about end of life with children with cancer, yet there remains limited research in this area. We examined family communication and preferred forms of support among bereaved caregivers of children with cancer. METHODS Bereaved caregivers were recruited through a closed social media group to complete an online survey providing retrospective reports of end of life communication with their child and preferences for communication support from health-care providers. The sample of 131 participants was mostly female (77.9%; n = 102) with an average age of 49.15 (SD = 8.03) years. Deceased children were of an average age of 12.42 years (SD = 6.01) and nearly 90% of children died within 5 years of diagnosis. RESULTS Most caregivers spoke with their child about their prognosis (61.8%; n = 131) and death (66.7%; n = 99). Half of children (48%; n = 125) asked about death, particularly older children (51.9% ≥12 years; p = 0.03). Asking about dying was related to having conversations about prognosis (p ≤ 0.001) and death (p ≤ 0.001). Most caregivers (71.8%; n = 94) wanted support to talk to their children. Fewer wanted providers to speak to children directly (12.2%; n = 16) or to be present while caregivers spoke to the child (19.8%; n = 26). Several themes emerged from a content analysis of open-ended responses regarding preferences for provider support. SIGNIFICANCE OF RESULTS Most caregivers discussed issues pertaining to end of life irrespective of demographic or medical factors. Qualitative themes provide insight into support desired by families to help with these difficult conversations.
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Affiliation(s)
- Ansley E Kenney
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Sima Zadeh Bedoya
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH
| | - Tammi Young-Saleme
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH
| | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Zhou X, Zhen R, Wu X. Insecure Attachment to Parents and PTSD among Adolescents: The Roles of Parent-Child Communication, Perceived Parental Depression, and Intrusive Rumination. Dev Psychopathol 2021; 33:1290-1299. [PMID: 32594930 DOI: 10.1017/s0954579420000498] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Based on attachment theory and a social-cognitive model of posttraumatic stress disorder (PTSD), this study examined the roles of parent-child communication, perceived parental depression, and intrusive rumination in the association between insecure attachment to parents and PTSD among adolescents following the Jiuzhaigou earthquake. In this study, 620 adolescents were recruited to complete self-report questionnaires. The results showed that the direct association between anxious attachment and PTSD was significant, but that between avoidant attachment and PTSD was non-significant. In addition, both anxious and avoidant attachment had indirect associations with PTSD via the mediating effects of parent-child communication openness and problems, perceived parental depression, and intrusive rumination. However, the specific paths between anxious and avoidant attachment and PTSD were different. The findings indicated that insecure attachment among adolescents following the earthquake was predictive for their PTSD, and the mechanisms underlying the association between anxious attachment and PTSD and the association between avoidant attachment and PTSD were distinct. To alleviate PTSD, more attention should be paid to improving the quality of parent-child communication for adolescents with avoidant attachment to parents, and to reducing negative cognition in adolescents with anxious attachment.
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Affiliation(s)
- Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Rui Zhen
- Institute of Psychological Science, Hangzhou Normal University, Hangzhou, China
| | - Xinchun Wu
- Faculty of Psychology, Beijing Normal University, Beijing, China
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Cowfer BA, Dietrich MS, Akard TF. Effect of time on quality of parent-child communication in pediatric cancer. Pediatr Blood Cancer 2021; 68:e29091. [PMID: 34165883 DOI: 10.1002/pbc.29091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND A diagnosis of childhood cancer results in new parent-child communication challenges. Little is known about how communication changes over time after diagnosis or relapse. The objective of this study was to determine the effect of time since diagnosis and relapse on quality of parent-child communication. We hypothesized that there would be a positive correlation between time and quality of parent-child communication. METHODS Cross-sectional study in children (7-17 years) with relapsed/refractory cancer and their caregivers, who spoke English, were not cognitively impaired, and had internet access. Parents were recruited through Facebook ads. Parents and children completed the Parent-Adolescent Communication Scale (PACS), a 20-item measure of communication quality, with openness and problem subscales. Spearman's rho (rs ) coefficients assessed correlations between PACS scores and time since diagnosis/relapse. RESULTS There was a statistically significant negative correlation between parent PACS scores and time since child's cancer diagnosis (rs = -0.21, p = .02), indicating a tendency for overall worsening communication as time since diagnosis increased. There was a positive correlation between the parent PACS problem scores and time since diagnosis (rs = +0.22, p = .01), indicating more problematic communication as time since diagnosis increased. Correlations of time since relapse and PACS scores were small and not statistically significant. CONCLUSION Parent-child communication worsens over time following a child's cancer diagnosis with more communication problems, contrary to our hypothesis. Future studies are needed to evaluate intervention timing to best support parent-child communication beyond the new-diagnosis period.
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Affiliation(s)
- Brittany A Cowfer
- Department of Pediatric Hematology/ Oncology , Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Mary S Dietrich
- Vanderbilt University Schools of Nursing and Medicine, Nashville, Tennessee, USA
| | - Terrah Foster Akard
- Vanderbilt University Schools of Nursing and Medicine, Nashville, Tennessee, USA
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14
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van Driessche A, De Vleminck A, Gilissen J, Kars MC, van der Werff ten Bosch J, Deliens L, Cohen J, Beernaert K. Advance care planning for adolescents with cancer and their parents: study protocol of the BOOST pACP multi-centre randomised controlled trial and process evaluation. BMC Pediatr 2021; 21:376. [PMID: 34470598 PMCID: PMC8408307 DOI: 10.1186/s12887-021-02841-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has highlighted the need for evidence-based interventions to improve paediatric advance care planning (pACP) in adolescents with cancer. Although adolescents express the desire and ability to share their values, beliefs and preferences for treatment, there is a lack of structured multicomponent interventions to improve parent-adolescent communication on different ACP themes including those not limited to end-of-life care. The aim of this study is to evaluate the effectiveness and implementation, context and mechanisms of impact of a novel ACP program in paediatric oncology. METHODS We will conduct a multi-centre parallel-group randomised controlled superiority trial with embedded mixed-methods process evaluation in Flanders, Belgium. Adolescents aged 10-18 who have cancer, and their parent(s) will be recruited via all four university hospitals in Flanders, Belgium, and support groups. Families will be randomised to receive care as usual or the multicomponent BOOST pACP program, consisting of three conversation sessions between an external facilitator and the adolescent and parent(s). The primary endpoint is improved parent-adolescent communication from the perspective of the adolescent. Secondary endpoints are adolescents' and parents' attitudes, self-efficacy, intention and behaviour regarding talking about ACP themes with each other, parents' perspective of shared decision making in the last clinical encounter, and the paediatric oncologist's intention and behaviour regarding talking about ACP themes with the family. Measurements will be performed at baseline, at 3 months and at 7 months using structured self-reported questionnaires. We will perform a process evaluation in the intervention group, with measurement throughout and post-intervention, using structured diaries filled out by the facilitators, interviews with facilitators, interviews with involved paediatric oncology teams, and audio-recordings of the BOOST pACP conversations. DISCUSSION The BOOST pACP program has been developed to stimulate conversations on ACP themes between parent(s) and the adolescents, simultaneously lowering the threshold to discuss similar themes with healthcare professionals, initiating a process of normalization and integration of ACP in standard care. This combined outcome and process evaluation aims to contribute to building the necessary evidence to improve ACP in paediatric oncology. TRIAL REGISTRATION The study is registered at ISRCTN, ISRCTN33228289 . Registration date: January 22, 2021.
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Affiliation(s)
- Anne van Driessche
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Aline De Vleminck
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Joni Gilissen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), California, USA
| | - Marijke C. Kars
- Center of Expertise Palliative Care, Julius Center of Health Sciences and Primary Care, UMC Utrecht, Universiteitsweg 100, Utrecht, CG 3584 the Netherlands
| | - Jutte van der Werff ten Bosch
- Department of Paediatric Hematology-Oncology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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15
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Fisher RS, Kenney AE, Fults MZ, Manring S, Rodriguez EM, Desjardins L, Rausch JR, Young-Saleme T, Ranalli MA, Vannatta K, Compas BE, Gerhardt CA. Longitudinal understanding of prognosis among adolescents with cancer. Pediatr Blood Cancer 2021; 68:e28826. [PMID: 33320998 DOI: 10.1002/pbc.28826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Despite calls to increase prognosis communication for adolescents with cancer, limited research has examined their perceptions of prognosis as compared with their parents. We assessed adolescents' understanding of their prognosis relative to parents and oncologists. METHODS Families of adolescents (aged 10-17) were recruited at two pediatric institutions following a new diagnosis or relapse. Seventy-four adolescents, 68 mothers, and 40 fathers participated at enrollment; 76 adolescents, 69 mothers, and 35 fathers participated one year later. The adolescent's primary oncologist reported on prognosis only at enrollment. Participants rated the likelihood of the adolescent's survival in five years, as well as reporting prognosis communication and sources of information. RESULTS Most oncologists (65%) and fathers (63%) discussed prognosis in numerical terms with the adolescent at baseline, which was greater than mother report (49%) of discussions of numerical prognosis with adolescents. Adolescents reported a better prognosis than oncologists, but comparable with mothers at diagnosis and one year. Adolescents' prognosis estimates were stable over time (P > .05). At diagnosis, adolescent-father (P = 0.025) and adolescent-oncologist (P < 0.001) discrepancies were larger for youth with advanced than non-advanced cancer. Adolescents whose parents received numerical prognosis estimates from the oncologist, and whose fathers reported providing numerical prognosis estimates had more accurate understandings of prognosis (P < 0.05). CONCLUSIONS Adolescent prognosis estimates were comparable with those of parents at diagnosis and one year but more favorable than that of oncologists. Although additional research is needed, results suggest discrepancies in prognosis estimates between family members and oncologists, particularly for adolescents with advanced cancer.
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Affiliation(s)
- Rachel S Fisher
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Ansley E Kenney
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Marci Z Fults
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Samantha Manring
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Erin M Rodriguez
- Department of Educational Psychology, The University of Texas at Austin, Austin, Texas
| | | | - Joseph R Rausch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Tammi Young-Saleme
- Division of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio
| | - Mark A Ranalli
- Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Division of Hematology/Oncology/Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Bruce E Compas
- Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
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16
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Akard TF, Dietrich MS, Friedman DL, Gerhardt CA, Given B, Hendricks-Ferguson V, Hinds PS, Ridner SH, Beckmann N, Gilmer MJ. Improved Parent-Child Communication following a RCT Evaluating a Legacy Intervention for Children with Advanced Cancer. PROGRESS IN PALLIATIVE CARE 2020; 29:130-139. [PMID: 34239227 DOI: 10.1080/09699260.2020.1826778] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although legacy-building is a priority for quality palliative care, research has rarely examined effects of legacy interventions in children, particularly their impact on parent-child communication.We examined the impact of a web-based legacy intervention on parent-child communication. We hypothesized that compared to usual care, legacy-making would improve quality of parent-child communication.Between 2015 and 2018, Facebook advertisements were used to recruit families of children (ages 7-17) with relapsed/refractory cancer. Parent-child dyads were randomly assigned to the intervention or usual care group. The intervention website guided children to create digital storyboards over 2 weeks by directing them to answer legacy questions about themselves and upload photographs, videos, and music. Families received a copy of the child's final digital story. Children and parents completed the Parent-Adolescent Communication Scale pre- (T1) and post-intervention (T2). Linear regressions tested for differences in change from T1 to T2 between the groups controlling for T1 values using an alpha of p < .05. Intervention effects were measured using Cohen's d. Ninety-seven parent-child dyads were included for analysis. Changes in parent-child communication were not statistically significantly different between the groups, yet meaningful intervention effects were observed. The strongest effects were observed for improving father-child communication (Cohen's d = -0.22-0.33). Legacy-making shows promise to facilitate improved parent-child communication, particularly for fathers. Future studies should include fathers and measure expression of feelings and parent-child interaction. Providers should continue to facilitate family communication for children with advanced disease and realize that legacy interventions may impact mother-child versus father-child communication differently.
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Affiliation(s)
- Terrah Foster Akard
- Vanderbilt University School of Nursing, Nashville, USA.,Vanderbilt University School of Medicine, Nashville, USA
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, USA.,Vanderbilt University School of Medicine, Nashville, USA
| | - Debra L Friedman
- Vanderbilt University School of Medicine, Nashville, USA.,Vanderbilt University Medical Center, Nashville, USA
| | - Cynthia A Gerhardt
- The Ohio State University and The Research Institute at Nationwide Children's Hospital, Columbus, USA
| | - Barbara Given
- Michigan State University College of Nursing, East Lansing, USA
| | | | - Pamela S Hinds
- Children's National Health System and The George Washington University, Washington DC, USA
| | | | | | - Mary Jo Gilmer
- Vanderbilt University School of Nursing, Nashville, USA.,Vanderbilt University Medical Center, Nashville, USA
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17
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Gajda J, Thiel B, Zimmermann T. Hilfreiche psychosoziale Unterstützung für Eltern in der pädiatrischen Onkologie. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Hintergrund
Krebserkrankungen im Kindes- und Jugendalter haben Auswirkungen auf die gesamte Familie – auch für die betroffenen Eltern hinsichtlich psychischer Aspekte. Gegenwärtig existieren nur wenige Untersuchungen zu den Anforderungen an hilfreiche psychosoziale Unterstützungsangebote für Eltern.
Ziel der Arbeit
Zur Gewinnung weiterer Erkenntnisse für die psychosoziale Versorgung wurden Eigenschaften und inhaltliche Komponenten von hilfreichen psychosozialen Unterstützungsangeboten für Eltern mit an Krebs erkrankten Kindern untersucht.
Methodik
Im Rahmen einer qualitativen Studie wurden N = 15 Expert_innen verschiedener Disziplinen und Standorte aus Akut- und Rehakliniken sowie ambulant tätige Kolleg_innen eingeschlossen. Die Durchführung basierte auf einem teilstrukturierten Interviewleitfaden. Die Auswertung erfolgte anhand der qualitativen Inhaltsanalyse.
Ergebnisse
Grundsätzlich erachteten die eingeschlossenen Expert_innen niedrigschwellige und flexible Angebote als ideale psychosoziale Unterstützungsform. Hinsichtlich des optimalen Zeitpunkts zeigte sich hingegen ein heterogenes Bild. Inhaltlich wurden häufig die Förderung der Familienkohäsion, der Kommunikationsfähigkeiten sowie der Selbstfürsorge, aber auch Erziehungsthemen und angenehme gemeinsame Aktivitäten in der Gemeinschaft als essenziell angesehen.
Diskussion
Die psychosoziale Versorgung von Eltern mit an Krebs erkrankten Kindern ist herausfordernd, da die Langzeitverläufe individuell und dynamisch fluktuierend beschrieben werden. Eine Kombination aus verschiedenen Interventionsformaten (Präsenztermine vs. E‑Health-Module, Gruppen‑, Einzel- oder partnerschaftliche Sitzungen, strukturiert vs. themenoffen) scheint am praktikabelsten zu sein.
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18
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Tillery R, Willard VW, Howard Sharp KM, Klages KL, Long AM, Phipps S. Impact of the parent‐child relationship on psychological and social resilience in pediatric cancer patients. Psychooncology 2019; 29:339-346. [DOI: 10.1002/pon.5258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Rachel Tillery
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
| | - Victoria W. Willard
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
| | | | - Kimberly L. Klages
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
- Department of Psychology The University of Memphis Memphis Tennessee
| | - Alanna M. Long
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
| | - Sean Phipps
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
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19
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Brand McCarthy SR, Kang TI, Mack JW. Inclusion of children in the initial conversation about their cancer diagnosis: impact on parent experiences of the communication process. Support Care Cancer 2019; 27:1319-1324. [PMID: 30675664 DOI: 10.1007/s00520-019-4653-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/15/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Including children in medical conversations is considered the standard of care for children with cancer. However, previous qualitative research has raised concerns about how the child's presence impacts the parent's communication experience. The current study examines the frequency and impact of child presence during a serious medical conversation on the parent's communication experience in pediatric oncology. METHODS Three hundred sixty parents of children newly diagnosed with cancer completed questionnaires assessing the child's presence during the initial conversation with the oncologist about diagnosis and treatment and parental communication experiences. Primary oncologists completed a survey question about the child's prognosis. RESULTS Sixty-one percent of children were present during the initial conversation, with lowest rates among children aged 3-6 (44%) and 7-12 (44%). Child presence was not associated with parents' reports that they received prognostic information (p = 0.20), high-quality information (p = 0.19), or high-quality communication about the child's cancer (p = 1.0). DISCUSSION The parent's communication experience is not diminished by the choice to include the child. Given the bioethical imperative to include children in conversations about serious illness whenever possible, this concern should not be used to exclude children, but rather to give parents additional time of their own when needed to fully process decisions.
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Affiliation(s)
- Sarah R Brand McCarthy
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Tammy I Kang
- Section of Pediatric Palliative Care, Texas Children's Hospital, Houston, TX, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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20
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Levine DR, Liederbach E, Johnson LM, Kaye EC, Spraker-Perlman H, Mandrell B, Pritchard M, Sykes A, Lu Z, Wendler D, Baker JN. Are we meeting the informational needs of cancer patients and families? Perception of physician communication in pediatric oncology. Cancer 2019; 125:1518-1526. [PMID: 30602057 DOI: 10.1002/cncr.31937] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/16/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND High-quality oncology care is marked by skillful communication, yet little is known about patient and family communication perceptions or content preferences. Our study sought to elicit pediatric oncology patient and parent perceptions of early cancer communication to establish whether informational needs were met and identify opportunities for enhanced communication throughout cancer care. METHOD An original survey instrument was developed, pretested, and administered to 129 patients, age 10-18 years, and their parents at 3 cancer centers between 2011 and 2015. Statistical analysis of survey items about perceived communication, related associations, and patient/parent concordance was performed. RESULTS A greater percentage of participants reported "a lot" of discussion about the physical impact of cancer (patients, 58.1% [n = 75]; parents, 69.8% [n = 90]) compared with impact on quality of life (QOL) (patients, 44.2% [n = 57]; parents, 55.8% [n = 72]) or emotional impact (patients, 31.8% [n = 41]; parents, 43.4% [n = 56]). One fifth of patients (20.9% [n = 27]) reported they had no up-front discussion about the emotional impact of cancer treatment. Parents indicated a desire for increased discussion regarding impact on family life (27.9% [n = 36]), long-term QOL (27.9% [n = 36]), and daily activities (20.2% [n = 26]). Patients more frequently than parents indicated a desire for increased physician/patient discussion around the impact on daily activities (patients, 40.3% [n = 52]; parents, 21.7% [n = 28]; P < .001), long-term QOL (patients, 34.9% [n = 45]; parents, 16.3% [n = 21]; P < .001), pain management (patients, 23.3% [n = 30]; parents, 7% [n = 9]; P < .001), physical symptom management (patients, 24% [n = 31]; parents, 7.8% [n = 10]; P < .001), short-term QOL (patients, 23.3% [n = 30]; parents, 9.3% [n = 12]; P = .001), and curative potential (patients, 21.7% [n = 28]; parents, 8.5% [n = 11]; P = .002, P values calculated using McNemar's test). CONCLUSION Oncologists may not be meeting the informational needs of many patients and some parents/caregivers. Communication could be enhanced through increased direct physician-patient communication, as well as proactive discussion of emotional symptoms and impact of cancer on QOL.
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Affiliation(s)
- Deena R Levine
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erik Liederbach
- Department of Oncology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Liza-Marie Johnson
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erica C Kaye
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Holly Spraker-Perlman
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Belinda Mandrell
- Division of Nursing Research, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michele Pritchard
- Division of Nursing Research, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - April Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Dave Wendler
- Department of Bioethics, National Institute of Health, Bethesda, Maryland
| | - Justin N Baker
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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21
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Yang BH, Chung CY, Li YS. Partnership between families of children with muscular dystrophy and healthcare professionals: From parents' perspective. Asian Nurs Res (Korean Soc Nurs Sci) 2018; 12:S1976-1317(17)30584-4. [PMID: 29807201 DOI: 10.1016/j.anr.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 05/15/2018] [Accepted: 05/21/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSES At present, there is still controversy between parents of children with muscular dystrophy (MD) and healthcare professionals on care issues. Partnerships can connect the affected children and their families to appropriate healthcare services, to jointly face the care environment together and thereby improve the quality of life of children with MD. Therefore, the objective of this study is to explore partnerships between families and healthcare professionals from the perspectives of parents of children with MD. METHOD Husserl's phenomenological research was applied to explore the basic structures of parents' descriptions of MD. Through purposive sampling, we conducted in-depth interviews with parents, and analyzed the data according to the theory of Giorgi. Nineteen parents (10 mothers, nine fathers) participated in this study. The precision of the research results was tested by applying the four standards of Lincoln and Guba. RESULTS This study identified five constituents: feasible resources and detailed care information; the provision of an integrated medical care across systems; family and home as key elements in critical care; respect and care for family care demands; and finally; feedback and support from families. CONCLUSION This study demonstrated that partnerships were established by healthcare professionals, enhancing the care capacity of the families, developing the preventive medicine of MD, and enhancing children's potential for self-care within the families. Hospital policies should include the promotion of family partnership care. The findings can help healthcare professionals recognize the life experiences of children with MD when providing medical care.
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Affiliation(s)
- Bao-Huan Yang
- School of Nursing, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Road, Guishan District, Taoyuan 33303, Taiwan, ROC.
| | - Chia-Ying Chung
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital; School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan 33303, Taiwan, ROC.
| | - Yuh-Shiow Li
- School of Nursing, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Road, Guishan District, Taoyuan 33303, Taiwan, ROC; Department of Nursing Management, Chang Gung Memorial Hospital.
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22
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Schepers SA, Sint Nicolaas SM, Maurice-Stam H, Haverman L, Verhaak CM, Grootenhuis MA. Parental distress 6 months after a pediatric cancer diagnosis in relation to family psychosocial risk at diagnosis. Cancer 2017; 124:381-390. [DOI: 10.1002/cncr.31023] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/31/2017] [Accepted: 08/14/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Sasja A. Schepers
- Psychosocial Department; Emma Children's Hospital, Academic Medical Center; Amsterdam the Netherlands
- Princess Máxima Center for Pediatric Oncology; Utrecht the Netherlands
- Department of Psychology; St. Jude Children's Research Hospital; Memphis Tennessee
| | - Simone M. Sint Nicolaas
- Department of Medical Psychology; Amalia Children's Hospital, Radboud University Medical Center; Nijmegen the Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department; Emma Children's Hospital, Academic Medical Center; Amsterdam the Netherlands
| | - Lotte Haverman
- Psychosocial Department; Emma Children's Hospital, Academic Medical Center; Amsterdam the Netherlands
| | - Chris M. Verhaak
- Department of Medical Psychology; Amalia Children's Hospital, Radboud University Medical Center; Nijmegen the Netherlands
| | - Martha A. Grootenhuis
- Psychosocial Department; Emma Children's Hospital, Academic Medical Center; Amsterdam the Netherlands
- Princess Máxima Center for Pediatric Oncology; Utrecht the Netherlands
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