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Ayoub M, Lövgren M, Kreicbergs U, Udo C. Voices of Children with Cancer and Their Siblings in the Family Talk Intervention. CHILDREN (BASEL, SWITZERLAND) 2025; 12:266. [PMID: 40150549 PMCID: PMC11941742 DOI: 10.3390/children12030266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 02/15/2025] [Accepted: 02/18/2025] [Indexed: 03/29/2025]
Abstract
BACKGROUND Children in pediatric oncology report unmet needs related to communication and information about the illness, care involvement, and psychosocial support. Supporting the whole family involves challenges, with a risk that children's voices are not heard above those of the adults. Article 12 of the UNCRC has been a catalyst in supporting children's voices and their right to participate in processes that affect them. The aim of this study was to explore how children with cancer and their siblings experienced participation in a family-centered psychosocial support intervention, the Family Talk Intervention (FTI). METHODS Interviews were held with 35 children (ill and siblings) from 26 families in pediatric oncology after having completed the FTI. A combined deductive and inductive qualitative content analysis was undertaken, guided by the Lundy model of child participation. RESULTS Children's experiences of being able to express their views, being listened to, and being involved during FTI were mainly positive. This was related to their participation in individual meetings where they could raise their concerns and views, undertake small activities while talking, and have their voices and needs mediated to relevant adults, such as parents and professionals. CONCLUSIONS The findings of this study showed that the FTI for families in pediatric oncology created opportunities to promote child participation. These findings indicate that, by offering children an individual space where they can express themselves freely and supporting them in various ways to do so, the children's voices and involvement are strengthened.
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Affiliation(s)
- Maria Ayoub
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden;
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 11628 Stockholm, Sweden; (M.L.); (U.K.)
- Advanced Pediatric Home Care, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 11628 Stockholm, Sweden; (M.L.); (U.K.)
- Louis Dundas Center, Great Ormond Street Institute of Child Health, University College London, London WC1E 6BT, UK
- Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institute, 17177 Stockholm, Sweden
| | - Camilla Udo
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden;
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Sajjad S, Barolia R, Gul RB. Living With Cancer: Child-Parent Dyads' Perspectives and Experiences From a Private Tertiary Care Hospital in Pakistan. QUALITATIVE HEALTH RESEARCH 2025; 35:174-189. [PMID: 39110198 DOI: 10.1177/10497323241255636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2025]
Abstract
The life experiences of children with cancer and their parents as individuals have been well documented in literature. However, little is known about their experiences as child-parent dyads in Pakistan regarding these children's quality of life. Thus, the study was conducted in the context of the family-centric society of Pakistan. In-depth interviews were conducted with 28 participants (14 child-parent dyads), comprising 9 female and 5 male children receiving cancer treatment and 8 mothers and 6 fathers (primary caregivers). All the participants were Muslims and hailed from diverse ethnic backgrounds, and most belonged to middle socioeconomic backgrounds. Thematic analysis was performed using Braun and Clarke's (2006) framework, which revealed four themes: (1) Stress, Fears, and Optimism; (2) Reactions to Restrictions; (3) Adaptation and Coping; and (4) Support Structure and Mechanisms. The findings indicated that children's and parents' daily lives were affected in various ways during the children's cancer journey. They faced several challenges which impacted their well-being. Particularly, the children considered their symptoms as restrictions in the way of carrying out their routine lives. However, children and parents also elaborated on using different coping strategies, such as play, reminiscing the past, incorporating religious practices into their daily routines, and keeping a family-centred approach towards the child's care. The parents also recommended that cancer-specialised services and support groups should be accessible. Conclusively, these findings are useful for healthcare providers in giving family-centred care to afflicted families and devising innovative interventions that address the needs of children with cancer and improve their quality of life.
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Affiliation(s)
- Sehrish Sajjad
- School of Nursing and Midwifery, The Aga Khan University, Karachi, Pakistan
| | - Rubina Barolia
- School of Nursing and Midwifery, The Aga Khan University, Karachi, Pakistan
| | - Raisa B Gul
- College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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Ye J, Yang L, Axelin A, Likitalo S, Wen C, Li X. The implementation and strategy of triadic communication in pediatric oncology: a scoping review. Pediatr Res 2024:10.1038/s41390-024-03590-w. [PMID: 39304788 DOI: 10.1038/s41390-024-03590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024]
Abstract
Triad child-parent-professional communication is considered a priority in evaluating and optimizing therapeutic alliance in pediatric oncology. This scoping review aimed to map the existing evidence in implementation, influencing factors, and strategies of triadic communication in pediatric oncology. Using Arksey and O'Malley's framework, we searched 5 databases and grey literature until June 15th, 2024. Two researchers selected studies and extracted data independently. The PAGER framework was employed to summarize the implications of existing research to inform future research and practice. A total of 24 articles were included. Healthcare professionals usually initiate triadic communication. Communication topics rarely focused on prognosis, emotions, and end-of-life care. The triad child-parent-professional exhibited similarities in language, emotional, and decision-making communication preferences but differed regarding skills and information preferences. The roles of the triad parts were unclear, especially nurses' role, responsibilities, and contributions were seldom specified. Factors influencing the implementation spanned individual, organizational, and socio-cultural levels. Five types including 21 specific suggested strategies were identified to facilitate implementation, yet few strategies were adopted by patients and caregivers, and limited effectiveness studies have evaluated specific strategies. Overall, while triadic communication has received considerable attention in the world, its practical implementation in real-world settings remains largely underdeveloped. IMPACT: Our research has mapped the global trajectories of triadic communication between child-parent-professional throughout the cancer journey. A precise delineation of roles and responsibilities within the triadic communication framework in pediatric oncology is crucial for augmenting collaborative efforts and achieving optimal coordination among stakeholders. Healthcare professionals could partner with families to comprehend individual communication preferences, cultivating a collaborative relationship that honors each participant's needs and enhances informed decision-making. The findings equip healthcare professionals with a range of strategies to navigate communication with children with cancer and their parents.
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Affiliation(s)
- Jinlin Ye
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Lei Yang
- School of Nursing, Shandong Xiehe University, Jinan, Shandong Province, China
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Susanna Likitalo
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Chuan Wen
- Department of Pediatrics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China.
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Zhang M, Li H, Li F, Zhang Y. Facilitators and barriers to parent-child communication in pediatric palliative care: An integrative review. Int J Nurs Sci 2024; 11:495-503. [PMID: 39830911 PMCID: PMC11740310 DOI: 10.1016/j.ijnss.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/05/2024] [Accepted: 08/06/2024] [Indexed: 01/22/2025] Open
Abstract
Objectives This study aimed to identify facilitators and barriers to parent-child communication in pediatric palliative care, providing insights for medical professionals developing targeted interventions to enhance parent-child communication and improve its effectiveness. Methods Whittemore and Knafl's integrative review method was employed to guide a systematic search for literature in six databases (Medline, Embase, CINAHL Complete, PsycINFO, Web of Science, and Cochrane Library). Peer-reviewer articles published in the English language from inception to December 2023. All of the identified studies were screened, extracted, and analyzed independently by two researchers. Results Twenty-four articles were included. The findings of the relevant studies were analyzed using thematic analysis. Four themes were identified as facilitators: legacy-making, resilience training programs, guidance from the healthcare team, and positive communication. Seven themes were identified as barriers: denial, being unprepared and evasive, mutual protection, being overwhelmed by painful emotions and overloaded with information, incorrect views of medical professionals and parents, negative communication, and cultural context. Conclusions Parents and professionals should avoid myths about protecting the child and encourage open communication that respects the child's wishes. The specialized pediatric palliative care team should carefully monitor parent-child communication, determine if any obstacles exist, and design more interventions to enhance it.
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Affiliation(s)
- Miao Zhang
- Facluty of nursing and Rehabilitation, Xi’an Medical University, Xi’an, China
| | - Huanhuan Li
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Fei Li
- Facluty of nursing and Rehabilitation, Xi’an Medical University, Xi’an, China
| | - Yongai Zhang
- Facluty of nursing and Rehabilitation, Xi’an Medical University, Xi’an, China
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Håkansson AS, Andersson AC, Abrahamsson J, Stenmarker M. Early phase clinical trials in pediatric oncology: Swedish pediatric oncologists' experiences of balancing hope and expectations in life-threatening illnesses. Front Oncol 2024; 14:1395841. [PMID: 39220655 PMCID: PMC11361959 DOI: 10.3389/fonc.2024.1395841] [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: 03/04/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Aim To study Swedish pediatric oncologists' practical and emotional experiences of referring, including and/or treating children in early-phase clinical trials. Methods A nationwide study was conducted using a mixed-method approach. Structured interviews based on a study-specific questionnaire and participants' personal reflections were utilized. Survey responses were analyzed using descriptive statistics, while participants' comments were analyzed using thematic analysis. All interviews were recorded and transcribed verbatim. Results In total, 29 physicians with 4 to 32 years of experience in pediatric oncology participated, with 19 (66%) having > 10 years of experience. Three themes appeared: 1) Optimization-based approach focused on finding the most suitable treatment and care for every child with a refractory/relapsed cancer eligible for an early-phase clinical trial; 2) Team-based approach aimed at establishing local and national consensus in decision-making for treatment options, including early-phase clinical trials and palliative care; 3) Family-based approach in which the physicians provided families with actionable information, listened to their desires, and endeavored to maintain hope in challenging circumstances. Several participants (40% with ≤ 10 years of experience and 58% with > 10 years of experience) viewed the early-phase clinical trial as a potential "chance of cure". A majority (80%) of physicians with ≤ 10 years of experience, reported that they often or always felt personally and emotionally affected by communication regarding early-phase clinical trials. Delivering difficult news in cases of uncertain prognosis was identified as the major challenge. None of the study participants felt adequately prepared in terms of sufficient knowledge and experience regarding early-phase clinical trials. The physicians expressed a need for guidance and training in communication to address these challenges. Conclusions Working with early-phase clinical trials highlight a field where physicians cannot solely rely on their expertise or past experiences, and where they are likely to be deeply emotionally involved. Physicians who care for children eligible for such studies require targeted educational initiatives and supervision.
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Affiliation(s)
- Anna Schröder Håkansson
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Queen Silvia Children’s Hospital, Gothenburg, Sweden
| | - Ann-Christine Andersson
- Jönköping Academy, Jönköping University, Jönköping, Sweden
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Jonas Abrahamsson
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Queen Silvia Children’s Hospital, Gothenburg, Sweden
| | - Margaretha Stenmarker
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Östergötland, Sweden
- Department of Pediatrics, Ryhov Hospital Jönköping, Jönköping, Sweden
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Weiner C, Pergert P, Castor A, Molewijk B, Bartholdson C. Children's voices on their values and moral dilemmas when being cared and treated for cancer- a qualitative interview study. BMC Med Ethics 2024; 25:75. [PMID: 38926715 PMCID: PMC11202330 DOI: 10.1186/s12910-024-01075-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Childhood cancers affect about 350 children every year in Sweden and are life-threatening diseases. During the treatment period, situations arise that can become morally challenging for the child. When knowing children's values and morally challenging situations in childhood cancer care, targeted ethics support could be developed and used in care. AIM To explore children's values and moral dilemmas when undergoing cancer treatment. METHODS This is a qualitative study based on empirical data. The data collection was conducted through three focus group interviews and six individual interviews with children between 10 and 18 years (n = 16). A content analysis methodology was used to generate themes. Children who were/have been treated for cancer at three childhood cancer centres in Sweden were invited to participate. The study was approved by the Swedish Ethical Review Authority. The children's participation was based on voluntariness and consent/assent. FINDINGS During the analysis, five themes of values emerged: Personal relationships, Bodily ease and identity, Feeling in control and being involved, Positive distractions and Right care that is needed. Their moral dilemmas were thematized into: Should I consider others or not? Should I rest or not? and Should I refuse treatment or not? CONCLUSION Children undergoing cancer treatment want to have personal relationships with healthcare professionals. Their moral dilemmas were about questioning their own physical and psychological well-being against their expectations, the values of others and the treatment required. Further research is needed to understand how to deal with moral dilemmas in children undergoing cancer treatment.
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Affiliation(s)
- Charlotte Weiner
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden.
- Children's Regional Health Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Pernilla Pergert
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics (CRB), Uppsala University, Uppsala, Sweden
| | - Anders Castor
- Department of Paediatrics, Lund University, Lund, Sweden
| | - Bert Molewijk
- Department of Ethics, Law and Medical Humanities, Amsterdam University Medical Center, Amsterdam, Netherlands
- Center for Medical Ethics, University of Oslo, Oslo, Norway
| | - Cecilia Bartholdson
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden
- Paediatric Neurology and Musculoskeletal Disorders and Homecare, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Chiou YG, Chen SY, Wu LM, Lotus Shyu YI, Chiang YC, Hsiao CC, Wu HC, Tang WR. Experiences and preferences of truth-telling in families of children with cancer: A phenomenological study. Asia Pac J Oncol Nurs 2024; 11:100500. [PMID: 38933686 PMCID: PMC11203385 DOI: 10.1016/j.apjon.2024.100500] [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: 03/06/2024] [Accepted: 04/27/2024] [Indexed: 06/28/2024] Open
Abstract
Objective The delivery of bad news is an unpleasant but necessary medical procedure. However, few studies have addressed the experiences and preferences of the families of school-aged children with cancer when they are informed of the children's condition. This study aimed to explore families of school-age children with cancer for their preferences and experiences of truth-telling. Methods This descriptive phenomenological qualitative research was conducted using focus group interviews and semistructured interview guidelines were adopted for in-depth interviews. Fifteen families participated in the study. The data were analyzed using Colaizzi's analysis. Data were collected from August 2019 to May 2020. Results The study identified two major themes: "caught in a dilemma" and "kind and comprehensive team support." The first major theme focused on families' experiences with cancer truth-telling. Three sub-themes emerged: (1) cultural aspects of cancer disclosure, (2) decision-making regarding informing pediatric patients about their illness, and (3) content of disclosure after weighing the pros and cons. The second major theme, which revealed families' preferences for delivering bad news, was classified into three sub-themes: (1) have integrity, (2) be realistic, and (3) be supportive. Conclusions This study underscores the dilemma encountered by the families of children with cancer after disclosure and their inclination toward receiving comprehensive information and continuous support. Health care personnel must improve their truth-telling ability in order to better address the needs of such families and to provide continuous support throughout the truth-telling process.
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Affiliation(s)
- Yen-Gan Chiou
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ying Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yea-Ing Lotus Shyu
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chien Chiang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chih-Cheng Hsiao
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hui-Chuan Wu
- Department of Post Baccalaureate Nursing, College of Medicine, I-SHOU University, Kaohsiung, Taiwan
| | - Woung-Ru Tang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Winger A, Holmen H, Birgisdóttir D, Lykke C, Lövgren M, Neergaard MA, Grönroos M, Kero J, Kristinsdóttir O, Pétursdóttir ÁB, Castor C. Children with palliative care needs - the landscape of the nordic countries. BMC Palliat Care 2024; 23:118. [PMID: 38720316 PMCID: PMC11077810 DOI: 10.1186/s12904-024-01447-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND To strengthen palliative care for children in the Nordic countries, an updated status of current needs, resources, clinical services, education, and research is necessary to align and consolidate future research. A Nordic research collaboration initiative for children with palliative care needs was assembled in 2023. Building on this initiative, this paper presents an overview of pediatric palliative care (PPC) in the Nordic countries' (a) population characteristics, (b) care models and setting of care, (c) education and training, and (d) research. METHODS The Nordic initiative researchers collaboratively gathered and assessed available data on the characteristics of PPC within Denmark, Finland, Greenland, Iceland, Norway, the Faroe Islands, Sweden, and Åland. Data were compiled in a matrix with population characteristics, models- and setting of care, education and training, and areas of research in a Nordic context. The findings are narratively and descriptively presented, providing an overview of Nordic PPC. RESULTS In total, the Nordic child population comprises around six million children (0-19 years), of which about 41.200 are estimated to be living with a life-limiting and/or life-threatening condition. Healthcare services are provided through various care models, ranging from specialized care to homecare settings. Overall, there remain few opportunities for education and training with some exceptions. Also, Nordic research within PPC has been shown to be a growing field although much remains to be done. CONCLUSION This overview is the first outline of the current PPC in Nordic countries. Although some differences remain important to acknowledge, overall, the strengths and challenges faced within PPC in the Nordic countries are comparable and call for joint action to increase evidence, services, and education to better serve the children, families, and healthcare personnel within PPC. Despite the varying structural premises for PPC, research endeavors aiming to provide evidence in this field seem increasing, timely and relevant for the Nordic countries, as well as the international context.
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Affiliation(s)
- Anette Winger
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway.
| | - Heidi Holmen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
- Division of Technology and Innovation, Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Dröfn Birgisdóttir
- Department of Clinical Sciences Lund, Faculty of Medicine, The Institute for Palliative Care, Lund University, Lund, Sweden
- Region Skåne, Lund, Sweden
| | - Camilla Lykke
- Section of Palliative Medicine, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology and Palliative Care, North Zealand Hospital, Hillerød, Denmark
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Advanced Pediatric Homecare, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, 171 64, Sweden
| | - Mette Asbjoern Neergaard
- Palliative Care Unit and Child & Youth Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marika Grönroos
- Department of Pediatric and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Johanna Kero
- Welfare and Health, Satakunta University of Applied Sciences, Pori, Finland
| | - Oddný Kristinsdóttir
- Pediatric department, Landspitali University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Ásta Bjarney Pétursdóttir
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
- School of Health Sciences, Faculty of Graduate Studies, University of Akureyri, Akureyri, Iceland
| | - Charlotte Castor
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Eklund R. Death and grief in illustrated storybooks: An inventory of Swedish literature for young children. DEATH STUDIES 2024; 49:329-336. [PMID: 38349235 DOI: 10.1080/07481187.2024.2317167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2025]
Abstract
Storybooks play a crucial role in the experience of childhood. As death is an inevitable part of life, storybooks can be a helpful tool to start communicating about death and grief. The aim of this study was to learn which storybooks were available regarding death and grief for Swedish-speaking children. During spring 2023, a literature search was conducted. A total of 62 books were included in the content analysis to assess language, words, symbolism, and coping strategies. This study provides valuable insights for adults, aiming to enrich the literary experiences of children and promote meaningful conversations about death and grief.
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Affiliation(s)
- Rakel Eklund
- Department of Women's and Children's Health, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
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Aydın A, Savaş EH, Bingöl H, Kebudi R. Taboo words in pediatric oncology: Communication experiences of nurses and physicians with dying children and their families. Eur J Oncol Nurs 2024; 68:102466. [PMID: 38101245 DOI: 10.1016/j.ejon.2023.102466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Despite the numerous benefits of effective communication between patients, families, and healthcare professionals, there are still substantial barriers and communication challenges. This study investigated the experiences of nurses and doctors working in different pediatric hematology-oncology units in Turkey communicating with children and their parents about end-of-life issues. METHOD This qualitative study was conducted with twenty-four physicians and nurses. A descriptive phenomenological approach was used. Data were analyzed using Braun and Clarke's six-step reflexive thematic analysis. The MAXQDA software was used to facilitate data management. RESULTS The findings revealed three main themes describing end-of-life communication experiences of physicians and nurses: Avoiding communication with a dying child, Everyone knows but nobody talks, and Complicating aspects of the setting. CONCLUSIONS Communication with dying children and their families is essential. However, multiple barriers remain for healthcare providers to do so. That issue burdens the child and their family more during the end-of-life, which is already a challenging experience to handle. Healthcare professionals need urgent training in communication with the dying children and their families.
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Affiliation(s)
- Ayfer Aydın
- School of Nursing, Istanbul University, Istanbul, Turkey
| | | | - Hülya Bingöl
- Istanbul University, Oncology Institute, Istanbul, Turkey
| | - Rejin Kebudi
- Istanbul University, Oncology Institute, Istanbul, Turkey
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Wong FKY, Ho JMC, Lai TC, Lee LPY, Ho EKY, Lee SWY, Chan SCW, Fung CW, Ho ACH, Li CH, Li CK, Chiu ATG, Tsui KW, Lam KKW. Importance of parental involvement in paediatric palliative care in Hong Kong: qualitative case study. Arch Dis Child 2024; 109:130-137. [PMID: 38041663 DOI: 10.1136/archdischild-2023-325810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/31/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To compare and contrast the perceived care needs of children with life-limiting conditions (CLLC) from the perspectives of the children, parents and healthcare providers. DESIGN A qualitative case study method using semistructured interviews was employed with a within-case and across-case analysis. Themes and subthemes emerging from the cases were compared and contrasted in the across-case analysis to explore the similarities and variations in participant perceptions. SETTING/PARTICIPANTS The setting was the paediatric departments of five regional hospitals in Hong Kong. Twenty-five sets of informants (CLLC-parent-healthcare provider) were recruited, with 65 individual interviews conducted. RESULTS A total of 3784 units of analysis were identified, resulting in three themes with subthemes. 'Living with the disease' (55.8%) occupied the largest proportion, followed by 'information and understanding about the disease' (27.4%), and 'care support and palliative care' (16.8%). Healthcare provider support mainly focused on physical concerns. Family and social support were present, but carer stress created tension between couples. Doctors were the primary source of medical information, but the parents had to seek further information via the internet and support from patient groups. There was a perceived need for better coordination and collaboration of care. The palliative care approach coordinated by nurses was seen as helpful in addressing the care needs of the CLLC. CONCLUSIONS This original study identified the importance of palliative care with active engagement of parents which can address the service gap for CLLC.
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Affiliation(s)
| | | | - Tsz Chui Lai
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Lilian Po Yee Lee
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kowloon, Hong Kong
| | - Eva Ka Yan Ho
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Susanna Wai Yee Lee
- Nursing Administrative Office, Hong Kong Baptist Hospital, Kowloon, Hong Kong
| | - Stephan C W Chan
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - Cheuk Wing Fung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | | | - Chak-Ho Li
- Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Chi Kong Li
- Department of Paediatrics, CUHK Faculty of Medicine, Shatin, Hong Kong
| | - Annie Ting Gee Chiu
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Kwing Wan Tsui
- Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
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12
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Høeg BL, Sevillano PB, Enesco I, Wakefield CE, Larsen HB, Bidstrup PE. Child-centered communication interventions in pediatric oncology: A scoping review and proposed new communication model. Pediatr Blood Cancer 2023:e30533. [PMID: 37401446 DOI: 10.1002/pbc.30533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023]
Abstract
Child-centered communication in pediatric oncology can be challenging. We aimed to review communication interventions with children about cancer treatment and prognosis to identify potentially effective child-centered communication models and approaches. We updated a previous review on communication interventions in oncology and searched MEDLINE, Scopus, and PsychINFO for studies indexed between October 2019 up to October 2022. We further searched for ongoing studies on ClinicalTrials.gov. Communication interventions targeting pediatric oncology patients (below 18 years), with outcomes of communication, psychological symptoms or satisfaction in the target population were eligible. We identified 685 titles/abstracts, screened the full text of 34 studies and included only one published study and two ongoing studies. The published study tested a communication tool to help clinicians inform adolescents about treatment options and facilitate shared decision-making. No communication models were identified. We drew on knowledge from existing studies and guidelines to develop a new child-centered communication model.
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Affiliation(s)
- Beverley Lim Høeg
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Paula Barrios Sevillano
- Department of Developmental Psychology, Faculty of Psychology, Complutense University of Madrid, Spain
| | - Ileana Enesco
- Department of Developmental Psychology, Faculty of Psychology, Complutense University of Madrid, Spain
| | - Claire E Wakefield
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Hanne Baekgaard Larsen
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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13
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Bassola B, Cilluffo S, Ongari E, Terzoni S, Targa A, Destrebecq A, Lusignani M. A qualitative phenomenological study of nurses' experiences in caring for infants and children with life-limiting and life-threatening conditions. J Pediatr Nurs 2023:S0882-5963(23)00121-5. [PMID: 37271668 DOI: 10.1016/j.pedn.2023.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/28/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To understand the experience of nurses caring for infants and children with life limiting and life-threatening conditions. DESIGN AND METHODS A qualitative phenomenological study was conducted, collecting data through deep interviews. Sample included twenty-seven nurses working in paediatric and neonatal intensive care units. RESULTS Four themes emerged: suffering, being there, protect yourself and support. The experience of caring for children with limiting and life-threatening conditions affects nurses positively, with personal and professional gratification, but also negatively, as it leads to the development of compartmentalization, avoidance, and high levels of stress. CONCLUSIONS The organization should make resources available to help nurses build resilience, improve emotional intelligence, and process experiences and emotions, thereby bringing benefits and improvements in infant and childcare. PRACTICE IMPLICATIONS Comparison between colleagues is one of the most effective tools for supporting each other. Dedicated times and spaces to be able to carry out the debriefings managed by the nurses themselves, guided and mediated by an expert figure, such as a psychologist or a trainer, would be recommended.
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Affiliation(s)
- Barbara Bassola
- ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan, Italy.
| | - Silvia Cilluffo
- ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan, Italy; Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Montpellier 1, Rome, Italy.
| | - Eleonora Ongari
- ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan, Italy.
| | - Stefano Terzoni
- ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, Milan, Italy.
| | - Alessia Targa
- ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan, Italy.
| | - Anne Destrebecq
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, Milan, Italy.
| | - Maura Lusignani
- ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, Milan, Italy.
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14
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Katz NT, Alpert AB, Aristizabal MP, McDaniels-Davidson C, Sacks BH, Sanft T, Chou CL, Martinez ME. Partnering With Patients and Caregivers in Cancer Care: Lessons From Experiences With Transgender, Hispanic, and Pediatric Populations. Am Soc Clin Oncol Educ Book 2023; 43:e397264. [PMID: 37200592 DOI: 10.1200/edbk_397264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
A cancer diagnosis thrusts patients and caregivers into a foreign world of health care with systems, protocols, and norms that can leave little room for individual needs and circumstances. Quality and efficacious oncology care requires clinicians to partner with patients and caregivers to understand and incorporate their needs, values, and priorities into information sharing, decision making, and care provision. This partnership is necessary for effective patient- and family-centered care and access to individualized and equitable information, treatment, and research participation. Partnering with patients and families also requires oncology clinicians to see that our personal values, preconceived ideas, and established systems exclude certain populations and potentially lead to poorer care for all patients. Furthermore, inequitable access to participation in research and clinical trials can contribute to an unequal burden of cancer morbidity and mortality. Leveraging the expertise of the authorship team with transgender, Hispanic, and pediatric populations, this chapter provides insights and suggestions for oncology care that are applicable across patient populations to mitigate stigma and discrimination and improve the quality of care for all patients.
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Affiliation(s)
- Naomi T Katz
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, VIC, Australia
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Palliative Care Service, Alfred Health, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Murdoch Children's Research Insitute, Melbourne, VIC, Australia
| | - Ash B Alpert
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - M Paula Aristizabal
- Department of Pediatrics, Division of Hematology, University of California and Peckman Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, CA
- Moores Cancer Center, University of California, San Diego, CA
| | - Corinne McDaniels-Davidson
- Moores Cancer Center, University of California, San Diego, CA
- School of Public Health, San Diego State University, San Diego, CA
| | - Bronwyn H Sacks
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Insitute, Melbourne, VIC, Australia
| | - Tara Sanft
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Calvin L Chou
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- Veterans Affairs Helathcare System, San Francisco, CA
| | - Maria Elena Martinez
- Moores Cancer Center, University of California, San Diego, CA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA
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15
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Hirata M, Kobayashi K. Experiences with the end-of-life decision-making process in children with cancer, their parents, and healthcare professionals: A systematic review and meta-ethnography. J Pediatr Nurs 2022; 69:e45-e64. [PMID: 36586777 DOI: 10.1016/j.pedn.2022.12.004] [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: 05/19/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Decision-making during the end-of-life (EOL) phase for children with cancer is extremely difficult for parents. We synthesized the qualitative experiences of children with cancer, parents, and healthcare professionals (HCPs), and their social interactions during the EOL decision-making process in the pediatric oncology setting. METHODS Meta-ethnography was used to conduct a systematic review and meta-synthesis. We searched four online databases to identify original studies published in English and Japanese and examined 21 relevant studies. Two Japanese reviewers discussed the differences/relationships and included studies that synthesized the translated qualitative findings. A conceptual model of social interactions was created. RESULTS We identified four themes regarding children's, parents', and HCPs' experiences: hope and confrontation with the child's death, guidance and support during uncertainty, awareness of being protected and having hope, and mutual unspoken integration of values. CONCLUSIONS These themes evince the experiences of children, parents, and HCPs during the EOL decision-making process and suggests a complex three-way social interaction model. While considering such distinctive social interactions during a child's EOL, this study revealed the sharing of prudent information and psychosocial support by HCPs. The findings indicate that hope and uncertainty are key elements for effectively understanding the experiences of children and parents and that EOL decision-making should not be rushed but should be supported by leaving room for uncertainty and acknowledging parents' emotional needs and fostering new hope. Further research into how hope can be further supported in situations that are rife with uncertainty is needed.
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Affiliation(s)
- Mika Hirata
- Department of Nursing, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama 343-8540, Japan.
| | - Kyoko Kobayashi
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
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16
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Bartholdson C, Kreicbergs U, Sveen J, Lövgren M, Pohlkamp L. Communication about diagnosis and prognosis-A population-based survey among bereaved parents in pediatric oncology. Psychooncology 2022; 31:2149-2158. [PMID: 36307935 PMCID: PMC10098496 DOI: 10.1002/pon.6058] [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: 04/05/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION When a child is diagnosed with cancer, the whole family is affected, and parents struggle to grasp challenging information regarding diagnosis and prognosis. Most parents and children want honest communication and openness, yet this remains a complex and challenging task for healthcare professionals. OBJECTIVES To describe bereaved mothers' and fathers' reports of communication of their child's cancer diagnosis and when the illness became incurable. METHODS Data from a Swedish population-based survey conducted in 2016, including 135 mothers and 97 fathers who had lost a child to cancer 1-5 years earlier, were studied regarding the parents' reports of communication about their child's illness. RESULTS A vast majority of parents wants information when their child's illness becomes incurable, and this need is generally met. However, fathers to a lesser extent than mothers, reported that they were informed about it. According to parents' reports 87% of children received diagnostic information and 44% of the children received prognostic information. CONCLUSION A vast majority of both mothers and fathers would like to know when their child's illness becomes incurable, yet it remains unknown to what extent they want their child to be informed.
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Affiliation(s)
- Cecilia Bartholdson
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden.,Paediatric Neurology and Musculoskeletal Disorders and Homecare, Children's and Women's Healthcare, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University College (formerly Ersta Sköndal Bräcke University College), Stockholm, Sweden
| | - Josefin Sveen
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University College (formerly Ersta Sköndal Bräcke University College), Stockholm, Sweden.,Advanced Pediatric Home Care, Karolinska University Hospital, Stockholm, Sweden
| | - Lilian Pohlkamp
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University College (formerly Ersta Sköndal Bräcke University College), Stockholm, Sweden
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Федотова Т. ПЕРЕЖИВАННЯ МОРАЛЬНОГО ДИСТРЕСУ ОСОБИСТОСТЮ: ТЕОРЕТИЧНЕ ОСМИСЛЕННЯ ПРОБЛЕМИ. PSYCHOLOGICAL PROSPECTS JOURNAL 2022. [DOI: 10.29038/2227-1376-2022-40-fed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Мета статті полягає у теоретичному аналізі проблеми морального дистресу в науковій літературі, з’ясуванні основних аспектів вивчення відповідної проблематики та встановленні особливостей прояву морального дистресу шляхом вторинного аналізу результатів емпіричних досліджень науковців.
Методи. У статті застосовано методи теоретичного вивчення наукової літератури (аналіз, синтез, узагальнення, систематизація підходів науковців) стосовно висвітлення проблеми переживання морального дистресу.
Результати. Проблеми морального дистресу в науковій літературі висвітлюється здебільшого шляхом її вивчення в ході реалізації професійної діяльності медичних працівників. Моральний дистрес розглядають як моральні страждання, які виникають в особистості в ситуації наявності знань про те, яким чином потрібно діяти, але неможливості діяти відповідно, через встановлені інституційних обмежень. Виокремлюють види морального дистресу: первинний (описують власне як моральний дистрес) та реактивний (розглядається як «моральний залишок»). Емпіричними маркерами морального дистресу є: почуття гніву, розчарування та провини, неможливість втілення морального судження в дію, невпевненість у собі, відсутність наполегливості, конформізм, уявне безсилля, відсутність критичності і розуміння ситуації тощо. Фізичними наслідками тривалого переживання морального дистресу для особистості можуть бути: безсоння, нудоту, мігрені, кишково-шлункові розлади, плаксивість та значне фізичне виснаження. В якості необхідної та/або достатньої умови переживання морального дистресу, на думку науковців, можуть виступати: моральне судження/необхідність вибору, інституційне/правове обмеження, психологічний ефект/вплив, моральний конфлікт, загроза моральної цілісності та автентичності, внутрішні обмеження та моральний клімат установи. У єдності з теорією морального дистресу розглядають теорію моральної розплати, стрижнем якої є аналіз переживання моральної розплати медсестрою: легкість, ситуативна прив’язка, вирішення та рефлексія.
Висновки. Здійснений теоретичний аналіз проблеми морального дистресу засвідчив складність та неоднозначність у визначені відповідного поняття, його показників та чинників. Теоретична розвідка означеної проблематики вказує на доцільність та важливість ґрунтованого вивчення морального дистресу з урахуванням вікового, статевого та професійного аспектів, а також актуальність та необхідність розробки програми психологічної підтримки осіб, які переживають моральний дистрес, комплексу заходів для збереження психічного здоров’я вразливих верств населення в умовах військових дій.
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Mira-Aladrén M, Martín-Peña J, Sevillano Cintora G, Celma Juste A, Gil-Lacruz M. Childhood Cancer and the Family: A Pilot Proposal for Comprehensive Intervention at the Time of Diagnosis. Healthcare (Basel) 2022; 10:1790. [PMID: 36141402 PMCID: PMC9498655 DOI: 10.3390/healthcare10091790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Childhood cancer has a great impact on children and their environment. To minimize this, countries such as Canada and the USA have protocols in the field of social work, although these are scarce in Europe and especially in Spain. This paper aims to develop a pilot protocol in Aragon (Spain) for the practice of onco-pediatric social work in one of the hardest moments: the diagnosis. For its elaboration, a previous study was carried out in three phases, which provided data on the disease and its impact on the family and children and a methodological basis for the intervention from social work, all considering the participation of the agents involved as a fundamental element. Variables have been identified that influence the impact on the family support network and its quality of life at the time of diagnosis of childhood cancer. In addition, different indicators have been explored, based on the reality of these families. Finally, a pilot proposal for a comprehensive family intervention protocol in the diagnosis of childhood cancer has been elaborated. This work is intended to be a guide for intervention and delimitation of quality standards to be considered when dealing with the diagnosis of childhood cancer.
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Affiliation(s)
- Marta Mira-Aladrén
- Faculty of Social Sciences and Labor, University of Zaragoza, 50009 Zaragoza, Spain
| | - Javier Martín-Peña
- Faculty of Social Sciences and Labor, University of Zaragoza, 50009 Zaragoza, Spain
| | | | - Antonio Celma Juste
- Association of Parents of Oncological Children of Aragon (ASPANOA), 50009 Zaragoza, Spain
| | - Marta Gil-Lacruz
- Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain
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De Clercq E, Grotzer M, Landolt MA, von Helversen B, Flury M, Rössler J, Kurzo A, Streuli J. No wrong decisions in an all-wrong situation. A qualitative study on the lived experiences of families of children with diffuse intrinsic pontine glioma. Pediatr Blood Cancer 2022; 69:e29792. [PMID: 35652529 DOI: 10.1002/pbc.29792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diffuse intrinsic pontine glioma (DIPG) is a rare, but lethal pediatric brain tumor with a median survival of less than 1 year. Existing treatment may prolong life and control symptoms, but may cause toxicity and side effects. In order to improve child- and family-centered care, we aimed to better understand the treatment decision-making experiences of parents, as studies on this topic are currently lacking. PROCEDURE The data for this study came from 24 semistructured interviews with parents whose children were diagnosed with DIPG in two children's hospitals in Switzerland and died between 2000 and 2016. Analysis of the dataset was done using reflexive thematic analysis. RESULTS For most parents, the decision for or against treatment was relatively straightforward given the fatality of the tumor and the absence of treatment protocols. Most of them had no regrets about their decision for or against treatment. The most distressing factor for them was observing their child's gradual loss of independence and informing them about the inescapability of death. To counter this powerlessness, many parents opted for complementary or alternative medicine in order to "do something." Many parents reported psychological problems in the aftermath of their child's death and coping strategies between mothers and fathers often differed. CONCLUSION The challenges of DIPG are unique and explain why parental and shared decision-making is different in DIPG compared to other cancer diagnoses. Considering that treatment decisions shape parents' grief trajectory, clinicians should reassure parents by framing treatment decisions in terms of family's deeply held values and goals.
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Affiliation(s)
- Eva De Clercq
- Institute of Bioethics and History of Medicine, University of Zürich, Zurich, Switzerland
| | - Michael Grotzer
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Markus A Landolt
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | - Maria Flury
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jochen Rössler
- Cancer Center Inselspital UCI, Inselspital University, Bern, Switzerland
| | - Andrea Kurzo
- Cancer Center Inselspital UCI, Inselspital University, Bern, Switzerland
| | - Jürg Streuli
- Institute of Bioethics and History of Medicine, University of Zürich, Zurich, Switzerland.,University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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20
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Yamaji N, Nagamatsu Y, Kobayashi K, Hasegawa D, Yuza Y, Ota E. Information needs of children with leukemia and their parents' perspectives of their information needs: a qualitative study. BMC Pediatr 2022; 22:414. [PMID: 35831839 PMCID: PMC9277964 DOI: 10.1186/s12887-022-03478-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite the potential benefits of effective communication, telling a child that they have a life-threatening condition is one of the most daunting challenges. This study aimed to explore the information needs of children with leukemia from the perspectives of children and their parents at the time of diagnosis. Methods We conducted an exploratory qualitative study using semi-structured individual interviews with children diagnosed with leukemia between seven and 13 years old (n = 7) and their parents (n = 9). Children and parents’ interview data were analyzed using thematic analysis. Results We identified three themes for the information needs of children with leukemia, 1) beginning to cope, 2) avoiding disclosure – protecting child, and 3) informational support. The children and their parents needed to receive understandable information at the best time to cope with cancer. However, the children and parents expressed different views about children’s information needs. The children needed clear information about the disease, treatment, hospitalization, and the benefits of hospitalization from the time of diagnosis. In contrast, the parents felt they should not tell their children about the disease if they were in shock by their child’s cancer diagnosis. Moreover, the parents believed that information that would be incomprehensible to the child and distress should be avoided to protect their children. Conclusions While the information needs of children with leukemia are varied, children and their parents need the information to cope with cancer. However, if the parents believe that the information would be distressful, they might manage communication with their children. Healthcare professionals should explore the motivations behind parents’ attitudes against communication with children and confront conflict. Healthcare professionals also should communicate with the children and their parents to understand their information needs and respect children’s views.
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Affiliation(s)
- Noyuri Yamaji
- Global Health Nursing, Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan.
| | - Yasuko Nagamatsu
- Global Health Nursing, Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Kyoko Kobayashi
- Child Health Nursing, Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Yuki Yuza
- Department of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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21
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Fang JT, Chen SY, Tian YC, Lee CH, Wu IW, Kao CY, Lin CC, Tang WR. Effectiveness of end-stage renal disease communication skills training for healthcare personnel: a single-center, single-blind, randomized study. BMC MEDICAL EDUCATION 2022; 22:397. [PMID: 35606757 PMCID: PMC9125352 DOI: 10.1186/s12909-022-03458-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Given that the consequences of treatment decisions for end-stage renal disease (ESRD) patients are long-term and significant, good communication skills are indispensable for health care personnel (HCP) working in nephrology. However, HCP have busy schedules that make participation in face-to-face courses difficult. Thus, online curricula are a rising trend in medical education. This study aims to examine the effectiveness of online ESRD communication skills training (CST) concerning the truth-telling confidence and shared decision-making (SDM) ability of HCP. METHODS For this single-center, single-blind study, 91 participants (nephrologists and nephrology nurses) were randomly assigned to two groups, the intervention group (IG) (n = 45) or the control group (CG) (n = 46), with the IG participating in ESRD CST and the CG receiving regular in-service training. Truth-telling confidence and SDM ability were measured before (T0), 2 weeks after (T1), and 4 weeks after (T2) the intervention. Group differences over the study period were analyzed by generalized estimating equations. RESULTS IG participants exhibited significantly higher truth-telling confidence at T1 than did CG participants (t = 2.833, P = .006, Cohen's d = 0.59), while there were no significant intergroup differences in the confidence levels of participants in the two groups at T0 and T2. Concerning SDM ability, there were no significant intergroup differences at any of the three time points. However, IG participants had high levels of satisfaction (n = 43, 95%) and were willing to recommend ESRD CST to others (n = 41, 91.1%). CONCLUSIONS ESRD CST enhanced short-term truth-telling confidence, though it is unclear whether this was due to CST content or the online delivery. However, during pandemics, when face-to-face training is unsuitable, online CST is an indispensable tool. Future CST intervention studies should carefully design interactive modules and control for method of instruction.
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Affiliation(s)
- Ji-Tseng Fang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ying Chen
- School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Lee
- Department of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - I-Wen Wu
- Department of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chen-Yi Kao
- Division of Hematology-Oncology, Department of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Woung-Ru Tang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist, Taoyuan, Taiwan.
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22
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Bennett CR, Coats H, Hendricks-Ferguson VL, Gauthier K, Sousa K. The Lived Experiences With Hope From Adolescents and Young Adults Who Have Advanced Cancer. J Pain Symptom Manage 2022; 63:581-589. [PMID: 34890726 DOI: 10.1016/j.jpainsymman.2021.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES 1. Describe the concept of hope based on perspectives of AYAs who experienced advanced cancer. 2. Differentiate the role hope has for AYAs before, during, and after experiencing cancer. CONTEXT In clinical care, addressing patients' hopes may stimulate conversations about their goals, concerns, and values; helping clinicians focus on patient-centered interventions to support the patient's psychological, spiritual, and existential needs. METHODS This descriptive qualitative study used a phenomenology informed approach to depict experiences with hope by AYAs who have advanced cancer. The participants completed two semi-structured audio-recorded virtual interviews and co-created narratives and drawings about the role of hope before, during, and after experiencing cancer. Thematic analyses were performed on the narratives. RESULTS Fifteen AYAs aged 12-21 years were recruited from an academic medical center and an online non-profit organization. During data collection participants had either completed treatments (60%), or were actively receiving treatments (40%). Approximately 67% of the sample experienced at least one relapse. A main theme identified from the narratives was Transitions of Hope. Participants described differences in their hope before and after experiencing cancer. Participants who experienced a relapse reported their past experiences helped them build hope during their relapse. Participants described a new sense of purpose after experiencing cancer, such as starting a non-profit organization, giving back to others, doing "what I'm passionate about", and honoring the legacies of others. CONCLUSION Transitions in the role of hope occurred over time, becoming a source of mental sustenance during cancer treatment, and a source of altruism after experiencing cancer. This study adds to the understanding of hope for AYAs who have advanced cancer.
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Affiliation(s)
- C Robert Bennett
- School of Medicine, University of Colorado Anschutz Medical Campus (C.R.B.), Aurora, Colorado, USA.
| | - Heather Coats
- College of Nursing, University of Colorado Anschutz Medical Campus (H.C.), Aurora, Colorado, USA
| | | | - Kristine Gauthier
- College of Nursing, University of Colorado Anschutz Medical Campus (K.G.), Aurora, Colorado, USA
| | - Karen Sousa
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Laronne A, Granek L, Wiener L, Feder-Bubis P, Golan H. "Some things are even worse than telling a child he is going to die": Pediatric oncology healthcare professionals perspectives on communicating with children about cancer and end of life. Pediatr Blood Cancer 2022; 69:e29533. [PMID: 34958524 PMCID: PMC9369103 DOI: 10.1002/pbc.29533] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION This study explored pediatric oncology healthcare professionals' (HCPs) perspectives on direct communication with children with advanced disease about their disease, palliative care, and end-of-life (EOL) communication. METHODS Forty-six pediatric oncologists, nurses, psychosocial team members, and other HCPs from six hospital centers in Israel participated in semi-structured interviews. The Grounded Theory method was used. Data were analyzed line-by-line with codes and categories developed inductively from participants' narratives. RESULTS HCPs viewed communication about disease progression and EOL as vital because children were often aware of their prognosis, because lack of communication could lead to emotional distress, and because communication is a prerequisite for shared decision-making. HCPs identified several barriers for communication including HCP barriers (such as emotional strains, lack of training), parental barriers, guardianship law, and language and culture. HCPs also described strategies to promote EOL communication. Direct strategies include tailoring communication, allowing for silence, echoing children's questions, giving information gradually, and answering direct questions honestly. Indirect strategies included encouraging parents to talk to their children and teamwork with colleagues. CONCLUSIONS Open communication with children who have cancer is essential. Nevertheless, multiple barriers persist. The rising accessibility of online information calls for urgent training of HCPs in communication so that children will not turn to unmediated and potentially misleading information online in the absence of HCP communication. Evidence-based effective communication training modules and emotional support should be offered to HCPs. Knowledge about children's development, age-appropriate communication, and cultural sensitivity should be included in this training.
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Affiliation(s)
- Anat Laronne
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leeat Granek
- School of Health Policy and Management and Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Hana Golan
- Pediatric Hematology Oncology Department, Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Uber A, Ebelhar JS, Lanzel AF, Roche A, Vidal-Anaya V, Brock KE. Palliative Care in Pediatric Oncology and Hematopoietic Stem Cell Transplantation. Curr Oncol Rep 2022; 24:161-174. [DOI: 10.1007/s11912-021-01174-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
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Mitchell S, Slowther AM, Coad J, Bertaud S, Dale J. Facilitators and barriers to the delivery of palliative care to children with life-limiting and life-threatening conditions: a qualitative study of the experiences and perceptions of healthcare professionals. Arch Dis Child 2022; 107:59-64. [PMID: 33980510 DOI: 10.1136/archdischild-2021-321808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/01/2021] [Accepted: 04/19/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To understand healthcare system facilitators and barriers to the delivery of palliative care for children with life-limiting and life-threatening conditions and their family members. DESIGN Focus groups with children's palliative care professionals. Data were analysed using thematic analysis. SETTING Four regions of England (West Midlands, South West, Yorkshire and Humber, and London) from December 2017 to June 2018. PARTICIPANTS Healthcare professionals (doctors, nurses and allied healthcare professionals) working in children's palliative care services. FINDINGS A total of 71 healthcare professionals participated in the focus groups. Three overarching themes were identified which influenced whether and when children were referred to and started to receive palliative care: (1) the unspoken background of clinical uncertainty which often delayed palliative care; (2) the cultural 'collusion of immortality', where conversations about the possibility of dying can be avoided or deferred; and (3) the role of paediatric palliative care teams in 'illuminating the blind spot' of palliative care as well as providing hands-on care. CONCLUSIONS Palliative care is a holistic approach to care that focuses on quality of life for people living with life-limiting and life-threatening conditions that can be delivered alongside active treatment. There is a need to prioritise and integrate this into healthcare services for children more effectively if improvements in care are to be realised. While more specialist paediatric palliative care services are needed, the unspoken background of clinical uncertainty needs to be addressed together with the collusion of immortality within healthcare culture and organisations.
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Affiliation(s)
- Sarah Mitchell
- Oncology and Metabolism, The University of Sheffield, Sheffield, UK .,Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jane Coad
- University of Nottingham School of Health Sciences, Nottingham, UK
| | - Sophie Bertaud
- The Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital for Children, London, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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26
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Schwartz-Attias I, Raz H, Natanzon-Bracha T, Finkelstein A, Kreitler S. Adolescents With Cancer Need Trustworthy Information and Prefer to Receive It From a Human Source Rather Than From the Internet: A Qualitative Study. Front Psychol 2021; 12:746810. [PMID: 34916993 PMCID: PMC8670381 DOI: 10.3389/fpsyg.2021.746810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In pediatric cancer, the legal obligation to provide information is usually toward the parents who are the authorized signatories of the informed consent form. It is now known that aside from providing information to the parents, it is also very important to provide information to the children and adolescents themselves. The question is how the adolescents relate to this. What information do they already possess and what would they like to know? Would they wish to hear the truth in all situations and at what stage? What are their preferred sources of information? Method: A qualitative study that included in-depth interviews with 19 adolescents with cancer, aged 8.5-18, who were receiving active treatments and had been diagnosed at least 1 month previously. The interviews were guided by 15 open-ended questions. Findings: The analysis of the interviews indicated that adolescents know quite a lot about the course of their disease and the information they lack is mainly etiological. The participants reported a lack of knowledge concerning sexuality and a sense of discomfort talking about it, leaving them with open questions. They all claimed that it is important to tell the truth: "Even if the truth is difficult, it is important to tell it." The participants reported that information can be scary, so it must be structured and adapted to the age and emotional readiness of the individual. Most of the participants prefer not to use the internet as an information resource due to the profusion of stressful and non-adapted information. Conclusion: Adolescents with cancer need trustworthy information and prefer to receive it from a human source rather than from the internet. Not telling the truth can lead them to feel fear and loneliness. The medical staff must operate in sensitive and creative ways to provide adolescents with access to information on various subjects, including sexuality, which they are ashamed to talk about, leaving them with a sense of shame and a lack of knowledge in this area.
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Affiliation(s)
| | - Haya Raz
- Jerusalem College of Technology, Jerusalem, Israel
| | | | | | - Shulamith Kreitler
- The School of Physiological Sciences, Tel Aviv University, Tel Aviv, Israel
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27
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Zanon BP, Paula CCD, Ribeiro AC, Padoin SMDM. Content validation to support the monitoring of disclosure of HIV diagnosis in childhood. Rev Bras Enferm 2021; 75Suppl 2:e20210027. [PMID: 34787279 DOI: 10.1590/0034-7167-2021-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to create and validate the content of a guide for monitoring the communication of the HIV diagnosis in childhood. METHODS methodological study, with a design guided by the Knowledge-to-Action (KTA) Framework, supported by a participatory approach. The guide's content was structured according to the communication elements proposed by Lasswel from review studies. RESULTS the content was validated by 26 experts from nursing, medicine, psychology and pedagogy, using a Likert-type scale for relevance, clarity and precision. Data collection took place online and achieved a Content Validity Index of 0.94. CONCLUSIONS the guide can contribute to the practice of professionals who care for children living with HIV, to support the family in communication and to the child's right to know their diagnosis. For further research, it is recommended to create and validate the face of the technology in order to implement it.
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Affiliation(s)
- Bruna Pase Zanon
- Faculdade Integrada de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil.,Universidade Federal de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil
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28
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Hori H, Ohta A, Matsui H, Yano K, Morita-Tominaka M, Linn Z, Masumoto D, Okumura Y, Okamura S, Kurihara K, Hayakawa A, Rikiishi T, Kobayashi K. Changes of cancer diagnosis disclosure to children in Japan in the last 20 years. Int J Clin Oncol 2021; 27:245-252. [PMID: 34599412 DOI: 10.1007/s10147-021-02038-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The practice of cancer diagnosis disclosure to children has been changed with the times. The regulations of clinical trials in the 2000s might change the practice in Japan. However, the perspective of this topic among children and adults has not been investigated in detail. METHODS We studied changes in the practice of information sharing with children with cancer at pediatric cancer centers and the perspective of cancer diagnosis disclosure to children among school children, their parents and pediatric oncologists in the last 20 years by comparing the results of questionnaire surveys conducted in 1998, 2008 and 2018. RESULTS This study revealed that the performing rate has increased with the times, but the institutions actively performing for children aged 7-9 years were 36.4% even in the 2018 survey. More than 70% of children wished diagnosis disclosure if they suffer from cancer in the series of surveys, while the ratio of parents who tell cancer diagnosis to their children hovered at 34.5 to 53.7% (p < 0.001 in all surveys). The ratio of pediatric oncologists having the policy to perform diagnosis disclosure proactively increased from 9.3 to 60.0%, while that of parents having the same policy stayed at 5.3% even in 2018. CONCLUSIONS The performing rate of information sharing with children with cancer was significantly changed in the last 20 years. The opinion gaps were observed between parents and children and between parents and pediatric oncologists.
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Affiliation(s)
- Hiroki Hori
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
- Department of Pediatrics, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Asuka Ohta
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Honami Matsui
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kanako Yano
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Miyuki Morita-Tominaka
- Department of Pediatrics, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Zayar Linn
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Daisuke Masumoto
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yosuke Okumura
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Pediatrics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Satoshi Okamura
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Pediatrics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kosuke Kurihara
- Department of Medical Education, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Pediatrics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akira Hayakawa
- Department of Palliative Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashi-Yodogawa-ku, Osaka, 533-0024, Japan
| | - Takeshi Rikiishi
- Department of Pediatrics, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kyoko Kobayashi
- Department of Child Health Nursing, St. Luke's International University Graduate School of Nursing Science, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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29
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Sisk BA, Schulz GL, Blazin LJ, Baker JN, Mack JW, DuBois JM. Parental views on communication between children and clinicians in pediatric oncology: a qualitative study. Support Care Cancer 2021; 29:4957-4968. [PMID: 33569673 PMCID: PMC8295182 DOI: 10.1007/s00520-021-06047-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Communication is essential to providing family-centered care in pediatric oncology. Previously, we developed a functional model of communication between parents and clinicians. Prior research has not examined the domains and purposes of communication between children and clinicians. We explored parental perspectives to begin understanding this communication. METHODS Secondary analysis of semi-structured interviews with 80 parents of children with cancer across 3 academic medical centers during treatment, survivorship, or bereavement. We employed semantic content analysis, using the functional model of parental communication as an a priori framework. RESULTS We identified 6 distinct functions of communication in child-clinician interactions: building relationships, promoting patient engagement, addressing emotions, exchanging information, managing uncertainty, and fostering hope. These communication functions were identified by parents of older (> 13 years old) and younger (< 12 years old) children, although the specific manifestations sometimes differed by age. Notably, age was not always an indicator of the child's communication needs. For example, some parents noted older children who did not want to discuss difficult topics, whereas other parent described younger children who wanted to know every detail. Two functions from the previous parental model of communication were absent from this analysis: supporting family self-management and making decisions. CONCLUSION Interviews with 80 parents provided evidence for 6 distinct functions of communication between children and clinicians. These functions apply to older and younger children, although specific manifestations might vary by age. This functional model provides a framework to guide clinicians' communication efforts and future communication research.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO, 63110, USA.
| | - Ginny L Schulz
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO, 63110, USA
| | - Lindsay J Blazin
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer W Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
| | - James M DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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30
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Eklund R, Lövgren M, Alvariza A, Kreicbergs U, Udo C. Talking about death when a parent with dependent children dies of cancer: A pilot study of the Family Talk Intervention in palliative care. DEATH STUDIES 2021; 46:2384-2394. [PMID: 34214023 DOI: 10.1080/07481187.2021.1947415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study focused on families with dependent children who participated in the Family Talk Intervention (FTI) and lost a parent during the intervention or directly thereafter. The aim was to explore how they perceived information and communication about the imminent death during the illness trajectory and after the loss. Seven families from palliative homecare settings in Sweden participated. This study suggests that it is important to support family communication when a parent is dying, since communication in this situation is unlike everyday family communication, as they enter a complex and existentially unfamiliar area, hard to initiate on their own.
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Affiliation(s)
- Rakel Eklund
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, National Centre for Disaster Psychiatry, Uppsala University, Uppsala, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institute, Solna, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Enskededalen, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institute, Solna, Sweden
| | - Camilla Udo
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Center for Clinical Research (CKF) Dalarna, Uppsala University, Sweden
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31
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Wibroe M, Ingersgaard MV, Larsen HB, Juhler M, Piil K. Living with the cerebellar mutism syndrome: long-term challenges of the diagnosis. Acta Neurochir (Wien) 2021; 163:1291-1298. [PMID: 32621064 DOI: 10.1007/s00701-020-04479-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/30/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND After posterior fossa tumour surgery, up to 39% of children experience postoperative cerebellar mutism syndrome (CMS) characterized by mutism and other motor and cognitive impairments. There is a lack of knowledge on the patient-reported challenges and long-term needs. Consequently, no specific recommendations exist for rehabilitative and supportive interventions for patients with CMS. The aims of this study were to explore the patients' experiences related to the sequelae of CMS, to identify challenges and needs regarding support and rehabilitation in the period of growing from child to adult and to add perspectives for future developments of supportive care and rehabilitative guidelines. METHODS Ten semi-structured interviews were conducted with young adults diagnosed with CMS as children. A thematic analysis identified four themes describing challenges impacting aspects of the participants' lives. RESULTS Four main themes were identified and highlight the rehabilitative need for focus on verbal and non-verbal communication skills in addition to the physical impairments. We found that brain tumour survivors with CMS can benefit from social and educational rehabilitation, straightforward and truthful information, support in structuring their everyday lives and increased public knowledge of CMS. CONCLUSION Children with CMS face a variety of challenges affecting many aspects of their everyday lives. They should be entitled to the elements of a current rehabilitation initiative for childhood cancer to support patients' social disability and educational decline. Finally, we identified a need for an official information publication.
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Affiliation(s)
- Morten Wibroe
- Department of Neurosurgery and Paediatric Department, 2092, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Marianne Vie Ingersgaard
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Bonkolab 5704, Blegdamsvej 9, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, 2092, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Karin Piil
- Department of Oncology, Center for Cancer and Organ diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
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Abstract
PURPOSE OF REVIEW Our goal was to provide healthcare professionals (HCPs) with evidence-based data about what can be done to handle prognostic discussions with empathy. RECENT FINDINGS First, disclosing prognosis involves a good reason to do so and making sure that the patient will be able to process the discussion. Second, communication tips are given for the three dimensions of empathy: "establishing rapport with the patient," which should not be overlooked; the emotional dimension, which involves an accurate understanding of the patient and communication skills; and the "active/positive" dimension which is about giving hope, explaining things clearly and helping patients take control with shared decision-making and a planned future. Although communication tips are helpful, empathy training should be based more on the development of HCPs' emotional skills, in order to help them regulate their emotions and thus be more comfortable with those of patients and families. Furthermore, research into empathy toward minorities and relatives is needed.
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Affiliation(s)
- Sophie Lelorain
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000, Lille, France.
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Lövgren M, Udo C, Alvariza A, Kreicbergs U. Much is left unspoken: Self-reports from families in pediatric oncology. Pediatr Blood Cancer 2020; 67:e28735. [PMID: 32975361 DOI: 10.1002/pbc.28735] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Communication about illness-related subjects is complex and difficult. To support entire families in pediatric oncology, health care professionals need to know what family members think, but leave unspoken. The aim of this study was to explore how families in pediatric oncology experienced illness-related information and communication with professionals and within the family. PROCEDURE A cross-sectional web survey was used. Families were recruited from one pediatric oncology center in Sweden, 2-3 months after diagnosis. One hundred eighteen family members (ill children, siblings, and parents) representing 27 families filled out age-adapted surveys. RESULTS Eighty-six percent of the parents and 71% of the siblings reported that they had not received enough or any information about how the cancer and its treatment could affect the child's psychological health. The families reported that they did not dare ask professionals questions about psychosocial issues and future-related subjects. Nor did they talk with one another, even though 55% of the parents and 24% of the children wanted to reveal more about how they felt to someone in the family. The parents reported the lowest family communication, and few families had all members reporting the same perception of family communication. CONCLUSIONS Much is still left unspoken in pediatric oncology and the needs of the families are prominent. Assessments of each family member's needs might form a basis for professionals to give each person adequate information and family support. An increased awareness in families about family members' different needs might lead to mutual understanding.
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Affiliation(s)
- Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
| | - Camilla Udo
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,School of Education, Health and Society, Dalarna University College, Falun, Sweden.,Center for Clinical Research Dalarna, Falun, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
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Zanon BP, Cremonese L, Ribeiro AC, Padoin SMDM, Paula CCD. Communication of bad news in pediatrics: integrative review. Rev Bras Enferm 2020; 73 Suppl 4:e20190059. [PMID: 32785469 DOI: 10.1590/0034-7167-2019-0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/30/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify the scientific evidence of the elements of communication in the process of communicating bad news in pediatrics. METHODS integrative review searched in the LILACS, PubMed and WoS databases. Primary studies in Portuguese, Spanish or English were included. RESULTS the evidence from the 40 studies were organized according to the elements of communication: sender (family and/or professional), receiver (family and/or child), message (bad or difficult news about diagnosis/prognosis; empathetically, honestly, objective, hopeful and available), channel (materials, quality, quantity and pace), context and effects (social and emotional changes), noise (feelings and language) and failures (silencing and misleading information). CONCLUSIONS there is a need to prepare the institution and team, as well as the family and the child, in order to promote co-responsibility in this process, to minimize suffering and communication noise and to avoid failures, recognizing the child's right to know their condition.
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Affiliation(s)
- Bruna Pase Zanon
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Luiza Cremonese
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
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Taylor J, Booth A, Beresford B, Phillips B, Wright K, Fraser L. Specialist paediatric palliative care for children and young people with cancer: A mixed-methods systematic review. Palliat Med 2020; 34:731-775. [PMID: 32362212 PMCID: PMC7243084 DOI: 10.1177/0269216320908490] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Specialist paediatric palliative care services are promoted as an important component of palliative care provision, but there is uncertainty about their role for children with cancer. AIM To examine the impact of specialist paediatric palliative care for children and young people with cancer and explore factors affecting access. DESIGN A mixed-methods systematic review and narrative synthesis (PROSPERO Registration No. CRD42017064874). DATA SOURCES Database (CINAHL, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO) searches (2000-2019) identified primary studies of any design exploring the impact of and/or factors affecting access to specialist paediatric palliative care. Study quality was assessed using The Mixed Methods Appraisal Tool. RESULTS An evidence base of mainly low- and moderate-quality studies (n = 42) shows that accessing specialist paediatric palliative care is associated with less intensive care at the end of life, more advance care planning and fewer in-hospital deaths. Current evidence cannot tell us whether these services improve children's symptom burden or quality of life. Nine studies reporting provider or family views identified uncertainties about what specialist paediatric palliative care offers, concerns about involving a new team, association of palliative care with end of life and indecision about when to introduce palliative care as important barriers to access. There was evidence that children with haematological malignancies are less likely to access these services. CONCLUSION Current evidence suggests that children and young people with cancer receiving specialist palliative care are cared for differently. However, little is understood about children's views, and research is needed to determine whether specialist input improves quality of life.
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Affiliation(s)
- Johanna Taylor
- Department of Health Sciences, University of York, York, UK
- Martin House Research Centre, University of York, York, UK
| | - Alison Booth
- Department of Health Sciences, University of York, York, UK
- Martin House Research Centre, University of York, York, UK
| | - Bryony Beresford
- Martin House Research Centre, University of York, York, UK
- Social Policy Research Unit, University of York, York, UK
| | - Bob Phillips
- Martin House Research Centre, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lorna Fraser
- Department of Health Sciences, University of York, York, UK
- Martin House Research Centre, University of York, York, UK
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Yamaji N, Suto M, Takemoto Y, Suzuki D, Lopes KDS, Ota E. Supporting the Decision Making of Children With Cancer: A Meta-synthesis. J Pediatr Oncol Nurs 2020; 37:431-443. [PMID: 32456542 DOI: 10.1177/1043454220919711] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2024] Open
Abstract
Background: Recently, awareness of children's decision making has increased in an effort to enhance palliative care. However, the conceptual framework for decision making among children with cancer remains unclear. Aims: We clarified the decision-making process of children with cancer regarding their care, treatment, and support from family and health care professionals, and identified their needs and preferences. Design: We used metaethnography to conduct a metasynthesis of relevant studies. Data sources: We searched PubMed, EMBASE, PsycINFO, MEDLINE, and CINAHL. This report was prepared in accordance with the PRISMA statement. Results: Of the 7,237 retrieved studies, 27 met our inclusion criteria. Four themes emerged that reflected the decision-making process of children with cancer: (a) facing changes brought about by a health threat, (b) preparing for action, (c) asserting one's choice, and (d) internal and external influences. Conclusion: Children with cancer initially undergo a decision-making process. Respecting children's preferences, values, and emotions may help build trusting relationships and promote their decision-making capability. Future research should focus on children's emotions, cognition, development, and interactions with parents and health care professionals.
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Affiliation(s)
- Noyuri Yamaji
- St. Luke's International University, Chuo-ku, Tokyo, Japan
| | - Maiko Suto
- National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Yo Takemoto
- Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Daichi Suzuki
- Josai International University, Togane City, Chiba, Japan
| | | | - Erika Ota
- St. Luke's International University, Chuo-ku, Tokyo, Japan
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Mitchell S, Bennett K, Morris A, Slowther AM, Coad J, Dale J. Achieving beneficial outcomes for children with life-limiting and life-threatening conditions receiving palliative care and their families: A realist review. Palliat Med 2020; 34:387-402. [PMID: 31431129 PMCID: PMC7074600 DOI: 10.1177/0269216319870647] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Palliative care for children and young people is a growing global health concern with significant resource implications. Improved understanding of how palliative care provides benefits is necessary as the number of children with life-limiting and life-threatening conditions rises. AIM The aim is to investigate beneficial outcomes in palliative care from the perspective of children and families and the contexts and hidden mechanisms through which these outcomes can be achieved. DESIGN This is a systematic realist review following the RAMESES standards. A protocol has been published in PROSPERO (registration no: CRD42018090646). DATA SOURCES An iterative literature search was conducted over 2 years (2015-2017). Empirical research and systematic reviews about the experiences of children and families in relation to palliative care were included. RESULTS Sixty papers were included. Narrative synthesis and realist analysis led to the proposal of context-mechanism-outcome configurations in four conceptual areas: (1) family adaptation, (2) the child's situation, (3) relationships with healthcare professionals and (4) access to palliative care services. The presence of two interdependent contexts, the 'expert' child and family and established relationships with healthcare professionals, triggers mechanisms, including advocacy and affirmation in decision-making, which lead to important outcomes including an ability to place the emphasis of care on lessening suffering. Important child and family outcomes underpin the delivery of palliative care. CONCLUSION Palliative care is a complex, multifactorial intervention. This review provides in-depth understanding into important contexts in which child and family outcomes can be achieved so that they benefit from palliative care and should inform future service development and practice.
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Affiliation(s)
- Sarah Mitchell
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Karina Bennett
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Morris
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jane Coad
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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Af Sandeberg M, Bartholdson C, Pergert P. Important situations that capture moral distress in paediatric oncology. BMC Med Ethics 2020; 21:6. [PMID: 31931787 PMCID: PMC6958740 DOI: 10.1186/s12910-020-0447-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The paediatric Moral Distress Scale-Revised (MDS-R) was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents' unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish paediatric MDS-R, among healthcare professionals (HCPs) in paediatric oncology. METHODS In this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach's alpha and inter-item correlation test. HCPs (n = 278) at all six Swedish paediatric oncology centres participated (> 89%). The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned. RESULTS Nursing assistants (NAs) reported higher intensity and lower frequency on all added items; registered nurses (RNs) reported a higher frequency on item 22-25; medical doctors (MDs) reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21. CONCLUSION In accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology.
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Affiliation(s)
- Margareta Af Sandeberg
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77, Stockholm, Sweden. .,Paediatric Haematology and Oncology, Children's and Women's Health Care, Karolinska University Hospital, Stockholm, Sweden.
| | - Cecilia Bartholdson
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77, Stockholm, Sweden.,Paediatric Neurology and Muscular Skeletal Disorders and Homecare, Children's and Women's Health Care, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Pergert
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77, Stockholm, Sweden.,Paediatric Haematology and Oncology, Children's and Women's Health Care, Karolinska University Hospital, Stockholm, Sweden
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39
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Yamaji N, Sawaguchi M, Ota E. Talking with Children about Cancer: A Content Analysis of Text in Children’s Picture Books. Health (London) 2020. [DOI: 10.4236/health.2020.127055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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40
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Lin B, Gutman T, Hanson CS, Ju A, Manera K, Butow P, Cohn RJ, Dalla‐Pozza L, Greenzang KA, Mack J, Wakefield CE, Craig JC, Tong A. Communication during childhood cancer: Systematic review of patient perspectives. Cancer 2019; 126:701-716. [DOI: 10.1002/cncr.32637] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Beryl Lin
- School of Public Health University of Sydney Sydney New South Wales Australia
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
| | - Talia Gutman
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Camilla S. Hanson
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Angela Ju
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Karine Manera
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Phyllis Butow
- Psycho‐oncology Co‐operative Research Group School of Psychology University of Sydney Sydney New South Wales Australia
| | - Richard J. Cohn
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
- Kids Cancer Centre Sydney Children's Hospital Randwick New South Wales Australia
| | - Luciano Dalla‐Pozza
- Cancer Centre for Children The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Katie A. Greenzang
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Dana‐Farber Cancer Institute Boston Massachusetts
| | - Jennifer Mack
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Dana‐Farber Cancer Institute Boston Massachusetts
| | - Claire E. Wakefield
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
- Kids Cancer Centre Sydney Children's Hospital Randwick New South Wales Australia
| | - Jonathan C. Craig
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Allison Tong
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
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Udo C, Kreicbergs U, Axelsson B, Björk O, Lövgren M. Physicians working in oncology identified challenges and factors that facilitated communication with families when children could not be cured. Acta Paediatr 2019; 108:2285-2291. [PMID: 31206784 PMCID: PMC6899467 DOI: 10.1111/apa.14903] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/08/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
Abstract
Aim We explored physicians’ experiences of communicating with families when their child had cancer and a cure was no longer an option, by focusing on barriers and facilitating factors. Methods Physicians from the six cancer centres in Sweden took part in focus group discussions between December 2017 and May 2018, and the data were analysed using qualitative content analysis. Focus groups enabled us to gather individual and shared perspectives. Results The 35 physicians (20 male) had a mean age of 47 (range 31‐74) and a mean of 11 years’ experience in oncology, ranging from under one year to 43 years. They reported communication challenges when a cure was not possible, namely: emotional and mental drain, lack of mutual understanding and uncertainty about communication skills. They also reported facilitating factors: flexibility in complex conversations, the child’s position in the conversations, continuity and trusting relationships, support from colleagues and having discussed the potentially life‐threatening nature of cancer from the very start of treatment. Conclusion Training to overcome communication issues could support the early integration of palliative care.
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Affiliation(s)
- Camilla Udo
- School of Education, Health and Social Studies Dalarna University Falun Sweden
- CKF Center for Clinical Research Dalarna Falun Sweden
- Department of Health Care Sciences, Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Department of Women’s and Children’s Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
| | - Bertil Axelsson
- Department of Radiation Sciences, Unit of Clinical Research Centre‐Östersund Umeå University Umeå Sweden
| | | | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Department of Women’s and Children’s Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
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Marsac ML, Kindler C, Weiss D, Ragsdale L. Let's Talk About It: Supporting Family Communication during End-of-Life Care of Pediatric Patients. J Palliat Med 2018; 21:862-878. [PMID: 29775556 DOI: 10.1089/jpm.2017.0307] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Communication is key in optimizing medical care when a child is approaching end of life (EOL). Research is yet to establish best practices for how medical teams can guide intrafamily communication (including surviving siblings) when EOL care is underway or anticipated for a pediatric patient. While recommendations regarding how medical teams can facilitate communication between the medical team and the family exist, various barriers may prevent the implementation of these recommendations. OBJECTIVE This review aims to provide a summary of research-to-date on family and medical provider perceptions of communication during pediatric EOL care. DESIGN Systematic review. RESULTS Findings from a review of 65 studies suggest that when a child enters EOL care, many parents try to protect their child and/or themselves by avoiding discussions about death. Despite current recommendations, medical teams often refrain from discussing EOL care with pediatric patients until death is imminent for a variety of reasons (e.g., family factors and discomfort with EOL conversations). Parents consistently report a need for honest complete information, delivered with sensitivity. Pediatric patients often report a preference to be informed of their prognosis, and siblings express a desire to be involved in EOL discussions. CONCLUSIONS Families may benefit from enhanced communication around EOL planning, both within the family and between the family and medical team. Future research should investigate a potential role for medical teams in supporting intrafamily communication about EOL challenges and should examine how communication between medical teams and families can be facilitated as EOL approaches.
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Affiliation(s)
- Meghan L Marsac
- 1 Department of Pediatrics, Kentucky Children's Hospital , Lexington, Kentucky.,2 College of Medicine, University of Kentucky , Lexington, Kentucky
| | - Christine Kindler
- 1 Department of Pediatrics, Kentucky Children's Hospital , Lexington, Kentucky
| | - Danielle Weiss
- 3 Department of Pediatrics, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Lindsay Ragsdale
- 1 Department of Pediatrics, Kentucky Children's Hospital , Lexington, Kentucky.,2 College of Medicine, University of Kentucky , Lexington, Kentucky
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Abstract
PURPOSE OF REVIEW Pediatric palliative oncology (PPO) is an emerging field that integrates the principles of palliative care early into the illness trajectory of children with cancer. PPO providers work with interdisciplinary clinicians to provide optimal medical and psychosocial care to children with cancer and their families. Ongoing advances in the field of pediatric oncology, including new treatment options for progressive cancers, necessitate the early integration of palliative care tenets including holistic care, high-quality communication, and assessment and management of refractory symptoms. RECENT FINDINGS Research in this emerging field has expanded dramatically over the past several years. This review will focus on advancements within several key areas of the field, specifically regarding investigation of the communication needs and preferences of patients and families, exploration of educational initiatives and interventions to teach PPO principles to clinicians, study of patient-reported and parent-reported tools to better assess and manage refractory symptoms, and development of novel models to integrate palliative care within pediatric oncology. SUMMARY Research findings in the field of PPO, concurrent with advances in the treatment of pediatric cancer, may help improve survival and quality of life for children with cancer.
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Parental coping in the context of having a child who is facing death: A theoretical framework. Palliat Support Care 2017; 16:432-441. [DOI: 10.1017/s1478951517000463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACTObjective:While improvements in healthcare have resulted in children with complex and life-threatening conditions living longer, a proportion of them still die. The death of a child puts parents at increased risk for anxiety, depression, and complicated grief. Increasing our understanding of the coping strategies that parents use under such extreme circumstances will enable us to best provide support to families, before and after a child's death. Our aim herein was to develop a theoretical framework of parental coping.Method:Evidence from the literature was employed to develop a theoretical framework to describe parental coping in the context of having a child with a life-limiting illness who is declining and facing eventual death.Results:The reasoning and argument consists of three guiding elements: (1) the importance of approach as well as avoidance (as coping strategies) in the context of managing the extreme emotions; (2) the importance of the social aspect of coping within a family, whereby parents cope for others as well as for themselves; and (3) the importance of a flexible and balanced coping profile, with parents using different coping strategies simultaneously. Central to the proposed framework is that effective coping, in terms of adjustment, is achieved by balancing coping strategies: accessing different coping strategies simultaneously or in parallel with a specific focus on (1) approach and avoidance and (2) coping aimed at self and others.Significance of results:Understanding of parental coping strategies is essential for health professionals in order to support parents effectively.
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Kurokawa S, Ogawa R, Yamazaki M, Terauchi F, Koshimizu T, Fujisaki A, Ando S, Morita T. A potential pitfall in diagnosing azoospermia with a peripheral blood karyotype of SRY-negative 46XX. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817707154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Reona Ogawa
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | | | | | | | - Akira Fujisaki
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Satoshi Ando
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Tatsuo Morita
- Department of Urology, Jichi Medical University, Tochigi, Japan
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Isaacs D. Let children be children. J Paediatr Child Health 2017; 53:99-100. [PMID: 28194893 DOI: 10.1111/jpc.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- David Isaacs
- Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Communication preferences of pediatric cancer patients: talking about prognosis and their future life. Support Care Cancer 2016; 25:769-774. [PMID: 27747479 DOI: 10.1007/s00520-016-3458-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The American Academy of Pediatrics recommends that healthcare providers communicate information to patients in a truthful and developmentally appropriate manner. However, there is limited guidance about how to translate these recommendations into clinical practice. The aim of this study was to explore how young cancer patients experienced communication around their illness, especially communication about possible outcomes from disease or treatment. METHODS Participants included young people ages 8 to under 18 years with cancer (N = 16). Semi-structured interviews focused on their expectations about the future, the process of information exchange, and their preferences for communication within the pediatric oncology setting. RESULTS Overall, participants wanted medical information to be provided to them by their healthcare providers and wanted to be direct participants in medical conversations. However, many participants displayed some ambivalence or conveyed conflicting wishes for prognostic information. For example, some participants reported that they were satisfied with what they knew, but later raised lingering questions. While not the focus of the study, almost every participant discussed social concerns as a key concern for their present and future life. CONCLUSIONS While most pediatric cancer patients want to be involved in conversations about their cancer care, including conversations about prognosis, this is an individual and sometimes fluctuating decision, and healthcare providers should be encouraged to discuss preferences for involvement with patients and families. This study highlights the importance of understanding the developmental factors that make pediatric patients unique, especially with regard to their patterns of communication.
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Rosenberg AR, Feudtner C. What else are you hoping for? Fostering hope in paediatric serious illness. Acta Paediatr 2016; 105:1004-5. [PMID: 27514005 DOI: 10.1111/apa.13510] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Abby R. Rosenberg
- Cancer and Blood Disorders Center; Seattle Children's Hospital; Seattle WA USA
- Treuman Katz Center for Pediatric Bioethics; Seattle Children's Research Institute; Seattle WA USA
- Department of Pediatrics; University of Washington School of Medicine; Seattle WA USA
| | - Chris Feudtner
- Department of Medical Ethics; Pediatric Advanced Care Team; The Children's Hospital of Philadelphia; Philadelphia PA USA
- Departments of Pediatrics, Medical Ethics and Health Policy; The Perelman School of Medicine; University of Pennsylvania; Philadelphia PA USA
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