Parental consent for bone marrow transplantation in the case of genetic disorders

The Influence of Parents' Religiosity or Spirituality on Decision Making for Their Critically Ill Child: An Integrative Review

Background: Religion and/or spirituality are important values for many parents of critically ill children; however, how religion and/or spirituality may influence which treatments parents accept or decline for their child, or how they respond to significant events during their child's illness treatment, remains unclear. Objective: To summarize the literature related to the influence of parents' religiosity or spirituality on decision making for their critically ill child. Design: Integrative review, using the Whittemore and Knafl approach. Setting/Subjects: Data were collected from studies identified through PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL plus), Embase, Scopus, and PsychInfo. Databases were searched to identify literature published between 1996 and 2016. Results: Twenty-four articles of variable methodological quality met inclusion criteria. Analysis generated three themes: parents' religiosity or spirituality as (1) guidance during decision making, (2) comfort and support during the decision-making process, and (3) a source of meaning, purpose, and connectedness in the experience of decision making. Conclusion: This review suggests that parents' religiosity and/or spirituality is an important and primarily positive influence on their decision making for a critically ill child.

[Anticipated grieving in patients requiring Hematopoietic Stem Cell Transplantation]

The scope of this study was to understand how the process of anticipated grieving is imbued in patients undergoing Hematopoietic Stem Cell Transplantation (HSCT). A cross-sectional clinical-qualitative study was conducted on a sample of 17 patients, mostly women, married, aged between 20 and 42 years and diagnosed with Chronic Myeloid Leukemia. Data was collected by semi-structured interviews applied individually and subjected to thematic content analysis. The results indicate that the loss of health imposes a new challenge in a life history already permeated by great hardships and premature losses. It was found that the expected reactions faced with normal grieving were expressed by the participants and that the most prevalent coping strategy was holding steadfast to their faith. Future plans involved being healed, returning to normality and vocational rehabilitation. The results may help the multidisciplinary teams to understand the emotional implications of the illness/treatment for implementing both preventive and intervention strategies. The critical aspect is that staff must be attentive as to how to communicate the diagnosis and the possibility of outlining a therapeutic plan, in order to augment the fighting spirit of the patient and strengthen the bond of trust with health professionals.

Percepção de pacientes com diabetes mellitus tipo 1 sobre o transplante de células-tronco hematopoéticas

O objetivo deste estudo foi investigar a percepção de pacientes com diabetes mellitus tipo 1 acerca do transplante de células-tronco hematopoéticas (TCTH). Participaram do estudo 12 pacientes, com idades entre 16 e 24 anos. Foi aplicado um roteiro de entrevista semiestruturada antes e um ano após o TCTH. Os relatos foram submetidos à análise de conteúdo temática e agrupados em três categorias: impacto do adoecimento, vivência do TCTH e retomada do cotidiano. Os resultados evidenciaram que os participantes foram capazes de identificar ganhos e refletir sobre as perdas advindas dessa situação-limite. Puderam perceber possibilidades de se beneficiarem do TCTH e vislumbraram no transplante uma oportunidade para além das inevitáveis dificuldades e limitações impostas pela terapêutica.

Quality of life of patients with autoimmune diseases submitted to bone marrow transplantation: a longitudinal study

This study aimed to assess the quality of life of patients with autoimmune diseases (AID) submitted to Bone Marrow Transplantation (BMT) at two different moments: when the patient is admitted at the hospital and at the moment of hospital discharge (30 days after the transplantation). Patients who attended the BMT unit, were older than 18 years, with conditions and availability to voluntarily collaborate to the study were selected. Data were collected through a semi-structured interview and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The sample consisted of 19 patients attended at a university hospital in the interior of São Paulo State, Brazil. The collected data suggest these patients' quality of life is reduced before the realization of the transplantation, followed by a progression in their diseases. Immediately after the transplantation, an improved capacity to perform daily activities is observed, as well as a renewed possibility of making future plans.

Validity and consequence of informed consent in pediatric bone marrow transplantation: The parental experience

BACKGROUND

Conditions supporting a high quality of consent for pediatric bone marrow transplantation (BMT) are suboptimal given the complexity of the procedure, lack of options, and parent emotional duress. We studied if parents perceived choice when consenting to BMT, if they felt the consent provided was valid, and how the consent process affected them.

METHODS

Telephone or face-to-face interviews were recorded using a semi-structured interview outline. Interview transcripts were anonymized, and independently analyzed by three reviewers.

RESULTS

Twenty parents of twelve children participated, including five bereaved parents. There were no differences in patient transplant characteristics between the eligible and study groups. Divorced or separated parents were underrepresented in the participant group. Fifteen parents felt personally compelled to consent; most (18) denied feeling external medical pressure to do so. All parents felt their consent was valid and most reported adequate levels of freedom, capacity, and information. Expectations formulated during the consent process strongly influenced parents' experience post-BMT. Good communication during consent contributed to trust and therapeutic alliance with physicians following BMT. Late parental stress and anxiety were periodic, but very high in some families.

CONCLUSIONS

Parents feel consent for pediatric BMT is valid, despite feeling personally compelled to consent. Strategies aimed at nurturing hope and realistic expectations may assist in improving the consent process, while diminishing long-term stressors.

Repercussões psicológicas do transplante de medula óssea no doador relacionado

O desenvolvimento do transplante de medula óssea (TMO), nas últimas décadas, permitiu o tratamento de doenças que antes eram invariavelmente fatais. Dentre os tipos de transplante realizados, o alogênico exige a participação ativa de um membro familiar, em geral, o irmão, que arca com o encargo da doação. O objetivo do presente estudo é analisar as repercussões psicológicas dessa doação nos doadores relacionados. A amostra foi composta por dez doadores, vinculados à Unidade de TMO do HCFMRP-USP, avaliados antes e após a doação. Os instrumentos utilizados foram: roteiro de entrevista, escalas e técnicas projetivas. Os resultados demonstraram que o nível de ansiedade dos sujeitos se encontrava dentro do esperado, porém foram constatados sintomas de estresse. Afirmaram terem ficado ansiosos e relataram dor no momento pós-doação, mas acreditam que esta foi mais fácil do que imaginaram. Finalmente, em relação aos dados das técnicas projetivas, constatou-se uma alta suscetibilidade emocional, indícios de sugestionabilidade e dependência.

Parental Experience of Family Stress During Hematopoietic Stem Cell Transplantation of Pediatric Patients in Germ-free Isolation in Taiwan

This qualitative inquiry study used convenience sampling through in-depth interviews to obtain life experiences and feelings of parents while their children underwent hematopoietic stem cell transplantation. Eleven parents of children younger than 18 years undergoing hematopoietic stem cell transplantation in a medical center in north Taiwan consented to participate in this study and provide oral and written responses in Mandarin or Taiwanese. Semistructured interviews lasting 60 minutes were conducted privately and audiotaped. Verbatim transcriptions of the interviews were examined by the content analysis method. The trustworthiness of the data was examined by Lincoln and Guba (Naturalistic Inquiry. Newbury Park, Calif: Sage; 1985) principles. Results indicated that family stress experiences of parents of children undergoing hematopoietic stem cell transplants include 4 themes: parental psychological distress, family lifestyle disturbances, parents' coping patterns, and family resources. The results of this study provide evidence of the nature of parents' experiences while their children undergo hematopoietic stem cell transplantation and provide guidelines for family-centered nursing care.

Ethical issues of informed consent: mothers' experiences enrolling their children in bone marrow transplantation research

Twelve mothers whose children had undergone bone marrow transplantation were interviewed about their experiences giving informed consent. They were asked to describe how they were introduced to bone marrow transplantation as a course of action to treat their gravely ill children, what their understanding of the protocol was, and the process by which they gave their consent. Their stories reveal complex ethical issues that may surface in the course of informed consent for research involving children. Findings suggest that mothers perceive life-and-death circumstances when a child is offered bone marrow transplantation, altering the voluntary nature of the research enterprise. The emotional trauma of the diagnosis decreases a mother's ability to absorb and understand vital information, and the emergent nature of the children's condition and the urgency to begin treatment further compromise informed consent by constricting the time and resources mothers may need to make a decision. Once a protocol is underway, mothers often experience regrets and self-recriminations about their decision to consent. Recommendations are offered that expand upon the current cognitive/rational approach to informed consent and take into account emotional experiences and the importance of building relationships to ensure informed consent over the life of a clinical trial.

Coping and support effects on mothers' stress responses to their child's hematopoietic stem cell transplantation

A hematopoietic stem cell transplantation (HSCT) is used as a treatment for cancer or nonmalignant hematological disorders in children. Little information is known about how an HSCT affects the mothers of these patients. The purposes of this repeated measures study were to examine the stress responses of mothers at four times during their child's hospitalization for an HSCT and to determine the relationships among mothers' stress responses and the resources for coping and social support. Maternal anxiety mean scores decreased significantly over time although a majority of the mothers had moderately high anxiety scores at all times. Mean scores of mothers' depressive symptomatologies decreased significantly over time. A majority of the mothers had depressive symptomatology scores above the cut-off score that indicates being at-risk for developing depression. At each of four data collection times, a specific coping style (defined as active reviewing of feelings or information associated with the situation) significantly explained the variance in mothers' scores for anxiety, depressive symptomatology, somatic complaints, and sleep behavior. Social support significantly explained differences in depressive symptomatology scores only at data collection times 1 and 3. Health care providers need to assess mothers for stress responses and assist them in dealing with their feelings and in understanding the information associated with an HSCT.