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Morris SE, Ryan AK, Malinowski P, Pozo-Kaderman C, Fasciano KM. The Development of a Bereavement Support Group Curriculum for Bereaved Parents of Young Adult Children: Bridging the Gap. J Adolesc Young Adult Oncol 2024; 13:281-287. [PMID: 37870751 DOI: 10.1089/jayao.2023.0060] [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] [Indexed: 10/24/2023] Open
Abstract
Purpose: There is limited research addressing the bereavement needs of parents whose young adult (YA) children have died from cancer. Research within oncology about the impact of child loss has tended to focus on parents of pediatric aged children. We adapted a general bereavement support group curriculum used with adults to address the unique needs of bereaved parents of YAs. Methods: Using a quality improvement framework, 25 bereaved parents of YA children participated in one of three 6-session bereavement support group programs during 2020 and 2021. Due to the coronavirus disease 2019 (COVID-19) pandemic, the programs were offered virtually. The participants provided feedback and completed an evaluation. Results: Nineteen mothers and six fathers participated with 20 (80%) completing the evaluation. The median time since the death of their child was 6 months. The participants evaluated the program highly, reporting that they felt less isolated (4.25/5 on a 5-point Likert scale); that their concerns were similar to others (4.45/5); and the discussion topics were relevant (4.20/5). Other topics that were identified included the impact on the family of losing a YA child, and how other relationships change. Forty-five percent of participants expressed a preference for a hybrid delivery model, incorporating in-person and virtual sessions. The majority also wished to continue meeting monthly, given they had little contact with other bereaved parents of YAs. Conclusion: The general bereavement support group curriculum was readily adapted for use with bereaved parents of YA children who died from cancer. A hybrid delivery model was the preferred method for future groups.
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Affiliation(s)
- Sue E Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Annelise K Ryan
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Paige Malinowski
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Cristina Pozo-Kaderman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Karen M Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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Fisher RS, Dattilo TM, DeLone AM, Basile NL, Kenney AE, Hill KN, Chang HF, Gerhardt CA, Mullins LL. The study of psychosocial outcomes of parents bereaved by pediatric illness: a scoping review of methodology and sample composition. J Pediatr Psychol 2024; 49:207-223. [PMID: 38423530 DOI: 10.1093/jpepsy/jsae008] [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: 08/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Parents of children who died of a medical condition experience a range of psychosocial outcomes. The current scoping review aims to summarize the outcomes assessed, methodology, and sample characteristics of recent psychosocial research conducted with this population. METHODS Included studies were limited to peer-reviewed, psychosocial outcomes research published between August 2011 and August 2022, written in English, and including caregiver study participants of children who died of a medical condition. Data sources were scholarly journal articles from 9 electronic databases, including Scopus, Web of Science, Academic Search Primer, ProQuest Research Library, PubMed, Embase, PsycINFO, Psychology & Behavioral Sciences Collection, and Health Source: Nursing/Academic Edition. The Mixed Methods Appraisal Tool-2018 evaluated methodological quality. RESULTS The study sample included 106 studies, most of which were either qualitative (60%) or quantitative (29%). Mixed-methods studies (8%) and randomized clinical trials (2%) were also identified. Study quality was variable, but most studies met all quality criteria (73%). Studies primarily represented cancer populations (58%), White participants (71%), and mothers (66%). Risk-based psychosocial outcomes (e.g., grief) were more commonly assessed than resilience-based outcomes. CONCLUSIONS The current scoping review revealed that recent research assessing the psychosocial outcomes of bereaved parents is limited in the representation of diverse populations, primarily qualitative, of broadly strong methodological quality, and oriented to psychosocial risk. To enhance the state of the science and inform evidence-based psychosocial services, future research should consider varied methodologies to comprehensively assess processes of risk and resilience with demographically and medically diverse populations.
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Affiliation(s)
- Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Alexandra M DeLone
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Ansley E Kenney
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Kylie N Hill
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hui-Fen Chang
- William E. Brock Memorial Library, Oklahoma State University, Stillwater, OK, United States
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
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Weaver MS, Nasir A, Lord BT, Starin A, Linebarger JS. Supporting the Family After the Death of a Child or Adolescent. Pediatrics 2023; 152:e2023064426. [PMID: 38009001 DOI: 10.1542/peds.2023-064426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/28/2023] Open
Abstract
Whether death occurs in the context of a chronic illness or as the sudden loss of a previously healthy infant, child, or adolescent, the death of a child is a highly stressful and traumatic event. Psychosocial support for families after the death of a child embodies core medical values of professional fidelity, compassion, respect for human dignity, and promotion of the best interests of a grieving family. The pediatrician has an important role in supporting the family unit after the death of a child through a family-centered, culturally humble, trauma-informed approach. This clinical report aims to provide the pediatrician with a review of the current evidence on grief, bereavement, and mourning after the loss of a child and with practical guidance to support family caregivers, siblings, and the child's community. Pediatricians have an important role in helping siblings and helping families understand sibling needs during grief. Ways for pediatricians to support family members with cultural sensitivity are suggested and other helpful resources in the community are described.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
- National Center for Ethics in Health Care, Veterans Health Affairs, Washington, District of Columbia
| | - Arwa Nasir
- Department of Pediatrics, University of Nebraska, Omaha, Nebraska
| | - Blyth T Lord
- Courageous Parents Network, Newton, Massachusetts
| | - Amy Starin
- National Association of Social Workers, Washington, District of Columbia
| | - Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
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Hill KN, Olsavsky A, Barrera M, Gilmer MJ, Fairclough DL, Akard TF, Compas BE, Vannatta K, Gerhardt CA. Factors associated with mental health service use among families bereaved by pediatric cancer. Palliat Support Care 2023; 21:829-835. [PMID: 35938399 PMCID: PMC9905324 DOI: 10.1017/s1478951522001018] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We identified types of interventions used by bereaved family members and examined associations with demographic and medical factors. Furthermore, we examined associations between distress and intervention use among bereaved families. METHODS Bereaved families (n = 85) were recruited from three children's hospitals 3-12 months after their child died of cancer. One eligible sibling (ages 8-17) per family was randomly selected for participation. During home visits 1-year post-death, parents reported on their own and the sibling's intervention use, helpfulness, and dose (self-help books, support groups, therapy, medication), and distress, defined as internalizing, externalizing, and total problems (Adult Self Report, Child Behavior Checklist). RESULTS Fifty percent of mothers used medications (n = 43); utilization was low among fathers (17%, n = 9) and siblings (5%, n = 4). Individuals with more total problems were more likely to use medications (mothers: rpb = 0.27; p = 0.02; fathers: rpb = 0.32; p = 0.02; siblings: rpb = 0.26; p = 0.02). Mothers and siblings with more total problems used more services (r = 0.24; p = 0.03 and r = 0.29; p = 0.01, respectively). Among mothers, the overall regression was significant, R2 = 0.11, F(2, 80) = 4.954, p = 0.01; the deceased child's age at death was significantly associated with total services used (b = 0.052, p = 0.022). Among fathers, the overall regression was significant, R2 = 0.216, F(3, 49) = 4.492, p = 0.007; race and years of education were significantly associated with total services used (b = 0.750, p = 0.030 and b = 0.154, p = 0.010). Among siblings, the overall regression was significant R2 = 0.088, F(2, 80) = 3.867, p = 0.025; greater total problems were significantly associated with total services used (b = 0.012, p = 0.007). SIGNIFICANCE OF RESULTS Although few background factors were related to intervention use, bereaved mothers and siblings may seek services if they have more distress. Healthcare providers should be aware of the types of services that are most often utilized and helpful to bereaved families to connect them with appropriate resources. Future research should investigate other predictors of intervention use and outcomes after the death of a child.
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Affiliation(s)
- Kylie N. Hill
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Anna Olsavsky
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- The Ohio State University College of Medicine, Columbus, OH
| | - Maru Barrera
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Kathryn Vannatta
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Cynthia A. Gerhardt
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- The Ohio State University College of Medicine, Columbus, OH
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Jones MT, Albanese E, Boles JC. "They were here, and they still matter": A qualitative study of bereaved parents legacy experiences and perceptions. Palliat Med 2023; 37:1222-1231. [PMID: 37310037 PMCID: PMC10503247 DOI: 10.1177/02692163231180926] [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] [Indexed: 06/14/2023]
Abstract
BACKGROUND Legacy building interventions are used in pediatric healthcare settings to help families cope with difficult healthcare experiences and typically reserved for intentional use at or near the end of a child's life. However, little is known about how bereaved families perceive the concept of legacy that these practices are meant to address. Emerging research challenges the view of legacy as a standardized, handheld keepsake item but rather as a summation of qualities and experiences that affect those left behind. Therefore, more research is needed. AIM To explore the legacy perceptions and experiences of bereaved parents/caregivers in an effort to inform legacy-oriented interventions in pediatric palliative care. DESIGN In this qualitative, phenomenological study grounded in social constructionist epistemology, bereaved parent/caregivers completed a semi-structured interview about their legacy perceptions and experiences. The interviews were audio-recorded, transcribed, and analyzed using an inductive, open coding approach grounded in psychological phenomenology. SETTING/PARTICIPANTS Participants were parents/caregivers and one adult sibling of children (ages 6 months-18 years) that died between 2000 and 2018 at a children's hospital in the Southeastern United States and spoke English as their primary language. RESULTS Sixteen parents/caregivers and one adult sibling were interviewed. Participants' responses converged across three themes: (1) definitions of legacy, including traits and characteristics, impacts on others, and the child's enduring presence; (2) manifestations of legacy, such as tangible items, experiences, traditions, and rituals, and altruism; and (3) factors perceived to affect legacy experiences, including characteristics of the child's death and one's personal grief process. CONCLUSION Bereaved parents/caregivers define and experience their child's legacy in ways and manifestations that conflict with current legacy building interventions used in pediatric healthcare settings. Thus, an immediate shift from standardized legacy-oriented care to individualized assessment and intervention is needed to provide high-quality patient- and family-centered pediatric palliative care.
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Affiliation(s)
- Maile T Jones
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Patient- and Family-Centered Care Department, Nashville, TN, USA
| | - Elena Albanese
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Jessika C Boles
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Patient- and Family-Centered Care Department, Nashville, TN, USA
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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Rheinberger D, Shand F, McGillivray L, McCallum S, Boydell K. Parents of Adolescents Who Experience Suicidal Phenomena-A Scoping Review of Their Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6227. [PMID: 37444075 PMCID: PMC10340647 DOI: 10.3390/ijerph20136227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
High prevalence rates of self-harm and suicide in adolescence provide unique challenges for parents. The aim of this scoping review was to explore key gaps in our understanding of the current scientific literature on the experience of parents who have adolescent children experiencing suicide crisis or self-harm. Four academic databases were searched using three broad concepts: self-harming behaviour or suicidal crisis; adolescents or young people; and the experiences or behaviour of parents, between journal inception and March 2022. Information reporting on the parents' experience was extracted and a qualitative synthesis was conducted. Twenty-two articles met inclusion criteria and were assessed in detail. The experience of parents with an adolescent engaged in self-harm or suicidal crisis were classified into three temporal themes: discovery of the suicidal phenomena, management of suicidal phenomena, and after the suicidal phenomena had ceased. Parents caring for an adolescent experiencing self-harm or suicidal crisis experience poorer psychological wellbeing, difficulty accessing support services, and changes in the parent-child relationship. Parents desire greater support for both themselves and their child and further investigation is required to understand specifically which supports would be most appropriate at each stage.
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Affiliation(s)
- Demee Rheinberger
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW 2031, Australia; (F.S.); (L.M.); (K.B.)
- Tyree Foundation Institute of Health Engineering, University of New South Wales, Sydney, NSW 2052, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW 2031, Australia; (F.S.); (L.M.); (K.B.)
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW 2031, Australia; (F.S.); (L.M.); (K.B.)
| | - Sonia McCallum
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2600, Australia;
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW 2031, Australia; (F.S.); (L.M.); (K.B.)
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Bourque C, Dumont E, Martisella M, Daoust L, Cantin S, Levasseur MC, de Steur Q, Duval M, Marquis MA, Sultan S. L’expérience à long terme des parents endeuillés en oncologie pédiatrique : une étude rétrospective de 2 à 18 ans après le décès d’un enfant. PSYCHO-ONCOLOGIE 2023. [DOI: 10.3166/pson-2022-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Objectifs : Cette étude rétrospective et transversale vise à comprendre l’expérience à long terme des parents endeuillés en oncologie pédiatrique et les différences du deuil parental en fonction du genre.
Matériel et méthodes : Un questionnaire multisectionnel coconstruit avec des cliniciens et intervenants en suivi de deuil a été tenu en ligne en 2018 et 2019. Les participants au sondage étaient des parents dont l’enfant était décédé au service d’hématologie-oncologie du CHU Sainte-Justine 2 à 18 ans auparavant. Des sections spécifiques sur les réactions, les changements et les souvenirs ont fait l’objet d’analyses descriptives.
Résultats : Les réponses de 48 parents ont été analysées. Les résultats indiquent que les mères ont tendance à modifier certaines de leurs activités sociales, alors que les pères cherchent plutôt à retrouver leurs habitudes. Les réactions initialement fortes des parents s’atténuent au fil du temps sans disparaître, en particulier la tristesse et les troubles du sommeil. Les parents ont des souvenirs apaisants des interactions et des soins reçus des intervenants en milieux clinique et communautaire même plusieurs années après le décès de leur enfant.
Conclusion : L’offre de soutien psychosocial communautaire et professionnel à long terme est pertinente, de même aux besoins des couples et aux besoins individuels des parents en fonction du genre.
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Rasouli O, Øglænd IS, Reinfjell T, Eilertsen MEB. Protective and risk factors in the grieving process among cancer-bereaved parents: A qualitative study. DEATH STUDIES 2022; 47:881-890. [PMID: 36352505 DOI: 10.1080/07481187.2022.2142324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This Norwegian nationwide study explored cancer-bereaved parents' perceptions of protective and risk factors in their grieving process. A total of 162 parents answered two open-ended questions 2-8 years after their child's death due to cancer. Qualitative analysis revealed three main themes: memories of the child's illness and death, going forward in life, and relationships-a resource and a barrier. The results support the perspective of going forward in life and accepting grief as part of life, contrary to the notion of "getting over" or "detaching" from the deceased child. Social support is also crucial for cancer-bereaved parents.
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Affiliation(s)
- Omid Rasouli
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Svela Øglænd
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trude Reinfjell
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mary-Elizabeth Bradley Eilertsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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9
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Wallace Chi Ho C, Grace Suk Man L, Miranda Mei Mui L, Molin Kwok Yin L, Clare Tsz Kiu Y, Jody Ka-Wing W. Facing the loss of siblings in childhood: Interactions and dynamics between bereaved siblings and their parents. J Pediatr Nurs 2022; 66:e1-e8. [PMID: 35817622 DOI: 10.1016/j.pedn.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/23/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The loss of a child in a family is a painful experience. Despite this, most studies focus on the grieving experience of parents. Our understanding of sibling bereavement therefore remains underexplored. This study aims to address this gap by exploring the bereavement experience of younger bereaved siblings from the perspective of the bereaved child and the parents. METHOD This study is a qualitative study conducted in Hong Kong. We recruited eleven bereaved families from 2019 to 2020. Semi-structured interviews were conducted separately with bereaved children and parents. Thematic analyses were performed. FINDINGS Eleven bereaved siblings, aged 5 to 11, and their parents were interviewed. Four themes were generated: Parents' unawareness of bereaved siblings' grief, protecting parents from grief, comparison with the deceased siblings, and learning how to grieve. CONCLUSION Our findings suggest that the family dynamics and interactions in the grieving experience are complex. The impact of grief on the bereaved child could emanate from the loss of the sibling or from the grief of the parents or from family interactions. PRACTICE IMPLICATIONS This study highlights the importance of viewing the sibling bereavement experience in a family context and of enhancing sibling bereavement services. Helping professionals should not only provide more bereavement support to the bereaved siblings individually, but they should also enhance parents' capacity to support their bereaved children.
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Affiliation(s)
| | | | - Leung Miranda Mei Mui
- Fellow of the Hong Kong Academy of Nursing (Hong Kong College of Paediatric Nursing), Hong Kong
| | | | - Yu Clare Tsz Kiu
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong.
| | - Wu Jody Ka-Wing
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong
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Berger I, Krishnasamy M, Thompson K, Celeste T, Joubert L. Service Needs of Parent Caregivers of Adolescents and Young Adults with Incurable Cancer: A Scoping Review. J Adolesc Young Adult Oncol 2022; 12:133-146. [PMID: 35787154 DOI: 10.1089/jayao.2022.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adolescent and Young Adult (AYA) oncology is an internationally recognized established subspecialty in cancer care. Dedicated programs tailored to local environments endeavor to address unique medical, psychological, cognitive, and social needs that historically, health services have been challenged to meet. In recent years there has been a growing appreciation of the challenges facing AYA with incurable cancer and their parent caregivers. While health care professionals recognize the importance of parents' involvement in the care trajectory, there is less understanding of the services needed for support. This scoping review set out to identify and describe evidence available to better understand the services and approaches required from hospital teams to address the needs of parent caregivers and to identify gaps in knowledge to inform areas for further research. The question guiding this review is: What are the service needs of parent carers of AYA with incurable cancer. Using the Arksey and O'Malley scoping review framework, 1009 studies were identified from a broad search of relevant online databases, gray literature, and reference lists of published studies. After removing duplicates and ineligible studies, 492 abstracts were screened. Of these, 421 were ineligible, and 71 articles underwent full-text review. Eight studies were included in the final review. No single study was focused exclusively on parent caregivers of AYA with incurable cancer, demonstrating a paucity of quantitative and qualitative evidence to inform practice and a need for further research in the field.
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Affiliation(s)
- Ilana Berger
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Center, Melbourne, Australia.,School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia.,Academic Nursing Unit, Peter MacCallum Cancer Center, Melbourne, Australia.,Research and Education Lead-Nursing, Victorian Comprehensive Cancer Center Alliance, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Center, Melbourne, Australia.,School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Tania Celeste
- School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Lynette Joubert
- School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
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11
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Love A, Greer K, Woods C, Clark L, Baker JN, Kaye EC. Bereaved Parent Perspectives and Recommendations on Best Practices for Legacy Interventions. J Pain Symptom Manage 2022; 63:1022-1030.e3. [PMID: 35157983 DOI: 10.1016/j.jpainsymman.2022.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
Abstract
CONTEXT Many pediatric hospitals offer legacy interventions for families to promote coping and support grief prior to and following the death of a child. Despite this practice, parent perceptions of the value of legacy activities are not well described, and best practices for offering and creating legacy interventions remain poorly understood. OBJECTIVES To characterize bereaved parents' perspectives on the value of legacy activities; to describe parent recommendations for optimizing provision of legacy activities by child life specialists and music therapists. METHODS In this qualitative study, a purposive sample of 19 bereaved parents of children who died from cancer participated in semi-structured interviews. Interviews were audio-recorded, transcribed, and analyzed inductively using content analysis to identify key concepts and emerging themes. RESULTS Analysis of transcripts revealed bereaved parent insights and recommendations across three core themes: 1) the value of legacy items and interventions; 2) the practical roles, uses, and functions of legacy items, and 3) best practices for offering legacy interventions. Bereaved parents sought meaning and purpose in abstract and concrete manifestations of legacy. Parents often used legacy items in specific ways to promote emotional expression and process their grief. Communication, timing, and creativity significantly influenced parent perceptions of legacy-building. Parents recommended individualized assessments to optimize provision of legacy interventions. CONCLUSION Bereaved parents emphasized the meaningfulness of legacy-building activities and the need for an individualized approach when offering these interventions. Future research should explore the perspectives and recommendations of patients and siblings on legacy activities.
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Affiliation(s)
- Amy Love
- St. Jude Children's Research Hospital, Memphis, TN , USA
| | | | - Cameka Woods
- St. Jude Children's Research Hospital, Memphis, TN , USA
| | - Lisa Clark
- St. Jude Children's Research Hospital, Memphis, TN , USA
| | - Justin N Baker
- St. Jude Children's Research Hospital, Memphis, TN , USA
| | - Erica C Kaye
- St. Jude Children's Research Hospital, Memphis, TN , USA.
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12
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Kingsley J, Taylor M, Bogetz JF, Trowbridge A, Rosenberg AR, Barton KS. Grief Trajectories of Bereaved Parents of Adolescents and Young Adults With Advanced Cancer: A Qualitative Analysis Using Phenomenology. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221101705. [PMID: 35575201 DOI: 10.1177/00302228221101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Different parents grieve differently. However, research directed at understanding the important contextual or individual factors that influence the path each bereaved parent takes is lacking. In this qualitative analysis we seek to understand the array of bereaved parent experiences more completely. By deeply diving into one parent dyad using interpretive phenomenology analysis and situating that story within the conventional content analysis of 13 other bereaved parents of adolescents and young adults (AYAs) who died from advanced cancer, we illustrate the roles of religion/spirituality, maintaining a connection, and fulfilling parental roles as elements of grief processing. Clinicians and investigators should consider similar individualized approaches to understanding and supporting the grief experiences of bereaved parents before and after the death of a child.
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Affiliation(s)
- Jenny Kingsley
- Department of Anesthesiology and Critical Care Medicine, 5150Children's Hospital Los Angeles, CA, USA
| | - Mallory Taylor
- Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Jori F Bogetz
- Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Amy Trowbridge
- Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Abby R Rosenberg
- Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Krysta S Barton
- Palliative Care and Resilience Lab, 145793Seattle Children's Research Institute, Seattle, WA, USA
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13
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van Kempen MM, Kochen EM, Kars MC. Insight into the content of and experiences with follow-up conversations with bereaved parents in paediatrics: A systematic review. Acta Paediatr 2022; 111:716-732. [PMID: 34995378 PMCID: PMC9304260 DOI: 10.1111/apa.16248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Abstract
Aim A follow‐up conversation with bereaved parents is a relatively well‐established intervention in paediatric clinical practice. Yet, the content and value of these conversations remain unclear. This review aims to provide insight into the content of follow‐up conversations between bereaved parents and regular healthcare professionals (HCPs) in paediatrics and how parents and HCPs experience these conversations. Methods Systematic literature review using the methods PALETTE and PRISMA. The search was conducted in PubMed and CINAHL on 3 February 2021. The results were extracted and integrated using thematic analysis. Results Ten articles were included. This review revealed that follow‐up conversations are built around three key elements: (1) gaining information, (2) receiving emotional support and (3) facilitating parents to provide feedback. In addition, this review showed that the vast majority of parents and HCPs experienced follow‐up conversations as meaningful and beneficial for several reasons. Conclusion An understanding of what parents and HCPs value in follow‐up conversations aids HCPs in conducting follow‐up conversations and improves care for bereaved parents by enhancing the HCPs' understanding of parental needs.
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Affiliation(s)
- Merel M. van Kempen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Eline M. Kochen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Marijke C. Kars
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
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Lockton J, Oxlad M, Due C. Grandfathers' Experiences of Grief and Support Following Pregnancy Loss or Neonatal Death of a Grandchild. QUALITATIVE HEALTH RESEARCH 2021; 31:2715-2729. [PMID: 34772285 DOI: 10.1177/10497323211041331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pregnancy loss and neonatal death are recognized as distressing experiences for parents and other family members. However, no research has specifically addressed the experiences of grandfathers. This study aimed to understand grandfathers' grief experiences, and to identify supports they provide, receive, and desire following the loss of a grandchild in pregnancy or the neonatal period. Semi-structured interviews with 10 Australian grandfathers were analyzed, applying principles of thematic analysis. Three themes related to grief and three themes related to support were identified. Findings indicated that grandfathers expressed grief in a range of ways, and emotional expressiveness did not reflect the extent of their grief. Grandfathers typically provided extensive support to their child and family; however, few supports were available to help grandfathers. Recognition and validation of grandfathers' grief, early access to information, and guidance to a variety of supports including written materials, peer and professional support, is required.
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Affiliation(s)
- Jane Lockton
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Melissa Oxlad
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Clemence Due
- The University of Adelaide, Adelaide, South Australia, Australia
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15
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Goldberg JM, Duplechain AC, Fraser CE, Boles JC. An Interdisciplinary Hospital-Based Committee to Improve Pediatric Bereavement Care. Hosp Pediatr 2021; 11:1287-1294. [PMID: 34599017 DOI: 10.1542/hpeds.2021-005964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although frequently overshadowed by adult mortality rates and bereavement care needs, the death of a child can significantly jeopardize the physical, psychosocial, and emotional health of surviving parents, caregivers, and family members. Unfortunately, researchers have only recently begun to explore the trajectory of pediatric bereavement care needs. As an ongoing public health concern, health care institutions and related organizations must partner with interdisciplinary care providers and bereaved families to design effective and sustainable bereavement supports in their communities. Therefore, the purpose of this article is to describe the development and accomplishments of an interdisciplinary bereavement committee at a children's hospital within an academic medical center. By relying on available empirical evidence and close collaboration with bereaved parent members, this effort has generated sizeable practice improvements and new service offerings within the organization, local community, and the individual patients and families the institution serves.
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Affiliation(s)
- Jessica M Goldberg
- Patient- and Family-Centered Care, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Anne C Duplechain
- Patient- and Family-Centered Care, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Camille E Fraser
- Patient- and Family-Centered Care, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Jessika C Boles
- Patient- and Family-Centered Care, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee .,Department of Psychology and Human Development, Peabody College Vanderbilt University, Nashville, Tennessee
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16
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Kim MA, Sang J, Yi J, Sung J, Howey W. Changes in Relationships in Bereaved Families: Perspectives of Mothers Who Lost a Child to Cancer. OMEGA-JOURNAL OF DEATH AND DYING 2021; 88:302228211047105. [PMID: 34565259 DOI: 10.1177/00302228211047105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The loss of a child greatly affects the dynamics of interpersonal relationships in bereaved families. This study explored the relationships in bereaved Korean families from the perspectives of mothers after the death of a child due to cancer. We conducted in-depth interviews with 15 bereaved mothers of a deceased child with childhood cancer. Thematic analysis identified 12 subthemes related to bereaved mothers' struggles in grief within three significant themes based on family relationships: (a) relationship with husband; (b) relationship with surviving child or children; and (c) relationships with extended family members. Findings highlight bereaved mothers' need to build supportive family relationships while acknowledging bereaved family members' different grieving styles and their own challenges in grieving the loss of a child.
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Affiliation(s)
- Min Ah Kim
- Department of Social Welfare, Sungkyunkwan University, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jina Sang
- School of Social Work and Family Sciences, The University of Akron, Akron, Ohio, United States
| | - Jaehee Yi
- College of Social Work, University of Utah, Salt Lake City, Utah, United States
| | - Jimin Sung
- Department of Social Welfare, Sungkyunkwan University, Sungkyunkwan University, Seoul, Republic of Korea
| | - Whitney Howey
- College of Social Work, University of Utah, Salt Lake City, Utah, United States
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17
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Ahmadi F, Zandi S. Meaning-Making Coping Methods among Bereaved Parents: A Pilot Survey Study in Sweden. Behav Sci (Basel) 2021; 11:131. [PMID: 34677224 PMCID: PMC8533093 DOI: 10.3390/bs11100131] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
The death of a child may result in traumatizing forms of grief, and meaning-making coping with loss seems to be important in prevention of intense psychosocial problems among bereaved parents. The aim of this quantitative pilot study was to discover the divergent meaning-making coping methods used by bereaved parents in Sweden. In doing so, 162 respondents were selected using a convenience sampling method, and they responded to the modified version of RCOPE. The study revealed that the strategies talking to others about their feelings, pondering the meaning of life alone, and being in nature for greater emotional affiliation, i.e., what we call secular existential coping methods, have been the most used meaning-making coping methods among Swedish mourning parents. While explaining the results, we considered the respondents' cultural background and speculated about the potential influence of cultural teachings and elements in the selection of ways of coping with bereavement. Further, we compared the results obtained with those of the two other Swedish studies conducted among people coping with cancer and COVID-19 to further discuss the impact of culture on coping with illness, loss, grief, and crisis. The study supports the idea that culture plays an essential role in the choice of coping methods.
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Affiliation(s)
| | - Saeid Zandi
- Department of Social Work and Criminology, Faculty of Health and Occupational Studies, University of Gävle, 80176 Gävle, Sweden;
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18
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Vig PS, Lim JY, Lee RWL, Huang H, Tan XH, Lim WQ, Lim MBXY, Lee ASI, Chiam M, Lim C, Baral VR, Krishna LKR. Parental bereavement - impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review. BMC Palliat Care 2021; 20:136. [PMID: 34481491 PMCID: PMC8418708 DOI: 10.1186/s12904-021-00831-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Losing a child tragically impacts the well-being and functioning of parents. With these effects extending beyond emotional, physical morbidity and compromising self-perceptions, appropriate, longitudinal, timely and personalised support is key to effective care of bereaved parents. However, in the absence of a comprehensive understanding of parental bereavement, effective support of bereaved parents remains suboptimal. To address this gap, we scrutinise prevailing data on the effects of a child's death, aged 0-12 years, through the lens of the Ring Theory of Personhood (RToP). METHODS To study prevailing accounts of bereaved parents following the death of a child, we adopt Krishna's Systematic Evidence Based Approach (SEBA) to structure our Systematic Scoping Review (SSR in SEBA). RESULTS Three thousand seventy-four abstracts were reviewed, 160 full text articles were evaluated, and 111 articles were included and analysed using thematic and content analysis. Four themes/categories were identified relating to the four rings of the RToP. Findings reveal that static concepts of protective and risk factors for grief are misplaced and that the support of healthcare professionals is key to assisting bereaved parents. CONCLUSION In the absence of consistent support of bereaved parents, this study highlights the need for effective training of healthcare professionals, beginning with an appreciation that every aspect of an individual parent's personhood is impacted by the loss of their child. Acknowledging grief as a complex, evolving and personalised process subjected to parental characteristics, settings, context and available support, this SSR in SEBA calls attention to effective nurturing of the relationship between parents and healthcare professionals, and suggests use of the RToP to assess and direct personalised, timely, specific support of parents in evolving conditions. We believe the findings of this review also call for further studies to support healthcare professionals as they journey with bereaved parents.
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Affiliation(s)
- Prachi Simran Vig
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Jia Yin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Randal Wei Liang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Huixin Huang
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Road, Block 3 Level 1, Singapore, 169608 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Vijayendra Ranjan Baral
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Division of Neonatal and Developmental Medicine, Singapore General Hospital, Outram Road, Block 5 Level 4, Singapore, 169608 Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
- Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA UK
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Examining the Experiences and Support Needs of Bereaved Parents After the Death of a Child During Early Adulthood From Cancer. Cancer Nurs 2021; 45:E719-E727. [PMID: 34483281 DOI: 10.1097/ncc.0000000000000998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parents experience unique grief, which may be experienced differently by mothers and fathers. A lack of knowledge about the particular bereavement experiences of the parents of young adults exists. OBJECTIVE The aim of this study was to investigate experiences and support needs of parents after the death of a child (aged 16-29 years) from cancer, exploring changes over time. METHODS The study used a Charmazian constructivist grounded theory approach. Semistructured interviews were conducted with 11 parents (7 mothers and 4 fathers) purposefully sampled and bereaved between 15 months and 7 years. Data were analyzed inductively using the constant comparative approach for category development. RESULTS "Living with continual loss" emerged as the core category central to parents' experiences of bereavement. Feelings of continual loss were compounded by parents' lack of information ("grieving in the dark") and a perceived lack of understanding from families and friends ("grieving alone"). Parents discovered strategies to manage the feeling of loss: "changing routines," "preserving the meaning of home," "maintaining memories and presence," and "sharing experiences." CONCLUSIONS This is the first study focusing solely on the experiences and support needs of bereaved parents of young adults who have died of cancer. Parents live with a continual sense of loss irrespective of the length of bereavement, and a lack of bereavement information and empathetic emotional support can exist. IMPLICATIONS FOR PRACTICE The need for improved information giving and development of peer support for bereaved parents has been identified. Cancer centers have a continuing role in developing and providing this support.
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20
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Carreño-Moreno S, Arias-Rojas M, Chaparro-Díaz L. Seeking an Adjustment from the Unnatural to the Supernatural: The Experience of Losing a Child from Cancer in Colombia. Indian J Palliat Care 2021; 27:23-30. [PMID: 34035613 PMCID: PMC8121221 DOI: 10.4103/ijpc.ijpc_72_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/19/2020] [Accepted: 07/01/2020] [Indexed: 11/04/2022] Open
Abstract
Aims The death of a child with cancer can be devastating for his or her parents. This study sought to understand the way in which the process of parental grief develops after the death of a child with cancer. Methods The research used a grounded theory approach, in which 18 participants were enrolled including parents whose child died from cancer 5 months to 5 years before. In-depth interviews were conducted, which were analyzed using constant comparisons until theoretical saturation was reached. Results Fifteen subcategories were identified and grouped into three categories that explain what the grieving process represents to the parents over time (a) crossing a desert, (b) dying while alive, and (c) coming back to life. From the emerging relationships among the categories, the core category "seeking adjustment from the unnatural to the supernatural" arises. The results show that grief begins from the moment of diagnosis until long after the child's death. For parents, it entails understanding the disruption in the natural course of life, going through indescribable pain, and being spiritually reconnected with their child. Conclusions These results enable nurses to design comprehensive interventions that meet the described needs of these parents.
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Affiliation(s)
- Sonia Carreño-Moreno
- Research Group Nursing Care for the Chronic Patient, Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Mauricio Arias-Rojas
- Department of Vocational Training, Faculty of Nursing, Universidad de Antioquia, Antioquia, Colombia
| | - Lorena Chaparro-Díaz
- Research Group Nursing Care for the Chronic Patient, Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá, Colombia
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21
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End-of-life decision making in critical illness: Perspectives of Asian parents. Palliat Support Care 2021; 20:233-242. [PMID: 33942708 DOI: 10.1017/s1478951521000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore parents' perspectives regarding end-of-life (EOL) decisions, factors and possible barriers that influence the EOL decision making process, and to understand parental preferences for communication about EOL care in an Asian population. METHOD A prospective questionnaire cohort study conducted in a university-based tertiary care hospital. 30 parents of children who had been admitted to general pediatric wards for acute ailments and/or were being followed up in general pediatric outpatient clinics after inpatient admissions or emergency department visits completed 30 interviewer-administered questionnaires. With the first 10 completed questionnaires, we sought feedback on the design of the four case vignettes and related questions. Responses to specific questions related to each case vignette were rated on a Likert scale. RESULTS The majority of parents were able to comprehend and identify with the issues in the case vignettes, which allowed them to respond appropriately. Parents tended to avoid active withdrawal or withholding of life-sustaining treatment. The top three priorities for parents making EOL decisions for their children were: the chance of improvement, the presence of pain or discomfort, and information provided by healthcare staff. Parents reported that they would prefer to know immediately if their child is at risk of dying; they also preferred to get as much information as possible from the healthcare team and thought that meeting with the healthcare team before making EOL decisions was pivotal. SIGNIFICANCE OF RESULTS Parents place highest priorities on their child's likelihood of improvement, perception of their child's pain, and information provided by healthcare professionals in making EOL decisions.
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22
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Dias N, Boring E, Johnson LA, Grossoehme DH, Murphy S, Friebert S. Developing a theoretically grounded, digital, ecological momentary intervention for parental bereavement care using the ORBIT model-Phase 1. DEATH STUDIES 2021:1-10. [PMID: 33913789 DOI: 10.1080/07481187.2021.1914239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Current models of bereavement care do not address all of bereaved parents' unique needs. Diverse challenges limit parents' ability to access certain bereavement services. A web-based intervention prototype for bereaved parents was developed. Using convenience and snowball techniques, 14 participants (pediatric providers, software developers, and bereaved parents) were enrolled in a descriptive, cross-sectional feasibility and usability study. While the intervention was generally considered acceptable, three themes were identified to enhance its usability and acceptability: timing; delivery; and revisions. Further intervention development is needed to improve both short- and long-term physical and psychological outcomes for bereaved parents.
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Affiliation(s)
- Nancy Dias
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Elizabeth Boring
- Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana, USA
| | - Lee Ann Johnson
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Daniel H Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, Ohio, USA
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA
| | - Savannah Murphy
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, Ohio, USA
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA
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23
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Schuelke T, Crawford C, Kentor R, Eppelheimer H, Chipriano C, Springmeyer K, Shukraft A, Hill M. Current Grief Support in Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2021; 8:278. [PMID: 33916583 PMCID: PMC8066285 DOI: 10.3390/children8040278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
Grief support changes as more is learned from current grief theory and research. The authors provide a comprehensive overview of current grief support as it relates to Pediatric Palliative Care (PPC). The following aspects of grief are addressed: (1) anticipatory grief: the nondeath losses that occur with a complex and chronic illness, as well as the time leading up to death; (2) grief around the time of death: the intense and sacred experience of companioning with a dying child; (3) grief after death: supporting bereavement and mourning through programing and other methods; (4) innovative approaches: the future of grief support. The contents of this article are meant to support and educate programs currently providing grief services and those aiming to begin the meaningful work of grief support.
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Affiliation(s)
- Taryn Schuelke
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Claire Crawford
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Rachel Kentor
- Department of Pediatrics, Baylor College of Medicine, Psychology Service, Texas Children’s Hospital, 6701 Fannin St., Houston, TX 77030, USA;
| | - Heather Eppelheimer
- Memorial Hermann Pediatric Hospice, 902 Frostwood Suite 288, Houston, TX 77024, USA;
| | | | - Kirstin Springmeyer
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Allison Shukraft
- Department of Pediatrics, Pediatric Advanced Care Team, Atrium Health’s Levine Children’s Hospital, MEB 415-F, 1000 Blythe Blvd, Charlotte, NC 28203, USA;
| | - Malinda Hill
- Justin Michael Ingerman Center for Palliative Care, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
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24
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Abdel Razeq NM, Al-Gamal E. Informing mothers of neonatal death and the need for family-centered bereavement care: A phenomenological qualitative study. J SPEC PEDIATR NURS 2021; 26:e12328. [PMID: 33511740 DOI: 10.1111/jspn.12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To understand the lived experience of mothers surrounding the time of being informed of neonatal deaths in intensive care units. DESIGN A phenomenological qualitative approach was employed. METHODS Twelve mothers (age 24-41 years) were identified from the neonatal mortality records of two large neonatal intensive care units with high neonate turnover rates in Amman, Jordan. Data were collected using semistructured interviews with the participants. Interpretive phenomenology was used to generate themes regarding the essence of the mother's experience. RESULTS Critical analyses of mothers' accounts revealed three major themes: (a) Minimize the hurt, which described how mothers intuited overprotection by their families while the news was conveyed indirectly to them; (b) The striking reality of death, which captured mothers' distressing experiences while realizing the loss of their neonates; and (c) Farwell my baby, which accentuated mothers' needs and experiences while neonates' bodies were honored and prepared for burial per the cultural norms in Jordan. PRACTICE IMPLICATIONS Our findings highlighted the complex dynamics of familial interactions and cultural influences on mothers' bereavement experiences at the time of neonatal death. The grieving mothers expressed unfulfilled needs of receiving professional bereavement support at the time of neonatal death. Strategies are needed to optimize the supportive role of specialized nurses in providing family-centered bereavement care to mothers and their families who experience neonatal death.
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Affiliation(s)
- Nadin M Abdel Razeq
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Ekhlas Al-Gamal
- Psychiatric and Mental Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan.,Psychiatric and Mental Health Nursing, College of Nursing, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Alhasa, Kingdom of Saudi Arabia
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25
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Hawthorne DM, Joyner R, Gaucher E, Liehr P. Death of an infant: Accessing the voices of bereaved mothers to create healing. A qualitative study. J Clin Nurs 2020; 30:229-238. [PMID: 33113218 DOI: 10.1111/jocn.15542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/09/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the health challenge for mothers whose infants have died and approaches and resources they used to manage the loss. BACKGROUND The death of an infant is a devastating experience for families. Bereaved mothers have higher rates of mental distress, loneliness and isolation. While some learn to cope, others remain consumed by grief, unable to function, with persistent affective, cognitive and physical symptoms. DESIGN Qualitative design guided by story theory. METHODS In-depth, semi-structured interviews were conducted with mothers 13-36 months after the death of their infant. Looking at the present, past and future, mothers were asked to describe the health challenge of losing an infant and approaches used to manage the loss. The COREQ checklist was used. RESULTS These mothers' experiences were captured in six main themes: 'Painful aloneness', 'Blemished identity', 'Burden of being misunderstood', 'Being with and being heard', 'Being present and building a future' and 'Finding meaning in the tragedy'. In sharing their stories, mothers identified positive and negative encounters with healthcare professionals following the death of their infant. CONCLUSION After losing an infant, mothers experience an array of challenges as they move forward. They describe their approaches used to manage the loss. This included a need to be heard, feel supported and find meaning in the loss as they try to build a new future. Their stories express a need for health care encounters to be healing, allowing mothers to feel cared for and supported on their unique journeys towards a new sense of well-being. RELEVANCE TO CLINICAL PRACTICE In sharing their stories what matters most to these mothers having lost an infant emerged. The study findings can be used to guide nursing practice, incorporated into healthcare providers bereavement training, increase knowledge and build effective communication skills.
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Affiliation(s)
- Dawn M Hawthorne
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | | | | | - Patricia Liehr
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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Dumont É, Bourque CJ, Duval M, Payot A, Sultan S. A Portrait of Self-Reported Health and Distress in Parents Whose Child Died of Cancer. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:958-973. [DOI: 10.1177/0030222820959943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Grieving a child following cancer is a substantially difficult task. The objectives of this research were: 1) to describe current quality of life (QoL), psychological distress and symptoms of grief of bereaved parents, and 2) to explore the role of possible contributors of QoL and psychological distress. Forty-six parents (32 mothers) of children who died of cancer were surveyed on their QoL, distress, and complicated grief. Data were analyzed using multiple linear regression. Parents had a high frequency of grieving symptoms (58%). Mothers reported more retrospective grief symptoms than fathers when describing the year after child death. Current lower mental well-being was associated with experiencing higher retrospective grief symptoms, a shorter period since child death, and being a father. Hence, parents experienced disturbances even long after child death. Mothers and fathers may present specificities that should be considered when developing supportive activities for this vulnerable population.
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Affiliation(s)
- Émilie Dumont
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- Sainte-Justine University Health Center, Montréal, Québec, Canada
| | - Claude Julie Bourque
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Michel Duval
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Antoine Payot
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Serge Sultan
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
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Cole JCM, Budney A, Howell LJ, Moldenhauer JS. Developing an Infrastructure for Bereavement Outreach in a Maternal-Fetal Care Center. Fetal Diagn Ther 2020; 47:960-965. [PMID: 32866961 DOI: 10.1159/000507480] [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: 12/31/2019] [Accepted: 03/25/2020] [Indexed: 11/19/2022]
Abstract
Although bereavement programs are a common element of palliative medicine and hospice programs, few maternal-fetal care centers offer universal bereavement outreach services following perinatal loss. In this article, we describe the implementation of a bereavement outreach program at the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia. The four primary goals identified when developing the bereavement outreach protocol included: (1) centralize communication for patient tracking when a perinatal loss occurs, (2) provide individualized and consistent resource support for grieving patients and families, (3) identify strategic outreach points throughout the first year post-loss, and (4) instate programmatic improvements in response to feedback from patients and their families. Strategies for establishing standardized follow-up protocols and operationalizing methods to address outreach initiatives will be shared, with the primary aim of providing other fetal care centers with a proposed model for perinatal bereavement outreach services.
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Affiliation(s)
- Joanna C M Cole
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,
| | - Alexandria Budney
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julie S Moldenhauer
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Leemann T, Bergstraesser E, Cignacco E, Zimmermann K. Differing needs of mothers and fathers during their child's end-of-life care: secondary analysis of the "Paediatric end-of-life care needs" (PELICAN) study. BMC Palliat Care 2020; 19:118. [PMID: 32753031 PMCID: PMC7405340 DOI: 10.1186/s12904-020-00621-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022] Open
Abstract
Background Mothers and fathers are severely challenged when providing care for their terminally ill child at end of life. Caregiving needs have been studied predominantly in mothers. Differences in caregiving needs between mothers and fathers during their child’s end of life have not, however, been explored so far. This knowledge is of importance to best meet individual parental needs in paediatric end-of-life care. Methods Secondary analysis of a quantitative survey on parental needs during their child’s last 4 weeks of life, collected in the Swiss multicentre “Paediatric End-of-Life Care Needs” (PELICAN) study. Caregiving needs of mothers and fathers (parental dyad) who had lost a child due to a cardiological, neurological or oncological disease or during the neonatal period in the years 2011–2012 were retrospectively assessed using a questionnaire representing six evidence-based quality domains of paediatric palliative and end-of-life care. Results Seventy-eight parental dyads were included in this analysis. Differences between mothers and fathers were mostly found around needs to be supported as a family. In all, 28 out of 34 needs-related questionnaire items were scored higher by mothers than by fathers, indicating higher importance for that need to be met. The results indicate that these differences might relate to different caregiving roles and gender-specific coping strategies. Conclusions To best meet parental needs in paediatric end-of-life care, particular attention should be paid to both mothers and fathers and their specific caregiving roles, as differences in these roles might influence their needs in this exceptional situation. Therefore, healthcare professionals should identify how parental dyads mutually navigate care for their sick child to best meet their needs in support. Additionally, mothers and fathers should be supported in their individual coping strategies.
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Affiliation(s)
- Tanja Leemann
- School of Human Medicine, University of Zurich Faculty of Medicine, Zurich, Switzerland
| | - Eva Bergstraesser
- Paediatric Palliative Care and Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, 8032, Switzerland
| | - Eva Cignacco
- Department of Health Professions, Berne University of Applied Sciences, Berne, Switzerland
| | - Karin Zimmermann
- Paediatric Palliative Care and Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, 8032, Switzerland. .,Department Public Health - Nursing Science, University of Basel, Bernoullistrasse 28, Basel, 4056, Switzerland.
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Parents' Wishes for What They Had or Had Not Done and Their Coping After Their Infant's or Child's Neonatal Intensive Care Unit/Pediatric Intensive Care Unit/Emergency Department Death. J Hosp Palliat Nurs 2020; 21:333-343. [PMID: 30933014 DOI: 10.1097/njh.0000000000000559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This qualitative study asked 70 mothers and 26 fathers 3 open-ended questions on what they wish they had and had not done and on coping 2, 4, 6, and 13 months after their infant's/child's neonatal intensive care unit/pediatric intensive care unit/emergency department death. Mothers wished they spent more time with the child, chosen different treatments, advocated for care changes, and allowed the child his or her wishes. Fathers wished they had spent more time with the child and gotten care earlier. Mothers wished they had not agreed to child's surgery/treatment, taken her own actions (self-blame), and left the hospital before the death. Fathers wished they had not been so hard on the child, agreed with doctors/treatment, and taken own actions (self-blame). Religious activities, caring for herself, and talking about/with the deceased child were the most frequent mothers' coping strategies; those of the fathers were caring for self and religious activities. Both mothers and fathers wished they had spent more time with their child and had not agreed to surgery/treatments. The most frequent coping was caring for themselves, likely to care for the family and retain employment. Nurses must be sensitive to parents' need for time with their infant/child before and after death and to receive information on child's treatments at levels and in languages they understand.
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Cai S, Guo Q, Luo Y, Zhou Y, Abbas A, Zhou X, Peng X. Spiritual needs and communicating about death in nonreligious theistic families in pediatric palliative care: A qualitative study. Palliat Med 2020; 34:533-540. [PMID: 31971068 DOI: 10.1177/0269216319896747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spiritual support should be offered to all patients and their families regardless of their affiliated status with an organized religion. AIM To understand nonreligious theistic parents' spirituality and to explore how parents discuss death with their terminally ill children in mainland China. DESIGN Qualitative study. SETTING/PARTICIPANTS This study was conducted in the hematology oncology center at Beijing Children's Hospital. Participants in this study included 16 bereaved parents. RESULTS Participants described themselves as nonreligious but showed a tendency toward a particular religion. Parents sought religious support in the face of the life-threatening conditions that affected their child and regarded the religious belief as an important way to get psychological and spiritual comfort after experiencing the death of their child. Religious support could partially address parents' spiritual needs. Parents' spiritual needs still require other supports such as bereavement services, death education, and family support groups. Some parents stated that it was difficult to find a way to discuss death with their children. For patients who come from nonreligious theistic families, their understanding of death was more complex and may be related to atheism. CONCLUSION Religious support could be an element of spiritual support for nonreligious theistic parents of terminally ill children. Multiple strategies including religious supports and nonreligious supports should be rationally integrated into spiritual support of nonreligious theistic family. Patient's personal belief in death should be assessed before discussing death with them.
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Affiliation(s)
- Siyu Cai
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qiaohong Guo
- School of Nursing, Capital Medical University, Beijing, China
| | - Yanhui Luo
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuchen Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ali Abbas
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuan Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Hovén E, Hagström J, Pöder U, Grönqvist H, von Essen L. Parents' needs of support following the loss of a child to cancer: a Swedish, prospective, longitudinal, multi-centre study. Acta Oncol 2020; 59:351-357. [PMID: 31702406 DOI: 10.1080/0284186x.2019.1686535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Parents' needs of support following the loss of a child to cancer and whether these needs are met are not fully known. This study aimed to describe parents' needs, opportunity, and benefit of support from healthcare professionals and significant others from shortly after, up to five years after bereavement.Material and methods: Data were collected at nine months (T5, n = 20), eighteen months (T6, n = 37), and five years after the child's death (T7, n = 38). Parents answered questions via telephone about need, opportunity, and benefit of talking to psychologists, social workers, partners, and friends. Needs were examined in relation to parent and child characteristics, including sex, age, and parent posttraumatic stress symptoms (PTSS).Results: The proportion reporting a need of support from psychologists varied from 56% and 46% at T5 to 20% and 6% at T7 (mothers and fathers, respectively). All mothers and 90% of fathers reported a need of support from social workers at T5. At T7, the corresponding percentages were 30% and 6%. More mothers than fathers reported a need of support from friends at T7 (p = .001). The proportion reporting a need of support from psychologists, social workers, and friends decreased over time (all p ≤ .050). Parents reporting a higher level of PTSS were more likely to report a need of support from social workers at T6 (p = .040) and from psychologists (p = .011) and social workers (p = .012) at T7. Opportunities for support from healthcare professionals varied, most reported need of and opportunity for support from significant others. Almost all reported benefit from received support.Conclusion: Bereaved parents need and benefit of support from healthcare professionals and significant others. Results show a need for improved access to psychosocial services, even at five years post bereavement. Large-scale studies are needed to better understand the associations between parent and child characteristics and support needs.
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Affiliation(s)
- Emma Hovén
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Josefin Hagström
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ulrika Pöder
- Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helena Grönqvist
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Mahat-Shamir M, Hamama-Raz Y, Leichtentritt RD. Body Perception and Organ Donation: Bereaved Parents' Perspectives. QUALITATIVE HEALTH RESEARCH 2019; 29:1623-1633. [PMID: 31140363 DOI: 10.1177/1049732319848405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The view of the body in sociological, psychological, and gender studies may be broadly summarized to three metaphors: (a) the body as a machine, (b) the body as Self, and (c) the body as sacred and sanctified entity. Each of these philosophical views has an impact on organ donation. The current study aimed at revealing body perception of bereaved Israeli parents who agreed to donate organs of their deceased child. A deductive and inductive thematic analysis captured an ongoing perceptual change that bereaved donor parents experienced in their view of the child's body. Parents' ability to move between two positions (the body as Self, the body as a machine) allowed them to agree with and protect their decision to donate as well as to maintain an ongoing bond with their deceased child. The view of the body as scared entity was not evident in the bereaved parents' narratives.
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Dias N, Hendricks-Ferguson VL, Wei H, Boring E, Sewell K, Haase JE. A Systematic Literature Review of the Current State of Knowledge Related to Interventions for Bereaved Parents. Am J Hosp Palliat Care 2019; 36:1124-1133. [DOI: 10.1177/1049909119858931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aims: The purpose of this systematic literature review is to describe the interventions for bereaved parents, evaluate intervention effectiveness through study methodology rigor, replicability, and theoretical foundations. Methods: We searched MEDLINE via PubMed (1966-2018), CINAHL (1937-present), PsycINFO (1887-present), and Embase (1947-present) using various search words and MeSH terms related to the study purpose. A blinded screening of title/abstract was performed, with conflicting inclusion decisions resolved through group discussions. Matrices for remaining articles were created and discussed among the team. The levels of evidence of the 9 records were rated from very low to high based on the Grading of Recommendations Assessment, Development, and Evaluation guidelines. Results: Our initial pool included 1025 articles. After the screening of titles/abstracts, 63 articles were retained for full-text reviews. Evaluated based on the inclusion/exclusion criteria, 9 records met the review criteria. Of the 9 records, 1 was graded as very low, 3 low, and 5 low to moderate. The interventions for bereaved parents varied from using single-model interventions such as expressive arts therapy and telephone support to multimodal interventions that combined resources (ie, peer support, resource packets, and health-care support). Only 1 study explicitly illustrated how its bereavement intervention was designed based on the proposed theoretical model. Conclusions: This review highlights the need for individualized, well-tested, and effective bereavement care interventions to support bereaved parents. In summary, the state of the science on interventions for bereaved parents is poor and much work needs to be done to effectively address the needs of bereaved parents, including both their physical and emotional health needs.
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Affiliation(s)
- Nancy Dias
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | | | - Holly Wei
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | - Elizabeth Boring
- Hope in Healing Pediatric Bereavement Program, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Kerry Sewell
- College of Nursing/Department of Nursing Science, East Carolina University, Greenville, NC, USA
| | - Joan E. Haase
- The IUPUI Research in Palliative and End-of-Life Communication and Training (RESPECT), Indiana University School of Nursing, Indianapolis, IN, USA
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Vegsund HK, Reinfjell T, Moksnes UK, Wallin AE, Hjemdal O, Eilertsen MEB. Resilience as a predictive factor towards a healthy adjustment to grief after the loss of a child to cancer. PLoS One 2019; 14:e0214138. [PMID: 30897157 PMCID: PMC6428287 DOI: 10.1371/journal.pone.0214138] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/07/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Grief among bereaved parents is known to cause psychological distress and physical illness, but knowledge concerning factors that can contribute to health promotion after bereavement is scarce. Childhood cancer remains the most common non-accidental cause of death among children in Norway. The aim of the present study was to explore if resilience factors among cancer-bereaved parents could predict whether they will be able to come to terms with their grief 2-8 years following the loss. METHODS A Norwegian cross-sectional national survey was conducted among 161 cancer-bereaved parents using a study-specific questionnaire. Logistic regression was used to explore whether resilience factors predicted parents' grief outcome 2-8 years after their loss. RESULTS On the Resilience Scale for Adults (RSA), three of the resilience factors contributed significantly in predicting whether the parents in the present study would come to terms with their grief 2-8 years after the loss their child: "Perception of self "(OR 2.08, p = .048), "Social resources" (OR 2.83, p = .008) and "Family cohesion" (OR .41, p = .025). The results showed a negative relationship between time since loss (2-6 years) and whether the parents answered that they had come to terms with their grief (p = < .05). The loss of a parent (OR .30, p = .030) combined with the loss of their child had a negative and significant effect on whether they indicated that they had processed their grief. CONCLUSION The total score of RSA and three of the six resilient factors contributed significantly in predicting whether cancer-bereaved parents in the present study indicated that they had come to terms with their grief to a great extent. The present study supports hypotheses that regard resilience as an important contribution in predicting healthy outcomes in people exposed to adverse life events.
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Affiliation(s)
- Hilde Kristin Vegsund
- Department of Public Health and Nursing, Centre for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Trude Reinfjell
- Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Unni Karin Moksnes
- Department of Public Health and Nursing, Centre for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Odin Hjemdal
- Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Mary-Elizabeth Bradley Eilertsen
- Department of Public Health and Nursing, Centre for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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Parents: Wish I had done, wish I had not done, and coping after child NICU/PICU death. J Am Assoc Nurse Pract 2019; 31:175-183. [DOI: 10.1097/jxx.0000000000000110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hawthorne DM, Youngblut JM, Brooten D. Use of spiritual coping strategies by gender, race/ethnicity, and religion at 1 and 3 months after infant's/child's intensive care unit death. J Am Assoc Nurse Pract 2017; 29:591-599. [PMID: 28834324 PMCID: PMC5640480 DOI: 10.1002/2327-6924.12498] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE In the United States, 57,000 children (newborn to 18 years) die annually. Bereaved parents may rely on religious or spiritual beliefs in their grief. The study's purpose was to examine differences in parents' use of spiritual and religious coping practices by gender, race/ethnicity, and religion at 1 and 3 months after infant/ICU death. METHODS The sample consisted of 165 bereaved parents, 78% minority. The Spiritual Coping Strategies Scale was used to measure religious and spiritual coping practices, separately. One-way ANOVAs indicated that Black non-Hispanic mothers used significantly more religious coping practices at 3 months than White non-Hispanic mothers. Protestant and Catholic parents used more religious coping practices than the "no" and "other" religion groups at 1 and 3 months. Within the 30 mother-father dyads (paired t-tests), mothers reported significantly greater use of religious coping practices at 1 and 3 months and spiritual coping practices at 3 months than fathers. CONCLUSION Religious coping practices were most commonly used by Black mothers and Protestant and Catholic parents. Within dyads, mothers used more spiritual and religious coping practices than fathers. IMPLICATIONS FOR PRACTICE These findings are beneficial for healthcare personnel in providing support to bereaved parents of diverse races/ethnicities and religions.
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Affiliation(s)
- Dawn M Hawthorne
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida
| | - JoAnne M Youngblut
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida
| | - Dorothy Brooten
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida
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Abstract
Bereaved parents have higher morbidity and mortality rates when compared to nonbereaved parents. Although parental grief is well studied, the complexities of challenges bereaved parents face are not understood. This study describes parental bereavement challenges during the first 6 months following the death of their child. The complex parental bereavement challenges are characterized by the absence of the child, their emotional response, and the changed relationships with family and friends. The adaptive leadership framework is a useful framework to identify and classify challenges. Future research can use this framework to provide a structure that test interventions to address the challenges.
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Affiliation(s)
- Nancy Dias
- a Indiana University School of Nursing , Indianapolis , Indiana , USA
| | - Sharron Docherty
- b Department of Pediatrics, School of Medicine , Duke University School of Nursing , Durham , North Carolina , USA
| | - Debra Brandon
- b Department of Pediatrics, School of Medicine , Duke University School of Nursing , Durham , North Carolina , USA
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