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Superdock AK, Barfield RC, Brandon DH, Docherty SL. Exploring the vagueness of Religion & Spirituality in complex pediatric decision-making: a qualitative study. BMC Palliat Care 2018; 17:107. [PMID: 30208902 PMCID: PMC6134505 DOI: 10.1186/s12904-018-0360-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 08/31/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Medical advances have led to new challenges in decision-making for parents of seriously ill children. Many parents say religion and spirituality (R&S) influence their decisions, but the mechanism and outcomes of this influence are unknown. Health care providers (HCPs) often feel unprepared to discuss R&S with parents or address conflicts between R&S beliefs and clinical recommendations. Our study sought to illuminate the influence of R&S on parental decision-making and explore how HCPs interact with parents for whom R&S are important. METHODS A longitudinal, qualitative, descriptive design was used to (1) identify R&S factors affecting parental decision-making, (2) observe changes in R&S themes over time, and (3) learn about HCP perspectives on parental R&S. The study sample included 16 cases featuring children with complex life-threatening conditions. The length of study for each case varied, ranging in duration from 8 to 531 days (median = 380, mean = 324, SD = 174). Data from each case included medical records and sets of interviews conducted at least monthly with mothers (n = 16), fathers (n = 12), and HCPs (n = 108). Thematic analysis was performed on 363 narrative interviews to identify R&S themes and content related to decision-making. RESULTS Parents from 13 cases reported R&S directly influenced decision-making. Most HCPs were unaware of this influence. Fifteen R&S themes appeared in parent and HCP transcripts. Themes most often associated with decision-making were Hope & Faith, God is in Control, Miracles, and Prayer. Despite instability in the child's condition, these themes remained consistently relevant across the trajectory of illness. R&S influenced decisions about treatment initiation, procedures, and life-sustaining therapy, but the variance in effect of R&S on parents' choices ultimately depended upon other medical & non-medical factors. CONCLUSIONS Parents consider R&S fundamental to decision-making, but apply R&S concepts in vague ways, suggesting R&S impact how decisions are made more than what decisions are made. Lack of clarity in parental expressions of R&S does not necessarily indicate insincerity or underestimation of the seriousness of the child's prognosis; R&S can be applied to decision-making in both functional and dysfunctional ways. We present three models of how religious and spiritual vagueness functions in parental decision-making and suggest clinical applications.
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Affiliation(s)
- Alexandra K. Superdock
- School of Medicine, Duke University, Durham, NC USA
- Pediatrics Residency Program, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, 15224 PA USA
| | - Raymond C. Barfield
- Division of Pediatric Hematology and Oncology, Duke University School of Medicine, 2 Chapel Drive, 0034 Westbrook, Durham, NC 27708 USA
| | - Debra H. Brandon
- Department of Pediatrics, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710 USA
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710 USA
| | - Sharron L. Docherty
- Department of Pediatrics, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710 USA
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710 USA
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Donnelly JP, Huff SM, Lindsey ML, McMahon KA, Schumacher JD. The needs of children with life-limiting conditions: A healthcare-provider-based model. Am J Hosp Palliat Care 2016; 22:259-67. [PMID: 16082911 DOI: 10.1177/104990910502200406] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pediatric hospice and palliative care has progressed in recent years with the development of new programs and models of care. Missing from the empirical literature, however, is a model of the needs of children. The purpose of the present study was to develop an empirically based conceptual model of the needs of children with life-limiting conditions. Recognizing the value of both qualitative and quantitative data, concept mapping methodology was selected as an effective way to obtain data that reflected both the “big picture” and subtleties of pediatric endof-life needs. The seven-cluster concept map appeared best in terms of both interpretability and parsimony. This model includes the following clusters of needs: 1) pain, 2) decision making, 3) medical system access and quality, 4) dignity and respect, 5) family-oriented care, 6) spirituality, and 7) psychosocial issues. We believe that the development of a comprehensive model of the needs of such children is a step toward concrete, measurable, and effective support for children and their families.
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Affiliation(s)
- James P Donnelly
- School and Educational Psychology, University at Buffalo/State University of New York, Buffalo, New York, USA
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3
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Kane JR, Hellsten MB, Coldsmith A. Human Suffering: The Need for Relationship-Based Research in Pediatric End-of-Life Care. J Pediatr Oncol Nurs 2016; 21:180-5. [PMID: 15296050 DOI: 10.1177/1043454204264393] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Children living with and dying from advanced cancer and their families experience significant suffering. The cure of disease and the relief of suffering are dual moral obligations of our professions. To relieve suffering, health care providers must understand the multiple dimensions of the person who suffers and the complex set of relationships within the natural and the clinical social networks. Pediatric oncology research must include appropriately designed studies with sound methodology and measurement strategies to test and refine theories that account for the link between human relationships and the relief of suffering. Studies should assess as many theoretical models as possible, including the social network, perceptions of support, and provider-recipient interactions; their physical, emotional, behavioral, and spiritual concomitants; and their impact on medical decision making and health outcomes. Future directions in pediatric end-of-life care research must also include evaluating social and spiritual interventions developed on the basis of solid hypotheses regarding the positive and negative influences of interpersonal dynamics on the processes that mediate between suffering and well-being.
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Affiliation(s)
- Javier R Kane
- Department of Pediatrics, UTHSC-SA, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
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Abstract
Survival rates for childhood cancer have increased over the past 2 decades, due in large part to the increase in the intensity and complexity of the treatment modalities used. We can presume that this increase in intensity has produced increased distress or suffering (physical, psychological, social, and spiritual) in the child or adolescent undergoing these therapies for cancer. However, measurement of suffering is more than symptom occurrence, frequency, duration, and severity. An analysis of the concept of suffering is presented. Suffering needs to be defined and measured by self-report (as opposed to parent or staff report) to gain an accurate, complete holistic picture of the nature and scope of the child’s and adolescent’s suffering. Knowledge of how children and adolescents experience suffering would enable practitioners to design interventions to prevent or ameliorate this suffering.
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Affiliation(s)
- Dianne Fochtman
- Kapiolani Medical Center for Women and Children, Honolulu, HI 96826, USA.
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5
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Epstein I. Adventure Therapy: A Mental Health Promotion Strategy in Pediatric Oncology. J Pediatr Oncol Nurs 2016; 21:103-10. [PMID: 15125554 DOI: 10.1177/1043454203262684] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In adventure therapy (AT), health professionals and adolescents with cancer come together to explore the wilderness of nature. One goal of this therapy is to encourage the adolescents to enhance their self-concept as part of an overall physical, cognitive, emotional or spiritual, social and psychological, or developmental rehabilitation that promotes health. The adolescents with cancer who participate in AT also learn about themselves through self-evaluation, self-exploration, self-reevaluation, self-acceptance, and self-realization. Mental health promotion (MHP) is considered a perspective and a strategy to promote health. An AT experience could be an example of an MHP initiative in which nurses can take a leadership role in participating, and further investigating, the health effects of AT on adolescents with cancer.
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Affiliation(s)
- Iris Epstein
- Faculty of Nursing, University of Toronto, Ontario, Canada
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6
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de Weerd W, van Tol D, Albers M, Sauer P, Verkerk M. Suffering in children: opinions from parents and health-care professionals. Eur J Pediatr 2015; 174:589-95. [PMID: 25326280 DOI: 10.1007/s00431-014-2440-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/07/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Alleviation of suffering is considered to be one of the important goals of medical interventions. Understanding of what constitutes suffering in children admitted to a pediatric intensive care unit (PICU) is lacking. This study aims to assess perceptions by parents, doctors, and nurses of suffering in critically ill children. We interviewed 124 participants (parents, physicians, and PICU nurses) caring for 29 admitted children in a 20-bed level-III PICU and performed a qualitative analysis. We found that most participants made a distinction between physical and existential suffering. Parents considered the child's suffering caused by or associated with visible signs as discomfort. Nurses linked suffering to the child's state of comfort. Physicians linked them to the intensity and impact of treatment and future perspectives of the child. Various aspects of the child's suffering and admission to a PICU caused suffering in parents. CONCLUSION Parents', physicians', and nurses' perceptions of suffering overlap but also show important differences. Differences found seem to be rooted in the relation to and kind of responsibility (parental/professional) for the child. The child's illness, suffering, and hospital admission cause suffering in parents. Health-care professionals in PICUs need to be aware of these phenomena.
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Affiliation(s)
- Willemien de Weerd
- Department of Pediatrics, Division of Intensive Care, Beatrix Children's Hospital, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands,
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Akard TF, Dietrich MS, Friedman DL, Hinds PS, Given B, Wray S, Gilmer MJ. Digital storytelling: an innovative legacy-making intervention for children with cancer. Pediatr Blood Cancer 2015; 62:658-65. [PMID: 25586983 PMCID: PMC4339662 DOI: 10.1002/pbc.25337] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/07/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study examined the feasibility of a legacy-making intervention in children with cancer and the preliminary effects on outcomes related to quality of life. PROCEDURE Children (N = 28) ages 7-17 years completed a baseline QOL questionnaire (PedsQL) at T1. After baseline, the intervention group (n = 15) completed a randomized intervention that guided children to answer questions about legacy-making and create a digital story about themselves. A final copy of the digital story was provided to the families. A control group (n = 13) received customary care. Children repeated the questionnaire at T2. Parents (N = 22) of children who completed the intervention completed follow-up survey questions regarding intervention effects. RESULTS Feasibility was strong (78% participation; 1 attrition). While differences between the groups in physical, emotional, social, or school functioning change was not statistically significant, the intervention group showed slightly better emotional and school functioning compared to controls. Parents reported that their child's digital story provided emotional comfort to them (n = 11, 46%), facilitated communication between parents and children (n = 9, 38%), and was a coping strategy for them (n = 4, 17%). Parents reported that the intervention helped children express their feelings (n = 19, 79%), cope (n = 6, 27%), and feel better emotionally (n = 5, 23%). CONCLUSIONS Our intervention is feasible for children with cancer, is developmentally appropriate for children 7-17 years of age, and demonstrates promise to improve quality of life outcomes for children with cancer and their parents.
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Affiliation(s)
- Terrah Foster Akard
- Vanderbilt University School of Nursing
- Correspondence to: Terrah Foster Akard, PhD, RN, CPNP, Vanderbilt University School of Nursing, 461 21 Avenue S, 418 Godchaux Hall, Nashville, TN 37240; Tel: (615) 343-6025; Fax: (615) 343-5898;
| | - Mary S. Dietrich
- Vanderbilt University School of Nursing
- Vanderbilt University School of Medicine
| | | | | | | | | | - Mary Jo Gilmer
- Vanderbilt University School of Nursing
- Monroe Carell Jr Children’s Hospital at Vanderbilt
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Ångström-Brännström C, Norberg A. Children undergoing cancer treatment describe their experiences of comfort in interviews and drawings. J Pediatr Oncol Nurs 2014; 31:135-46. [PMID: 24651546 DOI: 10.1177/1043454214521693] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with cancer often undergo a long course of treatment, described as painful, and associated with feelings of discomfort and need of comfort. The aim of this descriptive interview study was to investigate how children, aged 3 to 9 years, undergoing cancer treatment describe their experience of comfort. The children were interviewed and asked to make drawings. Data were content analyzed and four themes were constructed--enduring discomfort, expressing discomfort, finding comfort, and comforting others. The findings show that the children endured discomfort during treatment, and were sometimes able to express it. They found comfort especially from their family and from hospital staff. The children also described that they comforted family members. The findings are in accordance with previous research about children's and adults' accounts of comfort. An incidental finding is that parents were surprised when they listened to the children's accounts of their experience of discomfort and comfort and achieved a better understanding of their children.
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Petersen CL. Spiritual care of the child with cancer at the end of life: a concept analysis. J Adv Nurs 2013; 70:1243-53. [PMID: 24102699 DOI: 10.1111/jan.12257] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2013] [Indexed: 01/07/2023]
Abstract
AIM The aim of this paper is to report an analysis of the concept of spiritual care of a child with cancer at the end of life. BACKGROUND Spirituality is a vital dimension of a child's experience at the end of life; providing comfort; support; and a sense of connection. Spiritual care is paramount to address the substantial spiritual distress that may develop. DESIGN Rodgers' method of evolutionary concept analysis guided the review process. DATA SOURCES The literature search was not limited by start date and literature through the end of 2012 was included. English, peer-reviewed texts in the databases CINAHL, ATLA and PubMed were included. METHODS Critical analysis of the literature identified surrogate terms, related concepts, attributes, antecedents and consequences. RESULTS The analysis identified six attributes: assessing spiritual needs; assisting the child to express feelings; guiding the child in strengthening relationships; helping the child to be remembered; assisting the child to find meaning; and aiding the child to find hope. Antecedents include existential questions and spiritual distress. Consequences include a peaceful death, spiritual growth, a relationship of trust and enhanced end-of-life care. CONCLUSION Spiritual care is a vital aspect of holistic nursing care; however, gaps in knowledge and practice prevent children from receiving adequate spiritual care at the end of life. Nurses would benefit from increased awareness, skills and knowledge about spiritual care. Research is needed to identify interventions that exert the greatest effect on patient care outcomes.
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Primary Caregivers’ Decisions Around Communicating About Death With Children Involved in Pediatric Palliative Care. J Hosp Palliat Nurs 2013. [DOI: 10.1097/njh.0b013e318293dc20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McFerran K, Hogan B. The overture: initiating discussion on the role of music therapy in paediatric palliative care. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/096992605x42350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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Affiliation(s)
- Sun Young Son
- Transplant Coordinator, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
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14
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Foster TL, Lafond DA, Reggio C, Hinds PS. Pediatric Palliative Care in Childhood Cancer Nursing: From Diagnosis to Cure or End of Life. Semin Oncol Nurs 2010; 26:205-21. [DOI: 10.1016/j.soncn.2010.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Richter L, Chandan U, Rochat T. Improving hospital care for young children in the context of HIV/AIDS and poverty. J Child Health Care 2009; 13:198-211. [PMID: 19713404 DOI: 10.1177/1367493509336680] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Paediatric wards in South African government hospitals are occupied predominantly by children with HIV and AIDS-related illnesses. Although access to anti-retroviral treatment for adults is being scaled up, it is likely to be many years before South Africa achieves anywhere near universal access for children. Currently, most children living with HIV or AIDS are identified only when they become acutely or chronically ill and/or hospitalized, if at all. In the absence of treatment, the stress of caring for ill and hospitalized HIV-positive children often results in emotional withdrawal among both health professionals and caregivers. The demoralizing cycle of repeated admissions, treatment failure and death also affect the quality of the care given to HIV-negative children in over-burdened wards. This article describes the development of simple, low-cost and context-relevant interventions to improve the care environment for young hospitalized children within the context of the HIV/AIDS epidemic and poverty.
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Affiliation(s)
- Linda Richter
- Child, Youth, Family and Social Development, Human Sciences Research Council, Durban, South Africa.
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Baker JN, Hinds PS, Spunt SL, Barfield RC, Allen C, Powell BC, Anderson LH, Kane JR. Integration of palliative care practices into the ongoing care of children with cancer: individualized care planning and coordination. Pediatr Clin North Am 2008; 55:223-50, xii. [PMID: 18242323 PMCID: PMC2577813 DOI: 10.1016/j.pcl.2007.10.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Most parents of children with cancer have dual primary goals: a primary cancer-directed goal of cure and a primary comfort-related goal of lessening suffering. Early introduction of palliative care principles and practices into their child's treatment is respectful and supportive of these goals. The Individualized Care Planning and Coordination Model is designed to integrate palliative care principles and practices into the ongoing care of children with cancer. Application of the model helps clinicians to generate a comprehensive individualized care plan that is implemented through Individualized Care Coordination processes as detailed here. Clinicians' strong desire to provide compassionate, competent, and sensitive care to the seriously ill child and the child's family can be effectively translated into clinical practice through these processes.
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Affiliation(s)
- Justin N Baker
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA
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Baker JN, Barfield R, Hinds PS, Kane JR. A process to facilitate decision making in pediatric stem cell transplantation: the individualized care planning and coordination model. Biol Blood Marrow Transplant 2007; 13:245-54. [PMID: 17317576 DOI: 10.1016/j.bbmt.2006.11.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 11/13/2006] [Indexed: 11/24/2022]
Abstract
Providers of care for children undergoing stem cell transplantation (SCT) skillfully combine the roles of scientist and clinician. As scientists, they apply scientific methods and disease theory in the creation and testing of new therapies and in the careful observation and exploration of treatment outcomes. As clinicians, they are capable of intuitively delivering care in a patient- and family-centered context of meaning and life values. The specialty of SCT has inherent aspects that make treatment decision making complex and potentially contentious. Having a strategy ready to implement in advance or at the time when treatment decisions need to be made will facilitate and enhance the decision making process for both the health care team and family members. Here we introduce the individualized care planning and coordination (ICPC) model as a practical approach to facilitate ethical and effective decision making in pediatric SCT settings. The ICPC is a 3-step model comprising (1) relationship--understanding the illness experience from the perspective of the patient and family, sharing relevant information, and assessing ongoing needs; (2) negotiation--prognosticating, establishing goals of care, and discussing treatment options; and (3) plan--generating a comprehensive plan of care that includes life and medical plans. Based on a foundation of a care of competence, empathy, compassion, communication, and quality, the ICPC model aims to diminish contentious family-staff interactions that can lead to mistrust and help guide treatment decision making. The ICPC model enhances communication among patients, families, and clinicians by revealing patient and family values and medical and quality-of-life priorities before reaching or even during critical decision points in the transplantation process.
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Affiliation(s)
- Justin N Baker
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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Hinds PS, Drew D, Oakes LL, Fouladi M, Spunt SL, Church C, Furman WL. End-of-life care preferences of pediatric patients with cancer. J Clin Oncol 2005; 23:9146-54. [PMID: 16172453 DOI: 10.1200/jco.2005.10.538] [Citation(s) in RCA: 220] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The viewpoint of the terminally ill child at the time of an end-of-life decision has not been formally investigated. We identified the preferences of children and adolescents with advanced cancer about their end-of-life care and the factors that influenced their decisions. PATIENTS AND METHODS Pediatric patients 10 or more years of age were interviewed within 7 days of participating in one of the following three end-of-life decisions: enrollment onto a phase I trial (n = 7), adoption of a do not resuscitate order (n = 5), or initiation of terminal care (n = 8). The patient, a parent, and the primary pediatric oncologist were interviewed separately by using open-ended interview questions. RESULTS Twenty patients, aged 10 to 20 years (mean, 17 years and 4 months), with a refractory solid tumor (n = 12), brain tumor (n = 4), or leukemia (n = 4) participated. Eighteen patients (90%) accurately recalled all of their treatment options and identified their own death as a consequence of their decision. The factors that were most frequently identified included the following: for patients, caring about others (n = 19 patients); for parents, the child's preferences (n = 18 parents); and for physicians, the patient's prognosis and comorbid conditions (n = 14 physicians). CONCLUSION These children and adolescents with advanced cancer realized that they were involved in an end-of-life decision, understood the consequences of their decision, and were capable of participating in a complex decision process involving risks to themselves and others. The decision factors most frequently reported by patients were relationship based; this finding is contrary to existing developmental theories.
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Affiliation(s)
- Pamela S Hinds
- Division of Nursing Research and Patient Care Services, Department of Hematology-Oncology, Palliative and End-of-Life Care Task Force, and Ethics Committee, St Jude Children's Research Hospital, Memphis, TN, USA.
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Finder JD, Birnkrant D, Carl J, Farber HJ, Gozal D, Iannaccone ST, Kovesi T, Kravitz RM, Panitch H, Schramm C, Schroth M, Sharma G, Sievers L, Silvestri JM, Sterni L. Respiratory Care of the Patient with Duchenne Muscular Dystrophy. Am J Respir Crit Care Med 2004; 170:456-65. [PMID: 15302625 DOI: 10.1164/rccm.200307-885st] [Citation(s) in RCA: 505] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Woodgate RL, Degner LF. Expectations and beliefs about children's cancer symptoms: perspectives of children with cancer and their families. Oncol Nurs Forum 2003; 30:479-91. [PMID: 12719747 DOI: 10.1188/03.onf.479-491] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe the childhood cancer symptom course experienced by children with cancer from the perspectives of the children and their families. DESIGN Longitudinal, qualitative research approach. SETTING The participants' homes and inpatient and outpatient pediatric cancer units in western Canada. SAMPLE A theoretical purposive sample of 39 children (4.5-18 years of age) with a variety of cancer diagnoses and their family members. METHODS Open-ended formal interviews with children and their family members (N = 230) and participant observation of children and their family members for more than 960 hours during various periods during their illness, at various locations, and at different points in time during the study period. MAIN RESEARCH VARIABLES Children's and their families' perspectives of cancer symptoms experienced by children with cancer. FINDINGS Children and families had definite beliefs and expectations about the cancer symptom experiences, including (a) short-term pain for long-term gain, (b) you never get used to them, (c) they all suck, (d) it sort of helps, and (e) they are all the same but they are all different. Underpinning all of the participants' beliefs and expectations was the experience of suffering. Their beliefs and expectations contributed to and were a direct result of cancer symptoms that were ignored, unrelieved, or uncontrolled. CONCLUSIONS Children with cancer live with symptoms on a daily basis and have experiences of unrelieved cancer symptoms. Although cancer symptoms resulted in suffering by the children and families, they accepted the symptoms as an integral part of overcoming cancer and never expected complete symptom relief. IMPLICATIONS FOR NURSING Oncology nurses need to be more vigilant in their assessment and management of children's cancer symptoms. Further research is warranted detailing not only children's and family's beliefs and expectations of cancer symptom experiences but also nurses' understanding and interpretations of children's cancer symptom experiences. Intervention studies designed to relieve all types of cancer symptoms experienced by children must be undertaken.
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