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Abstract
In this narrative medicine essay, a pediatric oncologist grapples with the emotions of loss and guilt while attending the memorial service of her 8-year-old patient.
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Affiliation(s)
- Mallory R Taylor
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
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Loxton I, Oxlad M, Perry A. Consulting parents bereaved by childhood cancer: A qualitative study to improve bereavement services. DEATH STUDIES 2022; 47:891-901. [PMID: 36344115 DOI: 10.1080/07481187.2022.2142325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Twelve Australian parents bereaved by childhood cancer were interviewed about their experiences of, and preferences for, bereavement support, to inform recommendations to improve bereavement care. Reflexive thematic analysis resulted in five themes: Care, empathy, and connection assist with bereavement; Communication makes a difference; Early and ongoing support is desired; Gender matters when grieving the loss of a child; and The pull of peer support. Parents can be assisted through empathy, early and ongoing support, enhanced communication, peer support, and care that is inclusive of all genders. Parents in non-metropolitan areas require increased and flexible support options.
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Affiliation(s)
- Isabella Loxton
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Anna Perry
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Childhood Cancer Association, Adelaide, Australia
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Dos Santos KL, Gremigni P, Casu G, Zaia V, Montagna E. Development and validation of The Breaking Bad News Attitudes Scale. BMC MEDICAL EDUCATION 2021; 21:196. [PMID: 33827548 PMCID: PMC8028222 DOI: 10.1186/s12909-021-02636-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 03/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Communication of bad news plays a critical role in the physician-patient relationship, and a variety of consensus guidelines have been developed to this purpose, including the SPIKES protocol. However, little is known about physicians' attitudes towards breaking bad news and to be trained to deliver it. This study aimed to develop and validate a self-report questionnaire to assess physicians' attitudes towards principles of the SPIKES protocol and training on them. METHODS The Breaking Bad News Attitudes Scale (BBNAS) was administered to 484 pediatricians and 79 medical students, recruited at two scientific conferences and two medical schools in Brazil. The questionnaire structural validity, reliability, and associations with other variables were tested. RESULTS The BBNAS showed adequate validity and good reliability, with two factors measuring attitudes towards the SPIKES strategy for braking bad news (α = 0.81) and the possibility to be trained on it (α = 0.77), respectively. CONCLUSION The novel questionnaire is a psychometrically sound measure that provides information on physicians' agreement with the SPIKES protocol. The BBNAS can provide useful information for planning training and continuing education programs for clinicians on communication of bad news using the SPIKES as a framework.
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Affiliation(s)
- Kátia Laureano Dos Santos
- Centro Universitário FMABC, Faculdade de Medicina do ABC, Av Príncipe de Gales, 821, Santo André, 09060-650, Brazil
| | - Paola Gremigni
- Department of Psychology, University of Bologna, viale Berti Pichat, 5, 40127, Bologna, Italy
| | - Giulia Casu
- Department of Psychology, University of Bologna, viale Berti Pichat, 5, 40127, Bologna, Italy
| | - Victor Zaia
- Centro Universitário FMABC, Faculdade de Medicina do ABC, Av Príncipe de Gales, 821, Santo André, 09060-650, Brazil
- Centro Universitário FMABC, Instituto Ideia Fértl de Saúde Sexual e Reprodutiva, Av. Príncipe de Gales, 821, Santo André, 09060-650, São Paulo, Brazil
| | - Erik Montagna
- Centro Universitário FMABC, Faculdade de Medicina do ABC, Av Príncipe de Gales, 821, Santo André, 09060-650, Brazil.
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Kim K, Churilov L, Tan CO, Phan T, Geertsema J, Krieser R, Mehra R, Stewart PA, Rachbuch C, Huang A, Weinberg L. Anaesthetists' attitudes towards attending the funerals of their patients: A cross-sectional study among Australian and New Zealand anaesthetists. PLoS One 2020; 15:e0239996. [PMID: 33151958 PMCID: PMC7643987 DOI: 10.1371/journal.pone.0239996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022] Open
Abstract
A patient’s death can pose significant stress on the family and the treating anaesthetist. Anaesthetists’ attitudes about the benefits of and barriers to attending a patient’s funeral are unknown. Therefore, we performed a prospective, cross-sectional study to ascertain the frequency of anaesthetists’ attendance at a patient’s funeral and their perceptions about the benefits and barriers. The primary aim was to investigate the attitudes of anaesthetists towards attending the funeral of a patient. The secondary aims were to examine the perceived benefits of and barriers to attending the funeral and to explore the rate of bonds being formed between anaesthetists, patients and families. Of the 424 anaesthetists who completed the survey (response rate 21.2%), 25 (5.9%) had attended a patient’s funeral. Of the participants, 364 (85.9%) rarely formed special bonds with patients or their families; 233 (55%) believed that forming a special bond would increase the likelihood of their attendance. Showing respect to patients or their families was the most commonly perceived benefit of attending a funeral. Participants found expression of personal grief and caring for the patient at the end-of-life and beyond beneficial to themselves and the family. Fear of their attendance being misinterpreted or perceived as not warranted by the family as well as time restraints were barriers for their attendance. Most anaesthetists had never attended a patient’s funeral. Few anaesthetists form close relationships with patients or their families. Respect, expression of grief and caring beyond life were perceived benefits of attendance. Families misinterpreting the purpose of attendance or not expecting their attendance and time restraints were commonly perceived barriers. Trial registration:ACTRN 12618000503224.
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Affiliation(s)
- Kwangtaek Kim
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health) & Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, Victoria, Australia
| | - Chong Oon Tan
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Tuong Phan
- Department of Anaesthesia, St Vincent’s Hospital, Fitzroy, Victoria, Australia
| | - Jake Geertsema
- Department of Anaesthesia, The Northern Hospital, Epping, Victoria, Australia
| | - Roni Krieser
- Department of Anaesthesia, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Rishi Mehra
- Department of Anaesthesia, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul Anthony Stewart
- Department of Anaesthesia, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - Clive Rachbuch
- Department of Anaesthesia, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Andrew Huang
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Victoria, Australia
- * E-mail:
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Kochen EM, Jenken F, Boelen PA, Deben LMA, Fahner JC, van den Hoogen A, Teunissen SCCM, Geleijns K, Kars MC. When a child dies: a systematic review of well-defined parent-focused bereavement interventions and their alignment with grief- and loss theories. BMC Palliat Care 2020; 19:28. [PMID: 32164668 PMCID: PMC7068872 DOI: 10.1186/s12904-020-0529-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/19/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The availability of interventions for bereaved parents have increased. However, most are practice based. To enhance the implementation of bereavement care for parents, an overview of interventions which are replicable and evidence-based are needed. The aim of this review is to provide an overview of well-defined bereavement interventions, focused on the parents, and delivered by regular health care professionals. Also, we explore the alignment between the interventions identified and the concepts contained in theories on grief in order to determine their theoretical evidence base. METHOD A systematic review was conducted using the methods PALETTE and PRISMA. The search was conducted in MEDLINE, Embase, and CINAHL. We included articles containing well-defined, replicable, paediatric bereavement interventions, focused on the parent, and performed by regular health care professionals. We excluded interventions on pathological grief, or interventions performed by healthcare professionals specialised in bereavement care. Quality appraisal was evaluated using the risk of bias, adapted risk of bias, or COREQ. In order to facilitate the evaluation of any theoretical foundation, a synthesis of ten theories about grief and loss was developed showing five key concepts: anticipatory grief, working models or plans, appraisal processes, coping, and continuing bonds. RESULTS Twenty-one articles were included, describing fifteen interventions. Five overarching components of intervention were identified covering the content of all interventions. These were: the acknowledgement of parenthood and the child's life; establishing keepsakes; follow-up contact; education and information, and; remembrance activities. The studies reported mainly on how to conduct, and experiences with, the interventions, but not on their effectiveness. Since most interventions lacked empirical evidence, they were evaluated against the key theoretical concepts which showed that all the components of intervention had a theoretical base. CONCLUSIONS In the absence of empirical evidence supporting the effectiveness of most interventions, their alignment with theoretical components shows support for most interventions on a conceptual level. Parents should be presented with a range of interventions, covered by a variety of theoretical components, and aimed at supporting different needs. Bereavement interventions should focus more on the continuous process of the transition parents experience in readjusting to a new reality. TRIAL REGISTRATION This systematic review was registered in Prospero (registration number: CRD42019119241).
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Affiliation(s)
- Eline M Kochen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Floor Jenken
- Department Woman and Baby, Wilhelmina Childrens Hospital, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of clinical psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands
| | - Laura M A Deben
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Jurrianne C Fahner
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department Woman and Baby, Wilhelmina Childrens Hospital, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Karin Geleijns
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
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Being there: A scoping review of grief support training in medical education. PLoS One 2019; 14:e0224325. [PMID: 31774815 PMCID: PMC6880967 DOI: 10.1371/journal.pone.0224325] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/10/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Medical education experts argue that grief support training for physicians would improve physician and patient and family wellness, and should therefore be mandatory. However, there is little evidence about the range of curricula interventions or the impact of grief training. The aim of this scoping review was to describe the current landscape of grief training worldwide in medical school, postgraduate residency and continuing professional development in the disciplines of pediatrics, family medicine and psychiatry. Methods Using Arksey and O’Malley’s scoping review principles, MEDLINE, EMBASE, ERIC, PsychInfo and Web of Science were searched by a librarian. Two levels of screening took place: a title and abstract review for articles that fit a predefined criteria and a full-text review of articles that met those criteria. Three investigators reviewed the articles and extracted data for analysis. To supplement the search, we also scanned the reference lists of included studies for possible inclusion. Results Thirty-seven articles published between 1979 and 2019 were analyzed. Most articles described short voluntary grief training workshops. At all training levels, the majority of these workshops focused on transmitting knowledge about the ethical and legal dimensions of death, dying and bereavement in medicine. The grief trainings described were characterized by the use of diverse pedagogical tools, including lectures, debriefing sessions, reflective writing exercises and simulation/role-play. Discussion Grief training was associated with increased self-assessed knowledge and expertise; however, few of the studies analyzed the impact of grief training on physician and patient and family wellness. Our synthesis of the literature indicates key gaps exist, specifically regarding the limited emphasis on improving physicians’ communication skills around death and dying and the limited use of interactive and self-reflexive learning tools. Most trainings also had an overly narrow focus on bereavement grief, rather than a more broadly defined definition of loss.
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Kim K, Churilov L, Huang A, Weinberg L. Bereavement practices employed by hospitals and medical practitioners toward attending funeral of patients: A systematic review. Medicine (Baltimore) 2019; 98:e16692. [PMID: 31490361 PMCID: PMC6739025 DOI: 10.1097/md.0000000000016692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To ascertain bereavement practices offered by hospitals and medical practitioners (MPs), factors that influence the likelihood of MPs' involvement in funeral attendance, the benefits and barriers to attendance to a patient's funeral as perceived by MPs and the rate of attendance to patients' funeral by MPs. DESIGN MEDLINE (Ovid), Embase, PubMed, and Google Scholar were searched with a systematic search structure for randomized controlled trials, comparative observational studies, case series, cross-sectional studies, editorials, and letters. The search was limited to English only. The study was registered with Prospero (Registration Number: CRD42018095368). RESULTS A total of 381 articles were identified with 46 articles meeting the inclusion criteria. Of the 46, 16 were editorials and 12 were letters. Eighteen were cross-sectional studies conducted in the United States, Canada, Australia, Israel, and Ireland. Year of publication ranged from 1990 to 2017. Of these, 12 were quantitative, 3 were qualitative, and 3 were mixed-method studies. Two of the cross-sectional studies involved family members of deceased patients while others involved MPs. Bereavement practices offered by hospitals included memorial services, letters, and services provided by bereavement coordinators. Bereavement practices employed by MPs included answering or making phone calls, attending family meetings, and sending condolence letters. MPs' attendance at a patient's funeral was influenced by MPs' gender, age years of experience the medical specialty. Perceived benefits of MPs' attendance at a patient's funeral included providing support to the family, extending the professional relationship, illustrating respect to the patient and the family, resolving guilt and personal growth. Barriers to the attendance included a lack of time, blurring of professional boundaries, personal discomfort with death, emotional arousal, and discouragement by colleagues. General practice had an attendance rate of 71%. Attendance rates for palliative care, oncology, and psychiatrists ranged from 63% to 81%, 7.1% to 67%, and 15% to 67%, respectively. Intensivists had an attendance rate of 22%. CONCLUSION Several bereavement practices are provided by hospitals and MPs. Funeral attendance is an uncommon bereavement practice. MPs' attitudes toward attending a patient's funeral are understudied in many specialties. Patient factors that influence MPs' participation in bereavement practices are poorly understood.
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Affiliation(s)
| | - Leonid Churilov
- Department of Medicine (Austin Health), Melbourne Medical School, The University of Melbourne, Heidelberg, Australia
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Arzuaga BH, Petty C, Janvier A. The therapeutic space and doctor-parent relationship in paediatrics: trainees' experiences and perspectives. Acta Paediatr 2019; 108:1067-1073. [PMID: 30383899 DOI: 10.1111/apa.14634] [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: 09/10/2018] [Revised: 10/15/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022]
Abstract
AIM To explore paediatric trainees' experiences and perspectives regarding interactions and relationships between physicians and patients' parents. METHODS Email survey was sent to AAP Section of Pediatric Trainees members. Trainees were asked about 40 interactions with parents as well as perceived benefits/risks and potential influences. Analysis of associations between variables and perspectives/experiences used chi-square and Fisher exact. RESULTS Three hundred and seventy surveys were completed. Respondents participated in a median of nine interactions (IQR 7-13; range 0-37): 99.7% participated in at least one; 52% in 5-10; 41% in >10. 50% reported refusing to participate in at least one interaction following parental request; 8% refused 5-10; 1% refused >10. Electronic communication/social media domain had highest refusals and most interactions respondents believed should never be allowed. 94% agreed that interactions may be beneficial to providers: 75% identified at least one benefit; 86% one risk. Respondents who are parents or female reported increased interactions. CONCLUSION A variety of interactions with patient's parents are common amongst paediatric trainees, who identify risks and benefits. Disagreements relative to acceptability of certain interactions points to the need for additional research. A reflective educational approach, rather than a prescriptive one, may help trainees better manage these relationships.
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Affiliation(s)
- Bonnie H. Arzuaga
- Division of Newborn Medicine Boston Children's Hospital Boston MA USA
- Harvard Medical School Boston MA USA
| | - Carter Petty
- Institutional Centers for Clinical and Translational Research Boston Children's Hospital Boston MA USA
| | - Annie Janvier
- Department of Pediatrics Bureau de l’Éthique Clinique Université de Montréal Montréal QC Canada
- Division of Neonatology Research Center Clinical Ethics Unit Palliative Care Unit Unité de recherche en éthique clinique et partenariat famille CHU Sainte‐Justine Montréal QC Canada
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Zambrano SC, Chur-Hansen A, Crawford GB. Beyond Right or Wrong: Attitudes and Practices of Physicians, Nurses, Psychologists, and Social Workers Regarding Attendance at Patient Funerals. J Palliat Med 2019; 22:400-407. [DOI: 10.1089/jpm.2018.0234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sofia C. Zambrano
- Universitäres Zentrum für Palliative Care, Inselspital, Bern University Hospital, Bern, Switzerland
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Anna Chur-Hansen
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Gregory B. Crawford
- Northern Adelaide Palliative Service, Northern Adelaide Local Health Network, Adelaide, Australia
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Zambrano SC, Chur-Hansen A, Crawford GB. Attending patient funerals: Practices and attitudes of Australian medical practitioners. DEATH STUDIES 2017; 41:78-86. [PMID: 27611349 DOI: 10.1080/07481187.2016.1214631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The appropriateness of attending a patient's funeral is a medical dilemma. This article focuses on 437 doctors who participated in an online survey. Seventy-one percent of general practitioners, 67% of oncologists, 67% of psychiatrists, 63% of palliative medicine specialists, 52% of surgeons, and 22% of intensive care specialists had attended patient funerals. Significant differences in demographics and between specialties were identified in terms of barriers and benefits associated with attendance. Although attendance is a personal decision, there is a need for open discussions in medical education and professional development concerning death and the role of doctors after a patient dies.
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Affiliation(s)
- Sofía C Zambrano
- a School of Psychology , The University of Adelaide , Adelaide , Australia
| | - Anna Chur-Hansen
- a School of Psychology , The University of Adelaide , Adelaide , Australia
| | - Gregory B Crawford
- b School of Medicine , The University of Adelaide , Adelaide , Australia
- c Northern Adelaide Palliative Service , Northern Adelaide Local Health Network, Adelaide , Australia
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Jensen J, Weng C, Spraker-Perlman HL. A Provider-Based Survey To Assess Bereavement Care Knowledge, Attitudes, and Practices in Pediatric Oncologists. J Palliat Med 2017; 20:266-272. [PMID: 28072917 DOI: 10.1089/jpm.2015.0430] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bereavement support is a core tenet of palliative care that may prove difficult for clinicians as it is time-consuming, emotionally charged, and not emphasized in pediatrics training. This project is intended to describe the opinions, knowledge, and practice of bereavement care among pediatric oncologists to identify gaps in clinical care. PROCEDURES An internet-based survey instrument was pilot tested, refined, and distributed to pediatric oncologists in the United States. Statistical analysis was performed using SAS 9.2. RESULTS Electronic surveys were distributed to 2,061 pediatric oncologists and 522 surveys (25%) were fully completed. Participants were asked how likely they are to engage in particular bereavement activities (phone calls, condolence cards, memorial services, family meetings, or referrals for counseling) following the death of a pediatric cancer patient. Eighty-two percent of participants, at least, sometimes engage in at least one of these activities. Being female, an attending physician, and increased time in clinical practice were predictive of active participation in bereavement care. Nearly all participants (96%) believe that bereavement care is part of good clinical care, while 8% indicate that bereavement support is not their responsibility. Lack of time and resources were the biggest barriers to providing bereavement support. CONCLUSIONS The majority of pediatric oncologists engage in clinical practices to support bereaved families. Lack of time and physical resources pose significant barriers to clinician's efforts. Additional supports should be explored to increase pediatric oncology physician uptake of bereavement care practices.
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Affiliation(s)
- Jasmin Jensen
- 1 Division of Pediatric Hematology-Oncology, Kapiolani Medical Center for Women and Children , Honolulu, Hawaii
| | - Cindy Weng
- 2 Study Design and Biostatistics Center, School of Medicine, University of Utah , Salt Lake City, Utah
| | - Holly L Spraker-Perlman
- 3 Division of Pediatric Hematology-Oncology, University of Utah , Primary Children's Hospital, Salt Lake City, Utah
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Parental experiences with a hospital-based bereavement program following the loss of a child to cancer. Palliat Support Care 2016; 15:348-358. [DOI: 10.1017/s1478951516000821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AbstractObjective:The death of a child from cancer is an intense and life-changing loss for a parent. Guided by the principles of patient- and family-centered care, hospital-based caregivers developed a program to provide bereavement support for parents through phone calls and mailings. The aim of the present qualitative phenomenological study was to understand how parents experienced participating in this bereavement program.Method:A total of eight parents from six families participated in a focus-group evaluation of the two-year hospital-based bereavement program. Two social work clinicians/researchers independently analyzed the transcript of the focus group to define themes.Results:Four themes were identified: (1) lived experience of grief, (2) importance of relationships with the hospital-based team, (3) bereavement support from hospital-based providers, and (4) extending bereavement care.Significance of Results:Participants indicated the value of ongoing communication and connection with members of the healthcare team, who were often central to a family's life for years during their child's cancer treatment. Parents also provided suggestions for extending bereavement support through continued contact with providers and informal annual gatherings, as well as through a peer (parent-to-parent) support program.
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Brink HL, Thomsen AK, Laerkner E. Parents' experience of a follow-up meeting after a child's death in the Paediatric Intensive Care Unit. Intensive Crit Care Nurs 2016; 38:31-39. [PMID: 27526626 DOI: 10.1016/j.iccn.2016.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 06/20/2016] [Accepted: 06/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE 'To identify parents' experience of a follow up meeting and to explore whether the conversation was adequate to meet the needs of parents for a follow-up after their child's death in the Paediatric Intensive Care Unit (PICU). DESIGN AND SETTING Qualitative method utilising semi-structured interviews with six pairs of parents 2-12 weeks after the follow-up conversation. The interviews were held in the parents' homes at their request. Data were analysed using a qualitative, descriptive approach and thematic analysis. FINDINGS Four main themes emerged: (i) the way back to the PICU; (ii) framework; (iii) relations and (iv) closure. CONCLUSION The parents expressed nervousness before the meeting, but were all pleased to have participated in these follow-up meetings. The parents found it meaningful that the follow-up meeting was interdisciplinary, since the parents could have answers to their questions both about treatment and care. It was important that the staff involved in the follow-up meeting were those who had been present through the hospitalisation and at the time of the child's death. Parents experienced the follow-up meeting as being a closure of the course in the PICU, regardless the length of the hospitalisation.
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Affiliation(s)
- Helle L Brink
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark.
| | - Anja K Thomsen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
| | - Eva Laerkner
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
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Lichtenthal WG, Sweeney CR, Roberts KE, Corner GW, Donovan LA, Prigerson HG, Wiener L. Bereavement Follow-Up After the Death of a Child as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S834-69. [PMID: 26700929 PMCID: PMC4692196 DOI: 10.1002/pbc.25700] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/13/2015] [Indexed: 11/11/2022]
Abstract
After a child's death to cancer, families commonly want continued connection with the healthcare team that cared for their child, yet bereavement follow-up is often sporadic. A comprehensive literature search found that many bereaved parents experience poor psychological outcomes during bereavement and that parents want follow-up and benefit from continued connection with their child's healthcare providers. Evidence suggests that the standard of care should consist of at least one meaningful contact between the healthcare team and bereaved parents to identify those at risk for negative psychosocial sequelae and to provide resources for bereavement support.
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Affiliation(s)
- Wendy G. Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Corinne R. Sweeney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ
| | - Kailey E. Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Geoffrey W. Corner
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Leigh A. Donovan
- School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
| | - Holly G. Prigerson
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Granek L, Barrera M, Scheinemann K, Bartels U. When a child dies: pediatric oncologists' follow-up practices with families after the death of their child. Psychooncology 2015; 24:1626-31. [DOI: 10.1002/pon.3770] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Leeat Granek
- Department of Public Health, Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheva Israel
| | - Maru Barrera
- Department of Psychology and Hematology/Oncology Program; SickKids Hospital; Toronto ON Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - Katrin Scheinemann
- Division of Haematology/Oncology; McMaster Children's Hospital/McMaster University; Hamilton ON Canada
- Children's Hospital; Cantonal Hospital; Lucerne Switzerland
| | - Ute Bartels
- Division of Haematology/Oncology, NeuroOncology Program; SickKids Hospital; Toronto ON Canada
- University of Toronto; Toronto ON Canada
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KOCK M, BERNTSSON C, BENGTSSON A. A follow-up meeting post death is appreciated by family members of deceased patients. Acta Anaesthesiol Scand 2014; 58:891-6. [PMID: 24981404 DOI: 10.1111/aas.12358] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND A practice with a follow-up meeting post death (FUMPD) with physician and staff for family members of patients who died in the intensive care unit (ICU) was started as a quality project to improve the support of families in post-ICU bereavement. A quality improvement control was conducted after 4 years. METHOD The quality improvement control was made retrospectively as an anonymous non-coded questionnaire. Part A related to the FUMPD. Part B inquired if we could contact the family member again for a research project to evaluate family support post-ICU bereavement. The questionnaires were sent to 84 family members of 56 deceased patients. RESULTS Part A: 46 out of 84 family members answered and had attended a FUMPD. Ninety-one percent of the family members thought that we should continue to offer FUMPD. Seventy-eight percent were satisfied with their meeting. Eighty percent felt that they understood the cause of death. The majority wanted the meeting to take place within 6 weeks of death. Ninety-one percent rated the physician as important to be present at the meeting. The social worker was rated more important to attend the meeting than the assistant nurse. Ninety-one percent wanted to discuss the cause of death.Part B: 54 out of 84 family members answered. Twenty out of 54 did not want us to contact them again. CONCLUSION A routine with a Follow-Up Meeting Post Death with the ICU team for the families of the patients who die in the ICU is appreciated. The presence of the physician is important.
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Affiliation(s)
- M. KOCK
- Department of Anaesthesiology and Intensive Care; Sahlgrenska University Hospital/Östra; Göteborg Sweden
| | - C. BERNTSSON
- Department of Anaesthesiology and Intensive Care; Sahlgrenska University Hospital/Östra; Göteborg Sweden
| | - A. BENGTSSON
- Department of Anaesthesiology and Intensive Care; Sahlgrenska University Hospital/Östra; Göteborg Sweden
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Jones BL, Contro N, Koch KD. The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring. Pediatrics 2014; 133 Suppl 1:S8-15. [PMID: 24488541 DOI: 10.1542/peds.2013-3608c] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric palliative care physicians have an ethical duty to care for the families of children with life-threatening conditions through their illness and bereavement. This duty is predicated on 2 important factors: (1) best interest of the child and (2) nonabandonment. Children exist in the context of a family and therefore excellent care for the child must include attention to the needs of the family, including siblings. The principle of nonabandonment is an important one in pediatric palliative care, as many families report being well cared for during their child's treatment, but feel as if the physicians and team members suddenly disappear after the death of the child. Family-centered care requires frequent, kind, and accurate communication with parents that leads to shared decision-making during treatment, care of parents and siblings during end-of-life, and assistance to the family in bereavement after death. Despite the challenges to this comprehensive care, physicians can support and be supported by their transdisciplinary palliative care team members in providing compassionate, ethical, and holistic care to the entire family when a child is ill.
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Affiliation(s)
- Barbara L Jones
- University of Texas at Austin School of Social Work, Austin, Texas; and
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Process Improvement for Pediatric Supportive Care. J Hosp Palliat Nurs 2013. [DOI: 10.1097/njh.0b013e3182a571fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kovacs AH, Landzberg MJ, Goodlin SJ. Advance Care Planning and End-of-Life Management of Adult Patients With Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2013; 4:62-9. [DOI: 10.1177/2150135112464235] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As a result of advances in the diagnosis and treatment of congenital heart disease (CHD), it is now adult care providers, rather than pediatric providers, who are faced with the majority of patient deaths. Effective advance care planning and end-of-life (EOL) care require open communication and collaboration in order to benefit patients, family members, and clinicians. Published guidelines recommend early completion of advance directives and addressing EOL issues in routine care. This article reviews the pattern of shifting CHD mortality, current knowledge regarding advanced care planning and EOL discussions with adults with CHD (ACHD), and guidelines to facilitate and optimize these important discussions.
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Affiliation(s)
- Adrienne H. Kovacs
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Michael J. Landzberg
- Boston Adult Congenital Heart (BACH) and Pulmonary Hypertension Group, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, MA, USA
| | - Sarah J. Goodlin
- Patient-centered Education and Research, Salt Lake City, UT, USA
- Portland VA Medical Center, Portland, OR, USA
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Factors associated with pediatric critical care attending follow-up with families after the death of a patient: a national survey with an experimental design. Pediatr Crit Care Med 2011; 12:622-7. [PMID: 21263369 DOI: 10.1097/pcc.0b013e318207122f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate components of the family-physician relationship that affect the likelihood of self-reported physician follow-up with bereaved families. DESIGN Randomized, split-sample, national survey. SUBJECTS Two hundred four pediatric critical care attending physicians in the United States (54% response rate). MEASUREMENTS AND MAIN RESULTS Subjects were randomly assigned to respond to differing versions of three clinical vignettes varying in each instance in: 1) the patient's length of stay in the intensive care unit; 2) the depiction of the degree of trust of the family toward medical staff; or 3) the depiction of the family's emotional reactions. Subjects then reported their likelihood of following-up with the family after the patient's death. Physicians were more likely to report they would contact families depicted as having a trusting relationship with staff (p = .01). Variations in depicted length of patient stay (p = .5) and in the nature of the family's emotional reaction (p = .9) were not associated with self-reported likelihood of follow-up (p = .5). The only difference observed regarding the method of contacting families after a death was that participants were more likely to say they would attend the funeral of the patient with a trustful family (p < .01). CONCLUSIONS Pediatric critical care attending physicians were more likely to report following-up with a bereaved family and attend a funeral in a vignette portraying a trustful relationship between the family and staff.
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Heiner JD, Trabulsy ME. Coping With the Death of a Patient in the Emergency Department. Ann Emerg Med 2011; 58:295-8. [DOI: 10.1016/j.annemergmed.2010.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 11/21/2010] [Accepted: 12/17/2010] [Indexed: 11/17/2022]
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Affiliation(s)
- Amy Durall
- Havard Medical School, Division of Critical care Medicine, Department of Anesthesia, Perioperative, and Pain Medicine, Children's Hospital, Boston, MA 02115, USA.
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Physicians' experiences and perspectives regarding follow-up meetings with parents after a child's death in the pediatric intensive care unit. Pediatr Crit Care Med 2011; 12:e64-8. [PMID: 20581729 PMCID: PMC3327296 DOI: 10.1097/pcc.0b013e3181e89c3a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate critical care physicians' experiences and perspectives regarding follow-up meetings with parents after a child's death in the pediatric intensive care unit. Parents of children who die in the pediatric intensive care unit often desire a follow-up meeting with the physicians who cared for their child. DESIGN Semistructured, audio-recorded telephone interviews. SETTING Six clinical centers affiliated with the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. PARTICIPANTS Seventy critical care physicians (i.e., attendings and fellows) practicing or training at a Child Health and Human Development Collaborative Pediatric Critical Care Research Network clinical center between February 1, 2008 and June 30, 2008. MEASUREMENTS AND MAIN RESULTS Twenty-three (33%) physicians reported never participating in a follow-up meeting with bereaved parents; 22 (31%) participated in one to five meetings; and 25 (36%) participated in more than five meetings. Of those with prior experience, 44 (94%) met with parents at the hospital and 40 (85%) met within 3 months of the death. Meeting content included discussing autopsy, parent questions, hospital course, cause of death, genetic risk, bereavement services, and legal or administrative issues; providing emotional support; and receiving parent feedback. Forty (85%) physicians perceived the meetings to be beneficial to families, and 35 (74%) to physicians. Barriers included time and scheduling, family and physician unwillingness, distance and transportation, language and cultural issues, parent anger, and lack of a system for meeting initiation and planning. CONCLUSIONS Critical care physicians have a wide range of experience conducting follow-up meetings with bereaved parents. Although physicians perceive benefits to follow-up meetings, barriers exist that interfere with their implementation in clinical practice.
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