The Intervention Areas of the Psychologist in Pediatric Palliative Care: A Retrospective Analysis

The blue tick: WhatsApp as a care tool in pediatric palliative care

BACKGROUND

Comprehensive care, which includes psychological support for pediatric palliative care (PPC) patients, addresses all aspects of the patient's life. It focuses on managing disease-related challenges and identifying strategies for personal, relational, and social dynamics. Effective communication between patients and healthcare providers is essential in the PPC setting. While various assistive communication tools have been explored in literature, using instant messaging within PPC remains relatively unexamined. Therefore, this study aims to evaluate the role of this technology in supporting patient care.

METHODS

Virtual messages exchanged between psychologists and PPC patients via WhatsApp were analyzed retrospectively. The content of these messages was examined qualitatively through thematic analysis using ATLAS.ti software, and sociodemographic characteristics were also collected.

RESULTS

A total of 25 patients receiving PPC services were recruited, with 5,623 messages evaluated across 766 interaction threads between patients and psychologists. On average, there were 7.34 messages per thread, ranging from 1 to 116 messages per thread. The qualitative thematic analysis revealed that the message content primarily fell into two areas: informative and psychological. The informative area included exchanges about symptomatology, procedures performed, visits, and general health. The psychological area consisted of messages reflecting negative and positive thoughts and emotions related to personal experiences, peer relationships, and family dynamics. Notably, 8.2% of the messages were significant enough to be shared within the team, which helped redirect or modify the care plan for the child and family. Additionally, 8.9% of the messages prompted medical, nursing, or psychological emergency consultations.

CONCLUSIONS

This communication tool appears more accessible for adolescent patients who regularly use instant messaging applications. Its immediacy and ease of use make such communication strategies effective and efficient for organizing, coordinating, and implementing care for a sizable portion of PPC patients.

The role of psychologists in supporting illness-related dying and death: A systematic mixed studies review

Psychologists remain underrepresented in end-of-life care, and there is limited understanding of their role among healthcare professionals, patients, and caregivers. This systematic mixed-studies review, prospectively registered on PROSPERO (CRD42020215775), explored the role of psychologists, and the facilitators and barriers they experience, in supporting clients with illness-related dying and death. A search of six research databases was conducted in October 2023. Fifty-one studies, mainly qualitative and from the perspectives of psychologists, met inclusion criteria. Thematic synthesis highlighted how psychologists provided expertise across various contexts. They supported clients with preparing for death, and adjusting to dying, provided professional consultancy and support, and undertook leadership in enhancing psychological end-of-life care. Results illustrated the sustaining factors and ongoing challenges working in end-of-life care, namely, the unique nature of navigating the death space, recognition and awareness of psychologists' contribution, and the support, training and development required. Given the universality of dying and death, this review is relevant to psychologists working within and beyond more traditional end-of-life care contexts, such as employee assistance programs, private practice, schools, and other psychological services. Policy, clinical and research implications are discussed, including the need for greater engagement and training of psychologists in the dying and death space.

Competencies for Psychology Practice in Pediatric Palliative Care

OBJECTIVE

Pediatric psychologists have unique expertise to contribute to the care of youth with serious illnesses yet are not routinely integrated into pediatric palliative care (PPC) teams. To better define the role and unique skillset of psychologists practicing in PPC, support their systematic inclusion as part of PPC teams, and advance trainee knowledge of PPC principles and skills, the PPC Psychology Working Group sought to develop core competencies for psychologists in this subspecialty.

METHODS

A Working Group of pediatric psychologists with expertise in PPC met monthly to review literature and existing competencies in pediatrics, pediatric and subspecialty psychology, adult palliative care, and PPC subspecialties. Using the modified competency cube framework, the Working Group drafted core competencies for PPC psychologists. Interdisciplinary review was conducted by a diverse group of PPC professionals and parent advocates, and competencies were revised accordingly.

RESULTS

The six competency clusters include Science, Application, Education, Interpersonal, Professionalism, and Systems. Each cluster includes essential competencies (i.e., knowledge, skills, attitudes, roles) and behavioral anchors (i.e., examples of concrete application). Reviewer feedback highlighted clarity and thoroughness of competencies and suggested additional consideration of siblings and caregivers, spirituality, and psychologists' own positionality.

CONCLUSIONS

Newly developed competencies for PPC psychologists highlight unique contributions to PPC patient care and research and provide a framework for highlighting psychology's value in this emerging subspecialty. Competencies help to advocate for inclusion of psychologists as routine members of PPC teams, standardize best practices among the PPC workforce, and provide optimal care for youth with serious illness and their families.