1
|
Greene BL, Rosenberg AR, Marron JM. A Communication and Decision-Making Framework for Pediatric Precision Medicine. Pediatrics 2024; 153:e2023062850. [PMID: 38505927 PMCID: PMC10979296 DOI: 10.1542/peds.2023-062850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 03/21/2024] Open
Abstract
Advances in genomic testing have been pivotal in moving childhood cancer care forward, with genomic testing now a standard diagnostic tool for many children, adolescents, and young adults with cancer. Beyond oncology, the role of genomic testing in pediatric research and clinical care is growing, including for children with developmental differences, cardiac abnormalities, and epilepsy. Despite more standard use in their patients, pediatricians have limited guidance on how to communicate this complex information or how to engage parents in decisions related to precision medicine. Drawing from empirical work in pediatric informed consent and existing models of shared decision-making, we use pediatric precision cancer medicine as a case study to propose a conceptual framework to approach communication and decision-making about genomic testing in pediatrics. The framework relies on identifying the type of genomic testing, its intended role, and its anticipated implications to inform the scope of information delivered and the parents' role in decision-making (leading to shared decision-making along a continuum from clinician-guided to parent-guided). This type of framework rests on practices known to be standard in other complex decision-making but also integrates unique features of genomic testing and precision medicine. With the increasing prominence of genomics and precision medicine in pediatrics, with our communication and decision-making framework, we aim to guide clinicians to better support their pediatric patients and their parents in making informed, goal-concordant decisions throughout their care trajectory.
Collapse
Affiliation(s)
- Brittany L. Greene
- Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Abby R. Rosenberg
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, Massachusetts
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Jonathan M. Marron
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
2
|
Lacerda A, Martínez MA, Dumont B, Leiss U, Kokkinou G, Scheinemann K, Craig F. Embracing paediatric palliative care in paediatric oncology from diagnosis onwards. Pediatr Blood Cancer 2023; 70:e30561. [PMID: 37430425 DOI: 10.1002/pbc.30561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
Paediatric palliative care aims to support children and young people with life-limiting or life-threatening conditions, and their families, from the time of diagnosis. Early integration within oncology has been recognised as having benefits for all involved, whatever the outcome may be. Through improved communication and advance care planning, it enables user-centred care, where concerns about quality of life, preferences and values are given the same relevance as cutting-edge therapy. Challenges to the integration of palliative care within paediatric oncology include raising awareness and providing education, whilst searching for the best care model and adapting to an ever-changing therapeutic scenario.
Collapse
Affiliation(s)
- Ana Lacerda
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- European Association for Palliative Care Children and Young People Reference Group, Vilvoorde, Belgium
- Department of Paediatrics, Portuguese Institute of Oncology, Lisbon, Portugal
| | - María Avilés Martínez
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Paediatric Palliative Care Unit, Niño Jesús Children's University Hospital, Madrid, Spain
- Department of Nursing, Autonomous University of Madrid, Madrid, Spain
| | - Benoît Dumont
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Paediatric Hematology and Oncology Institute, Léon Bérard Cancer Center, Lyon, France
| | - Ulrike Leiss
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Georgia Kokkinou
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Floga - Parents Association of Children with Cancer, Athens, Greece
- Childhood Cancer International Europe, Vienna, Austria
| | - Katrin Scheinemann
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Division of Oncology-Haematology, Department of Paediatrics, Kantonsspital Aarau, Aarau, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Paediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Finella Craig
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- European Association for Palliative Care Children and Young People Reference Group, Vilvoorde, Belgium
- Louis Dundas Paediatric Palliative Care Centre, Great Ormond Street Hospital, London, UK
| |
Collapse
|
3
|
Merz A, Stevens SE, Das PJ, Avery M, Revette AC, Wolfe J, Feraco AM. Adaptation of the Day100 Talk communication intervention for Spanish-speaking families of children with cancer. Pediatr Blood Cancer 2023; 70:e30101. [PMID: 36546398 DOI: 10.1002/pbc.30101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/07/2022] [Accepted: 10/22/2022] [Indexed: 12/24/2022]
Abstract
The Day100 Talk (Day100) bridges communication gaps between parents and clinicians early in pediatric cancer care through an interprofessional family conference facilitated by structured tools. We aimed to understand communication challenges and facilitators and to adapt Day100 for Spanish-speaking parents. We interviewed Spanish-speaking parents with limited English proficiency, Spanish-English medical interpreters, and clinicians to gather communication experiences and adapt Day100. Results showed that communication difficulties were precipitated by linguistic and cultural differences, nonvisual technologies, and limited spontaneous communication. Interpreters enhanced communication as linguistic and cultural brokers. Nonverbal cues also facilitated communication. Participants offered recommendations to adapt Day100 for future study.
Collapse
Affiliation(s)
- Alexandra Merz
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sarah E Stevens
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - P Jeet Das
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,University of Michigan Medical School, University of Michigan, Ann Arbor, USA
| | - Madeline Avery
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anna C Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joanne Wolfe
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Angela M Feraco
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Greenzang KA, Scavotto ML, Revette AC, Schlegel SF, Silverman LB, Mack JW. "There's no playbook for when your kid has cancer": Desired elements of an electronic resource to support pediatric cancer communication. Pediatr Blood Cancer 2023; 70:e30198. [PMID: 36602023 PMCID: PMC10375908 DOI: 10.1002/pbc.30198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Acute lymphoblastic leukemia (ALL), the most common childhood malignancy, has a relatively favorable long-term prognosis. Yet the complexity of treatment and the emotionality of the diagnosis leave families feeling unprepared for many aspects of therapy. This qualitative study aimed to identify desired elements and format of a communication resource to support patients and families facing a diagnosis of ALL. METHODS Semi-structured interviews of 12 parents of children receiving ALL treatment, 10 parents of survivors of ALL, and eight adolescent and young adult (AYA) survivors of ALL were conducted between February and June 2021. The interviews focused on communication experiences throughout treatment and identified domains to be addressed in a resource in development. RESULTS All participants supported the development of an interactive, electronic health (eHealth) resource to help navigate ALL treatment. They felt a website would be helpful in addressing information gaps and mitigating pervasive feelings of overwhelm. Participants specifically sought: (a) information resources to address feelings of cognitive overload; (b) practical tips to help navigate logistical challenges; (c) clear depictions of treatment choices and trajectories to facilitate decision-making; and (d) additional psychosocial resources and support. Two overarching themes that families felt should be interwoven throughout the eHealth resource were connections with other patients/families and extra support at transitions between phases of treatment. CONCLUSIONS A new diagnosis of ALL and its treatment are extremely overwhelming. Patients and families unanimously supported an eHealth resource to provide additional information and connect them with emotional support, starting at diagnosis and extending throughout treatment.
Collapse
Affiliation(s)
- Katie A Greenzang
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Madison L Scavotto
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anna C Revette
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sarah F Schlegel
- Division of Pediatric Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer W Mack
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Ebelhar J, DeGroote NP, Massie AM, Labudde E, Allen KE, Castellino SM, Wasilewski-Masker K, Brock KE. Differences in palliative opportunities across diagnosis groups in children with cancer. Pediatr Blood Cancer 2023; 70:e30081. [PMID: 36377714 DOI: 10.1002/pbc.30081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood cancer causes significant physical and emotional stress. Patients and families benefit from palliative care (PC) to reduce symptom burden, improve quality of life, and enhance family-centered care. We evaluated palliative opportunities across leukemia/lymphoma (LL), solid tumors (ST), and central nervous system (CNS) tumor groups. PROCEDURE A priori, nine palliative opportunities were defined: disease progression/relapse, hematopoietic stem cell transplant, phase 1 trial enrollment, admission for severe symptoms, social concerns or end-of-life (EOL) care, intensive care admission, do-not-resuscitate (DNR) status, and hospice enrollment. A single-center retrospective review was completed on 0-18-year olds with cancer who died from January 1, 2012 to November 30, 2017. Demographic, disease, and treatment data were collected. Descriptive statistics were performed. Opportunities were evaluated from diagnosis to death and across disease groups. RESULTS Included patients (n = 296) had LL (n = 87), ST (n = 114), or CNS tumors (n = 95). Palliative opportunities were more frequent in patients with ST (median 8) and CNS tumors (median 7) versus LL (median 5, p = .0005). While patients with ST had more progression/relapse opportunities (p < .0001), patients with CNS tumors had more EOL opportunities (p < .0001), earlier PC consultation, DNR status, and hospice enrollment. Palliative opportunities increased toward the EOL in all diseases (p < .0001). PC was consulted in 108 (36%) patients: LL (48%), ST (30%), and CNS (34%, p = .02). CONCLUSIONS All children with cancer incur many events warranting PC support. Patients with ST and CNS tumors had more palliative opportunities than LL, yet received less subspecialty PC. Understanding palliative opportunities within each disease group can guide PC utilization to ease patient and family stress.
Collapse
Affiliation(s)
- Jonathan Ebelhar
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Nicholas P DeGroote
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - A McCauley Massie
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Emily Labudde
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kristen E Allen
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Pediatric Palliative Care, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
6
|
Uber A, Ebelhar JS, Lanzel AF, Roche A, Vidal-Anaya V, Brock KE. Palliative Care in Pediatric Oncology and Hematopoietic Stem Cell Transplantation. Curr Oncol Rep 2022; 24:161-174. [DOI: 10.1007/s11912-021-01174-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
|