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Contro N, Sourkes BM. Opportunities for Quality Improvement in Bereavement Care at A Children's Hospital: Assessment of Interdisciplinary Staff Perspectives. J Palliat Care 2018. [DOI: 10.1177/082585971202800105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the current state of bereavement care at a university-based children's hospital from the perspective of the interdisciplinary staff. In all, 60 staff members from multiple disciplines participated in in-depth interviews. In at least two-thirds of the interviews, issues related to the bereavement experience of both staff and families emerged and were consistently identified. Themes included: disparities in bereavement care based on relationship factors; logistics of time and space; geographical distances; the different cultures and languages of families; continuity in family follow-up; needs of siblings and other family members; staff communication, cooperation, and care coordination; staff suffering; and education, mentoring, and support for staff. This evidence-based needs assessment furnishes an empirical basis for the design and implementation of bereavement services for both families and staff. It can serve as a template for evaluation at other children's hospitals and thus contribute to the sound and creative development of the field of pediatric palliative care.
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Affiliation(s)
- Nancy Contro
- BM Sourkes (corresponding author): Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford, 725 Welch Road, Room 2129, Palo Alto, California, USA 94304–5731
| | - Barbara M. Sourkes
- N Contro: Lucile Packard Children's Hospital at Stanford, Palo Alto, California, USA
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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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Contro N, Sourkes BM. Opportunities for quality improvement in bereavement care at a children's hospital: assessment of interdisciplinary staff perspectives. J Palliat Care 2012; 28:28-35. [PMID: 22582469] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study examined the current state of bereavement care at a university-based children's hospital from the perspective of the interdisciplinary staff. In all, 60 staff members from multiple disciplines participated in in-depth interviews. In at least two-thirds of the interviews, issues related to the bereavement experience of both staff and families emerged and were consistently identified. Themes included: disparities in bereavement care based on relationship factors; logistics of time and space; geographical distances; the different cultures and languages of families; continuity in family follow-up; needs of siblings and other family members; staff communication, cooperation, and care coordination; staff suffering; and education, mentoring, and support for staff. This evidence-based needs assessment furnishes an empirical basis for the design and implementation of bereavement services for both families and staff. It can serve as a template for evaluation at other children's hospitals and thus contribute to the sound and creative development of the field of pediatric palliative care.
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Affiliation(s)
- Nancy Contro
- Lucile Packard Children's Hospital at Stanford, Palo Alto, California 94304-5731, USA
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Davies B, Larson J, Contro N, Cabrera AP. Perceptions of discrimination among Mexican American families of seriously ill children. J Palliat Med 2011; 14:71-6. [PMID: 21194301 PMCID: PMC3021359 DOI: 10.1089/jpm.2010.0315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2010] [Indexed: 11/12/2022] Open
Abstract
This paper describes Mexican American family members' descriptions of perceived discrimination by pediatric health care providers (HCPs) and the families' reactions to the HCPs' discriminatory conduct. A retrospective, grounded theory design guided the overall study. Content analysis of interviews with 13 participants from 11 families who were recruited from two children's hospitals in Northern California resulted in numerous codes and revealed that participants perceived discrimination when they were treated differently from other, usually white, families. They believed they were treated differently because they were Mexican, because they were poor, because of language barriers, or because of their physical appearance. Participants reported feeling hurt, saddened, and confused regarding the differential treatment they received from HCPs who parents perceived "should care equally for all people." They struggled to understand and searched for explanations. Few spoke up about unfair treatment or complained about poor quality of care. Most assumed a quiet, passive position, according to their cultural norms of respecting authority figures by being submissive and not questioning them. Participants did not perceive all HCPs as discriminatory; their stories of discrimination derived from encounters with individual nurses or physicians. However, participants were greatly affected by the encounters, which continue to be painful memories. Despite increasing efforts to provide culturally competent palliative care, there is still need for improvement. Providing opportunities for changing HCPs' beliefs and behaviors is essential to developing cultural competence.
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Affiliation(s)
- Betty Davies
- Family Health Care Nursing, University of California San Francisco, San Francisco, California, USA.
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Abstract
OBJECTIVES This study aimed to learn about experiences of Mexican American and Chinese American families who require pediatric palliative care. This article describes parents' perceptions of information-sharing by health care providers during their child's hospitalizations and at their child's death. METHODS The study used a retrospective design of grounded theory analysis. Participants included 36 parents (26 Mexican American and 10 Chinese American) from 28 families who experienced between 6 months and 5 years before study participation the death of a child who was aged </=20 years. Participants were recruited through 2 university hospitals in northern California. RESULTS Parents' identified 3 types of information shared by health care providers: (1) information about the child's daily life in hospital; (2) information about the parents' daily life in hospital; and (3) information about treatment and end-of-life issues. Parents' narratives focused primarily on information shared by physicians; nurses, social workers, chaplains, interpreters, and other parents were also important sources of information. Four patterns of information-sharing emerged: (1) no information; (2) basic information; (3) basic information plus implications; and (4) basic information plus implications plus attention to parents' questions, concerns, and emotions. Positive and negative impacts of these patterns on parents are described. CONCLUSIONS Language and cultural differences create barriers to information-sharing by health care providers to parents who are in need of pediatric palliative care. Less than optimal patterns of information-sharing contribute to frustration, anger, and sadness for parents long after their child's death.
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Affiliation(s)
- Betty Davies
- Family Health Care Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA 94143-0606.
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Contro N, Davies B, Larson J, Sourkes B. Away from home: experiences of Mexican American families in pediatric palliative care. J Soc Work End Life Palliat Care 2010; 6:185-204. [PMID: 21132599 DOI: 10.1080/15524256.2010.529020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this study, the authors describe the experiences of Mexican American family members who immigrated to the United States and then experienced the death of a child. Participants described difficulties they encountered crossing the border, leaving the culture of their homeland, and then caring for a seriously ill child. Key themes that characterized their experience of being far from home included a backdrop of poverty, absence of traditional social support, and challenges caring for healthy siblings. Participants made comparisons between health care in Mexico and the United States and assessed the trade-off they made to come to the United States, discussing access to medical care and how they were able to relate to health care providers. Further, participants conveyed how rituals from their home country were important in maintaining connections with the child who died. Based on these themes, clinical implications and strategies that focus on understanding participants' experiences with past traumas, communication and literacy needs, and the challenges of living in poverty--especially with a critically ill child--are needed.
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Affiliation(s)
- Nancy Contro
- Pediatric Palliative Care Program, Lucile Packard Children's Hospital at Stanford, Palo Alto, California 94304, USA.
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Abstract
A fundamental premise of pediatric palliative care is that support is provided not only to the ill child but to the family as well. In doing so, a number of services may be offered to family members throughout the child's illness, at the time of death and into bereavement, such as respite, counseling, expressive therapies, and bereavement support. Support may also be needed for the child's peers at school, church, or on sporting teams. Evidence on family supportive care in pediatric palliative care research is scarce. The majority of existing studies are undertaken with bereaved parents. Although these studies are insightful, further information is needed to understand families' needs along the illness trajectory and to determine whether unmet needs exist.
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Affiliation(s)
- Caprice A Knapp
- Departments of Epidemiology and Health Policy Research, University of Florida, 1329 SW 16th St, Room 5130, Gainesville, FL 32610, USA.
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Davies B, Larson J, Contro N, Reyes-Hailey C, Ablin AR, Chesla CA, Sourkes B, Cohen H. Conducting a qualitative culture study of pediatric palliative care. Qual Health Res 2009; 19:5-16. [PMID: 19001106 DOI: 10.1177/1049732308327346] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
While conducting a grounded theory study of Chinese American and Mexican American families' experiences in pediatric palliative care, we encountered a number of unanticipated challenges regarding project development, Institutional Review Boards, recruitment, data collection, and data analysis. In this article, we describe our experiences, strategies, and insights for the benefit of other researchers and clinicians in the field.
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Affiliation(s)
- Betty Davies
- Department of Family Health Care Nursing, University of California-San Francisco, San Francisco, California 94143-0606, USA.
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Schiffman JD, Chamberlain LJ, Palmer L, Contro N, Sourkes B, Sectish TC. Introduction of a Pediatric Palliative Care Curriculum for Pediatric Residents. J Palliat Med 2008; 11:164-70. [PMID: 18333729 DOI: 10.1089/jpm.2007.0194] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joshua D. Schiffman
- Division of Pediatric Hematology-Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Lisa J. Chamberlain
- Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Laura Palmer
- Division of Child Psychiatry, Stanford University School of Medicine, Palo Alto, California
| | - Nancy Contro
- Division of Pediatric Palliative Care, Stanford University School of Medicine, Palo Alto, California
| | - Barbara Sourkes
- Division of Pediatric Palliative Care, Stanford University School of Medicine, Palo Alto, California
| | - Theodore C. Sectish
- Division of General Pediatrics, Harvard Medical School, Boston, Massachusetts
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Sourkes B, Frankel L, Brown M, Contro N, Benitz W, Case C, Good J, Jones L, Komejan J, Modderman-Marshall J, Reichard W, Sentivany-Collins S, Sunde C. Food, toys, and love: pediatric palliative care. Curr Probl Pediatr Adolesc Health Care 2005; 35:350-86. [PMID: 16301200 DOI: 10.1016/j.cppeds.2005.09.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Barbara Sourkes
- Pediatric Palliative Care Program, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA 94304-5731, USA.
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Abstract
BACKGROUND As a prelude to establishing a Pediatric Palliative Care Program, we solicited information from families about their experiences and their suggestions for improving the quality of end-of-life care. Participants were English- and Spanish-speaking family members of deceased pediatric patients who received care at Lucile Salter Packard Children's Hospital, Stanford University Medical Center, Palo Alto, Calif. METHODS Sixty-eight family members of 44 deceased children were interviewed regarding treatment, transition to palliative care, and bereavement follow-up. Four clinical social workers and one clinical psychologist reviewed the participants' responses and identified frequently occurring themes. RESULTS Several areas of unsatisfactory interactions with staff were identified: confusing, inadequate, or uncaring communications regarding treatment or prognosis; preventable oversights in procedures or policies; failure to include or meet the needs of siblings and Spanish-speaking family members; and inconsistent bereavement follow-up. A discrepancy emerged between the high degree of pain described by the families and parents' perceptions that pain had been managed well. Community hospice programs are frequently poorly prepared to serve pediatric patients. CONCLUSIONS There is a need to improve pediatric palliative care. Recurring themes in the family interviews suggest useful issues to consider in the development of a palliative care program.
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Affiliation(s)
- Nancy Contro
- Pediatric Palliative Care Program Development, Lucile Salter Packard Children's Hospital, Stanford University Medical Center, 725 Welch Rd, Palo Alto, CA 94304, USA.
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Bergman AS, Contro N, Zivetz N. Clinical social work in a medical setting. Soc Work Health Care 1984; 9:1-12. [PMID: 6740453 DOI: 10.1300/j010v09n03_01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This paper, using case vignette and discussion, will elaborate on two specific functions of the clinical social worker practicing in a medical setting. The first, helping patient, family and staff to acknowledge the psychological impact of physical illness; the second is helping a family to accept that there may be no organic etiology for a symptom, and that the symptom may be psychogenic in origin. Barriers to performing these functions are discussed as well as reasons why the social worker is in an ideal position to integrate medical and psychological information into a coherent and practical treatment plan.
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