A Pilot Study of a Family Management Program for Parents of Children with Acute Lymphoblastic Leukemia

OBJECTIVES

The aim of this completed pilot study was to evaluate the feasibility of implementing a family management program (FMP) for parents of children with acute lymphoblastic leukemia (ALL).

DATA SOURCES

A convenience sample of 11 parents of preschool-aged children with ALL were recruited from an ambulatory chemotherapy-care clinic at a tertiary hospital in Thailand. Participants received three FMP sessions over 3 weeks. The FMP is based on two established family programs (ie, FMP-style framework and building on family strengths) and reviewed literature. The following measures were used to evaluate parents' responses at baseline, postintervention, and follow-up: Family Management Measure, Beach-Center Family Quality-of-Life Scale, and Pediatric Quality of Life Inventory. Data were analyzed using one-way repeated-measures analysis of variance.

CONCLUSION

The study results provide promising evidence that the FMP is feasible and improves family management and quality of life for parents of enrolled children with ALL.

IMPLICATIONS FOR NURSING PRACTICE

Educating pediatric oncology nurses and other healthcare professionals to replicate the FMP may help to provide better family management, and child quality of life support to future parents and other family members of young children diagnosed with ALL. This support should focus on educating parents about the potential effects of caring for a child with ALL on the family and fostering positive relationships within the family and offering guidance on effective family communications and decision-making processes.

A simulation training of family management for parents of children with epilepsy: a randomized clinical trial

BACKGROUND

Epilepsy is a chronic neurological disorder that is more likely to be diagnosed in children. The main treatment involves long-term use of anti-epileptic drugs and above all, home care is of great importance. As there has not been a widely accepted home care protocols, simulating a home care environment is necessary for caregivers to develop skills of proper home care. This study aims to evaluate the effectiveness of a simulation training of family management style (STOFMS) for parents of children with epilepsy in China.

METHODS

A randomized controlled trial was conducted on 463 children with epilepsy and their families. They were recruited from March 2020 to November 2022 and randomly assigned to the STOFMS group or the conventional group in a 1:1 ratio. Scores of family management measures, 8-item of Morisky Medication Adherence and epilepsy clinical symptom of both groups were collected at three points of time: within 24 h after admission (T0), 3 months after discharge (T1), and 6 months after discharge (T2). Changes due to intervention were compared across groups by repeated-measures ANOVA. The study report followed the CONSORT 2010 checklist.

RESULTS

There were statistically significant differences between the two groups at T2. A considerable increase over the baseline was observed in the total management level score and subscale scores in the STOFMS group at T1, compared with essentially no change in the control group. In terms of medication adherence, the STOFMS group performance improved greatly at T1 and T2 compared with the control group. The same result was also found in clinical efficacy at T2 (p < 0.05).

CONCLUSION

STOFMS is an effective intervention to improve family management level, treatment adherence and clinical efficacy for children with epilepsy.

TRIAL REGISTRATION

The registration number is ChiCTR2200065128. Registered at 18 October 2022, http://www.medresman.org.cn.

Development and validation of a nomogram prediction model for ADHD in children based on individual, family, and social factors

OBJECTIVES

A reliable, user-friendly, and multidimensional prediction tool can help to identify children at high risk for ADHD and facilitate early recognition and family management of ADHD. We aimed to develop and validate a risk nomogram for ADHD in children aged 3-17 years in the United States based on clinical manifestations and complex environments.

METHODS

A total of 141,356 cases were collected for the prediction model. Another 54,444 cases from a new data set were utilized for performing independent external validation. The LASSO regression was used to control possible variables. A final risk nomogram for ADHD was established based on logistic regression, and the discrimination and calibration of the established nomogram were evaluated by bootstrapping with 1000 resamples.

RESULTS

A final risk nomogram for ADHD was established based on 13 independent predictors, including behavioral problems, learning disabilities, age, intellectual disabilities, anxiety symptoms, gender, premature birth, maternal age at childbirth, parent-child interaction patterns, etc. The C-index of this model was 0.887 in the training set, and 0.862 in the validation set. Internal and external validation proved that the model was reliable.

CONCLUSIONS

A nomogram, a statistical prediction tool that assesses individualized ADHD risk for children is helpful for the early identification of children at high risk for ADHD and the construction of a conceptual model of society-family-school collaborative diagnosis, treatment, and management of ADHD.

Cancer centre information and support services and patient needs: participatory action research study

OBJECTIVES

Clear information and supportive care are necessary for oncology patients and their relatives to manage the disease (trajectory). Centres for information and support aim to address their needs by offering informal and non-medical formal services. This study evaluated whether the centres' services offered meet the needs of its visitors, and whether there is interest for these among oncology patients treated at affiliated hospitals.

METHODS

In this participatory action research, interviews were conducted among visitors of two centres (Patient Information Center Oncology (PATIO) and IntermeZZo) and among patients treated at the affiliated hospitals. Visitors were interviewed to share their experiences regarding the centres' services offered. Patients from the hospitals were interviewed about their interest in such support. Data were collected during three different periods and adjustments were made to the centres' services between measurements.

RESULTS

111 (PATIO) and 123 visitors (IntermeZZo) were interviewed, and 189 and 149 patients at the respective hospitals. Reasons to visit PATIO/IntermeZZo were to relax (93.1%), seek professional advice (54.6%) and meet peers (36.3%). Visitors indicated that the visits met their needs (99.1%), citing the accessible support and the expertise in oncology. 20% of patients interviewed at the hospitals expressed interest in visiting PATIO/IntermeZZo. The majority of patients (89.6%) considered these centres an integral part of their treatment process. These findings were stable over time.

CONCLUSIONS

Patients and their relatives highly value the services of hospital-affiliated centres for information and support. Future research should address how such centres best be integrated in the Dutch healthcare system.

Quality of life and family management of paediatric chronic condition amidst the COVID-19 pandemic

PURPOSE

This study aimed to describe the perception of parents of children/adolescents with chronic conditions of their quality of life and family functioning during the COVID-19 pandemic and explore how the COVID-19 pandemic affected family management of children/adolescents' chronic conditions.

DESIGN AND METHODS

A total of 237 parents of children/adolescents with chronic conditions participated in this cross-sectional study. Data were collected through an online questionnaire using the Paediatric Quality of Life Inventory™ Family Impact Module and an open-ended question about the impact of the pandemic on the family management of the paediatric chronic condition.

RESULTS

The Total Score of PedsQL™ FIM was slightly higher than the midpoint of the scale (M = 60.27; SD = 19.04), and the impact of the pandemic on the family's management of the chronic condition was perceived by 30% of parents as high or moderate. Statistically significant differences were found between parents who reported a high or moderate impact of the pandemic and those reporting little or no impact of the pandemic regarding parental quality of life and family functioning (t (233) = 8.13, p = .00, Cohen's d = 1.14). Two themes emerged from the analysis of the open-ended question: Impact on the child/adolescent and Impact on the family.

CONCLUSIONS

Parents of children/adolescents with chronic conditions reported an average quality of life, and the COVID-19 pandemic significantly impacted the family management of chronic conditions.

PRACTICE IMPLICATIONS

These results highlight the importance of developing interventions to support families in complex situations and contexts, targeting family functioning, family quality of life, and emotional management.

Health literacy interventions for informal caregivers: systematic review

AIM

The aim of the systematic review was to identify conceptual models and interventions designed to improve health literacy in caregivers of adults with a chronic disease/disability.

METHODS

MEDLINE, CINAHL, PsycINFO and Embase were searched for relevant literature. Articles were included if they focused on adults who provided informal care to someone aged 18+ with a chronic disease/disability. Quantitative studies were included if they reported an intervention designed to improve caregiver health literacy (CHL) and assessed outcomes using a validated measure of health literacy. Qualitative and mixed method studies were included if they described a conceptual model or framework of CHL or developed/assessed the feasibility of an intervention. Study quality was appraised using the Mixed Methods Assessment Tool.

RESULTS

Eleven studies were included. Five studies used pre-post design to assess outcomes of an intervention; four described intervention development and/or pilot testing; two described conceptual models. Two of five studies reported pre-post intervention improvements in CHL; one reported an improvement in one of nine health literacy domains; two reported no improvements following intervention. Interventions predominantly aimed to improve: caregiver understanding of the disease, treatment and potential outcomes, day-to-day care, self-care and health provider engagement. Few interventions targeted broader interpersonal and health service factors identified as influencing CHL.

DISCUSSION

Evidence on the development and assessment of comprehensive CHL interventions is scarce. Recommendations include the development of interventions that are guided by a CHL framework to ensure they address individual, interpersonal and health service/provider factors that influence CHL.

Peer support-based online education, burden of care and quality of life among family caregivers of patients with leukaemia: non-randomised clinical trial

OBJECTIVE

The responsibility of caring for patients with leukaemia places a heavy burden on family caregivers (FCs) and negatively impacts their quality of life (QoL). This study aimed to investigate the effects of peer support (PS)-based online education programme on the burden of care (BoC) and QoL of FCs of patients with leukaemia.

METHODS

This before-after study involved a total of 80 eligible FCs of patients with leukaemia (40 individuals per group). The participants received the necessary information from a researcher and peers through online sessions and WhatsApp group. To collect data, the Zarit Burden Interview and the Caregiver Quality of Life Index-Cancer (CQOLC) had been been completed once before the intervention and once 1 month after the intervention.

RESULTS

There was no significant difference between the two groups regarding baseline variables except the mean BoC that was significantly higher in the intervention group (IG) (p<0.001). However, after controlling for the effects of confounding variables, the mean BoC score of participants in IG was significantly lower than that of the control group (p<0.001). Additionally, there was no significant difference between the two groups in terms of CQOLC before (p=0.178) and after (p=0.538) the intervention.

CONCLUSION

The PS-based online education programme had a positive impact on reducing the care burden of FCs of patients with leukaemia. This programme can effectively reduce costs, particularly during emergencies and crises such as pandemics, as it eliminates the need for FCs and peers to physically visit hospitals.

REGISTRATION

The study was registered at the Iranian Registry of Clinical Trials on 18 July 2021 (IRCT registration number: IRCT20210507051209N1).

Pressure ulcer prevention: family caregiver training effectiveness

OBJECTIVE

To determine the effectiveness of pressure ulcer prevention training for the relatives of palliative care inpatients.

METHODS

This study had a pretest-post-test design with parallel groups and a randomised control group, and it was conducted with 70 (experimental n=35, control n=35) patient relatives. A personal information form and Pressure Ulcer Knowledge Test were used as data collection tools. Parametric tests were performed for statistical analysis.

RESULTS

The pressure ulcer prevention training given to the relatives of palliative care patients in the experimental group was significantly effective in increasing their level of knowledge about these ulcers (p<0.05). However, the routine ward discharge training given to the relatives of palliative care patients in the control group was not significantly effective in increasing their level of knowledge about them (p>0.05).

CONCLUSIONS

Specialised training regarding pressure ulcers should be given to the relatives of patients receiving palliative care. It is important that the educational materials used in this trainings appeal to all sensory organs in order to improve the educational outcomes.

TRIAL REGISTRATION NUMBER

NCT05979402.

Advance care planning and caregiver outcomes: intervention efficacy - systematic review

CONTEXT

Caregivers make difficult end-of-life (EOL) decisions for patients, often adversely affecting their own psychological health. Understanding whether advance care planning (ACP) interventions benefit caregivers can enable healthcare systems to use these approaches to better support them.

OBJECTIVE

We conducted a systematic review and meta-analysis to identify and quantify the impacts of ACP interventions on caregiver outcomes.

METHODS

We searched MEDLINE, Embase and Cochrane databases for English-language randomised or cluster randomised controlled trials (RCTs) published until May 2021. Two reviewers independently assessed methodological quality using the Physiotherapy Evidence-Based Database Scale. We conducted a narrative synthesis for each outcome. Difference between arms with a p value of <0.05 was considered statistically significant.

RESULTS

Of the 3487 titles reviewed, 35 RCTs met eligibility; 68.6% were rated high quality. Included RCTs were heterogeneous in intervention characteristics, setting and disease. Meta-analysis of 17 RCTs showed that ACP had large and significant improvement in congruence in EOL care preferences between caregivers and patients (standardised mean difference 0.73, 95% CI 0.42 to 1.05). The effect of ACP on this outcome, however, declined over time. We also found some evidence that ACP improved bereavement outcomes (three of four RCTs), satisfaction with care quality/communication (four of the six RCTs), reduced decisional conflict (two of the two RCTs) and burden (one RCT). No study showed that mental health of caregivers were adversely affected.

CONCLUSION

The review provides most comprehensive evidence about the efficacy of ACP on caregiver outcomes. Findings suggest some evidence of benefit of ACP on caregiver outcomes.

Quality of dying and death in intensive care units: family satisfaction

OBJECTIVE

This cohort study identified patterns/classes of surrogates' assessment of their relative's quality of dying and death (QODD) and to evaluate their associations with family satisfaction with intensive care unit (ICU) care.

METHODS

We identified QODD classes through latent class analysis of the frequency component of the QODD questionnaire and examined their differences in summary questions on the QODD and scores of the Family Satisfaction in the ICU questionnaire among 309 bereaved surrogates of ICU decedents.

RESULTS

Four distinct classes (prevalence) were identified: high (41.3%), moderate (20.1%), poor-to-uncertain (21.7%) and worst (16.9%) QODD classes. Characteristics differentiate these QODD classes including physical symptom control, emotional preparedness for death, and amount of life-sustaining treatments (LSTs) received. Patients in the high QODD class had optimal physical symptom control, moderate-to-sufficient emotional preparedness for death and few LSTs received. Patients in the moderate QODD class had adequate physical symptom control, moderate-to-sufficient emotional preparedness for death and the least LSTs received. Patients in the poor-to-uncertain QODD class had inadequate physical symptom control, insufficient-uncertain emotional preparedness for death and some LSTs received. Patients in the worst QODD class had poorest physical symptom control, insufficient-to-moderate emotional preparedness for death and substantial LSTs received. Bereaved surrogates in the worst QODD class scored significantly lower in evaluations of the patient's overall QODD, and satisfaction with ICU care and decision-making process than those in the other classes.

CONCLUSIONS

The identified distinct QODD classes offer potential actionable direction for improving quality of end-of-life ICU care.

A Comparison of Family Management Between Families of Children With Autism Spectrum Disorder and Families of Children With Down Syndrome

INTRODUCTION

This cross-sectional study aimed to (1) compare family management between families of children with autism spectrum disorder (ASD) or Down syndrome and (2) evaluate the contribution of the child (ASD behaviors, feeding difficulties, sleep disturbances), caregiver (mental health) and family (social support) factors to the caregiver's perceived condition management ability and effort.

METHOD

Eighty-five caregivers (56 ASD, 29 Down syndrome) completed quantitative instruments online. Data analysis included independent samples t-tests and multiple linear regression.

RESULTS

There were no significant differences in the dimensions of family management between groups. More ASD behaviors were associated with lower condition management ability and higher condition management effort. Lower perceived social support and higher caregiver age were associated with lower condition management ability.

DISCUSSION

Integrating care into family life may be more challenging when the child has more social differences and behavioral rigidity. Nursing care should include an assessment of family social support.

Supportive relationships between patients and family caregivers in specialist palliative care: a qualitative study of barriers and facilitators

OBJECTIVES

Patients with advanced illness and their family caregivers can be mutually supportive. However, what facilitates and/or restricts supportive relationships between patients and family caregivers in palliative care remains unclear. We aimed to identify key barriers to and facilitators of supportive relationships between people with advanced illness and family caregivers in specialist palliative care.

METHODS

A qualitative study using grounded theory methodology was conducted. Semistructured interviews were undertaken with 15 patients with advanced illness and 21 family caregivers purposively and theoretically sampled from a large regional specialist palliative care service. Verbatim transcripts were analysed in line with grounded theory coding procedures.

RESULTS

Mutual support was underpinned by mutual concern and understanding. Facilitators of supportive relationships included patients and family caregivers already having a close relationship, caregivers assuming caregiving duties by choice, caregivers feeling competent in a caregiving role, patients valuing caregiver efforts, availability of respite for the caregiver and direct support from healthcare professionals to help both patients and caregivers adjust to advanced illness. Barriers to supportive relationships included absence of support from the wider family, prior mutual conflict between the patient and caregiver, caregivers feeling constrained in their caregiving role and patient and caregiver distress induced by mutual loss.

CONCLUSIONS

Multiple factors at both a micro (eg, relationship based) and mesolevel (eg, assistance from services) impact patient and family caregiver ability to support one another in specialist palliative care. Supportive relationships between patients and family caregivers are mediated by feelings pertaining to both control and loss.

Effect of exercise interventions based on family management or self-management on glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

Most studies about exercise interventions for patients with type 2 diabetes mellitus (T2DM) have been conducted in hospitals or labs, but it is unclear whether study findings from this specific condition can be generalised to real-life T2DM communities. If patients with T2DM can exercise on their own or with family members, it may also reduce the need for patient supervision by medical staff, thereby reducing the burden of medical treatment and improving condition management's cost-effectiveness and practicability. Much of the current research on exercise interventions for T2DM was focused on the type of exercise and less on the mode of management, so we aimed to examine the effect of exercise interventions based on family management or self-management on glycaemic control in patients with T2DM.

METHODS

Articles were searched from eight Chinese and English databases. Randomized control trials (RCTs) published in English and Chinese, from inception to October 17, 2022, were included in this review. The methodological quality of the included studies was assessed using the RCT risk of bias assessment tool provided by the Cochrane Collaboration's tool. Meta-analysis was performed using Rev Man 5.4 and Stata 15.0 software. Heterogeneity was investigated using sensitivity analysis and subgroup analyses. Publication bias was tested by funnel plot and Egger's asymmetry tests.

RESULTS

A total of 10 studies with a total of 913 subjects were finally included in this review. The Meta-analysis showed that exercise interventions based on family management or self-management were more effective than control groups in reducing HbA1c (Z = 3.90; 95% CI MD = - 0.81; - 1.21 to - 0.40; P < 0.0001), fasting glucose (Z = 4.63; 95% CI MD = - 1.17; - 1.67 to - 0.68; P < 0.00001), 2-h plasma glucose (Z = 5.53; 95% CI MD = - 1.84; - 2.50 to - 1.19; P < 0.00001), and Low-density lipoproteins levels (Z = 3.73; 95% CI MD = - 0.38; - 0.58 to - 0.18; P = 0.0002).

CONCLUSIONS

Exercise interventions based on family management or self-management can significantly reduce glycosylated haemoglobin, fasting glucose, 2-h plasma glucose, and Low-density lipoproteins levels in patients with T2DM, which can effectively delay disease progression and reduce the risk of developing complications. In the future, for exercise interventions based on family or self-management, this review recommended that exercise intervention programmes should be formulated according to 30-60 min per session, more than three times per week, for more than six months of aerobic exercise or aerobic combined with resistance exercise.

Advanced heart failure patients and family caregivers health and function: randomised controlled pilot trial of online dignity therapy

OBJECTIVES

This research investigated the effectiveness of the caregiver-mediated online dignity therapy in enhancing dyadic health and family function.

METHODS

Heart failure (HF) family dyads were recruited between May and December 2021 from a university-affiliated hospital in China. The dyads (N=70) were randomly allocated to the intervention group and the control group. We assessed patients' outcomes (hope, well-being, Family APGAR Index and quality of life (QoL)) and their family caregivers' outcomes (anxiety, depression and Family APGAR Index) at baseline (T0), 1 week (T1), 4 weeks (T2) and 8 weeks (T3) after discharge.

RESULTS

For patients, the difference over time was significant in QoL (p<0.001). The interaction effects were significant for hope (p<0.001), well-being (p<0.001), Family APGAR Index (p<0.001) and QoL (p=0.007). For family caregivers, a significant difference in depression (p=0.001) was found within groups. Meanwhile, the interaction effects were significant on anxiety (p=0.002) and depression (p=0.016).

CONCLUSIONS

Caregiver-mediated online dignity therapy among patients with advanced HF had potential to enhance patient outcomes (level of hope, well-being, family function and QoL) and alleviate caregiver outcomes (anxiety, depression) at 4-week and 8-week follow-up. Thus, we provided scientific evidence for palliative care for advanced HF.

TRIAL REGISTRATION NUMBER

ChiCTR2100053758.

Access for Cancer Caregivers to Education and Support for Shared Decision Making (ACCESS) intervention: a cluster cross-over randomised clinical trial

OBJECTIVES

The purpose of this study was to test an intervention named ACCESS (Access for Cancer Caregivers to Education and Support for Shared Decision Making). The intervention uses private Facebook support groups to support and educate caregivers, preparing them to participate in shared decision-making during web-based hospice care plan meetings. The overall hypothesis behind the study was that family caregivers of hospice patients with cancer would experience lower anxiety and depression as a result of participating in an online Facebook support group and shared decision-making with hospice staff in a web-based care plan meeting.

METHODS

This is a cluster cross-over randomised three-arm clinical trial where one group participated in both the Facebook group and the care plan team meeting. A second group participated only in the Facebook group and the third group was a control group and received usual hospice care.

RESULTS

There were 489 family caregivers who participated in the trial. There were no statistically significant differences between the ACCESS intervention group and the Facebook only or the control group on any outcome. The participants in the Facebook only group, however, experienced a statistically significant decrease in depression compared with the enhanced usual care group.

CONCLUSIONS

While the ACCESS intervention group did not experience significant improvement in outcomes, caregivers assigned to the Facebook only group showed significant improvement in depression scores from baseline as compared with the enhanced usual care control group. Further research is needed to understand the mechanisms of action leading to reduced depression.

Cancer palliative care referral: patients' and family caregivers' perspectives - a systematic review

BACKGROUND

Despite the evidence of palliative care benefits, referrals are infrequent and delayed. Patients and their caregivers are essential stakeholders in the referral process with valuable perspectives. This review systematically explored their perceived facilitators and barriers to palliative care referral.

METHODS

4 subject-specific databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and EMBASE), 3 multidisciplinary databases (SCOPUS, Web of Science and Cochrane database) and 11 journals from 1 January 1990 to 31 May 2022 were searched; and scored for their methodological rigour using Hawker's tool. Findings were synthesised using Popay's Narrative Synthesis method and interpreted using decision-making theory.

RESULTS

4 themes were generated from 14 studies: (1) The timing of referral should be right and communication must be comprehensive. Delays in initiating serious illness conversations, prognostication, and decision-making hindered referral. In contrast, the presence of symptoms facilitated it. (2) Referral was equated to death, and as an inferior form of treatment, a rebranding might mitigate the stigma. (3) Referral made families feel emotional and devastated; explanation and team initiatives enabled the normalisation and positive coping. (4) Long-term holistic palliative care facilitated a positive care experience and a sense of reassurance and satisfaction, enabling a smooth transition from curative to comfort care. The late referral was associated with perceived inadequate symptom management, diminished quality of life and death and complicated bereavement issues.

CONCLUSION

Patients' and caregivers' predisposition to palliative care engagement was influenced by timely referral, comprehensive communication, perception and stigma about palliative care. Longitudinal association with the palliative care team mitigated negative perceptions and improved satisfaction and coping.

PROSPERO REGISTRATION NUMBER

CRD42018091481.

Family Management of Severe Obesity in Adolescents

PURPOSE

Severe obesity, defined as a body mass index (BMI) ≥120th percent of the 95th BMI percentile for age and sex, is the fastest growing subcategory of obesity among youth, yet little is known about how this group understands and incorporates weight management strategies. The aims of this study were to explore how parents and adolescents understand severe obesity and incorporate management into their daily lives and evaluate the applicability of the Family Management Styles Framework (FMSF) to better understand the impact of severe obesity for adolescents.

DESIGN AND METHODS

Directed content analysis grounded in a modified version of the FMSF was used to analyze one-time in-home face-to-face interviews with adolescents aged 12-17 years (N = 14) who received pediatric weight management care and a parent (N = 17).

RESULTS

Both adolescents and parents described the day-to-day management as challenging and impactful to parent-child and sibling relationships. They described the need for sustained support and coaching in meeting daily physical activity requirements and related stories of weight stigma experienced. Further, parents' and adolescents' views were mostly congruent, except in their view of effectiveness of daily routines and how family attitudes and actions did or did not support the adolescent.

CONCLUSIONS

The FMSF was successfully applied to understand family management of adolescents with severe obesity. These adolescents have complex physical and psychological needs impacting effective weight management and family life.

PRACTICE IMPLICATIONS

Technology interventions should be considered to improve physiological and psychological outcomes for youth with severe obesity.

Unusual immunohistochemical “null” pattern of four mismatch repair proteins in gastric cancer: A case report

BACKGROUND

Immunohistochemical (IHC) staining for mismatch repair (MMR) proteins is useful for gastric cancer treatment and prognosis. Different IHC staining patterns reflect the complex biological phenomena underlying MMR deficiency. We herein report a rare IHC staining pattern of four MMR-related proteins in gastric cancer.

CASE SUMMARY

A “null” IHC staining pattern of four MMR-related proteins, including MLH1, PMS2, MSH2, and MSH6, in a 67-year-old male patient with gastric cancer pT3N3aM0 revealed promoter hypermethylation of MLH1. Next-generation sequencing showed that these four genes exhibited changes. One of these was the somatic mutation of the missing copy number in exon 14 of MSH2. Mutation analysis using peripheral blood showed no germline mutations in these four genes. The patient had no history of personal or family tumor history. We classified this case as sporadic. The patient returned to normal after operation, and there were no signs of tumor metastasis and recurrence. After six cycles of adjuvant chemotherapy, the patient was discharged in a stable condition. The patient had a mild reaction to chemotherapy and a good prognosis. At present, 16 mo after the operation, the patient's condition is stable.

CONCLUSION

Abnormal MMR protein expression, helpful for individualized follow-up care, helped identify a sporadic case lacking familial clinical management implications.

'Do not attempt cardiopulmonary resuscitation' (DNACPR)-difficulty in discussions with older medical inpatients and their families: a survey of hospital doctors

OBJECTIVES

To determine, for doctors looking after older medical inpatients: (1) how difficult they find discussions about 'do not attempt cardiopulmonary resuscitation' (DNACPR); (2) whether difficulty is associated with doctors' personal and professional characteristics; (3) how frequently DNACPR discussions are made more difficult by practical issues and by doctors' uncertainties.

METHODS

Survey of hospital doctors working on the acute medical wards of a UK NHS teaching hospital.

RESULTS

171/200 (86%) of eligible doctors participated. 165 had experience of DNACPR discussions with older inpatients and/or their families and were included in our analysis. 'Difficulty' (defined as finding discussions 'fairly difficult' or 'difficult') was experienced by 52/165 (32%) for discussions with patients and 60/165 (36%) for discussions with families. Doctors with specific training in DNACPR discussions were less likely to have difficulty in discussions with patients. Older, more experienced doctors were less likely to have difficulty in discussions with families. Lack of time and place, and uncertainty about prognosis were the most frequently reported causes of difficulty.

CONCLUSIONS

Many doctors have difficulty in DNACPR discussions. Training needs to include managing discussions with families, as well as with patients, and doctors need time and space to deliver this important part of their job.

Parents' experience of caring for children with type 1 diabetes in mainland China: A qualitative study

BACKGROUND

Parents of children with type 1 diabetes mellitus (T1DM) are under heavy caregiving stress, and parental caregivers' experience can affect the health outcomes of children with T1DM.

AIM

To describe the true inner feelings of parents caring for children with T1DM.

METHODS

Descriptive research methods were used to classify and summarize parents' experience when adapting to the role of caregivers for children with T1DM. The data was sorted and analyzed using content analysis. Themes of parents' experience caring for children with T1DM were refined, and their feelings were deeply investigated.

RESULTS

A total of 4 themes and 12 subthemes were identified: (1) Desire for information (disease-related information, home care information, and channels of information acquisition); (2) Skill guidance needs (insulin injection techniques, skills required for symptom management, and skills for parent-child communication); (3) Seeking emotional support (family support, peer support from other parents of children with T1DM, and professional support); and (4) Lack of social support (needs for financial support and needs for social security).

CONCLUSION

Exploring the true experience of parents caring for children with T1DM is of great significance for helping them adapt to their role as caregivers. Nurses should provide professional guidance in terms of information, skills, emotion, and social support to parental caregivers.

Family Management in Childhood Attention Deficit Hyperactivity Disorder: A Qualitative Inquiry

PURPOSE

The purpose of this study was to better understand how caregivers and families manage childhood Attention Deficit Hyperactivity Disorder (ADHD) in their everyday lives and explore family management factors most relevant to child outcomes, including the child's daily life, condition management effort, condition management ability, and view of condition impact.

DESIGN AND METHODS

Cross-sectional data from caregivers (N = 50) of children with ADHD (ages 5-12 years) within a large northeastern city were collected, analyzed, and interpreted using directed content analysis and qualitative methods. This inquiry was part of a larger mixed method study which examined the impact of family management on childhood ADHD and how family management factors were related to children's level of impairment across a spectrum of child functioning.

RESULTS

Thematic summaries based on qualitative descriptive methods highlighted four aspects of family management including: 1) how caregivers contextualized their child's condition in everyday family life, 2) the significant effort required by caregivers to manage their child's ADHD, 3) how caregivers perceived their ability to manage their child's condition, and 4) the impact of ADHD on their child and family's future.

CONCLUSIONS

Family management is an important concept within pediatric literature and may be extended to further research and practice changes for children with ADHD and their caregivers.

PRACTICE IMPLICATIONS

Pediatric nurses are at the forefront of working with children and families. Understanding caregiver perspectives in regard to family management is important for strengthening collaborative partnerships with families and improving the care of children with ADHD.

Time-varying effects of family smoking and family management on adolescent daily smoking: The moderating roles of behavioral disinhibition and anxiety

BACKGROUND

Family smoking environment and family management are associated with risk of teen smoking behaviors. However, less is known about whether these associations increase or decrease in strength across adolescence, and whether there are person-environment interactions. The current study examined 1) the age-varying main effects of family smoking and family management on adolescent daily smoking from ages 12-18 and tested 2) whether behavioral disinhibition and anxiety moderated these relationships.

METHODS

Data were drawn from the Seattle Social Development Project (SSDP; N = 808), a longitudinal study examining prosocial and antisocial behavior. Analyses used time-varying effect modeling (TVEM), which tested the stability of the relationship between family smoking and family management and youth daily smoking across adolescence.

RESULTS

Greater family smoking increased the likelihood of adolescent daily smoking, whereas greater family management reduced the likelihood of daily smoking. Significant interactions between family management and youth behavioral disinhibition and anxiety during early and mid-adolescence indicated that family management was more protective for adolescents with low (compared to high) behavioral disinhibition and anxiety. The effect of family smoking was not moderated by behavioral disinhibition or anxiety.

CONCLUSIONS

Family smoking and family management are key risk and protective factors that may be targeted for adolescent smoking prevention. Our interaction results for individual differences in behavioral disinhibition and anxiety suggest that certain types of youth may respond differently to family management practices. Findings also show periods during adolescence where family-centered preventive interventions could be optimally timed to prevent or reduce persistent adolescent smoking.

Adapting the Family Management Styles Framework to Include Children

EMPIRICAL STUDY PURPOSE

Propose an adapted Family Management Style Framework that includes the perspectives of children with chronic health conditions.

DESIGN AND METHODS

Building on the current Family Management Style Framework, the authors used recent empirical studies with children to further develop the framework. Definitions of each dimension and component of the framework were reviewed and revised to reflect the perspectives of the child, based on the child data and prior work.

RESULTS

The Family Management Style Framework was adapted to reflect children's perspectives of themselves and their family. Based upon our understanding of the components of the framework, we expanded the components and revised the definitions of the dimensions to reflect the child perspectives.

CONCLUSIONS

Incorporating the perspectives of children allows us to consider the transactions that occur during condition management between parents, children and families. Additional research is needed to explore this interaction and the implications it has on the outcomes.

PRACTICE IMPLICATIONS

Children experience the way their family manages their chronic health condition and incorporate those experiences as part of their developing understanding of themselves and their condition. Practitioners should encourage children to express their understanding of their condition and its management to model and encourage them to dialogue about management with their families.

Longitudinal, reciprocal relationships between family management and antisocial peer associations

INTRODUCTION

Poor family management and antisocial peer associations are related risk factors for negative outcomes such as adolescent substance misuse and conduct disorders. The relationship between family management and antisocial peer associations is complex. The purpose of this study was to test the reciprocal relationships between youth-reports of poor family management and antisocial peer associations over multiple time-points.

METHODS

We used four data points (5th-11th grade) from the Australian arm of the longitudinal International Youth Development Study (IYDS) to test a random-intercepts cross-lagged path model (N = 922).

RESULTS

The model fit the data well with path estimates showing that poor family management predicted greater antisocial peer associations at the next wave but not the reverse. A second model included a third autoregressive path to control for youth's own antisocial behavior; the direction of the relationships between poor family management and antisocial peer associations did not change.

CONCLUSIONS

These results indicate that across adolescence poor family management predicts greater antisocial peer association, which provides evidence that family-focused interventions are an important prevention strategy even in adolescence.

Family management risk and protective factors for adolescent substance use in South Africa

Background

An increasingly recognised prevention approach for substance use entails a reduction in risk factors, and the enhancement of promotive, or protective factors in individuals and the environment surrounding them during their growth and development.

Methods

This exploratory study evaluated the effect of potential risk and protective factors associated with family management relating to adolescent substance use in South Africa. Exploratory analysis and cumulative odds ordinal logistic regression modelling was performed on the data, while controlling for the influence of demographic and socio-economic characteristics on adolescent substance use.

Results

The most frequently used substances were cannabis, followed by other illicit substances and alcohol in decreasing order of use intensity. The specific protective, or risk effect of family management factors, varied according to substance. Risk factors associated with demographic and socio-economic factors included being male, of a younger age, lower education grades, of a coloured ethnicity, adolescents from divorced parents, and unemployed or fully employed mothers. Several family management factors, categorised as parental monitoring, discipline, behavioural control and rewards, demonstrated either risk or protective effects on adolescent substance use.

Conclusions

This exploratory study demonstrated that various risk and protective factors associated with family management may affect adolescent substance use. Interaction amongst risk or protective factors, as well as the type of substance, should be considered when further considering interventions based on these risk or protective factors.

The psychological costs of comparisons: Parents' social comparison moderates the links between family management of epilepsy and children's outcomes

Parents play a key role in how children deal with epilepsy. When diagnosed with health conditions, people seek comparison information from fellow patients and families, and this information has consequences for how they evaluate their situation. This study examined the moderating role of parents' social comparison orientation in the associations between family management (parental perceptions of family life difficulties and child's daily life) and adaptation outcomes of children with epilepsy (HRQoL and perceived stigma). Participants included 201 dyads of children with epilepsy and either their mother or father. The results showed that when parents perceived higher difficulties managing their child's epilepsy and/or reported that their child was more affected by this condition, children reported higher perceived stigma and worse HRQoL only when parents had a higher social comparison orientation. Our results are innovative in showing that when parents have a higher social comparison orientation, their children may be at increased risk of poorer outcomes.

'It's a hard conversation to have'. Healthcare professionals' views concerning advance care discussions with young people affected by life-limiting neuromuscular diseases: an interview study

OBJECTIVE

Life-limiting neuromuscular disease, such as some of the muscular dystrophies, are often diagnosed in early childhood: when death comes, commonly in the second or third decade of life, patients rarely have advance care plans in place or documented end-of-life care preferences. There is very limited literature concerning the discussions about end-of-life plans healthcare professionals have with young people affected by life-limiting neuromuscular diseases. The aim of this study was to investigate the views and experiences of healthcare professionals concerning having discussions about advance care plans and end-of-life care with teenagers and young adult patients affected by life-limiting neuromuscular diseases.

METHODS

Semistructured interviews with a maximum variety sample of nine professionals involved in the care of young people with life-limiting neuromuscular diseases in one region of the UK.

RESULTS

While recognising the inevitable progression of the conditions, there was no consensus among interviewees concerning best approaches to discuss end-of-life care plans. Several environmental and personal barriers were identified that lead to avoidance of the emotionally challenging and difficult conversations.

CONCLUSIONS

Community-based professionals with well-established relationships with patients and families may be best placed to take the lead and coordinate discussions, but individual case-by-case preferences need to be carefully considered.

Self-management interventions in pediatric epilepsy: What is the level of evidence?

OBJECTIVE

To respond to recommendations put forth by the Institute of Medicine to improve self-management resources for youth with epilepsy by conducting a systematic review of the self-management literature in pediatric epilepsy.

METHODS

Inclusion criteria: youth birth to 18 years with a seizure disorder or an epilepsy diagnosis and/or their caregivers, published 1985-2014 in English, and conducted in countries with a very high human development index. Abstract and keywords had to explicitly refer to "self-care" (pre-1996) and/or self-management (post-1996). The review was conducted in seven phases: (1) identification of bibliographical search criteria and databases; (2) abstract assessment; (3) full article review; (4) organization of final citations into instrument development, intervention, factors associated with self-management categories; (5) American Academy of Neurology level of evidence (LOE) assessment for intervention studies; (6) CONsolidated Standards of Reporting Trials (CONSORT) evaluation of LOE level III articles utilizing a control group; and (7) categorization of intervention outcomes across four self-management domains.

RESULTS

Of the 87 articles that met eligibility criteria, 24 were interventions and received LOE scores of level III or IV. Most studies (n = 20, 80%) were scored at level III; however, only eight had a control group and adhered to CONSORT guidelines. They largely neglected information on intervention components (e.g., implementation, treatment fidelity), randomization, participant flow, missing data, and effect size or confidence intervals. The 24 intervention studies reported significant impact in four domains: individual (n = 13), family (n = 6), health care system (n = 3), and community (n = 2).

SIGNIFICANCE

There are no level I or II studies. No study met full CONSORT guidelines. Outcomes were well described; however, the nature of self-management interventions (e.g., multiple foci, skills targeted) and the observed heterogeneity in outcomes complicates comparisons across studies. Randomized controlled trials (RCTs) that include large sample sizes, impact of the intervention, treatment fidelity, and power analyses are necessary to further this evidence base.

End-of-life experiences of mothers with advanced cancer: perspectives of widowed fathers

OBJECTIVE

Despite the importance of parenting-related responsibilities for adult patients with terminal illnesses who have dependent children, little is known about the psychological concerns of dying parents and their families at the end of life (EOL). The aim of this study was to elicit widowed fathers' perspectives on how parental status may have influenced the EOL experiences of mothers with advanced cancer.

SUBJECTS

344 men identified themselves through an open-access educational website as widowed fathers who had lost a spouse to cancer and were raising dependent children.

METHODS

Participants completed a web-based survey about their wife's EOL experience and cancer history, and their own depression (Center for Epidemiologic Studies Depression Scale, CES-D) and bereavement (Texas Revised Inventory of Grief, TRIG) symptoms. Descriptive statistics, Fisher's exact tests, and linear regression modelling were used to evaluate relationships between variables.

RESULTS

According to fathers, 38% of mothers had not said goodbye to their children before death and 26% were not at all 'at peace with dying.' Ninety per cent of widowed fathers reported that their spouse was worried about the strain on their children at the EOL. Fathers who reported clearer prognostic communication between wife and physician had lower CES-D and TRIG scores.

CONCLUSIONS

To improve EOL care for seriously ill patients and their families, we must understand the concerns of parents with dependent children. These data underscore the importance of parenting-related worries in this population and the need for additional clinical and research programmes devoted to addressing these issues.

In the Dark: Challenges of Caring for Sons with Klinefelter Syndrome

The purpose of this mixed method study was to describe family management challenges for parents who have sons with Klinefelter Syndrome (KS). Standardized survey results showed that stress, quality of life and family management struggles varied by parent age. When interviewed, parents described feeling uninformed and without support to make decisions about managing their sons' KS. Parents reported that a lack of guidance and case coordination created barriers in caring for their sons throughout childhood. Given the prevalence of KS, health care providers need to be prepared to provide comprehensive evaluation and anticipatory guidance for KS boys and families.

Identifying factors related to family management during the coping process of families with childhood chronic conditions: a multi-site study

This study was designed to determine the key predictors for each aspect of family management of families with children who have chronic conditions in China. The participants included 399 caregivers whose children have chronic illnesses. We used the following instruments: Child Behavior Checklist; Feetham Family Functioning Survey; and Family Management Measures. The final modes of the hierarchical regression explained 29-48% of the variance in aspects of family management. More family support should be provided for those with low family income, children with renal and genetic disorders and rheumatic diseases and those living in rural areas. Child and family functioning affects family management.

A revised Self- and Family Management Framework

BACKGROUND

Research on self- and family management of chronic conditions has advanced over the past 6 years, but the use of simple frameworks has hampered the understanding of the complexities involved.

PURPOSE

We sought to update our previously published model with new empirical, synthetic, and theoretical work.

METHODS

We used synthesis of previous studies to update the framework.

DISCUSSION

We propose a revised framework that clarifies facilitators and barriers, processes, proximal outcomes, and distal outcomes of self- and family management and their relationships.

CONCLUSIONS

We offer the revised framework as a model that can be used in studies aimed at advancing self- and family management science. The use of the framework to guide studies would allow for the design of studies that can address more clearly how self-management interventions work and under what conditions.

Understanding the link between early sexual initiation and later sexually transmitted infection: test and replication in two longitudinal studies

PURPOSE

Age at sexual initiation is strongly associated with sexually transmitted infections (STI); yet, prevention programs aiming to delay sexual initiation have shown mixed results in reducing STI. This study tested three explanatory mechanisms for the relationship between early sexual debut and STI: number of sexual partners, individual characteristics, and environmental antecedents.

METHODS

A test-and-replicate strategy was employed using two longitudinal studies: the Seattle Social Development Project (SSDP) and Raising Healthy Children (RHC). Childhood measures included pubertal age, behavioral disinhibition, and family, school, and peer influences. Alcohol use and age of sexual debut were measured during adolescence. Lifetime number of sexual partners and having sex under the influence were measured during young adulthood. Sexually transmitted infection diagnosis was self-reported at age 24. Early sex was defined as debut at <15 years. Path models were developed in SSDP evaluating relationships between measures, and were then tested in RHC.

RESULTS

The relationship between early sex and STI was fully mediated by lifetime sex partners in SSDP, but only partially in RHC, after accounting for co-occurring factors. Behavioral disinhibition predicted early sex, early alcohol use, number of sexual partners, and sex under the influence, but had no direct effect on STI. Family management protected against early sex and early alcohol use, whereas antisocial peers exacerbated the risk.

CONCLUSIONS

Early sexual initiation, a key mediator of STI, is driven by antecedents that influence multiple risk behaviors. Targeting co-occurring individual and environmental factors may be more effective than discouraging early sexual debut and may concomitantly improve other risk behaviors.

Patterns of family management of childhood chronic conditions and their relationship to child and family functioning

Understanding patterns of family response to childhood chronic conditions provides a more comprehensive understanding of their influence on family and child functioning. In this paper, we report the results of a cluster analysis based on the six scales comprising the Family Management Measure (FaMM) and the resulting typology of family management. The sample of 575 parents (414 families) of children with diverse chronic conditions fell into four patterns of response (Family Focused, Somewhat Family Focused, Somewhat Condition Focused, Condition Focused) that differed in the extent family life was focused on usual family routines or the demands of condition management. Most (57%) families were in either the Family Focused or Somewhat Family Focused pattern. Patterns of family management were related significantly to family and child functioning, with families in the Family Focused and Somewhat Family Focused patterns demonstrating significantly better family and child functioning than families in the other two patterns.

Relational mechanisms and psychological outcomes in couples affected by breast cancer: a systematic narrative analysis of the literature

INTRODUCTION

Relationships are a significant dimension of illness experience. At the couple level, partners will respond to illness as an interpersonal unit rather than individuals in isolation. Research adopting a relational perspective have focused on communication, relational coping and relationship functioning and satisfaction. To our knowledge, there is no published systematic review of literature that reports associations between a couple's relationship and psychological outcomes of patients and partners affected by breast cancer.

AIM

To review studies that examine the impact of relational mechanisms on psychological outcomes in couples affected by breast cancer and thereby improve understanding of the connections between patient, disease and family.

METHODS

A systematic search for literature was conducted, which was followed by a thematic analysis of study findings and a narrative synthesis.

RESULTS

Sixteen papers were included. Papers were published relatively recently between 1988 and 2010. Three relational components were identified: (i) couple coping, (ii) relationship functioning and satisfaction, (iii) communication. While the literature indicates associations between relational and psychological variables, with such a small evidence base, the use of different terminology and different theoretical frameworks makes it almost impossible to draw definitive conclusions about which relational component holds greatest potential for effecting change on psychological well-being.

CONCLUSIONS

While there remain many opportunities for contributing to the theoretical and empirical work in this field, there is sufficient evidence to propose a relational approach to supporting people affected by cancer.