A Multidisciplinary Review of Nutrition Considerations in the Pediatric Oncology Population: A Perspective From Children's Oncology Group

Over the past few decades, great progress has been made in the survival rates of childhood cancer. As survival rates have improved, there has been an increased focus on supportive care. Nutrition is a supportive-care modality that has been associated with improved tolerance to chemotherapy, improved survival, increased quality of life, and decreased risk of infection in children undergoing anticancer therapy. Guidelines and assessment criteria have been proposed for the nutrition management of a child with cancer; however, there is no consistent use of criteria among institutions treating children with cancer. This review will present the current evidence and standards of practice incorporating aspects of nutrition, nursing, pharmacology, and psychosocial challenges to consider in the nutrition management of a child with cancer. Recommendations for clinical practice are presented.

Protective Isolation in Hemopoietic Stem Cell Transplants: A Review of the Literature and Single Institution Experience

Princess Margaret Hospital for Children, Perth, Western Australia, is a pediatric bone marrow transplant center. This center has both laminar flow and HEPA- (high-efficiency particulate air-)filtered rooms for children under-going allogeneic and autologous transplantation. HEPA-filtered rooms on negative pressure are used to nurse oncology children with infectious diseases. Over the winter months of 2001, there was an increased demand for single rooms for children with infectious diseases. Over the same period, a number of transplants were planned. Consequently, to guide practice decisions, a review of the literature and a survey of nursing practice in Australian and North American pediatric oncology units were undertaken. Findings showed that protective isolation measures such as positive-pressure single rooms, low microbial diets, and strict hand washing should be used only for children requiring allogeneic transplants. Use of other isolation measures were found to be of no added value for transplantation. As autologous transplants are increasingly performed in outpatient clinics, these children should not require the same level of protective isolation.

Community and Home Care Services Provided to Children with Cancer: A Report from the Children's Cancer Group Nursing Committee—Clinical Practice Group

A survey directed to home care providers was conducted by the Children's Cancer Group Nursing Committee—Clinical Practice Group. The purpose of the survey was to (a) assess the treatments, resources, and counseling services provided to children with cancer and (b) query what are their informational needs in servicing this specialized population. The survey found that there are many chemotherapy, biotherapy, and supportive therapies being provided in the home. There are also variations in the experiences of the agencies and home care providers in delivering these services. There were numerous informational needs identified by the agencies. The survey results were discussed with the Clinical Practice Group and several themes were expressed: (a) safety, (b) protocol adherence, (c) making the home into a hospital, and (d) meeting the informational needs of the home care providers.

Evaluation of a nurse education workshop on children’s grief

This paper provides an overview of the development and evaluation of an educational program to increase the knowledge of hospice and paediatric nurses who support grieving children and improve their attitudes toward death and bereavement. The specific target groups for the project included nurses providing care through community-based hospice services and inpatient palliative care units, as well as nurses providing inpatient and community-based care at a children's teaching hospital. Fifty-nine nurses from hospice, community and inpatient settings participated in three workshops. Results indicated that the workshop produced a sustained improvement in bereavement knowledge among the nurses and an improvement in their attitudes toward death and bereavement.

Bereavement support for families following the death of a child from cancer: experience of bereaved parents

This study explored the experiences and needs of nine parents who had received hospital-based bereavement support following the death of their child from cancer, in Western Australia. Six prominent themes emerged from thematic data analysis: personal grief, personal coping, concern for siblings of the deceased child, hospital bereavement support, community supports and unmet needs. Parents identified the need for more supportive contact from hospital staff during the palliative phase and following the child's death, early provision of information on how to practically and emotionally prepare for the death of their child, contact with other bereaved parents, and formal grief support for siblings. Areas for future research include exploration of parents' wish to become involved in activities to help others, bereavement support for siblings, the level of contact with the hospital unit that may be therapeutically beneficial, and parental behaviors associated with accessing both hospital and community-based bereavement supports.

Content Validity and Reliability Testing of the FIN-PED II: A Tool to Measure Care Needs of Parents of Children With Cancer

This study tested the reliability and validity of the refined Family Inventory of Needs-Pediatrics (FIN-PED), the FIN-PED II, a 17-item instrument structured to measure care needs of parents of children with cancer. The instrument comprises three rating scales. The first rating scale measures the importance-of-care needs, the second measures the extent to which needs are met, and the third measures the need for further information. The revised instrument was first pilot tested with an expert panel of three mothers and three fathers of children with cancer who rated the tool for clarity, apparent internal consistency, and content validity. All items met preset criteria for these assessments. The instrument was then mailed to 85 parents of Australian children with cancer and tested for internal consistency reliability and test-retest reliability. Thirty-four parents returned the instrument. All three rating scales achieved high estimates of internal consistency. Evidence of the instrument’s stability over time was also achieved. This study provided support for the reliability and content validity of the FIN-PED II.

Bereavement support for families following the death of a child from cancer: practice characteristics of Australian and New Zealand paediatric oncology units

OBJECTIVE

The impact of childhood cancer on the patient and family is devastating and results in significant emotional and physical effects on the child and family. An increasing awareness of the role of health care professionals at this time has led to the development of hospital-based bereavement support services. However, many services are not evidence based, and family support varies between institutions. The objective of this study was to determine current practice relating to hospital-based bereavement support programmes.

METHODS

A survey of all major tertiary paediatric oncology units in Australia and New Zealand (N = 10) was undertaken. The survey instrument consisted of a 19-item questionnaire with open-ended and closed questions.

RESULTS

Nine hospitals (90%) participated. Most hospitals provided a multidisciplinary bereavement service for approximately one year after a child's death. Programmes varied, but the most common hospital-based supports provided were counselling and support groups. Important findings were: a significant number of hospitals worked from a limited theoretical basis and understanding, did not screen for high risk of complicated grieving, did not formally evaluate their programme, and identified areas of unmet needs.

CONCLUSION

The majority of paediatric oncology units in Australia and New Zealand provide dedicated multidisciplinary bereavement support services. There is variation in services provided, often due to a lack of resources and staffing. Findings indicate a need to further develop bereavement programmes, improve staff education and support, and increase the availability of resources in this area. Future research should explore the needs of bereaved families, as well as the range of services and evaluation methods that could be implemented as the baseline for 'best practice' hospital-based bereavement programmes.

Priorities for paediatric cancer nursing research in Western Australia: a Delphi study

A Delphi study was undertaken to identify paediatric cancer nursing research priorities at the sole paediatric tertiary referral centre in Western Australia. Thirty one responses were received from the first Delphi round and 22 from the second round. The top 10 priorities identified were different from those identified in prior North American Delphi studies. The top ranked research topic was 'To effective methods of communication in a multi-disciplinary identify health care team'. The findings will provide a research agenda for cancer nursing at the study setting and may stimulate discussion and re-assessment of research priorities in other paediatric cancer settings.

The total care unit for pediatric hematology and oncology, Princess Margaret Hospital for Children, Perth, Australia

The total care unit for the treatment of pediatric hematology/oncology in Perth, Australia is so named to embody the philosophy of multidisciplinary care of children and their families. Where possible, patients are treated according to randomized controlled trials of the large cooperative Children's Cancer Group. There is a seamless association of clinical and laboratory research. Hemopoietic stem cell transplantation is managed within the unit, as well as treatment of a range of non-malignant hematological disorders. Long-term follow-up of survivors of childhood cancer is coordinated from the unit.