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Simons M, Harvey G, McMillan L, Ryan EG, De Young AG, McPhail SM, Kularatna S, Senanayake S, Kimble R, Tyack Z. Implementation outcomes of a digital, trauma-informed care, educational intervention targeting health professionals in a paediatric burns setting: A mixed methods process evaluation. Burns 2024; 50:1690-1703. [PMID: 38664169 DOI: 10.1016/j.burns.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/05/2024] [Accepted: 03/31/2024] [Indexed: 06/14/2024]
Abstract
Trauma-informed care practices are associated with a culture of safety following traumatic experiences, including medical trauma. An interactive, web-based training package ('Responsive CARE') was developed for voluntary uptake by paediatric burns health professionals to increase staff knowledge about trauma-informed practice. This paper reports on a mixed methods process evaluation conducted alongside a preliminary effectiveness study of 'Responsive CARE'. The process evaluation was conducted using The Consolidated Framework for Implementation Research (CFIR) and a logic model, to examine feasibility of both the intervention and implementation strategy. Health practitioners (including senior managers) delivering care to children and caregivers attending an outpatient burns service were eligible to enrol in 'Responsive CARE'. Qualitative interview data and quantitative metadata were used to evaluate the implementation outcomes (adoption, acceptability, fidelity, feasibility and preliminary effectiveness). Children and caregivers attending an outpatient service for change of burn wound dressing or burn scar management during the 3-month control or 3-month intervention period were eligible to enrol in the effectiveness study. The impact on child pain and distress, as well as cost, was investigated using a pretest-posttest design. Thirteen (from anticipated 50 enrolled) health professionals (all female) with mean 10 years (SD=11) of experience with paediatric burns hospital-based outpatient care completed an average of 65% (range 36% to 88%) of available content. Twenty-five semi-structured interviews were completed with health practitioners (21 female) and with 14 caregivers (11 female). Four themes were identified as influencing feasibility and acceptability of the intervention: 1) Keeping a trauma-informed lens; 2) Ways of incorporating trauma-informed care; 3) Working within system constraints; and 4) Being trauma-informed. Preliminary effectiveness data included 177 participants (median age 2 years, and median total body surface area burn 1%). Causal assumptions within the logic model were unable to be fully tested, secondary to lower-than-expected adoption and fidelity. We found no significant difference for pain, distress and per-patient hospital care costs between groups (pre- and post-intervention). Future implementation strategies should include organizational support to keep a trauma-informed lens and to incorporate trauma-informed principles within a medical model of care. Despite efforts to co-design a staff education intervention and implementation approach focused on stakeholder engagement, adaptations are indicated to both the intervention and implementation strategies to promote uptake highlighting the complexity of changing clinician behaviours.
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Affiliation(s)
- Megan Simons
- Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Queensland, Australia; Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia.
| | - Gillian Harvey
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lucinda McMillan
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia
| | - Elizabeth G Ryan
- QCIF Faculty for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Alexandra G De Young
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia; School of Psychology, The University of Queensland, Queensland, Australia; Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia; Digital Health and Informatics Directorate, Metro South Health, Queensland, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
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McBain S, Cordova MJ. Medical traumatic stress: Integrating evidence-based clinical applications from health and trauma psychology. J Trauma Stress 2024. [PMID: 38970812 DOI: 10.1002/jts.23075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 07/08/2024]
Abstract
Medical events in both childhood and adulthood, including components of the illness or injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic. There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD). Existing evidence suggests that trauma-focused treatment can promote both physical and psychological recovery. However, there continues to be a dearth of clinical guidance on how to (a) best identify and treat prior trauma exposure that complicates adjustment to illness and increases the risk for medically induced PTSD and (b) address medically induced PTSD while concurrently targeting health-related concerns (e.g., pain, adjustment to illness, acquired disability) that may negatively impact recovery. Originally presented as a premeeting institute at the 2023 Annual Meeting of the International Society for Traumatic Stress Studies, this paper describes the biopsychosocial impacts of medical trauma on adults and considerations for assessment and intervention in both traditional trauma and integrated care settings. This includes clinical applications, including assessment, case conceptualization, and health and rehabilitation interventions, that can promote health-related adjustment and coping within the context of trauma-focused treatment.
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Affiliation(s)
- Sacha McBain
- Departments of Psychiatry and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Matthew J Cordova
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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Liu G, Xin H, Lin J, Li X, Zhang Y, Wang X, Liao J, Hu R. Analysis of the survival journey and post-traumatic growth process of children and their families following paediatric intensive care unit admission: A grounded theory study. Aust Crit Care 2024:S1036-7314(24)00116-4. [PMID: 38969541 DOI: 10.1016/j.aucc.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVES Advances in critical care technology have lowered mortality rates among critically ill individuals. Nonetheless, survivors and their families may develop new physical, mental, cognitive, and social challenges due to paediatric intensive care unit (PICU) treatments, impacting their quality of life. The aim of this study was to investigate the survival journey and post-traumatic growth process of children and their families following PICU admission within the Chinese cultural context. METHODS Twenty-six children who have been or are currently admitted to the PICU, alongside their parents and three PICU nurses, were chosen through purposive and theoretical sampling. Data collection involved face-to-face interviews and observations, with data analysis conducted through continuous comparison, open coding, and selective coding techniques. FINDINGS A model outlining the survival journey and post-traumatic growth process of critically ill children and their families post PICU admission has been established. This model encompasses two central trajectories: an upward trajectory consisting of confusion, charging, action, and sublimation phases and a downward trajectory comprising confusion, doubt and fear, inhibition (including confrontation and avoidance), and drowning phases. CONCLUSIONS Critically ill children and their families encounter diverse survival experiences and psychological journeys following traumatic events in the PICU. The survival experience has alternative upwards or downwards trajectories that are flexible/adaptable. Hence, offering timely psychological support can alter their developmental trajectories and foster post-traumatic growth.
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Affiliation(s)
- Guihua Liu
- Department of Child Health Care, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian 350001, China; The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Huining Xin
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian 350001, China.
| | - Jinling Lin
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Xiaoting Li
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Yuhong Zhang
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Xiaojuan Wang
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Jinhua Liao
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China
| | - Rongfang Hu
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian 350000, China.
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Şenol FB, Şenol Y. The effect of drama on psychosocial problems and emotional states of hospitalized children with cancer. J Pediatr Nurs 2024; 77:e276-e282. [PMID: 38670864 DOI: 10.1016/j.pedn.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/13/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND PURPOSE Hospitalization is a traumatic experience for children. Especially in the case of childhood cancers that require long-term hospitalization, children need psychosocial support. The study aimed to examine the effectiveness of drama in reducing psychosocial problems in hospitalized paediatric children diagnosed with cancer. METHODS The study used a mixed method approach, combining both qualitative and quantitative methods with a single group. Drama sessions prepared according to the Tasks and Skills Model were used to support their psychosocial conditions. The Facial Expression Form, The Assessment Scale for Psychosocial Symptoms in Hospitalized Children, and the Drawing and Writing Technique were used before and after the drama sessions. RESULTS This study differs from others in its use of drama intervention to reduce psychosocial problems in children undergoing cancer treatment. As a result of the study, it was found that there was a decrease in anxiety, hopelessness, anger-aggression and communication difficulties among psychosocial problems and a change in mood towards feeling happy. The study suggests that drama sessions were effective in relieving emotional distress in paediatric cancer patients. CONCLUSION The study suggests that drama sessions were effective in relieving emotional distress in paediatric cancer patients. PRACTICE IMPLICATIONS Applying drama to children undergoing long-term hospital treatment can help alleviate psychosocial problems by reducing stress, emotional suppression, and compensating for trauma.
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Affiliation(s)
- Fatma Betül Şenol
- Department of Special Education, Faculty of Education, Afyon Kocatepe University, Afyonkarahisar 03030, Türkiye.
| | - Yiğit Şenol
- Department of Public Health, Afyonkarahisar Provincial Health Directorate, Afyonkarahisar 03030, Türkiye.
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Colville G, Pierce CM. Post-traumatic stress trajectories of children and their parents over the year following intensive care discharge: A secondary analysis. Nurs Crit Care 2024; 29:830-834. [PMID: 37994217 DOI: 10.1111/nicc.13014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND New research in the field of psychological trauma has emphasized (a) the heterogeneity of psychological reactions after traumatic events and (b) the existence of distinct symptom trajectories. AIMS In this study, existing data on post-traumatic stress disorder (PTSD) symptoms in 66 parent-child dyads were re-examined in the light of this literature in order to establish whether a similar pattern of symptom trajectories also applies to this population. STUDY DESIGN A prospective observational cohort study. Participants' PTSD symptoms were assessed 3 and 12 months after discharge from a paediatric intensive care unit (PICU), using a short form of the Davidson Trauma Scale with parents and the Child Revised Impact of Events Scale with children aged 7-17 years. RESULTS Results confirmed that the majority of children (58%) and parents (46%) exhibited a 'Resilient' PTSD trajectory over the year, in the sense that their scores remained in the non-clinical range at both timepoints. Children displaying a 'Resilient' trajectory were more likely to have a parent who also displayed a 'Resilient' trajectory (p = .018). However, there was also evidence of a 'Recovery' trajectory in a significant minority in this sample and over 1 in 4 children and parents exhibited a 'Chronic' or 'Delayed' symptom trajectory. CONCLUSIONS Although average PTSD scores reduced over time in this sample and 'Resilient' trajectories were common, a significant proportion of children and parents exhibited 'Chronic' and 'Delayed' symptom trajectories. RELEVANCE TO CLINICAL PRACTICE These results suggest that, although the majority do well, a significant number of children and family members may develop chronic or delayed symptoms of PTSD in the year following PICU discharge. The monitoring of individual family members' symptoms beyond 3 months post-discharge may help to determine those who might most benefit from further support.
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Affiliation(s)
- Gillian Colville
- Population Health Research Institute, St George's University of London, London, UK
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Carlton EF, Yagiela LM. Improving PICU Family Outcomes: Moving From Measurement Toward Interventions. Pediatrics 2024; 154:e2024066285. [PMID: 38916041 DOI: 10.1542/peds.2024-066285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 06/26/2024] Open
Affiliation(s)
- Erin F Carlton
- Division of Critical Care Medicine, Department of Pediatrics
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Lauren M Yagiela
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
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Kim A, Burton ET. Addressing Obesity Care in Children With Chronic Health Conditions. Child Obes 2024; 20:371-374. [PMID: 37852004 DOI: 10.1089/chi.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Obesity care in pediatric populations has entered a new era. The recent discovery of molecular genetic causes for abnormal weight gain, development of antiobesity medications, mounting data on the robust efficacy and favorable safety profile of bariatric surgery, and implementation of clinical guidelines fill a long-standing gap in the care of children affected by obesity, one of the most challenging pediatric diseases. However, these novel clinical approaches do not appear to have reached every individual who is in need, particularly children with chronic health conditions (CHCs), raising important questions for equitable medical care. In this study, we discuss specific etiologies, challenges, and ideas for future directions in diagnosing and managing obesity in children with CHCs. Although this article is not intended to be utilized as clinical guidelines, it underscores potential practical solutions for the current issues.
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Affiliation(s)
- Ahlee Kim
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - E Thomaseo Burton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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de Castro EK, da Silva Oliveira JA, Armiliato MJ, Peloso F, Valentini F. Profiles of Posttraumatic Growth and Posttraumatic Stress Symptoms in Childhood Cancer Survivors. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:457-465. [PMID: 38938963 PMCID: PMC11199458 DOI: 10.1007/s40653-023-00605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 06/29/2024]
Abstract
The experience of childhood cancer (CC) could be a traumatic event that produces long-term emotional responses such as posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) in survivors. The relationship between both PTSS and PTG is not clear in CC survivors. Assessing challenges to core beliefs and rumination could give information regarding the different paths that lead to traumatic responses. Thus, this study aims to identify childhood cancer survivors' profiles from PTSS and PTG measures and to examine the pathways of relationships between PTSS and PTG, rumination, and challenge to core belief. Sixty-two CC survivors completed surveys on their childhood cancer experience, PTSS, PTG, challenge to core beliefs, and rumination. High PTG scores among childhood cancer survivors (Cluster 1), High PTSS scores among childhood cancer survivors (Cluster 2), and Childhood cancer survivors without changes (Cluster 3). Network analysis found that the challenge to core beliefs is the central point in the relationship between the variables, in a direct and positive relationship with PTG. We found an indirect path from challenge to core beliefs to PTSS, mediated by intrusive and deliberative ruminations. The combined findings suggested that there are different profiles related to trauma in CC survivors and the relationship between PTSS and PTG is mediated by the challenge to core beliefs and deliberative and intrusive rumination.
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Affiliation(s)
| | | | - Maria Júlia Armiliato
- Programa de Pós-Graduação em Psicologia, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Franciele Peloso
- Programa de Pós-Graduação em Psicologia, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Felipe Valentini
- Programa de Pós-Graduação em Psicologia, Universidade São Francisco, Campinas, Brazil
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Stegenga K, Henley AK, Harman E, Robb SL. Shifting perspectives and transformative change: Parent perspectives of an active music engagement intervention for themselves and their child with cancer. Pediatr Blood Cancer 2024; 71:e30913. [PMID: 38337169 PMCID: PMC10959685 DOI: 10.1002/pbc.30913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Children with cancer (ages 3-8 years) and their parents experience significant, interrelated distress associated with cancer treatment. Active music engagement (AME) uses music-based play and shared music-making to mitigate this distress. To advance our understanding about how AME works and its essential features, we interviewed parents who received the AME intervention as part of a multi-site mechanistic trial. The purpose of this qualitative analysis was to describe parents' experiences of AME for themselves and their child and to better understand how the intervention worked to lower parent-child distress. PROCEDURE We conducted a total of 43 interviews with parents/caregivers, and purposively analyzed all interviews from underrepresented groups based on race/ethnicity and parent role. We used thematic analysis and achieved thematic redundancy after analyzing 28 interviews. RESULTS The following statement summarizes resulting themes: Music therapists skillfully use AME to create a safe and healthy space (Theme 1), where parents/children have transformative experiences (Theme 2) that lead to learning and enactment (Theme 3) of new skills that counteract suffering (Theme 4) through empowerment, connectedness, and sustained relief. CONCLUSIONS This work elucidates how AME works to counteract stressful qualities of cancer treatment. As parents witnessed positive and transformative changes in their child, they experienced relief and reported shifts in their perspective about cancer treatment. This led to learning and use of music as a coping strategy that extended beyond therapist-led sessions. Accessible, music-based interventions, like AME, offer a developmentally appropriate and effective way to support parents and young children during treatment.
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Affiliation(s)
- Kristin Stegenga
- Children’s Mercy, Kansas City, Division of Hematology/Oncology/BMT, Kansas City, MO
| | - Amanda K. Henley
- Indiana University, Herron School of Art and Design, Indianapolis, IN
| | | | - Sheri L. Robb
- Indiana University, School of Nursing, Indianapolis, IN
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Alzawad Z, Weiss JM, Lee J, Perkhounkova Y, Hein M, McCarthy AM. Exploring Factors Affecting Parental Psychological Vulnerability During Their Child's PICU Admission: A Prospective Pilot Cohort Study. J Pediatr Health Care 2024; 38:323-336. [PMID: 38260924 DOI: 10.1016/j.pedhc.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Parental psychological responses during their child's pediatric intensive care unit (PICU) admission are often overlooked. This study aimed to identify pre-existing and peri-traumatic factors explaining parental stress and anxiety during their child's PICU admission and one-month follow-up. METHOD A prospective pilot study included 60 PICU parents. Parental Stressors Scale and State-trait Anxiety Inventory measured stress and anxiety during PICU admission, and the State-trait Anxiety Inventory and Perceived Stress Scale at a one-month follow-up. RESULTS During PICU admission, parental stress correlated with age, race, and adverse childhood experiences (ACEs), anxiety was linked to income. At one-month follow-up, anxiety related to child's health worries, perceived stress was linked to parental ACEs and education. Parental ACEs predicted perceived stress (b = 0.83, p = .028). Children's diagnoses explained anxiety, particularly respiratory and cardiac diagnoses (b = -13.44, p = .023; -10.03, p = .045). DISCUSSION Identifying factors helps teams understand parental vulnerability and provide appropriate support.
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Griffin BR, Trenoweth K, Dimanopoulos TA, De Young AC, Cobham VE, Williams H, Kimble R. Co-design of a paediatric post-trauma electronic psychosocial screen. J Pediatr Nurs 2024; 76:52-60. [PMID: 38359545 DOI: 10.1016/j.pedn.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE To optimise care pathways and provide greater transparency of the psychosocial needs of injured children after hospital discharge by extending post-discharge psychosocial screening to children admitted with traumatic injury for ≥24 h. DESIGN AND METHODS This mixed-methods study used a co-design approach informed by the Experience-Based Co-design (EBCD) framework. Interviews with carers were used to evaluate experiences and generate views on psychosocial support interventions. Online surveys by international child psychologists' indicated preferences for a psychosocial screening tool, and clinician-stakeholder consensus meetings facilitated the development of an electronic post-injury psychosocial screening tool. RESULTS Carers found the initial year of follow-up from trauma family support services helpful, appreciating the hospital connection. Flexible follow-up timings and additional resources were mentioned, and most carers were interested in participating in an electronic screening activity to predict their child's coping after injury. Child trauma experts recommended including several screening tools, and the multidisciplinary paediatric trauma service and study investigators collaborated over a year to workshop and reach a consensus on the screening tool and follow-up process. CONCLUSION The multidisciplinary team co-designed an electronic psychosocial screening and follow-up process for families with children with traumatic injuries. This tool improves the visibility of injured children's psychosocial needs post-injury and potentially aids clinical targeted resource allocation for trauma family support services. PRACTICE IMPLICATIONS The study emphasises the significance of specialised psychosocial screening tools in paediatric nursing, especially in trauma care, for understanding patients' psychosocial needs, tailoring follow-up plans, and promoting a patient-centred approach.
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Affiliation(s)
- Bronwyn R Griffin
- Menzies Health Institute Queensland, Griffith University, Nathan Campus, QLD, Australia; Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Kate Trenoweth
- Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Tanesha A Dimanopoulos
- Menzies Health Institute Queensland, Griffith University, Nathan Campus, QLD, Australia; Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia.
| | - Alexandra C De Young
- Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland, Hospital Health Service, Brisbane, QLD, Australia; Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia; Child and Youth Mental Health Service, Children's Health Queensland, Brisbane, QLD, Australia
| | - Hayley Williams
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Roy Kimble
- Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
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Hosoda-Urban T, O'Donnell EH. Diabetes-Related Posttraumatic Stress Symptoms in Adolescents and Young Adults With Type 1 Diabetes: A Pilot Study. J Acad Consult Liaison Psychiatry 2024; 65:248-253. [PMID: 38302058 DOI: 10.1016/j.jaclp.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/16/2023] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Posttraumatic stress symptoms (PTSS) may adversely affect glycemic control. Yet no studies have focused on trauma and PTSS induced by diabetes-related events in adolescents and young adults (AYA) with type 1 diabetes. OBJECTIVE This study explores PTSS arising from diabetes-related events (e.g., severe symptoms or emergency room visits due to complications) among AYA with type 1 diabetes. METHODS In this cross-sectional pilot study, self-reported measures (Posttraumatic Diagnostic Scale for DSM-5, Child Posttraumatic Stress Disorder Symptom Scale 5) were employed to assess trauma experiences and PTSS in AYA with type 1 diabetes at a pediatric diabetes clinic within a large hospital/academic medical center. RESULTS Fifty AYA with type 1 diabetes completed questionnaires assessing trauma and PTSS. Of the sample, 82% (n = 41) reported experiencing at least one form of general trauma (e.g., physical abuse, witnessing violence, or serious injuries). Among those who reported trauma, 22% (n = 9) indicated that the most distressing event was specifically diabetes-related. Over a quarter of participants exhibited clinically relevant levels of PTSS related to diabetes events. Females assigned at birth and those with a higher frequency of emergency room visits due to diabetes had an elevated risk of developing clinically relevant levels of diabetes-related PTSS. CONCLUSIONS Our results suggest that diabetes itself can serve as a traumatic stressor for some individuals. Therefore, interventions should be designed to prevent or mitigate PTSS starting from the time of diagnosis.
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Affiliation(s)
- Tamaki Hosoda-Urban
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Clinical Psychology, Graduate School of Medical Sciences, Tottori University, Yonago, Tottori, Japan.
| | - Ellen H O'Donnell
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Hayes LC, Shepard JA, SooHoo MM, Rouse CM, Papadakis JL. Preventing Pediatric Medical Traumatic Stress in a Pediatric Urology Outpatient Setting: Application of the Pediatric Psychosocial Preventative Health Model (PPPHM). J Pediatr Psychol 2024; 49:259-265. [PMID: 37738669 DOI: 10.1093/jpepsy/jsad064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The objectives of this topical review are to (1) increase understanding of pediatric medical traumatic stress (PMTS) in pediatric urology populations through literature review, (2) identify a theoretical model to guide prevention of PMTS in this population, and (3) provide clinical care recommendations based on the model identified. Authors introduce a new term "uropsychology" to describe psychological practice that specializes in the treatment of urology patients. METHODS Pediatric uropsychologists from 5 pediatric medical care centers gathered to discuss their experience with treating PMTS in their settings and to review existing literature related to PMTS in pediatric urology, PMTS in other populations, and established models for prevention. Authors provide recommendations based on literature review for preventing PMTS in a pediatric urology population. RESULTS Gaps in the evidence base for preventing PMTS in this population are identified. Authors provide a series of clinical care recommendations, utilizing clinical experience, and the Pediatric Psychosocial Preventative Health Model (PPPHM) as a framework. CONCLUSIONS While there is limited research on PMTS in pediatric urology populations, urologic interventions can be perceived as invasive, painful, distressing, and traumatic. Application of the PPPHM can guide prevention and intervention efforts. Future research is needed to characterize PMTS in this population, evaluate the efficacy of trauma-informed prevention and intervention practices, and develop screening measures that accurately identify at-risk patients. Authors recommend intradisciplinary collaboration among uropsychologists, urology specialists, and patients and families to create formal standards of care, avenues for other future research, and equitable access to uropsychology care.
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Affiliation(s)
- Lillian C Hayes
- Department of Urology, Boston Children's Hospital, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Jaclyn A Shepard
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, USA
| | | | | | - Jaclyn L Papadakis
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, USA
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14
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Marshall KH, Pincus HA, Tesson S, Lingam R, Woolfenden SR, Kasparian NA. Integrated psychological care in pediatric hospital settings for children with complex chronic illness and their families: a systematic review. Psychol Health 2024; 39:452-478. [PMID: 35635028 DOI: 10.1080/08870446.2022.2072843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To synthesize and critically evaluate evidence on the effectiveness of integrated psychological care models for children with complex chronic illness within pediatric hospital settings and provide recommendations for successful implementation. DESIGN Six electronic databases (Medline, Cochrane, Embase, PsycINFO, Scopus, CINAHL) were systematically searched for English language studies including families of children aged 0-17 years with complex chronic illness. Eligible studies reported on psychology or neuropsychology screening, assessment, intervention, or services provided within a pediatric hospital setting. RESULTS Fifteen studies were identified for review; nine assessed a psychological service, five examined psychosocial screening, and one examined a neuropsychology service. Three studies demonstrated the effectiveness of integrated psychological services in improving child or parent physical, psychological, or behavioral health outcomes. Uptake of psychosocial screening was high (84-96%), but only 25-37% of children or families identified as 'at-risk' engaged with on-site psychology services. Integrated psychological services offering consultations at the same time and location as the child's medical visit reported the highest rates of uptake (77-100%). CONCLUSIONS The available evidence supports co-location of child medical and psychological services. A more consistent and comprehensive approach to the assessment of patient- and caregiver-reported outcomes and implementation effectiveness is recommended.
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Affiliation(s)
- Kate H Marshall
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Harold A Pincus
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
- Irving Institute for Clinical and Translational Research, Columbia University and New York‑Presbyterian Hospital, New York, NY, USA
| | - Stephanie Tesson
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Susan R Woolfenden
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney local health District, Sydney, NSW, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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15
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Marshall E, Shieh E, Franzone JM, Enlow PT. Mental health screening in pediatric lower limb deficiency population. PM R 2024. [PMID: 38511432 DOI: 10.1002/pmrj.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Youth with lower limb deficiency (LLD) may be at increased risk for mental health difficulties. However, guidelines around psychosocial screening are not well established. OBJECTIVE To describe the implementation and results of a mental health screening process in a multidisciplinary prosthetics clinic. DESIGN Survey. SETTING Outpatient specialty care clinic located within a children's hospital. PATIENTS All patients ages 0-18 years with LLD seen at a monthly multidisciplinary prosthetics clinic between September 2019 and January 2023 (n = 75). INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES Quality of life was measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric proxy survey. Psychological functioning was measured using the Strengths and Difficulties Questionnaire (SDQ). RESULTS Descriptive statistics were used to determine the proportion of patients who endorsed clinically significant concerns. Of the 75 clinic visits during the study time frame, the psychosocial screeners were completed at 38 (51%). A total of 25 unique patients completed the screeners; 12 patients completed the screener more than once. The most commonly endorsed concerns on the PROMIS were issues with physical mobility (65%) and upper extremity function (40%). The SDQ revealed that a majority (62.5%) of the screened patients had an overall score above the clinical cutoff, indicating psychosocial distress in more than one area. The most commonly reported mental health concern was peer problems (62.5%). Post hoc analysis of repeat screenings indicated that most problems identified during the first screening persisted at follow-up screenings. CONCLUSIONS Clinically significant psychological concerns were common among the sample, indicating the need to address this aspect of patients' well-being. Preliminary data on repeat screenings suggest that clinically significant concerns may not self-resolve. Routine psychosocial screening is critical for early identification of mental health problems and timely referral to evidence-based psychological interventions.
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Affiliation(s)
- Emily Marshall
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eileen Shieh
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Division of Physical Medicine and Rehabilitation, Nemours Children's Health, Wilmington, Delaware, USA
| | - Jeanne M Franzone
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Orthopedic Surgery, Nemours Children's Health, Wilmington, Delaware, USA
| | - Paul T Enlow
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA
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16
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Seasons M, Morrongiello BA. Returning to sport after injury: the influence of injury appraisals and post-traumatic stress symptoms on adolescent risk-taking intentions post-injury. J Pediatr Psychol 2024; 49:175-184. [PMID: 38281129 DOI: 10.1093/jpepsy/jsae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/07/2023] [Accepted: 01/01/2024] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVE How youth think about injury risk can affect their decisions about whether to engage in behaviors that can lead to injury. Appraisals also influence the development of post-traumatic stress symptoms (PTSS), which occur in approximately 20% of children after a medically treated injury. The current study examined how the injury appraisals of youth are associated with the development of PTSS post-skateboarding injury, and if PTSS or perceived benefits of the sport are also associated with youths' intentions to return to the sport. METHOD One hundred three youth who had a medically treated skateboarding injury within the last year provided survey data on injury appraisals, PTSS, the benefits of skateboarding, and intentions to return to the sport. RESULTS A two-stage moderated statistical mediation path model was specified. In the first stage, there was a positive relationship between pain at injury and PTSS, which was attenuated by the moderator, perceived bad luck. PTSS fully mediated the association between perceived pain at the time of injury and intentions to return to skateboarding. In the second stage of the mediation model, the moderator perceived benefits of skateboarding, reversed the negative relationship between PTSS and intentions to return to skateboarding. CONCLUSIONS Skateboarders are a group at risk for injury that can lead to PTSS, and they also are likely to return to the sport despite PTSS. This research identifies factors that impact the decision to return to skateboarding after injury. Limitations of the study and implications for mental health support and injury prevention are provided.
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Mai K, Dawson AE, Gu L, LaMotte JE, Molitor S, Zimmerman CT. Common mental health conditions and considerations in pediatric chronic kidney disease. Pediatr Nephrol 2024:10.1007/s00467-024-06314-8. [PMID: 38456918 DOI: 10.1007/s00467-024-06314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
The mental health of youth with chronic kidney disease (CKD) has been increasingly recognized as an area of clinical need. The development of mental health concerns is influenced by a range of physiological, psychological, and environmental factors. Some of these factors are common across child development, but some are more unique to youth with CKD. Mental health concerns are associated with increased risk for a range of poor medical outcomes (e.g., adherence, risk of transplant rejection) and quality of life concerns. In this educational review, we discuss the current evidence base regarding the development of mental health concerns in youth with CKD. The review covers multiple domains including mood and anxiety disorders, traumatic stress, and neurodevelopmental disorders. Estimated prevalence and hypothesized risk factors are outlined, and the potential impact of mental health on medical care and functional outcomes are reviewed. Finally, we introduce options for intervention to support positive mental health and offer recommendations for building access to mental health care and improving the mental health education/training of medical professionals.
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Affiliation(s)
- Katherine Mai
- Division of Pediatric Nephrology, Cohen Children's Medical Center, 420 Lakeville Road, New Hyde Park, NY, 11364, USA.
| | - Anne E Dawson
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lidan Gu
- Division of Clinical Behavioral Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Julia E LaMotte
- Division of Child and Adolescent Psychiatry, Riley Children's Health, Indianapolis, IN, USA
| | - Stephen Molitor
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Cortney T Zimmerman
- Division of Psychology and Nephrology Service, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, 77030, USA
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18
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Ferraz A, Santos M, Pereira MG. Portuguese Validation of the TAPQoL: A Health-Related Quality of Life Instrument for Children Aged 0-6 Years. Eur J Investig Health Psychol Educ 2024; 14:399-410. [PMID: 38391494 PMCID: PMC10888349 DOI: 10.3390/ejihpe14020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
In Portugal, there are few generic and specific instruments to assess health-related quality of life (HRQoL) in children, especially those of preschool age. This study aimed to adapt and validate the Portuguese version of the Preschool Children Quality of Life Questionnaire (TAPQoL) in a community and clinical sample of children aged 0-6 years. The parents of 409 healthy children and 137 children undergoing treatment for burns and acute lymphoblastic leukemia completed the TAPQoL and were assessed on psychological morbidity and family functioning. Exploratory and confirmatory factor analyses were performed, as well as analysis of the psychometric properties as shown by internal consistency measures, convergent validity, and average variance extracted. Confirmatory factor analysis confirmed an 11-factor structure with good psychometric properties. The current version of the TAPQoL is a valid and reliable instrument for assessing HRQoL in Portuguese preschool children in community and clinical settings.
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Affiliation(s)
- Ana Ferraz
- Psychology Research Centre (CIPsi), School of Psychology, University of Minho, 4710-057 Braga, Portugal
| | - Martim Santos
- Psychology Research Centre (CIPsi), School of Psychology, University of Minho, 4710-057 Braga, Portugal
| | - M Graça Pereira
- Psychology Research Centre (CIPsi), School of Psychology, University of Minho, 4710-057 Braga, Portugal
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19
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Rothschild CB, Balistreri KA, Mulligan K, Lee KJ, Karst J, Privatt M, Magner K, Lee HJ, Scanlon M, Davies WH. Acceptability and Feasibility of Text Message Interface to Assess Parents' Real-time PICU Experiences. J Intensive Care Med 2024; 39:159-169. [PMID: 37605433 DOI: 10.1177/08850666231195754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Parents of children in the pediatric intensive care unit (PICU) experience substantial stress; a parent's perception of their child's illness severity, more than objective measures, predicts psychological outcomes. No tools exist to assess parents' real-time experiences. This pilot study evaluated the feasibility and acceptability of a text-based tool to measure parental experience. METHODS Inclusion criteria included PICU stay >48 h, physician approval, smartphone access, and English-speaking caregiver. Eligible parents received a text-based baseline survey and surveys every other day while hospitalized regarding their mood/experiences and optional open-ended questions regarding stressors. They received post-discharge follow-up surveys at 1 week and 1, 3, and 6 months. Follow-up surveys assessed mood and symptoms of depression, anxiety, and post-traumatic stress. Interviews and surveys about the interface were conducted 1 week and 3 months following discharge. Feasibility was assessed by descriptive statistics (eg, response rates), and acceptability was assessed by descriptive statistics (survey results) and thematic analyses of interviews. RESULTS Of 20 enrolled participants, the first 5 were excluded due to technical issues. Of the 15 included, results demonstrated feasibility and acceptability. Most participants (86%) completed all surveys during the PICU stay and continued to complete surveys at a high rate: 79%-94% 3 months post-discharge. All participants agreed that the system was easy to use and were satisfied with the system at discharge, and 91% remained satisfied 3 months post-discharge. Additionally, 76% reported comfort, and 69% reported benefit. From the interviews, participants lauded the system's convenience and applicability of content. Some proposed changes to improve ergonomics. Many suggested this interface could help teams better support families. CONCLUSIONS A text-based interface for measuring experience in the PICU is feasible and acceptable to parents. Further research can explore how this could identify parents most at risk of adverse psychological sequelae and lead to earlier supportive interventions.
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Affiliation(s)
| | | | - Kathryn Mulligan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - K Jane Lee
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey Karst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miranda Privatt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kristin Magner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Matthew Scanlon
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - W Hobart Davies
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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20
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Afzal N, Lyttle MD, Rajabi M, Rushton-Smith F, Varghese R, Trickey D, Halligan SL. Emergency department clinicians' views on implementing psychosocial care following acute paediatric injury: a qualitative study. Eur J Psychotraumatol 2024; 15:2300586. [PMID: 38197257 PMCID: PMC10783840 DOI: 10.1080/20008066.2023.2300586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction: The early post-trauma period is a key time to provide psychological support to acutely injured children. This is often when they present to emergency departments (EDs) with their families. However, there is limited understanding of the feasibility of implementing psychological support for children and their families in EDs. The aim of this study was to explore UK and Irish ED clinicians' perspectives on developing and implementing psychosocial care which educates families on their children's post-trauma psychological recovery.Methods: Semi-structured individual and group interviews were conducted with 24 UK and Irish ED clinicians recruited via a paediatric emergency research network.Results: Clinicians expressed that there is value in offering psychological support for injured children and their families; however, there are barriers which can prevent this from being effectively implemented. Namely, the prioritisation of physical health, time constraints, understaffing, and a lack of training. Therefore, a potential intervention would need to be brief and accessible, and all staff should be empowered to deliver it to all families.Conclusion: Overall, participants' views are consistent with trauma-informed approaches where a psychosocial intervention should be able to be implemented into the existing ED system and culture. These findings can inform implementation strategies and intervention development to facilitate the development and delivery of an accessible digital intervention for acutely injured children and their families.
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Affiliation(s)
- Nimrah Afzal
- Department of Psychology, University of Bath, Bath, UK
| | - Mark D. Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Mohsen Rajabi
- Department of Psychology, University of Bath, Bath, UK
| | | | - Rhea Varghese
- Department of Psychology, University of Bath, Bath, UK
| | | | | | - on behalf of the Paediatric Emergency Research in the UK and Ireland (PERUKI)
- Department of Psychology, University of Bath, Bath, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
- Anna Freud Centre, UK Trauma Council, London, UK
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21
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Leenders AEM, Kremer-Hooft van Huijsduijnen E, Robalo B, van Male R, De Luca A, Kemps R, Hoving E, Lequin MH, Grootenhuis MA, Partanen M. Unraveling the relations between post-traumatic stress symptoms, neurocognitive functioning, and limbic white matter in pediatric brain tumor patients. Neurooncol Adv 2024; 6:vdae026. [PMID: 38476931 PMCID: PMC10929421 DOI: 10.1093/noajnl/vdae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background Pediatric brain tumor patients are at risk of developing neurocognitive impairments and associated white matter alterations. In other populations, post-traumatic stress symptoms (PTSS) impact cognition and white matter. This study aims to investigate the effect of PTSS on neurocognitive functioning and limbic white matter in pediatric brain tumor patients. Methods Sixty-six patients (6-16 years) completed neuropsychological assessment and brain MRI (1-year post-diagnosis) and parents completed PTSS proxy questionnaires (CRIES-13; 1-3 months and 1-year post-diagnosis). Mean Z-scores and percentage impaired (>1SD) for attention, processing speed, executive functioning, and memory were compared to normscores (t-tests, chi-square tests). Multi-shell diffusion MRI data were analyzed for white matter tractography (fractional anisotropy/axial diffusivity). Effects of PTSS on neurocognition and white matter were explored with linear regression models (FDR correction for multiple testing), including age at diagnosis, treatment intensity, and tumor location as covariates. Neurocognition and limbic white matter associations were explored with correlations. Results Attention (M = -0.49, 33% impaired; P < .05) and processing speed (M = -0.57, 34% impaired; P < .05) were significantly lower than healthy peers. PTSS was associated with poorer processing speed (β = -0.64, P < .01). Treatment intensity, age at diagnosis, and tumor location, but not PTSS, were associated with limbic white matter metrics. Neurocognition and white matter metrics were not associated. Conclusions Higher PTSS was associated with poorer processing speed, highlighting the need for monitoring, and timely referrals to optimize psychological well-being and neurocognitive functioning. Future research should focus on longitudinal follow-up and explore the impact of PTSS interventions on neurocognitive performance.
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Affiliation(s)
- Anne E M Leenders
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Bruno Robalo
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Rosa van Male
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Rachèl Kemps
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Eelco Hoving
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Maarten H Lequin
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marita Partanen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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22
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Segers EW, Ketelaar M, de Man MACP, Schoonhoven L, van de Putte EM, van den Hoogen A. How to support children to develop and express their coping preferences around minor invasive medical procedures: children's and parents' perspectives. Eur J Pediatr 2023; 182:5553-5563. [PMID: 37787922 PMCID: PMC10746775 DOI: 10.1007/s00431-023-05222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
Invasive medical procedures in hospitals are major sources of stress in children, causing pain and fear. Non-pharmacological interventions are indispensable in effective pain and fear management. However, these interventions must be personalized to be effective. This qualitative study aims to gain insight into children's and parents' experiences, needs, and wishes related to supporting children to develop and express their coping preferences for dealing with pain and fear during minor invasive medical procedures in order to decrease pain and fear. A qualitative study using thematic analysis was performed. Data were collected through semi-structured interviews with children and parents who had undergone at least five minor invasive medical procedures in the last year. Nineteen children (8-18 years) and fourteen parents were interviewed individually. The experiences, needs, and wishes expressed in the interviews could be classified into one overarching theme, that of the personal process, and two content-related sub-themes: feeling trust and gaining control. The personal process was divided into two different phases, that of developing and of expressing coping preferences. Children and parents both reported it as a continuous process, different for every child, with their own unique needs. Children and parents expected personalized attention and tailored support from professionals. Conclusion: Professionals must combine clinical skills with child-tailored care. In the process of searching for and communicating about coping preferences, children's unique needs and personal boundaries will thereby be respected. This gives children and parents increased trust and control during invasive medical procedures. What is Known: • Untreated pain and stress caused by medical procedures can have severe and important short- and long-term consequences for children. Personalized non-pharmacological interventions are an essential element of procedural pain management. What is New: • A personalized coping strategy is important for children when undergoing medical procedures. Each individual child has a personal way of expressing their own coping strategy. Children and their parents need information and the space to develop and express their individual coping preferences. • Children and parents expect to receive child-tailored care from professionals including respect for their own, unique needs and boundaries. Professionals should build trustful relationships and provide appropriately tailored autonomy around medical procedures.
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Affiliation(s)
- Elisabeth W Segers
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, Brain Center University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marjorie A C P de Man
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Elise M van de Putte
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
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23
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Keenan HT, Wade SL, Miron D, Presson AP, Clark AE, Ewing-Cobbs L. Reducing Stress after Trauma (ReSeT): study protocol for a randomized, controlled trial of an online psychoeducational program and video therapy sessions for children hospitalized after trauma. Trials 2023; 24:766. [PMID: 38017574 PMCID: PMC10683223 DOI: 10.1186/s13063-023-07806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Post-traumatic stress symptoms develop in a quarter to half of injured children affecting their longer-term psychologic and physical health. Evidence-based care exists for post-traumatic stress; however, it is not readily available in some communities. We have developed an eHealth program consisting of online, interactive educational modules and telehealth therapist support based in trauma-focused cognitive behavioral therapy, the Reducing Stress after Trauma (ReSeT) program. We hypothesize that children with post-traumatic stress who participate in ReSeT will have fewer symptoms compared to the usual care control group. METHODS This is a randomized controlled trial to test the effectiveness of the ReSeT intervention in reducing symptoms of post-traumatic stress compared to a usual care control group. One hundred and six children ages 8-17 years, who were admitted to hospital following an injury, with post-traumatic stress symptoms at 4 weeks post-injury, will be recruited and randomized from the four participating trauma centers. The outcomes compared across groups will be post-traumatic stress symptoms at 10 weeks (primary outcome) controlling for baseline symptoms and at 6 months post-randomization (secondary outcome). DISCUSSION ReSeT is an evidence-based program designed to reduce post-traumatic stress symptoms among injured children using an eHealth platform. Currently, the American College of Surgeons standards suggest that trauma programs identify and treat patients at high risk for mental health needs in the trauma system. If effectiveness is demonstrated, ReSeT could help increase access to evidence-based care for children with post-traumatic stress within the trauma system. TRIAL REGISTRATION ClinicalTrials.gov NCT04838977. 8 April 2021.
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Affiliation(s)
- Heather T Keenan
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center Division of Pediatric Rehabilitation, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Devi Miron
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave. #8055, New Orleans, LA, 70112, USA
| | - Angela P Presson
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Capecchi Dr. , Salt Lake City, UT, 84112, USA
| | - Amy E Clark
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Linda Ewing-Cobbs
- Children's Learning Institute, McGovern Medical School at UTHealth, 7000 Fannin, Suite 2401, Houston, TX, 77030, USA
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Hocking P, Broadhurst M, Nixon RDV, Gannoni A. Validation of the Psychosocial Assessment Tool 2.0 for paediatric burn patients. Burns 2023; 49:1632-1642. [PMID: 37211476 DOI: 10.1016/j.burns.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The Psychosocial Assessment Tool 2.0 (PAT-B) is an adaptation of an existing screening tool with the aim of the present study to examine its effectiveness and suitability to identify children and families at risk of emotional, behavioral, and social maladjustment following paediatric burns. METHODS Sixty-eight children aged between 6 months - 16 years (M = 4.40) admitted into hospital following paediatric burns, and their primary caregivers, were recruited. The PAT-B comprises several dimensions including family structure and resources, social support, as well as caregiver and child psychological difficulties. Caregivers completed the PAT-B and several standardized measures for validation purposes (e.g., caregiver reports of family functioning, child emotional and behavioural problems, caregiver distress). Children old enough to complete measures reported on their psychological functioning (e.g., posttraumatic stress and depression). Measures were completed within 3 weeks of child admission and then again at 3 months after burn. RESULTS The PAT-B demonstrated good construct validity, evidenced by moderate to strong correlations between the PAT-B Total and subscale scores and several criteria measures (family functioning, child behaviour and caregiver distress, child depressive symptoms, rs ranging from 0.33 -0.74). Preliminary support for criterion validity of the measure was observed when examined against the three tiers of the Paediatric Psychosocial Preventative Health Model. The proportion of families falling within these tiers of risk (Universal [low risk], 58.2%; Targeted, 31.3%; or Clinical range, 10.4%) was consistent with prior research. Sensitivity of the PAT-B to identify children and caregivers at high risk of psychological distress was 71% and 83%, respectively. CONCLUSION The PAT-B appears to be a reliable and valid instrument for indexing psychosocial risk across families who have sustained a paediatric burn. However, further testing and replication using a larger sample size is recommended before the tool is integrated into routine clinical care.
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Affiliation(s)
- Phoebe Hocking
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia
| | - Miriam Broadhurst
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia
| | - Reginald D V Nixon
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia; Flinders University Institute for Mental Health and Wellbeing, Flinders University; Adelaide, South Australia, Australia.
| | - Anne Gannoni
- Department of Psychological Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Boztepe H, Çınar Özbay S, Akçam A, Kanbay Y. The pediatric provider communication skills assessment scale. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2023; 36:307-315. [PMID: 37394543 DOI: 10.1111/jcap.12433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
PROBLEM Building rapport and trust between healthcare professional and patient/parents would improve satisfaction of patient/parents. The purpose of this study was to develop "The Pediatric Provider Communication Skills Assessment Scale" in this study. METHODS A trial form, with linguistic and psychometric validation and consisting of 44 statements, was administered to a sample of 325 individuals. Data were collected between January 20 and October 22, 2021. The validity of the scale was concluded after examining its construct validity and internal validity. "Exploratory factor analysis" was used for determining construct validity, and "comparison of lower-upper groups" for internal validity. "Cronbach's α reliability coefficient" and "split half test consistency coefficient" were calculated for testing the reliability of the scale. FINDINGS The Pediatric Provider Communication Skills Assessment Scale that we developed consists of one dimension and 20 items, and the variance it can explain was calculated as 62.3%. The Cronbach α reliability coefficient of the scale was calculated as 0.90, indicating high reliability. CONCLUSIONS According to the findings, "The Pediatric Provider Communication Skills Assessment Scale" is a scale with features that can measure in a valid and reliable way, with high variance and a low number of items. The study aims to develop the "The Pediatric Provider Communication Skills Assessment Scale," and present it to the literature as a validated and reliable new objective measurement tool. This study will enable us to understand more about the complex communication processes involved in pediatric care and how these may influence care delivery.
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Affiliation(s)
- Handan Boztepe
- Department of Nursing, Faculty of Health Sciences, Atilim University, Ankara, Turkey
| | - Sevil Çınar Özbay
- Emergency Aid and Disaster Management, Faculty of Health Sciences, Artvin Coruh University, Artvin, Turkey
| | - Aysun Akçam
- Department of Turkish Language Teaching, Faculty of Education, Necmettin Erbakan University, Konya, Turkey
| | - Yalçın Kanbay
- Department of Nursing, Faculty of Health Sciences, Artvin Coruh University, Artvin, Turkey
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Harman E, Shoemark H. Patterns of toxic stress and trauma for pediatric Hematopoietic Stem Cell Transplantation (HSCT): creating a model of responsive intervention. J Psychosoc Oncol 2023; 42:457-472. [PMID: 37904534 PMCID: PMC11058118 DOI: 10.1080/07347332.2023.2276966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
BACKGROUND It is well documented that invasive medical treatment, such as Hematopoietic Stem Cell Transplant (HSCT), can be stressful and potentially traumatic for children, leading to Post Traumatic Stress Disorder (PTSD) or Post Traumatic Stress Symptoms (PTSS) after treatment. Despite this evidence, little is known about the patterns of stress and trauma that develop throughout the HSCT admission. PURPOSE To examine patterns of toxic stress and trauma that develop throughout the pediatric HSCT admission and understand how music therapists, as members of the interdisciplinary psychosocial care team, may proactively intervene to mitigate the impact of traumatic experiences. METHOD A two-phase retrospective longitudinal multi-case design was used with a combination of time series and template analyses. SAMPLE The sample included 14 pediatric patients (aged 0-17) undergoing HSCT at a large pediatric hospital in the Midwestern United States. FINDINGS The results were identifiable patterns of toxic stress and trauma and a model of care for music therapy that is responsive to the identified patterns.
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Affiliation(s)
- Elizabeth Harman
- Postdoctoral Research Scholar, Indiana University, School of Nursing, Indianapolis, IN, USA
| | - Helen Shoemark
- Professor of Music Therapy, Temple University, Boyer College of Music and Dance, Philadelphia, PA, USA
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Cuneo AA, Sifflet C, Bardach N, Ly N, von Scheven E, Perito ER. Pediatric Medical Traumatic Stress and Trauma-Informed Care in Pediatric Chronic Illness: A Healthcare Provider Survey. J Pediatr 2023; 261:113580. [PMID: 37353148 DOI: 10.1016/j.jpeds.2023.113580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To inform approaches to pediatric medical traumatic stress (PMTS) by exploring providers' (1) perception of the impact of PMTS on the medical care of patients with pediatric-onset chronic illnesses, (2) self-reported competencies and practices of PMTS prevention, treatment, and counseling, and (3) perception of the barriers influencing the adoption of these practices. STUDY DESIGN A convenience sample of multidisciplinary healthcare providers was recruited through a multimodal recruitment strategy to participate in an electronic survey adapted from the Trauma-Informed Care Provider Survey. RESULTS Among participants (n = 304), 99% agreed that PMTS impacts patient health. Participants report altering medical care plans due to PMTS, including deferring or stopping treatments (n = 98 [32%]) and changing medication regimens (n = 88 [29%]). Sixty-eight percent (n = 208) report negative impact of PMTS on patient implementation of medical care plans, including medication nonadherence (n = 153 [50%]) and missed appointments (n = 119 [39%]). Although participants agreed it is their job to decrease patient stress (n = 292 [96%]) and perform PMTS assessments (n = 268 [88%]), few practiced PMTS-focused trauma informed care. Systems-level barriers to practice included insufficient training, absent clinical workflows, and lack of access to mental health experts. CONCLUSIONS Our findings have helped inform a conceptual framework for understanding the relationship between PMTS and health outcomes. Systems-level opportunities to optimize PMTS-focused trauma-informed care include (1) dissemination of provider training, (2) integrated workflows for PMTS mitigation, and (3) enhanced accessibility to mental health providers. Further work is required to determine if these interventions can improve health outcomes in patients with pediatric-onset chronic illnesses.
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Affiliation(s)
- Addison A Cuneo
- Department of Pediatrics, University of California San Francisco, San Francisco, CA.
| | - Christopher Sifflet
- School of Public Health, University of California, Berkeley, Berkeley, CA; School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Naomi Bardach
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Ngoc Ly
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Emily von Scheven
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Emily R Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
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Traino KA, Fisher RS, Basile NL, Dattilo TM, Baskin LS, Buchanan CL, Chan YM, Cheng EY, Coplen DE, Kolon TF, Lakshmanan Y, Palmer BW, Mullins LL, Ciciolla LM, Wisniewski AB. Adverse Birth Experiences and Parent Adjustment Associated With Atypical Genital Appearance Due to Differences of Sex Development. J Pediatr Psychol 2023; 48:759-767. [PMID: 37500595 PMCID: PMC10516460 DOI: 10.1093/jpepsy/jsad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Differences/disorders of sex development (DSDs) are rare, congenital conditions involving discordance between chromosomes, gonads, and phenotypic sex and are often diagnosed in infancy. A key subset of parents of children newly diagnosed with a DSD experience clinically elevated distress. The present study examines the relationship between perinatal factors (i.e., gestational age, delivery method) and trajectories of parental adjustment. METHODS Parent participants (mothers = 37; fathers = 27) completed measures at baseline, 6- and 12-month follow-up. Multilevel linear regression controlled for clustering of the data at three levels (i.e., time point, parent, and family) and examined the relationship between perinatal factors and trajectories of depressive and anxious symptoms. Two-way interactions between perinatal factors and parent type were evaluated. RESULTS Overall depressive and anxious symptoms decreased over time. There were significant interactions between gestational age and parent type for depressive and anxious symptoms, with younger gestational age having a stronger negative effect on mothers vs. fathers. There was a significant interaction between time and gestational age for depressive symptoms, with 36 weeks' gestational age demonstrating a higher overall trajectory of depressive symptoms across time compared to 38 and 40 weeks. Findings for the delivery method were not significant. CONCLUSIONS Findings uniquely demonstrated younger gestational age was associated with increased depressive symptoms, particularly for mothers compared to fathers. Thus, a more premature birth may predispose parents of infants with DSD to distress. Psychosocial providers should contextualize early diagnosis-related discussions within stressful birth experiences when providing support.
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Affiliation(s)
- Katherine A Traino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center, USA
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, USA
| | - Yee-Ming Chan
- Division of Endocrinology, and Harvard Medical School, Boston Children’s Hospital, USA
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Douglas E Coplen
- Division of Urologic Surgery, St. Louis Children’s Hospital, USA
| | - Thomas F Kolon
- Division of Urology, Children’s Hospital of Philadelphia, USA
| | | | - Blake W Palmer
- Department of Pediatric Urology, Cook Children’s Medical Center, USA
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Lucia M Ciciolla
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Amy B Wisniewski
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
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van Gorp M, Irestorm E, Twisk JWR, Dors N, Mavinkurve-Groothuis A, Meeteren AYNSV, de Bont J, van den Bergh EMM, van der Meer WVDP, Beek LR, Aarsen FK, Streefkerk N, van Litsenburg RRL, Grootenhuis MA. The course of health-related quality of life after the diagnosis of childhood cancer: a national cohort study. BMC Cancer 2023; 23:855. [PMID: 37697253 PMCID: PMC10496372 DOI: 10.1186/s12885-023-11379-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Comprehensive insight in the longitudinal development of health-related quality of life (HRQOL) after childhood cancer diagnosis could improve quality of care. Thus, we aimed to study the course and biopsychosocial determinants of HRQOL in a unique national cohort of children with cancer. METHODS HRQOL of 2154 children with cancer was longitudinally reported (median: 3 reports) between diagnosis and 5 years after, using the pediatric quality of life inventory generic core scales (PedsQL). HRQOL was modelled over time since diagnosis using mixed model analysis for children 2-7 years (caregiver-reports) and ≥ 8 years (self-reports). Differences in the course between hematological, solid and central nervous system malignancies were studied. Additional associations of demographics, disease characteristics (age at diagnosis, relapse, diagnosis after the national centralization of childhood cancer care and treatment components) and caregiver distress (Distress thermometer) were studied. RESULTS Overall, HRQOL improved with time since diagnosis, mostly in the first years. The course of HRQOL differed between diagnostic groups. In children aged 2-7 years, children with a solid tumor had most favorable HRQOL. In children aged ≥ 8 years, those with a hematological malignancy had lower HRQOL around diagnosis, but stronger improvement over time than the other diagnostic groups. In both age-groups, the course of HRQOL of children with a CNS tumor showed little or no improvement. Small to moderate associations (β: 0.18 to 0.67, p < 0.05) with disease characteristics were found. Centralized care related to better HRQOL (β: 0.25 to 0.44, p < 0.05). Caregiver distress was most consistently associated with worse HRQOL (β: - 0.13 to - 0.48, p < 0.01). CONCLUSIONS The HRQOL course presented can aid in identifying children who have not fully recovered their HRQOL following cancer diagnosis, enabling early recognition of the issue. Future research should focus on ways to support children, especially those with a CNS tumor, for example by decreasing distress in their caregivers.
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Affiliation(s)
- Marloes van Gorp
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Elin Irestorm
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
- Faculty of Medicine, Department of Paediatrics, Lund University, Lund, Sweden
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Natasja Dors
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Judith de Bont
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Laura R Beek
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Femke K Aarsen
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Nienke Streefkerk
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
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Klašnja S, Hausmeister IK, Kavčič M, Masten R, Kitanovski L. Paediatric Medical Traumatic Stress in Children with Cancer and their Parents: Difference in Stress Levels Due to Illness and Treatment Factors. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:579-587. [PMID: 37593054 PMCID: PMC10427565 DOI: 10.1007/s40653-023-00521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 08/19/2023]
Abstract
Pediatric medical traumatic stress (PMTS) is a set of children's and their parents' psychological and physiological responses to pain, injuries, serious illnesses, and other experiences with the medical environment. Pediatric cancer patients have the highest prevalence of PMTS as the illness its treatment involve a set of stressors that trigger many negative psychological reactions. The current study examined the difference in levels of traumatic stress in children with cancer and their parents due to medical factors (type of cancer, outcome, duration, and intensity of treatment, time since diagnosis, relapse, and hospitalization in ICU). The study involved 183 parents of 133 children and 62 children and adolescents who were treated between 2009 and 2019 at the Clinical Department of Pediatric Hematology and Oncology of University Children's Hospital in Ljubljana. We collected the data using The Intensity of Treatment Rating Scale 2.0 [IRT-2], PTSD Checklist for Children/Parent [PCL-C/PR], The PTSD Checklist for DSM-5 [PCL-5] and The Child PTSD Symptoms Scale for DSM-5 [CPSS-5]. Traumatic stress symptoms are frequently present in both children and their parents, regardless of the cancer type, treatment duration, and treatment outcome. Children with relapse, children with more intensive treatment, and parents of the latter are at higher risk for PMTS occurrence. Additionally, we found a decreasing trend of traumatic responses after five or more years post-cancer diagnosis. [Table: see text].
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Affiliation(s)
- Sandra Klašnja
- Division of Pediatrics, Departmant of Haematooncology, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
| | - Ivana Kreft Hausmeister
- Division of Pediatrics, Departmant of Haematooncology, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
| | - Marko Kavčič
- Division of Pediatrics, Departmant of Haematooncology, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
| | - Robert Masten
- Division of Pediatrics, Departmant of Haematooncology, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Lidija Kitanovski
- Division of Pediatrics, Departmant of Haematooncology, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
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Joosten MMH, van Gorp M, van Dijk J, Kremer LCM, van Dulmen-den Broeder E, Tissing WJE, Loonen JJ, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Ronckers C, Bresters D, Louwerens M, Neggers SJCCM, van der Heiden-van der Loo M, Maurice-Stam H, Grootenhuis MA. Psychosocial functioning of adult siblings of Dutch very long-term survivors of childhood cancer: DCCSS-LATER 2 psycho-oncology study. Psychooncology 2023; 32:1401-1411. [PMID: 37434295 DOI: 10.1002/pon.6191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To describe psychosocial outcomes among adult siblings of very long-term childhood cancer survivors (CCS), to compare these outcomes to reference populations and to identify factors associated with siblings' psychosocial outcomes. METHODS Siblings of survivors (diagnosed <18 years old, between 1963 and 2001, >5 years since diagnosis) of the Dutch Childhood Cancer Survivor Study DCCSS-LATER cohort were invited to complete questionnaires on HRQoL (TNO-AZL Questionnaire for Adult's HRQoL), anxiety/depression (Hospital Anxiety and Depression Scale), post-traumatic stress (Self-Rating Scale for Post-traumatic Stress Disorder), self-esteem (Rosenberg Self-Esteem Scale) and benefit and burden (Benefit and Burden Scale for Children). Outcomes were compared to a reference group if available, using Mann-Whitney U and chi-Square tests. Associations of siblings' sociodemographic and CCS' cancer-related characteristics with the outcomes were assessed with mixed model analysis. RESULTS Five hundred five siblings (response rate 34%, 64% female, mean age 37.5, mean time since diagnosis 29.5) of 412 CCS participated. Siblings had comparable HRQoL, anxiety and self-esteem to references with no or small differences (r = 0.08-0.15, p < 0.05) and less depression. Proportions of symptomatic PTSD were very small (0.4%-0.6%). Effect sizes of associations of siblings' sociodemographic and CCS cancer-related characteristics were mostly small to medium (β = 0.19-0.67, p < 0.05) and no clear trend was found in the studied associated factors for worse outcomes. CONCLUSIONS On the very long-term, siblings do not have impaired psychosocial functioning compared to references. Cancer-related factors seem not to impact siblings' psychosocial functioning. Early support and education remain essential to prevent long-term consequences.
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Affiliation(s)
- Mala M H Joosten
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marloes van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jennifer van Dijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Jacqueline J Loonen
- Radboudumc Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Erasmus MC Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Erasmus MC Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cécile Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Health Services Research, Carl v Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
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Sharp R, Muncaster M, Baring CL, Manos J, Kleidon TM, Ullman AJ. The parent, child and young person experience of difficult venous access and recommendations for clinical practice: A qualitative descriptive study. J Clin Nurs 2023; 32:6690-6705. [PMID: 37204006 DOI: 10.1111/jocn.16759] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
AIMS AND OBJECTIVES Explore the parent and child/young person experience of difficult venous access and identify ideas and preferences for changes to clinical practice. BACKGROUND Peripheral intravenous catheter insertion is one of the most common invasive procedures in hospitalised paediatric patients. Multiple insertion attempts in paediatric patients are common and associated with pain and distress. Little research has explored the parent and child/young person experience of difficult venous access nor sought to identify their suggestions to improve clinical practice. DESIGN Qualitative description. METHODS A purposive sampling approach was used to identify children and young people with experience of difficult venous access and their parents. Semi-structured interviews were conducted, with sample size based on data saturation. Transcripts were analysed using thematic analysis. RESULTS There were 12 participants, seven parents and five children/young people (five parent/child dyads and two individual parents). Analysis of the data revealed three main themes: (1) Distress-before, during and after (2) Families navigating the system: the challenging journey from general clinician to specialist and (3) Difficult venous access impacts both treatment and life outside the hospital A pre-determined theme, (4) Recommendations for good clinical practice is also described. CONCLUSIONS Multiple attempts to insert a peripheral intravenous catheter are a source of substantial distress for children/young people, leading to treatment avoidance. Effective interpersonal skills, providing choice and avoiding frightening language are important to minimise distress. Clinicians without specialist training should assess each child's venous access experience and consider immediate referral to a specialist if they have a history of difficult venous access. Cultural change is required so clinicians and healthcare services recognise that repeated cannulation may be a source of psychological distress for children/young people.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Michele Muncaster
- South Australian Medical Imaging, Adelaide, South Australia, Australia
- Womens' and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Catherine L Baring
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- South Australian Medical Imaging, Adelaide, South Australia, Australia
- Womens' and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Jacinta Manos
- South Australian Medical Imaging, Adelaide, South Australia, Australia
- Womens' and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Tricia M Kleidon
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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Alderfer MA, Amaro CM, Kripalani S, Taggi Pinto A, Lewis AM, Arasteh K, Hildenbrand AK, Lown EA, Long KA. Trajectories of Traumatic Stress Symptoms Among Siblings of Children With Cancer: The First Two Years Post-Diagnosis. J Pediatr Psychol 2023; 48:688-699. [PMID: 37354552 DOI: 10.1093/jpepsy/jsad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE Identify and describe trajectories of cancer-related posttraumatic stress symptoms (PTSS) among siblings of children with cancer within two years of diagnosis. METHOD Siblings (aged 8-18; M = 11.2 years) across the United States, and for each, one caregiver, were recruited for a cohort sequential longitudinal study with three data collection points six months apart beginning at 6- or 12-months after cancer diagnosis. Siblings (N = 229; 42% of eligible/approached; 53% identifying as female; 68% identifying as non-Hispanic White) completed the Child Posttraumatic Stress Disorder Symptom Scale. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ). Latent class growth analysis (LCGA) and growth mixture modeling (GMM) identified PTSS patterns across time. RESULTS Fit statistics supported models with three to five PTSS trajectories. The three-class LCGA model included a large mild PTSS group (61%), a moderate PTSS group (35%), and a small (4%) stable severe PTSS group. The four-class LCGA and three- and four-class GMM included groups improving from moderate to mild PTSS (7-21%) and worsening to moderate PTSS across time (12-17%). Across models, siblings with mild PTSS had fewer caregiver-reported emotional and behavioral difficulties on the SDQ. CONCLUSIONS A large group of siblings of children with cancer demonstrate resiliency, however, substantial subsets experience patterns of PTSS that include levels in the moderate-to-severe range during the first two years post-diagnosis. Future research should examine these patterns in more diverse/representative samples and identify factors associated with increasing and sustained severe PTSS to inform intervention targets and reduce cancer-related burden on families.
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Affiliation(s)
- Melissa A Alderfer
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christina M Amaro
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Simran Kripalani
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Taggi Pinto
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
| | - Amanda M Lewis
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
| | - Kamyar Arasteh
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
| | - Aimee K Hildenbrand
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - E Anne Lown
- Department of Social and Behavioral Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - Kristin A Long
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Cuneo AA, Outram S, Marsac ML, Vendlinski S, Heyman MB, Ly N, von Scheven E, Perito ER. Medical traumatic stress in cystic fibrosis: A qualitative analysis. J Cyst Fibros 2023; 22:763-771. [PMID: 36925385 DOI: 10.1016/j.jcf.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/18/2022] [Accepted: 12/16/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND People living with cystic fibrosis (PwCF) face a lifetime of potentially traumatic illness-related experiences that can lead to posttraumatic stress symptoms. Existing criteria for this type of posttraumatic stress, called medical traumatic stress (MTS), may not fully capture the CF experience. In this study we aimed to explore: 1) illness-related experiences perceived as traumatic in the setting of CF, 2) perceived MTS symptoms in PwCF, and 3) perceived health-related functional impairments from MTS. METHODS Informed by our aims, we developed and piloted guides for semi-structured interviews and focus groups with PwCF, family members of PwCF, and CF medical providers. We then conducted a series of interviews and focus groups. The qualitative analytical process followed Deterding and Waters' three stages of flexible coding for in-depth interviews, generating key themes and sub-themes in each domain of study inquiry. RESULTS We recruited 51 participants, including 24 PwCF, 7 family members of PwCF, and 20 CF care team members. Illness-related experiences perceived as traumatic were often characterized by themes of loss of agency, threats of bodily harm, and shifts in identity. Prominent MTS symptoms included shame, survivor guilt, burden guilt, germaphobia, and symptom panic. Health-related themes of functional impairments perceived to result from MTS included poor adherence and strained relationships between providers and patients/families. CONCLUSIONS This is the first study to explore the specific experiences of MTS in PwCF. It highlights the need for screening that includes these specific exposure types and symptoms, which may be mitigatable with medical trauma-focused interventions.
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Affiliation(s)
- Addison A Cuneo
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
| | - Simon Outram
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Meghan L Marsac
- Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY, USA
| | - Siena Vendlinski
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Melvin B Heyman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Ngoc Ly
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Emily von Scheven
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Emily R Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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de Sonnaville ESV, van Woensel JBM, van Goudoever JB, Otten MH, Teela L, Aarnoudse-Moens CSH, Terheggen-Lagro SWJ, van der Hulst AE, Engelen M, Kӧnigs M, Oosterlaan J, Knoester H. Structured Multidisciplinary Follow-Up After Pediatric Intensive Care: A Model for Continuous Data-Driven Health Care Innovation. Pediatr Crit Care Med 2023; 24:484-498. [PMID: 36807306 PMCID: PMC10226472 DOI: 10.1097/pcc.0000000000003213] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVES Morbidity after PICU admission for critical illness is a growing concern. Sequelae may occur in various domains of functioning and can only appropriately be determined through structured follow-up. Here, we describe the process of designing and implementing a structured multidisciplinary follow-up program for patients and their parents after PICU admission and show the first results illustrating the significance of our program. DESIGN Prospective observational cohort study. SETTING Outpatient PICU follow-up clinic. PATIENTS Patients 0-18 years old admitted to our PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In our structured multidisciplinary follow-up program, follow-up care is provided by a pediatric intensivist and psychologist and in addition, depending on patient's critical illness and received PICU treatment(s), by a pediatric pulmonologist, cardiologist, neurologist, and/or neuropsychologist. All consultations are scheduled consecutively. Collected data are stored in a hospital-wide data warehouse and used for yearly health care evaluation sessions as well as scientific research. Challenges in organizing this follow-up program include technological challenges, providing time-efficient care, participation rate, and completeness of questionnaires. In our experience, a dedicated team is essential to tackle these challenges. Our first results, obtained in 307 of 388 referred patients (79.1%), showed the diversity of problems arising after PICU discharge, including physical, neurocognitive, and psychosocial sequelae. In addition, our data also reflected the risk of psychosocial problems among parents. Within the limited operation time of our follow-up program, the program has evolved based on our experiences and the data collected. CONCLUSIONS We successfully developed and implemented a structured multidisciplinary follow-up program for patients and their parents after PICU admission. This program may help to timely initiate appropriate interventions, improve the standard of care during and after PICU admission, and facilitate scientific research on outcome and prognosis after PICU admission.
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Affiliation(s)
- Eleonore S V de Sonnaville
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam & Vrije Universiteit, Emma Children's Hospital, Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marieke H Otten
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Lorynn Teela
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development & Amsterdam Public Health Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development & Amsterdam Public Health Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Suzanne W J Terheggen-Lagro
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Pulmonology and Allergy, Amsterdam Reproduction and Development & Infection and Immunity Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Annelies E van der Hulst
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Cardiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marc Engelen
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Neurology, Amsterdam Leukodystrophy Center, Amsterdam Neuroscience & Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marsh Kӧnigs
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hennie Knoester
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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Tanaka K, Hayakawa M, Mori M, Maeda N, Nagata M, Horibe K. Medical staff's sense of awareness of informed consent for adolescent cancer patients and the need for decision-making support practiced from the perspective of trauma-informed approach. BMC Med Ethics 2023; 24:28. [PMID: 37149683 PMCID: PMC10164311 DOI: 10.1186/s12910-023-00907-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/14/2023] [Indexed: 05/08/2023] Open
Abstract
It has not been established how to assess children's and adolescents' decision-making capacity (DMC) and there has been little discussion on the way their decision-making (DM). The purpose of this study was to examine actual situation and factors related to difficulties in explaining their disease to adolescent cancer patients or obtaining informed consent (IC). The cross-sectional questionnaire survey was conducted. Physicians who have been treating adolescent cancer patients for at least five years answered a self-administered questionnaire uniquely developed about clinical difficulties in explaining, IC and factors related patient's refusal of medical treatment (RMT). Descriptive statistics for each item and a polychoric correlation analysis of the problems and factors related to the explanation were conducted. As a result, fifty-six physicians were participated (rate of return: 39%). Explaining the disease and treatment to patients (83.9%), IC to patients (80.4%), and explaining the disease and treatment to parents (78.6%) was particularly problematic. Difficulties to provide support related with patient's refusal of medical treatment and to explain disease and treatment for patient and parents were related to difficulties obtaining IC for the patient. Conclusion: There are clinically difficult to explain for the patient or parents and to obtain IC for the patient. It is necessary to establish a disease acceptance assessment tool for the adolescence generation so that it can be applied in the field.
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Affiliation(s)
- Kyoko Tanaka
- National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
- Division of Consultation liaison Department of Psychosocial Medicine, 2-10-1 Okura, Setagaya- ku, Tokyo, 157-8535, Japan.
| | - Maoko Hayakawa
- National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
- Ochanomizu University Human Developmental Sciences, Bunkyo-ku, Tokyo, Japan
| | - Makiko Mori
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Saitama, Japan
| | - Naoko Maeda
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Masako Nagata
- Psychological Support&Research Center for Human Development, NAGOYA UNIVERSITY, Nagoya-shi, Aichi, Japan
| | - Keizo Horibe
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
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Canter KS, Vega G, Perez Ramirez A, Munoz Osorio A, Thomas C, Lewis AM, Arasteh K, Kazak A. Acceptability and Feasibility of eSCCIP: Results From a Pilot Study of the Electronic Surviving Cancer Competently Intervention Program. J Pediatr Psychol 2023; 48:216-227. [PMID: 36303445 PMCID: PMC10027060 DOI: 10.1093/jpepsy/jsac082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Providing high-quality psychosocial care to parents and other primary caregivers of children with cancer (henceforth referred to as caregivers) is important, given the numerous challenges associated with a pediatric cancer diagnosis and the increased risk for negative psychosocial sequelae among caregivers. The Electronic Surviving Cancer Competently Intervention Program (eSCCIP) is a psychosocial eHealth intervention for caregivers, developed using an iterative, user-centered process. METHOD eSCCIP was tested in a single-arm pilot trial at Nemours Children's Hospital, Delaware (NCT05333601). The primary outcomes were intervention acceptability and feasibility, assessed via enrollment and retention targets, and item-level acceptability ratings. Enrollment and retention targets of 45% were set based on previous work, and an item-level acceptability threshold of 80% was set. A secondary exploratory analysis was conducted examining acute distress, anxiety, symptoms of post-traumatic stress, and family functioning. RESULTS 44 caregivers enrolled in the study and 31 completed. The intervention was rated favorably by completers, with over 80% of the sample selecting "mostly true" or "very true" for all items of the eSCCIP Evaluation Questionnaire, which was used to assess acceptability and feasibility. Enrollment and retention rates were 54% and 70%, respectively. Exploratory psychosocial outcomes showed statistically significant decreases from pre-intervention to post-intervention for overall symptoms of post-traumatic stress disorder (PTSD), cluster D symptoms of PTSD (negative mood and cognitions), and anxiety. Small-moderate effect sizes were observed for all psychosocial outcomes of interest. CONCLUSIONS eSCCIP is an acceptable and feasible intervention for caregivers. Results are promising regarding reductions in symptoms of post-traumatic stress and anxiety.
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Affiliation(s)
- Kimberly S Canter
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gabriela Vega
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Alejandra Perez Ramirez
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Angel Munoz Osorio
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Courtney Thomas
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Amanda M Lewis
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Kamyar Arasteh
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Anne Kazak
- Nemours Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
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Weissinger GM, Evans L, Van Fossen C, Winston-Lindeboom P, Ruan-Iu L, Rivers AS. Parent experiences during and after adolescent suicide crisis: A qualitative study. Int J Ment Health Nurs 2023; 32:917-928. [PMID: 36882964 DOI: 10.1111/inm.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/31/2023] [Accepted: 02/18/2023] [Indexed: 03/09/2023]
Abstract
Parents of adolescents who have suicide crises (i.e. suicide attempt and/or significant ideation) are often highly involved in the care management, treatment and preventing future suicides of their children. How they experience these suicide crises, and the period afterward, has not been well studied. The purpose of this study was to understand parents' (defined in this study as any legal guardian of an adolescent taking on a parental role) experience of adolescent suicide crises and its impact on themselves and the family system. Semi-structured interviews were conducted with parents (N = 18) of adolescents who had a suicide crisis in the past 3 years. Thematic analysis was used with a combined inductive-deductive coding approach, drawing from Diamond's conceptualization of family treatment engagement for suicidal youth and iterative close readings of transcripts. Five themes emerged related to parent experience: Trauma of the Experience (subtheme: Feelings of Failure); Living in Fear; Alone and Seeking Connection; Lasting Impact; and A New Normal (subtheme: Turn the Pain to Purpose). Parents experienced these events as traumatic, damaging their sense of self. They experienced long periods of time where fear and loneliness dominated their lives. Recovery was both an individual and a family process, occurring in tandem with, but distinct from, adolescent experiences. Descriptions and illustrative quotes illustrate parent experiences and their understanding of the impact on the family system. Results highlighted that parents require support both for themselves and as caregivers for adolescents around an adolescent's suicide crisis and that family-focused services are vital.
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Affiliation(s)
- Guy M Weissinger
- Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Lili Evans
- Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Catherine Van Fossen
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Payne Winston-Lindeboom
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Linda Ruan-Iu
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Alannah Shelby Rivers
- Department of Psychology and Philosophy, Texas Woman's University, Denton, Texas, USA
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Tör Nurdağ F, Şengün Ïnan F. Investigation of the Role of Cognitive Emotion Regulation Strategies on Depressive Symptoms in Mothers of Children Given A Diagnosis of Cancer. Cancer Nurs 2023; Publish Ahead of Print:00002820-990000000-00117. [PMID: 36881652 DOI: 10.1097/ncc.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND The role of cognitive emotion regulation on depressive symptoms in mothers of children given a diagnosis of cancer is not yet well understood. OBJECTIVE The aim of this study was to investigate the effect of cognitive emotion regulation strategies on depressive symptoms in mothers of children with cancer. METHODS This study was conducted with a cross-sectional correlational design. The study included 129 participants. Participants completed the sociodemographic characteristics form, Beck Depression Inventory, and Cognitive Emotion Regulation Questionnaire. Hierarchical regression analysis was performed to determine the effect of cognitive emotion regulation strategies on depressive symptoms. RESULTS Hierarchical multiple regression revealed that depressive symptoms were independently associated with self-blame (β = 0.279, P = .001) and catastrophizing (β = 0.244, P = .003) after controlling for sociodemographic characteristics of mothers. Emotion regulation strategies explained approximately 39.9% of the variance in depressive symptoms. CONCLUSION The results of the study indicate that more frequent engagement of self-blame and catastrophizing were associated with more depressive symptoms. IMPLICATIONS FOR PRACTICE Nurses should screen mothers of children with cancer for depressive symptoms and identify mothers of children with cancer who use maladaptive cognitive emotion regulation strategies, such as self-blame and catastrophizing, as a risk group. Furthermore, nurses need to be involved in developing psychosocial interventions including adaptive cognitive emotion regulation strategies to help mothers coping with adverse emotions during a childhood cancer journey.
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Affiliation(s)
- Fazilet Tör Nurdağ
- Author Affiliations: Department of Nursing, Dokuz Eylul University Institute of Health Sciences (Mrs Tör Nurdağ), Izmir; and Department of Psychiatric Nursing, Faculty of Health Sciences, Gazi University (Dr Şengün İnan), Ankara, Turkey
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40
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Dewan T, Birnie K, Drury J, Jordan I, Miller M, Neville A, Noel M, Randhawa A, Zadunayski A, Zwicker J. Experiences of medical traumatic stress in parents of children with medical complexity. Child Care Health Dev 2023; 49:292-303. [PMID: 35947493 PMCID: PMC10087969 DOI: 10.1111/cch.13042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/25/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Parents of children with medical complexity (CMC) experience high levels of stress and adverse mental health outcomes. Pediatric medical traumatic stress (PMTS) could be an important contributor that has not yet been explored. PMTS describes parents' reactions to their child's illness and medical treatment and can lead to post-traumatic stress symptoms. This is the first study to describe the experiences and impact of PMTS among parents of CMC. METHODS We conducted semi-structured interviews with 22 parents of CMC. Reflexive thematic analysis was used to generate themes that described the experiences of PMTS and potential contributing factors in the healthcare setting. Themes were validated by study participants. RESULTS Parents experienced a spectrum of events and circumstances that impacted PMTS. These corresponded to three major themes: (a) the distinctive context of being the parent of a CMC, (b) interactions with healthcare providers that can hurt or heal and (c) system factors that set the stage for trauma. The consequences of repeated PMTS were a common point of emphasis among all the themes. Parents identified numerous changes that could mitigate PMTS such as acknowledgement of trauma and provision of proactive mental health support. CONCLUSIONS Our study highlights the issue of PMTS among parents of CMC and presents opportunities to mitigate their traumatic experiences. Supporting the integration of trauma-informed care practices, increasing awareness of PMTS and advocating for parental mental health services could better support parents and families.
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Affiliation(s)
- Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Katie Birnie
- Department of Anesthesia and Pain Medicine, University of Calgary, Calgary, Canada
| | | | | | - Megan Miller
- Rotary Flames Children's Hospice and Palliative Care Service, Calgary, Canada
| | | | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Alam Randhawa
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Anna Zadunayski
- Department of Pediatrics, University of Calgary, Calgary, Canada
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41
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van Gorp M, Joosten MMH, Maas A, Drenth BL, van der Aa-van Delden A, Kremer LCM, van Dulmen-den Broeder E, Tissing WJE, Loonen JJ, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Ronckers C, Bresters D, Louwerens M, Neggers SJCCM, van der Heiden-van der Loo M, Maurice-Stam H, Grootenhuis MA. Psychosocial functioning of parents of Dutch long-term survivors of childhood cancer. Psychooncology 2023; 32:283-294. [PMID: 36426662 PMCID: PMC10107521 DOI: 10.1002/pon.6069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe health-related quality of life (HRQoL), post-traumatic stress and post-traumatic growth of parents of long-term survivors of childhood cancer (CCS) and study associated factors. METHODS Parents of survivors of the Dutch Childhood Cancer Survivor Study LATER cohort below 30 years and diagnosed 1986-2001 were invited to complete the TNO-AZL Questionnaire for Adult's HRQoL (e.g., sleep and aggressive emotions), Self-Rating Scale for Post-traumatic Stress Disorder, Post-traumatic Growth Inventory, and Illness Cognition Questionnaire. HRQoL domain scores were compared to references using Mann-Whitney U tests. Correlations between post-traumatic stress, growth and HRQoL were evaluated. Medical characteristics of their child and illness cognitions were studied as associated factors of HRQOL, post-traumatic stress and growth. p < 0.05 was considered statistically significant. RESULTS Parents (n = 661 of n = 448 survivors, 56% female, mean time since child's diagnosis: 21.3 [SD: 3.3] years) reported better HRQoL in social functioning and aggressive emotions than references (r = .08-0.17). Mothers additionally reported better HRQoL in pain, daily activities, sexuality, vitality, positive and depressive emotions (r = .07-0.14). Post-traumatic stress was symptomatic in 3%, and associated with worse HRQoL (r = -0.27-0.48). Post-traumatic growth was positively associated to post-traumatic stress and better HRQoL (r = 0.09-0.12). Cancer recurrence was associated to better HRQoL (β = 0.37-0.46). Acceptance illness cognitions were associated to better (β = 0.12-0.25), and helplessness to worse outcomes (β = 0.14-0.38). CONCLUSIONS HRQoL of parents of young adult survivors of CCS is comparable to references or slightly better. Only a small proportion reports symptomatic post-traumatic stress. Improving acceptance and reducing feelings of helplessness may provide treatment targets for parents with psychosocial problems.
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Affiliation(s)
- Marloes van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Mala M H Joosten
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Anne Maas
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Babet L Drenth
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Obstetrics and Gynecology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of pediatric oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Erasmus MC Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Erasmus MC Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cécile Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Health Services Research, Carl v Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands.,Willem-Alexander Children's Hospital, Leiden, The Netherlands
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Jenkins C, Geisthardt C, Day JK. Supporting Children and Families in Medical Settings: Insights from Child Life Specialists During the COVID-19 Pandemic. JOURNAL OF CHILD AND FAMILY STUDIES 2023; 32:1599-1616. [PMID: 36714377 PMCID: PMC9860232 DOI: 10.1007/s10826-023-02537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 06/11/2023]
Abstract
Medical settings can be frightening and stressful places for pediatric patients and their families. During the COVID-19 pandemic fear and anxiety associated with receiving medical care increased as medical facilities dramatically altered the way they functioned in attempts to stop the spread of the virus. Certified Child Life Specialists (CCLSs) are medical professionals who provide psychosocial support for pediatric patients and their families by helping them understand and cope with medical procedures and the medical environment. In this role, CCLSs are likely to have important insights into the experiences and needs of pediatric patients and their families during COVID-19. Using a mixed-methods design, 101 CCLSs completed an online survey and 15 participated in follow-up interviews examining their experiences with and observations of children and families in medical environments during the pandemic. Participants emphasized a need to maintain a focus on child- and family-centered care for the well-being of patients and their families. While recognizing the need to socially distance to limit the spread of COVID, participants expressed concern about restrictive policies that did not balance the physical and mental health needs of patients and families. Participants also discussed the important role of child life services during the pandemic and the unique and multifaceted contributions CCLSs made to support patients, families, other medical professionals, and communities. Recommendations for supporting children and families in medical environments moving forward are discussed in light of lessons learned during the pandemic.
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Affiliation(s)
- Carly Jenkins
- Department of Human Development and Family Studies, Central Michigan University, 228 Education and Human Services, Mt. Pleasant, MI 48858 USA
| | - Cheryl Geisthardt
- Department of Human Development and Family Studies, Central Michigan University, 228 Education and Human Services, Mt. Pleasant, MI 48858 USA
| | - Jack K. Day
- Department of Human Development and Family Studies, Central Michigan University, 228 Education and Human Services, Mt. Pleasant, MI 48858 USA
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Bidstrup PE, Salem H, Andersen EW, Schmiegelow K, Rosthøj S, Wehner PS, Hasle H, Dalton SO, Johansen C, Kazak AE. Effects on Pediatric Cancer Survivors: The FAMily-Oriented Support (FAMOS) Randomized Controlled Trial. J Pediatr Psychol 2023; 48:29-38. [PMID: 35849020 DOI: 10.1093/jpepsy/jsac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To examine as secondary analyses the effect the FAMily-Oriented Support (FAMOS) family therapy program on reducing parent-reported medical traumatic stress in the sub-sample of pediatric cancer survivors, age 2-5 years. METHODS The FAMOS study was a national multicenter randomized controlled trial with all four pediatric oncology departments in Denmark (Clinicaltrials.gov [NCT02200731]). Families were randomized in parallel design (1:1) to intervention or usual care. The FAMOS program includes seven home-based psychotherapeutic sessions and is based on family systems therapy to address the individuals in the family system using cognitive behavioral, problem-solving and goal-setting techniques. Questionnaires were completed by parents at baseline, 6, and 12 months. In linear mixed-effects models, the effect of FAMOS on reducing children's trauma-related behavior after 6 and 12 months was examined in 62 children (31 in the intervention and 29 in the control group, respectively). It was also examined if a trauma-related behavior effect was mediated through reduced symptoms of depression in mothers and fathers, respectively. RESULTS On average, children in the intervention group experienced significantly larger decreases in trauma-related behaviors at 6 and 12 months than the control group (predicted mean difference -3.89, p = .02 and -6.24, p = .003, respectively). The effect on trauma-related behavior was partly mediated through reduced symptoms of depression in mothers, but not fathers. CONCLUSIONS Adding to previously reported positive effects of the FAMOS intervention on parents' symptoms of post-traumatic stress and depression, significant improvements were found in young children's trauma related-behavior. Further research is needed to develop therapy for children with cancer.
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Affiliation(s)
- Pernille E Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Denmark.,Department of Psychology, University of Copenhagen, Denmark
| | - Hanin Salem
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Denmark
| | | | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, and Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Denmark
| | - Steen Rosthøj
- Pediatric Department, Aalborg University Hospital, Denmark
| | - Peder Skov Wehner
- Department of Pediatric Hematology and Oncology, H.C. Andersen Children's Hospital, Odense University Hospital, Denmark
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Denmark
| | - Susanne O Dalton
- Survivorship and Social Inequality in Cancer, Danish Cancer Society Research Center, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark
| | - Christoffer Johansen
- CASTLE Cancer Late Effect Research, Oncology Clinic, University Hospital Rigshospitalet, Denmark.,Psychological Aspects of Cancer, Danish Cancer Society Research Center, Denmark
| | - Anne E Kazak
- Nemours Children's Health, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, USA
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Robb SL, Stegenga K, Perkins SM, Stump TE, Moody KM, Henley AK, MacLean J, Jacob SA, Delgado D, Haut PR. Mediators and Moderators of Active Music Engagement to Reduce Traumatic Stress Symptoms and Improve Well-being in Parents of Young Children With Cancer. Integr Cancer Ther 2023; 22:15347354231218266. [PMID: 38145309 PMCID: PMC10750508 DOI: 10.1177/15347354231218266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/03/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVE This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes. METHODS Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models. RESULTS No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 (P = .01) and avoidance subscale scores at T3 (P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 (P = .01). There were no moderation effects for child age. CONCLUSIONS AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.
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Affiliation(s)
| | | | | | | | | | - Amanda K. Henley
- Purdue School of Engineering and Technology, IUPUI, Indianapolis, IN, USA
| | | | | | - David Delgado
- Astellas Pharma Global Development, Inc, Northbrook, IL, USA
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Group Psychotherapy for Parents of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09926-0. [PMID: 36480109 DOI: 10.1007/s10880-022-09926-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 12/13/2022]
Abstract
Parents of children with diagnoses of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) may experience significant psychological distress related to their child's severe and relapsing illness and challenges with the traumatic nature of its treatment. No manualized or studied psychological interventions specifically for parents of youth with PANS have existed prior to this study. In this pilot study, we assessed the feasibility, satisfaction, and treatment fidelity of a brief 9-session group therapy intervention for parents based on principles of trauma-focused cognitive behavior therapy (CBT). We hypothesized that, if initially elevated, symptoms of depression, anxiety, and trauma would decrease and participants' utilization of positive coping mechanisms would increase post-intervention. We adapted an existing evidence-based group intervention developed for parents of children with premature infants to target sources of stress and coping in parents of children with PANS. Ten parents participated in the study. The 9-session intervention used a combination of techniques that included cognitive restructuring, coping skills, self-care, and a trauma narrative to address psychological stress, trust, grief, and unwanted emotions. Outcome measures included parental symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD), as well as rating of parental satisfaction with the intervention. The treatment was feasible and deliverable with high fidelity. The intervention was rated as useful and satisfactory by parents (overall average usefulness of 4.54 and satisfaction of 4.71 out of 5.0). Elevated symptoms of PTSD and depression decreased with large effect sizes (Cohen's d = 1.42 and Cohen's d = 1.38, respectively). Participating parents demonstrated significantly more active coping and acceptance behaviors and stances. A brief 9-session group therapy intervention based on principles of trauma-focused CBT was found to be effective in reducing symptoms of psychological distress in parents of children with PANS.
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46
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Tanaka K, Hayakawa M, Noda C, Nakamura A, Akiyama C. Effects of artificial intelligence aibo intervention on alleviating distress and fear in children. Child Adolesc Psychiatry Ment Health 2022; 16:87. [PMID: 36424648 PMCID: PMC9685979 DOI: 10.1186/s13034-022-00519-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Procedures and actions such as injections and immobilization cause distress to children. In the pediatric field, there is a need for interventions and support to alleviate the pain and distress caused by such medical procedures. In recent years, the introduction of robots as a means of distraction has begun to be attempted. METHODS In this study, we conducted a non-randomized controlled trial to examine the effect of intervention using 'aibo', a dog-like robot which has artificial intelligence (AI), to promote distraction in children after vaccination. Children between the ages of 3 and 12 years old eligible for the Japanese encephalitis vaccine, and their caregivers were assigned to intervention group or control group. Then, children evaluated their pain and children's behavior were observed by observer. The mean values of Faces pain rating scale scores and observer pain scale scores were compared between groups using an unpaired t-test. RESULTS Fifty-seven children (32 in the intervention group) participated in the study. Results of a t-test with the control group showed that the intervention group using aibo had significantly less pain following the post-vaccination intervention than the control group using stuffed dog (Face Scale, t(55) = 2.582, p = .0125; Behavioral Observation Scale, t(55) = 2.772, p = .00759). The results support the hypothesis that the aibo intervention group will be less distressed and able to calm down more quickly after vaccination than the control group. CONCLUSION Interactive communicative play intervention by an artificially intelligent aibo before and after painful and frightening medical procedures may alleviate fear and anxiety and prevent medical trauma in children.
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Affiliation(s)
- Kyoko Tanaka
- National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan. .,Division of Adolescent Mental Health, Department of Psychosocial Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya- Ku, Tokyo, 157-8535, Japan.
| | - Maoko Hayakawa
- grid.63906.3a0000 0004 0377 2305National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan ,grid.412314.10000 0001 2192 178XOchanomizu University Human Developmental Sciences, Bunkyo-Ku, Tokyo, Japan
| | - Chihiro Noda
- grid.63906.3a0000 0004 0377 2305National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan
| | - Akio Nakamura
- grid.63906.3a0000 0004 0377 2305National Center for Child Health and Development, Setagaya-Ku, Tokyo, Japan ,grid.258269.20000 0004 1762 2738Department of Pediatrics Juntendo University Faculty of Medicine, Bunkyo-Ku, Tokyo, Japan
| | - Chieko Akiyama
- Clinic for Children, Akiyama Kodomo Clinic, Mitaka, Tokyo Japan
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Demers LA, Wright NM, Kopstick AJ, Niehaus CE, Hall TA, Williams CN, Riley AR. Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101575. [PMID: 36291511 PMCID: PMC9600460 DOI: 10.3390/children9101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.
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Affiliation(s)
- Lauren A. Demers
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Naomi M. Wright
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Psychology, University of Denver, Denver, CO 80208, USA
| | - Avi J. Kopstick
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Tech University Health Science Center El Paso, El Paso, TX 97705, USA
| | - Claire E. Niehaus
- Division of Psychology and Psychiatry, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Correspondence: ; Tel.: +1-503-418-2134
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrew R. Riley
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
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Dunbar JE, Jones MT, Boles JC. Hospitalized children's perceptions of legacy: 'A symbol of yourself that you leave behind'. Child Care Health Dev 2022; 49:534-543. [PMID: 36218248 DOI: 10.1111/cch.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Legacy building is a developmentally grounded, trauma-informed and family-centred psychosocial intervention designed to bolster patient and family resilience through collaborative activities and meaning making. However, little is known about the effects of these interventions, partially because of a lack of clarity regarding how children of different developmental levels understand the concept of legacy. Therefore, this study explored the ways in which hospitalized children defined the concept of legacy. METHODS Semi-structured interviews were conducted with 45 hospitalized children (ages 6 to 18 years) on the acute and critical care units of an academic children's medical centre. Interviews were audio-recorded and transcribed verbatim; transcripts were independently coded by at least two members of the research team using an inductive, line-by-line approach; and codes were categorized and assembled into four overarching themes, resulting in a developmental typology of the concept of legacy. RESULTS Participants described legacy as (1) concepts, actions or feelings motivated by the future; (2) represented through both tangible and intangible means; (3) informed by personal, educational, experiential and ideological sources; and (4) experienced as good, bad or neutral. CONCLUSIONS The findings of this study demonstrate that hospitalized children are aware of and can articulate an emerging concept of legacy - one that mirrors the progression of cognitive complexity shaped by their unique personal life and healthcare experiences. The developmental typology presented in this study can be a useful starting point for clinicians as they present and facilitate legacy building interventions throughout a child's hospital stay.
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Affiliation(s)
| | - Maile T Jones
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Jessika C Boles
- Department of Human Development and Psychology, Vanderbilt University, Nashville, TN, USA
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Aramideh J, Ogez D, Rondeau É, Duval M, Sultan S. Development and refinement of Rel@x:A training in hypnosis-derived communication for pediatric nurses to prevent procedural pain. Br J Pain 2022; 16:546-559. [PMID: 36389009 PMCID: PMC9644098 DOI: 10.1177/20494637221103170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Introduction Studies in pediatric oncology have shown that hypnosis effectively reduces patients' pain and distress during painful procedures. This remains underutilized in the healthcare system due to the staff cost and availability of hypnotherapists. To develop the use of hypnosis-derived communication, we aimed to train nurses to use hypnosis-derived communication while they perform painful procedures. Objectives This study aimed to (1) develop a brief training in hypnosis-derived communication for pediatric nurses named Rel@x, (2) pretest the training with experienced pediatric oncology nurses, and (3) refine the training based on nurses' suggestions. Methods The Rel@x training consists of two 4-h sessions: one related to relational aspects and another one presenting one of two selected hypnotic communication techniques ("pleasant place" or "magic glove"). Rel@x makes use of manuals, cue card reminders, visual aids, videos, and an e-learning platform. To refine Rel@x, a complete training cycle was conducted with seven female pediatric oncology nurses. A mixed method study with an evaluation questionnaire and a post-training focus group interview was conducted. Results Quantitative data showed that nurses overall positively rated the training program: relevance and acceptability (median average of 5.4/6); use of hypnotic communication (median average of 5.2/6); expected effects (median average of 5.4/6); program implementation (5.6/6). Two general themes emerged from the qualitative data: perceptions of hypnotic communication and the evaluation of the Rel@x training program. Based on nurses' suggestions, Rel@x was refined by adding more practical components, more time for practice, more time between the two sessions and additional tools (cue card reminders, keywords, virtual e-learning recap module). Conclusion and clinical implications The use of hypnosis-derived communication during painful procedures and the Rel@x training were viewed favorably amongst pediatric nurses. Rel@x offers a complete training in hypnosis-derived communication for pediatric nurses. This training fosters the optimal use of hypnosis-derived communication during care and may significantly reduce children's procedural pain and distress.
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Affiliation(s)
- Jennifer Aramideh
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - David Ogez
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Department of Anesthesiology and
Pain Medecine, Université de Montréal, Montréal, QC, Canada
- Research Center, Maisonneuve-Rosemont
Hospital, Montréal, QC, Canada
| | - Émélie Rondeau
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, QC, Canada
| | - Michel Duval
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montréal, QC, Canada
| | - Serge Sultan
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montréal, QC, Canada
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Pediatric Medical Traumatic Stress in Inflammatory Bowel Disease, Pancreatitis, and Cystic Fibrosis. J Pediatr Gastroenterol Nutr 2022; 75:455-461. [PMID: 35881966 DOI: 10.1097/mpg.0000000000003569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Known as pediatric medical traumatic stress (PMTS), posttraumatic stress symptoms from medical experiences have not been explored in children with chronic gastrointestinal diseases. This cross-sectional study of children and adolescents with inflammatory bowel disease, chronic pancreatitis and cystic fibrosis, aimed to (1) estimate the prevalence of medical potentially traumatic events (PTEs) and PMTS, (2) explore potential risk factors for PMTS, and (3) explore potential consequences of PMTS. METHODS This cross-sectional study used validated, self-report measures to evaluate PTEs and PMTS. Descriptive statistics and regression analyses were used to achieve study objectives. RESULTS Over two-thirds of children reported a medical potentially traumatic event (91 of 132, 69%). Forty-eight had PMTS symptoms (36%). PMTS was associated with medication burden, emergency and intensive care visits, and parent posttraumatic stress disorder in multivariate analysis. Potential consequences associated with PMTS included school absenteeism, home opioid use, poor quality of life, and parent missed work. CONCLUSIONS A substantial portion of our cohort reported medical PTEs and PMTS. The exploratory analysis identified potential associations between PMTS and illness factors, parent posttraumatic stress disorder, and functional impairments. Further studies of PMTS detection, prevention and treatment are integral to optimizing these children's health and quality of life.
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