Transplantation in children. A longitudinal assessment of mothers' stress, coping, and perceptions of family functioning

Validity and consequence of informed consent in pediatric bone marrow transplantation: The parental experience

BACKGROUND

Conditions supporting a high quality of consent for pediatric bone marrow transplantation (BMT) are suboptimal given the complexity of the procedure, lack of options, and parent emotional duress. We studied if parents perceived choice when consenting to BMT, if they felt the consent provided was valid, and how the consent process affected them.

METHODS

Telephone or face-to-face interviews were recorded using a semi-structured interview outline. Interview transcripts were anonymized, and independently analyzed by three reviewers.

RESULTS

Twenty parents of twelve children participated, including five bereaved parents. There were no differences in patient transplant characteristics between the eligible and study groups. Divorced or separated parents were underrepresented in the participant group. Fifteen parents felt personally compelled to consent; most (18) denied feeling external medical pressure to do so. All parents felt their consent was valid and most reported adequate levels of freedom, capacity, and information. Expectations formulated during the consent process strongly influenced parents' experience post-BMT. Good communication during consent contributed to trust and therapeutic alliance with physicians following BMT. Late parental stress and anxiety were periodic, but very high in some families.

CONCLUSIONS

Parents feel consent for pediatric BMT is valid, despite feeling personally compelled to consent. Strategies aimed at nurturing hope and realistic expectations may assist in improving the consent process, while diminishing long-term stressors.

An Interruption in Family Life: Siblings' Lived Experience as They Transition Through the Pediatric Bone Marrow Transplant Trajectory

PURPOSE/OBJECTIVES

To arrive at an understanding of the lived experience of healthy donor and nondonor siblings as they transition through the bone marrow transplantation (BMT) trajectory.

RESEARCH APPROACH

Qualitative study guided by the philosophy of hermeneutic phenomenology.

SETTING

Participants' homes or the investigator's university or hospital office.

PARTICIPANTS

Eight siblings of pediatric BMT recipients were recruited based on their knowledge of the experience of transitioning through the BMT trajectory.

METHODOLOGIC APPROACH

Data were collected by semistructured, open-ended interviews; demographic forms; and field notes during a period of six months. Data analysis occurred concurrently with data collection. Thematic statements were isolated using Van Manen's selective highlighting approach. Interviews were reviewed repeatedly for significant statements.

MAIN RESEARCH VARIABLE

Siblings' lived experience of the BMT trajectory.

FINDINGS

Interruption in family life emerged as the essence of siblings' lived experience. Four themes supported this essence: life goes on, feeling more or less a part of a family, faith in God that things will be okay, and feelings around families.

CONCLUSIONS

Hermeneutic phenomenologic research increases understanding of what being a sibling of a pediatric BMT recipient means. This study is one of the few that have afforded siblings the opportunity to speak about what is important to them.

INTERPRETATION

Findings from this study provide insight into how siblings live and cope throughout the BMT trajectory and will guide nurses as they seek to provide more sensitive and comprehensive care.

Factors influencing satisfaction and well-being among parents of congenital heart disease children: development of a conceptual model based on the literature review

AIM AND METHOD

The treatment and management of congenital heart disease (CHD) has improved dramatically over the past 25 years, necessitating re-evaluation of satisfaction with care and well-being among CHD children and their parents (PCCHD). The present study reviews the published literature over the past 25 years on parental satisfaction with the paediatric care of CHD and well-being among the parents, with the specific aim of: (a) assessing the extent of psychosocial problems and grade of satisfaction with care and (b) modelling factors associated with satisfaction and well-being among the parents.

RESULTS

There is general agreement in the literature that PCCHD experience psychosocial morbidity to a higher degree than parents of children with other paediatric conditions and parents of healthy children. The research on satisfaction with care among PCCHD is not conclusive, though there is considerable agreement that a substantial proportion of PCCHD may not be receiving adequate information regarding the ill-child's condition, treatment and medical prognosis. Finally, based on the review of factors affecting satisfaction and well-being, a model is generated indicating that interactions between parental perception of CHD, psychosocial resources and social vulnerability may account for differences in well-being among PCCHD, which in turn may explain differences in satisfaction with care among them.

CONCLUSION

A holistic approach to the care of CHD that acknowledges the role of parents' perception of CHD, need for psychosocial resources and social vulnerability in the adaptation process is recommended to improve parental satisfaction with the care of CHD.

Psychosocial morbidity among parents of children with congenital heart disease: A prospective longitudinal study

OBJECTIVE

The study objectives were to assess long-term psychosocial morbidity and its determinants among parents of children with congenital heart disease (PCCHD), and to compare mothers with fathers on psychosocial variables.

METHOD

The study design was longitudinal. Data comprising PCCHD (n = 632, 58% were women) were collected on two occasions 1 year apart.

RESULTS

Many PCCHD reported psychosocial problems manifested in depression (18%), anxiety (16%-18%), somatization (31%-38%), and hopelessness (16%) during both measurement points. In addition, 7% to 22% reported psychosocial problems persisting over a 1-year period. Consistently over time, mothers reported more severe symptoms of depression, anxiety, somatization, and hopelessness than fathers. Children's clinical severity did not significantly explain parent's psychosocial morbidity over time. Instead, parental caregiving burden, dissatisfaction with care, social isolation, and financial instability were associated with an increased risk of long-standing psychosocial morbidity.

CONCLUSIONS

An important proportion of PCCHD are at risk of long-standing psychosocial morbidity, suggesting that psychosocial intervention may be beneficial. Feasible interventions are discussed.

Parent/caregiver stress during pediatric hospitalization for chronic feeding problems

This study examined changes in stress in 37 mothers/caregivers of children with chronic feeding problems. Stress was measured by the Parenting Stress Index-Short Form at three specific stages during pediatric hospitalization for treatment of chronic feeding problems. The relationship between caregiver stress and stage of hospitalization as well as that between stress and various child and family variables were investigated. Repeated-measures analyses of variance and t tests found that stress related to social isolation and self-perception and total parenting stress changed significantly in relation to the stage of hospitalization. Correlational analyses indicated that caregiver stress was positively related to the presence of mental retardation, oral-motor dysfunction, tonal abnormalities, or a pervasive developmental disorder in the hospitalized child. Caregiver stress was negatively related to coping strategies that involved understanding the child's medical situation. These results provide a more comprehensive picture of families of children with chronic feeding problems, a population that has received little attention in the research literature. Information regarding parent/caregiver stress during a child's hospitalization can enhance nurses' understanding of the experiences of these families, thereby contributing to more effective treatment planning. In addition, the results emphasize the need to examine a variety of child and family factors that may influence parenting stress as well as family involvement in intervention services.

Sociocultural Issues in Pediatric Transplantation: A Conceptual Model

OBJECTIVE

To demonstrate the value of viewing the pediatric transplant experience through a sociocultural lens and to offer an organized framework for identifying influential sociocultural variables in pediatric transplantation.

METHODS

A conceptual model is presented which organizes sociocultural factors that may influence the transplant process. A review of the pediatric and adult transplant literature is conducted.

RESULTS

The need for a model addressing sociocultural issues and benefits of using the proposed model is evident. Guided by the proposed model, pediatric psychologists will be prepared to more readily attend to sociocultural influences associated with the transplant experience when conducting research or providing clinical services to patients and families.

CONCLUSIONS

Further development and evaluation of the proposed model are necessary to investigate its practical utility and validate the influence of the identified variables on assessment and treatment of pediatric transplant patients as well as patient health outcomes.

Patterns of distress in parents of children undergoing stem cell transplantation

Parents (N = 151) of children undergoing bone marrow or stem cell transplantation (BMT) were assessed in a prospective, longitudinal design with repeated measures of distress (mood disturbance, perceived stress, caregiver burden). Parents were assessed weekly from admission for BMT (week-1) through week +6 post-BMT, followed by monthly assessments through month +6. Concurrent measures of child distress (somatic distress, mood disturbance) were also obtained by parent and child report. Parents demonstrate modest, but significant elevations in distress, particularly during the early period from admission through week +3. Elevations in parental distress are transient, and appear to be largely resolved by 4-6 months post-BMT. Parental distress was unrelated to child age, gender, diagnosis, or type of transplant, but was significantly related to parental socioeconomic status (SES). Parents from lower SES backgrounds reported greater levels of distress throughout the BMT process. Moderate correlations were observed between measures of parent and child distress, and level of child distress at the time of admission for BMT was predictive parental distress trajectories across the acute phase of BMT. These findings point to appropriate targets for intervention to reduce transplant-related distress.

Anxiety, depressive, and posttraumatic stress disorders among mothers of pediatric survivors of hematopoietic stem cell transplantation

OBJECTIVE

To examine the prevalence and predictors of anxiety, depression, and posttraumatic stress disorder among mothers of children who underwent hematopoietic stem cell transplantation (HSCT).

METHODS

A total of 111 mothers of children who survived HSCT completed self-report measures of psychological functioning at the time of HSCT and self-report measures and a structured psychiatric interview 18 months after HSCT. Demographic data and medical data were also collected.

RESULTS

Approximately 20% of mothers had clinically significant distress reactions. When subthreshold posttraumatic stress disorder was included, nearly one third of mothers met the criterion for persistent distress. Mothers with 1 of the 4 psychiatric diagnoses reported a significantly lower quality of life, suggesting that the diagnoses had an impact on their general quality of life. Mothers who had 1 of the 4 diagnoses at 18 months were younger and had higher anxiety and depressive symptoms at the time of HSCT.

CONCLUSIONS

A subset of mothers of children who survive HSCT may require psychological intervention. Mothers who are most at risk are younger and evidence anxiety and depressive symptoms at the time of transplantation.

Coping patterns in mothers/caregivers of children with chronic feeding problems

INTRODUCTION

In this study, with use of the Coping Health Inventory for Parents (CHIP), coping behaviors were examined in 35 mothers/ caregivers of children with chronic feeding problems during hospitalization for treatment of these problems. Coping in families of children with these problems has not been addressed in research. This information is beneficial in planning and implementing treatment and follow-up services.

METHOD

Correlations and t tests were used to look at variables related to the mothers'/caregivers' coping patterns and to compare their frequency of usage of these patterns.

RESULTS

The mothers/caregivers in this study were most likely to cope with their child's feeding problems by making active attempts to understand the problems and by doing activities with family members. Several child and family variables were significantly related to maternal coping patterns.

DISCUSSION

These results suggest that it is important to provide a variety of resources to families of children with chronic feeding problems during their children's hospitalizations, including access to support and information groups. The results also suggest that it is beneficial for these families to acquire a thorough understanding of their child's medical situation because this understanding seems to help them in their ability to cope.

Coping and the course of mother's depressive symptoms during and after pediatric bone marrow transplantation

OBJECTIVE

To evaluate the role of maternal coping strategies in depressive symptoms experienced by mothers of children undergoing bone marrow transplantation (BMT).

METHOD

A total of 207 mothers completed measures of coping and depressive symptoms at the time of the child's BMT, 3 and 6 months post-BMT. The sample was collected between 1998 and 2002. The acceptance rate was 73%. The contribution of demographic, illness and treatment parameters, and mothers' concerns about the child were also evaluated. Growth curve modeling was used to evaluate the role of coping in the course of depressive symptoms. Both main effects and interactions of coping strategies with time of assessment were evaluated.

RESULTS

Acceptance and humor were associated with reductions in maternal depressive symptoms, and planning and alcohol/substance use were associated with increases in maternal depressive symptoms. Positive reframing, use of emotional support, and use of religion were associated with the course of depressive symptoms, but the magnitude of associations differed depending on the use of the coping strategies at the time of transplantation. Mothers' fears about the child also predicted depressive symptoms.

CONCLUSIONS

Acceptance and humor may be targets for behavioral interventions to reduce mothers' depressive symptoms during and after pediatric BMT hospitalization.

Symptoms of posttraumatic stress disorder in parents of transplant recipients: incidence, severity, and related factors

OBJECTIVE

To examine the incidence, severity, and factors related to posttraumatic stress disorder (PTSD) symptoms in parents of pediatric solid organ transplant recipients.

METHOD

A total of 170 caregivers of pediatric transplant recipients completed self-report measures of psychological functioning between 10 and 38 months after their child's most recent transplant. Demographic data, child health variables, and ratings of medical attitudes and social functioning were also collected to help explain individual differences in psychological functioning.

RESULTS

Although caregivers of pediatric transplant recipients did not report elevated levels of depression or anxiety, they did report elevated levels of PTSD symptoms. Multiple regression analyses revealed that PTSD symptoms were most strongly associated with parent reports of child health, family impact of the transplant, and attitudes toward medical caregivers.

CONCLUSIONS

PTSD seems to be relatively common in parents of pediatric transplant recipients and may be largely the result of how parents perceive and interpret the transplant experience.

Living-related liver transplantation: a Thai family's stressors and concerns

This case study reviews the experience of a Thai family who traveled to Japan for living-related liver transplantation. The recipient experienced multiple problems after transplantation, which placed additional stress on the family. The cultural gap and language barrier resulted in a lack of understanding and often made it difficult for the medical team and family to communicate effectively. However, the use of interpreters helped to resolve these problems. This study shows that it is especially important for transplant coordinators and social workers to facilitate the collaboration and understanding between families and the medical team when cultural and language differences exist.

Non-adherence in pediatric transplantation: a review of the existing literature

The degree of medical adherence in pediatric solid-organ transplant recipients frequently correlates with the degree of psychological distress, family functioning, and the physiological side-effects of immunosuppressant medications. This article examines the current literature regarding each of these factors and proposes recommendations for increasing the medical compliance among childhood transplant recipients.