Psychosocial issues in the world of children with cancer

Cultural Influence on Family Management of Children With Cancer

A family's cultural context directly influences how they define and manage their child's cancer. Knowing this dynamic can guide nurses in delivering holistic, culturally competent care. This literature review examines the international and domestic pediatric oncology research as it relates to the inclusion of family and cultural variables. Most international studies and comparative studies have investigated Asian cultures and found that health beliefs, communication beliefs, religious practice, and family structure are common themes of cultural influences on families. Additional studies within the United States are needed to explore cultural beliefs through carefully tailored family assessments. Implications for practice include the possibility of providing evidence-based culturally competent care to families of children with cancer.

Exploring Factors Influencing Transcultural Caring Relationships in the Pediatric Stem Cell Transplant Setting: An Explorative Study

In the literature, there is evidence about the importance of ensuring a Family-Centered approach for foreign patients to provide culturally competent care. The Italian context shows a lack of studies concerning nurses' perceptions regarding factors that influence foreign patients' daily care. In addition, the number of pediatric patients coming to Italian hospitals to be cured has increased dramatically in the last few years. This study aims to investigate the pediatric nurses' perception of the factors influencing nursing care for foreign pediatric patients who have undergone a stem cell transplant (SCT) and their families. A qualitative approach is used. Semi-structured interviews were recorded, transcribed verbatim, and analyzed using qualitative techniques for recurrent themes. Italian SCT pediatric nurses were interviewed until data saturation was achieved. Four themes emerged from the analysis: "Respect for other cultural traditions," "Different roles," "Communication," "Equal treatment and different opportunities." Communication was seen as a barrier in caring for foreign patients. Nurses perceived a lack in their training and knowledge when caring for foreign patients. The hospital supports nurses when caring for foreign patients. We found that pediatric nurses do not feel they are caring for foreign patients in the same way as they do for Italians, but adopt strategies to improve their relationships with them. Semi-structured interviews proved to be useful in highlighting the nurses' perceptions. These data were confirmed by the results of the audit conducted with the "Children and Young People's Audit Policy Tool," The tool suggests specific interventions when foreign patients are admitted.

Understanding the perceptions of children battling cancer about self and others through drawing

Background:

Childhood cancer is a stressful experience and may cause a change in the child's perception of himself/ herself, the family and the world around him/ her.

Aims:

This study sought to (a) explore the self-perception of children; and (b) examine the relation of children with others.

Materials and Methods:

The total population of the study consisted of all the children, undergoing cancer treatment at Children Cancer Hospital, located in Karachi. The participants were asked to draw a drawing on self and others. Through qualitative approach (phenomenology), themes and sub-themes were derived.

Results:

Using purposive sampling, the total sample size drawn for this study was 78 children aged 7-12, receiving treatment for cancer (1st stage) at the Children Cancer Hospital, Karachi, Pakistan. The drawings of the children were categorized into facial expressions, self images and family ties. Within each category, there were sub-categories. Under facial expressions, the common emotions reflected were sadness, seriousness, anger; and pain. The self-image pictures uniformly reflected low self-esteem, especially focusing on hair loss, missing body parts. Under the category of family ties, most of the children's drawings reflected their isolation or emotional detachment from or abandonment by their family members.

Conclusions:

The study concludes that the self- image of most of the participants is deteriorated and they are socially isolated. Social and moral support can bring positive emotional development and helps to correct their self-perception.

Pediatric HIV adherence: an ever-evolving challenge

Providers working with children living with HIV strive to achieve "good adherence," often viewed only as consistent pill taking by the infected child. This goal, while important, needs to be expanded with a thorough examination of the many biopsychosocial factors impacting the HIV affected family. The complexity of the issues affecting adherence to a pediatric HIV medical regimen can overwhelm both the practitioner and the patient. By utilizing a developmental framework and emphasizing the critical importance of the relationship between provider, patient and family, the authors (both of whom are social workers who have worked over a period of many years with children and families living with terminal and serious chronic illnesses) describe a developmental approach that includes comprehensive assessment to address the multiple challenges faced by individuals and families they have worked with.

Pediatric palliative, end-of-life, and bereavement care

The pediatric hospitalist plays an integral role in providing palliative, end-of-life, and bereavement care for children and families. This article focuses on a multifaceted approach to this domain of care in which the physician is a key member of an interdisciplinary team. We believe that we can improve quality of life and relieve suffering only by paying attention to the medical, emotional, spiritual, and practical needs and goals of dying children and their loved ones.

Exploring Parents' Stories of Coping with Their Child's Cancer: A Qualitative Study

The focus of this investigation was to explore stories about coping with childhood cancer in a support group for parents. Using the principles of ethnographic epistemology, this study considered the stories of eight parents whose children were diagnosed with cancer and who decided to join a support group. Themes were identified which led to a delineation of how each parent coped with this trauma in their lives. In addition, the researchers' perspective as to what was helpful to the group members is discussed. An overview of the existing body of knowledge on childhood cancer and the family is presented and the value of a social support group in parenting a child with cancer is considered. It is argued that there is a need for a conceptual shift in order to understand the problem of parenting such a child.

The long-term psychosocial effects of cancer diagnosis and treatment on children and their families

Using both qualitative and quantitative methods, a study of 77 families was undertaken to examine the long-term psychosocial effects of cancer on children and their families. This paper focuses specifically on the findings in relation to the parents' subgroup of the overall study. Key findings were that the majority of parents and their children readjust to ordinary family life following completion of treatment. Gender differences in parents' coping mechanisms emerged. The period immediately following the cessation of treatment can create feelings of isolation and vulnerability, and many parents have ongoing worries about their child's continued well-being.

Psychosocial practice trends in pediatric oncology

Children with cancer are now living longer lives. As a result, the focus on care has shifted to include psychosocial components to help promote healthy adjustment to the diagnosis of cancer. In addition, the focus extends to the systems that encompass the patient and family. This ranges from cultural needs to comfort care and how the medical team and institutions address these issues. Through well-defined psychosocial practices, children and families are better prepared to cope with cancer and become well-adjusted survivors. However, regardless of the eventual outcome of the disease, providing psychosocial services can add to the quality of life. Many common practices have emerged over the last 25 years, and many more will continue to arise as outcome studies continue to address the impact of psychosocial services and interventions. This report explores some current trends and common psychosocial practices in working with children with cancer and their families.

The treatment of retinoblastoma: a case study

Research in the treatment of retinoblastoma and multidrug resistance has led to new treatment protocols for children. This case study introduces information regarding a clinical trial for the treatment of intraocular retinoblastoma. It also highlights important nursing issues in the care of these children and their families.

Psychosocial issues of adolescents with cancer

Although researchers agree that cancer during adolescence does not lead to serious psychopathology, the adolescent patient is confronted with a number of biopsychosocial problems. This article reviews the literature on nine psychosocial issues: (1) Health concerns, (2) Family relationships, (3) Sexual and reproductive issues, (4) Peer relationships, (5) Body image, (6) School disruption, (7) Interaction with treatment team, (8) Future goals and career development, and (9) Positive life changes. Practice implications and support group interventions for this population are presented.

Development of a tool to measure the life situation of parents of children with cancer

The aim of this study was to test the validity and reliability of the recently developed Life Situation Scale for Parents (LSS-P) among parents of children with cancer. One hundred and ten parents of seventy-four children and adolescents who visited three paediatric wards in Sweden filled out three instruments: The LSS-P, the Quality of Life Scale and the Family Support Scale. The reliability coefficient, Cronbach's alpha, was found to be 0.82 for the LSS-P. A factor analysis with orthogonal varimax rotation of 37 items of the LSS-P gave twelve factors. A higher order factor analysis reduced the factors to four (Care, Well-being, Social life and Preparedness), explaining the underlying dimensions to 57.9%. The total LSS-P correlated significantly with the Quality of Life Scale, and the higher order factor Care with the Family Support Scale. The LSS-P discriminated, in some aspects, between two-parent visiting the ward for treatment or check-up. The conclusion is that this first version of the LSS-P was valid and reliable (internal consistency) to a certain extent, but that the instrument should be tested on larger samples and during different phases of the disease.