Are we meeting the informational needs of cancer patients and families? Perception of physician communication in pediatric oncology

Cross-Cultural Adaptation and Psychometric Validation of the Interview Satisfaction Questionnaire (ISQ) to Assess Unmet Health Communication Needs of Iranian Breast Cancer Patients

Autonomous and patient-centered health communication (PCHC) between a healthcare provider (HCP) and a client (HCC) is a critical fundament for successful healthcare outcomes. A standard and validated data collection tool for studying the satisfaction of Iranian breast cancer patients (BCPs) with various aspects of their health communication with HCPs does not exist. The current study assessed the application, feasibility, and cultural appropriateness of the Persian-translated version of the interview satisfaction questionnaire (ISQ) in the Iranian context. A standard translation/back-translation procedure was used to prepare a preliminary Persian version of the ISQ (ISQ-P) which was then evaluated for content and face validity by a panel of experts. The study data were collected from 200 breast cancer patients and used to estimate the internal consistency measure of Cronbach's alpha and intra-class correlation coefficient. Confirmatory factor analysis (CFA) was performed to verify the compatibility of the instrument's identified dimensions with the original ISQ's factor structure. The calculated content validity index (CVI = 0.89), content validity ratio (CVR = 0.49), and Cronbach's alpha coefficient (0.79) indicated the appropriateness of the ISQ-P for its intended purpose. The CFA's outputs (root mean square error of approximation (RMSEA) = 0.09, comparative fit index (CFI) = 0.954, Tucker-Lewis index (TLI) = 0.931, standardized root mean square residual (SRMR) = 0.04) affirmed the fitness of the study data to the original 4-factor conceptual model. The study findings supported the suitability of ISQ-P for assessing health communication episodes by Persian-speaking BCPs. However, due to cultural variation, cross-border diversity of health systems, and organizational circumstances, further validity and reliability appraisal of the ISQ-P in distinct sub-samples is recommended.

The information needs of relatives of childhood cancer patients and survivors: A systematic review of quantitative evidence

OBJECTIVE

We aimed to: (1) summarize the quantitative evidence on the information needs of relatives of childhood cancer patients, survivors, and children deceased from cancer; and (2) identify factors associated with these needs.

METHODS

PubMed, PsycINFO, Scopus, and CINAHL were systematically searched. The methodological quality of all included publications was assessed, and the extracted data were analyzed using narrative synthesis.

RESULTS

Of 5810 identified articles, 45 were included. Information needs were classified as unmet, met (satisfied), and unspecified and categorized into five domains: medical information, cancer-related consequences, lifestyle, family, and support. Most unmet information needs concerned cancer-related consequences (e.g., late effects), while information needs on support were generally met. Migrant background and higher education were associated with higher information needs among parents. Siblings had lower information needs than parents.

CONCLUSION

This systematic review provides a comprehensive overview of the information needs of relatives in the context of childhood cancer, showing that information on cancer-related consequences is needed most often. The socioeconomic background of the relatives needs continued consideration throughout the cancer trajectory.

PRACTICE IMPLICATIONS

Our findings suggest the need for personalized information. Healthcare professionals should adapt their communication strategies to respond to the different and evolving needs of all affected relatives.

Unveiling perspectives on the psychosocial impacts of childhood cancer survival on young adult survivors' reassimilation journey: A qualitative exploration

Background

Approximately 82% of children with childhood cancer survive more than five years after diagnosis. Living as a cancer survivor elicits a new reality that can include psychosocial impacts. These psychosocial impacts interact collectively, especially regarding reassimilation, and are rarely explored.

Objective

To explore the psychosocial impacts of surviving childhood cancer and reassimilation back into society in young adult survivors of childhood cancer.

Methodology

Individual in-depth semi-structured interviews were conducted with childhood cancer survivors and explored psychosocial aspects associated with returning to work, school, and social environments after remission. Interpretive phenomenological analysis was conducted once interviews were manually transcribed. A group interview with survivors was held to discuss the study's findings and interpretation.

Results

Individual interviews and the group interview revealed three major themes: outlook on reassimilating, outlook on coping, and outlook on cancer.

Conclusions

This work is a first step to understanding how survivors' personal outlook on coping and healthcare system barriers play influential roles in reassimilation following cancer treatment. Survivors expressed the need for reliable survivorship information and improved communication with healthcare providers regarding what to expect, so they could feel prepared for life post-cancer. These aspects need to be explored more deeply through other qualitative studies.

Regards sur les séquelles psychosociales des cancers pédiatriques sur le parcours de réintégration des jeunes survivants devenus adultes: étude qualitative exploratoire

Contexte

Environ 82 % des personnes atteintes d’un cancer pendant l’enfance survivent plus de 5 ans après le diagnostic. La survivance transforme leur quotidien et entraîne parfois des difficultés psychosociales. Les séquelles psychosociales – rarement étudiées – sont interreliées, surtout en ce qui concerne la réinsertion aux activités normales.

Objectif

Examiner les effets psychosociaux de la survie au cancer pédiatrique et la réinsertion sociale des jeunes adultes.

Méthodologie

Des entrevues individuelles semi-structurées détaillées ont été réalisées auprès de personnes ayant survécu à un cancer pédiatrique afin d’étudier les aspects psychologiques du retour au travail, à l’école et en société après la rémission. Après la transcription manuelle des entrevues, on a procédé à une analyse phénoménologique interprétative. Un groupe de discussion a été organisé pour permettre aux survivants de discuter des résultats de l’étude et de l’interprétation des données.

Résultats

Les entrevues individuelles et le groupe de discussion ont fait ressortir trois grands thèmes: le regard porté sur la réinsertion, le regard porté sur l’adaptation et le regard porté sur le cancer.

Conclusions

La présente recherche amorce une démarche visant à comprendre en quoi le regard que portent les survivants sur l’adaptation et les obstacles liés au système de santé influence la réintégration après le cancer. Les survivants ont exprimé le besoin d’obtenir des renseignements fiables sur la survivance au cancer et d’être mieux informés par leurs professionnels de la santé afin de se préparer à la vie après le cancer. Ces aspects devront faire l’objet d’autres études qualitatives détaillées.

Unmet supportive care needs of families of children with chronic illness: A systematic review

BACKGROUND AND AIMS

Unmet supportive care needs (SCN) refer to perceived gaps in the support parents want to manage caregiving activities for children with chronic health conditions (CHC) and the support received. This review aims to systematically identify the unmet SCN of families with children living with five common paediatric CHC and characterise the assessment tools used to measure SCN.

DESIGN

Systematic review methodology with narrative synthesis of data. Reporting followed the PRISMA statement guidelines.

METHOD

Literature searches were conducted in electronic databases Medline complete, PsycINFO, CINHAL and EMBASE to retrieve relevant articles published between 1990 and July 2022. Eligible studies involved (i) children aged 0-18 years diagnosed with either of cancer, congenital heart disease (CHD), diabetes, asthma, renal disease and (ii) assessment of unmet SCN. Studies involving children with genetic or developmental conditions were excluded. The methodological quality of studies was assessed using JBI assessment tool.

RESULTS

Of 6223 articles screened, 34 papers were included (25 quantitative, 5 qualitative and 4 mixed design). Most papers explored unmet needs of families with cancer (n = 26). The remaining articles concerned CHD (n = 5), asthma (n = 2) and mixed CHC (n = 1, renal failure, and diabetes). Information (e.g. treatment, lifestyle, etc.) and health care (e.g. emotional support, practical services, etc.) were the most common unmet need domains across health conditions. A variety of methods and need assessments hampered comparisons between studies both across and within CHC.

CONCLUSION

Irrespective of illness, addressing unmet informational or health care needs may help to optimise outcomes and care for children and families living with common CHC. There was considerable variation in reporting styles, study design and need assessments both within and across conditions.

RELEVANCE TO CLINICAL PRACTICE

Health care professionals must routinely evaluate the type, quality and quantity of psychoeducation and support that families of children with CHC want and receive. Providing nurses with more effective strategies to assess child and family needs across a broad range of domains may help to increase understanding of where further support for families is required.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution to this study as it involved a systematic review of existing literature.

Practical considerations for prognostic communication in pediatric cancer

High-quality communication is essential for the optimal care of children with cancer and their families. There are opportunities for pediatric oncologists to engage in clear and compassionate prognostic communication across the disease trajectory including at the time of diagnosis, disease recurrence or progression, and end of life. Contrary to previously held beliefs, prognostic disclosure supports parental hope and meets the needs and expectations of families who prefer honest conversations about prognosis. These communication encounters can be challenging with many oncologists having little training in this important skill. In this summary, we aim to provide practical guidance for prognostic communication in pediatric cancer across the illness trajectory giving phrases we have found helpful including a brief overview of some published communication frameworks utilized in the care of pediatric oncology patients and families.

Childhood Cancer Information-Seeking: Findings from the National Cancer Institute's Cancer Information Service

The benefits of cancer information-seeking may be particularly salient to individuals impacted by childhood cancer, including patients, caregivers, health professionals, and advocates. The purpose of this study was to explore information-seeking patterns for childhood cancer through the National Cancer Institute's Cancer Information Service (CIS), a multi-channel, bilingual resource for cancer information. The study team conducted descriptive analyses on secondary data characterizing 1820 caregivers, health professionals, organizations, and members of the general public who contacted the CIS about childhood cancer between September 2018 and June 2022. Almost 80% of inquiries about childhood cancer were initiated by caregivers, followed by the public, health professionals, and organizations. Although English was the primary language used by individuals to reach the CIS when discussing childhood cancer, there were variations in points of access (i.e., telephone, instant messaging, email, social media) across the four user groups. Most childhood cancer inquiries were about staging and treatment, and the primary cancer sites discussed by CIS users were neurologic or brain, hematologic, and musculoskeletal cancers. Discussion topics included managing and coping with cancer, clinical trials, and treatment side effects. Just over half (54%) of CIS contacts about childhood cancer resulted in a health professional referral. Findings provide direction for the CIS and other public health organizations to deliver, prioritize, and tailor their services to support the information needs of childhood cancer survivors and their families-as well as those who care and advocate for them-who may have a significant need for credible cancer information.

The New Oncologic Diagnosis Discussion: Perspectives of Pediatric Oncologists

PURPOSE

We aimed to understand how new diagnosis discussions are conducted in pediatric oncology, and the training provided for their conduct.

METHODS

This mixed-methods study used a sequential exploratory design. Qualitative interviews (n = 20) were conducted with pediatric oncologists (n = 15) and fellows (n = 5) at a single institution, focusing on the process used to convey the diagnosis and treatment plan to the family. Accreditation Council for Graduate Medical Education-accredited pediatric oncology fellowship program directors (n = 38) and fellows (n = 70) were subsequently surveyed to confirm qualitative results and elucidate the training that fellows receive in conducting new diagnosis discussions.

RESULTS

Our findings suggest that new diagnosis discussions in pediatric oncology are typically conducted in three stages: (1) concern for cancer; (2) confirmation of diagnosis; and (3) treatment plan/consent, and are fundamentally similar across settings; however, pediatric oncologists skillfully tailor their approach on the basis of clinical circumstances and parental needs. Decisions regarding inclusion of the child are primarily determined by parental preference, whereas inclusion of health care team members is driven by physician role (ie, trainee v program director) and health care organization-related factors. Physician preparation for discussions involves logistical, intellectual, and emotional components. Disclosure of prognosis is nuanced. There is variability across pediatric oncology fellowship programs in the provision of training for these discussions.

CONCLUSION

We identified common practices of pediatric oncologists as they prepare for and lead new diagnosis discussions in pediatric oncology. We found variability in the training that pediatric oncology fellows receive regarding how to conduct these discussions, highlighting a need for standardized training curricula.

Communication with parents and young adult patients affected by complex vascular malformations

BACKGROUND

Vascular malformations (VMs) are rare disorders that can cause pain, coagulopathy, disfigurement, asymmetric growth, and disability. Families affected by complex VMs experience misdiagnosis, limited trustworthy information, delayed or inappropriate treatments, and persistent uncertainty. However, more research is needed to understand the communication experiences of these families during clinical encounters.

PROCEDURE

We performed semi-structured interviews with 34 parents of children with VMs (18% men; 82% women; mean age = 41 years) and 25 young adults with VMs (8% men; 88% women; 4% nonbinary; mean age = 29) living in the United States, recruited through four patient advocacy groups. We performed thematic analysis to assess communication experiences, using a previously developed functional model of communication in pediatric oncology as an a priori framework.

RESULTS

We identified evidence of eight communication functions previously identified in pediatric oncology: building relationships, exchanging information, enabling self-management, managing uncertainty, responding to emotions, making decisions, providing validation, and supporting hope. Uncertainty was pervasive through participants' experiences and seemed to influence the fulfillment of communication functions. Fewer participants seemed to highlight the role of clinicians in responding to emotions or supporting hope, compared to other communication functions.

CONCLUSION

Interviews with parents and young adult patients with VMs provided evidence for eight functions of communication. While exchanging information and building relationships were described by nearly every respondent, supporting hope and responding to emotions were mentioned less frequently. Future studies should develop patient-reported communication measures to quantify the fulfillment of these functions and to identify areas of communication in need of intervention.

Communication and information sharing with pediatric patients including refugees with advanced cancer, their caregivers, and health care professionals in Jordan: a qualitative study

Introduction

Effective communication in pediatric palliative cancer care is an important aspect of practice to enhance patient- and family-centered care, and to optimize decision-making. However, little is known about communication preferences practices from the perspectives of children, caregivers and their health care professionals (HCPs) in the Middle Eastern region. Furthermore, involving children in research is crucial but limited. This study aimed to describe the communication and information-sharing preferences and practices of children with advanced cancer, their caregivers, and health care professionals in Jordan.

Methods

A qualitative cross-sectional study was conducted using semi-structured face to face interviews with three groups of stakeholders (children, caregivers and HCPs). Purposive sampling recruited a diverse sample from inpatient and outpatient settings at a tertiary cancer center in Jordan. Procedures were in line with the Consolidated criteria for reporting qualitative research (COREQ) reporting guidelines. Verbatim transcripts were thematically analyzed.

Findings

Fifty-two stakeholders participated: 43 Jordanian and 9 refugees (25 children, 15 caregivers and 12 HCPs). Four major themes emerged: 1) Hiding information between the three stakeholders which includes parents who hide the information from their sick children and ask the HCPs to do so to protect the child from distressful emotions and children who hide their suffering from their parents to protect them from being sad; 2) Communication and sharing of clinical versus non-clinical information; 3) Preferred communication styles such as use of a companionate approach by acknowledging patients and caregivers' suffering, building a trustful relationship, proactive information sharing, considering child age and medical status, parents as facilitators in communication, and patients' and caregivers' health literacy; 4) Communication and information sharing with refugees where they had dialect issues, which hindered effective communication. Some refugees had unrealistically high expectations regarding their child's care and prognosis, which posed challenges to communication with staff.

Discussion

The novel findings of this study should inform better child-centered practices and better engage them in their care decisions. This study has demonstrated children's ability to engage in primary research and to express preferences, and parents' ability to share views on this sensitive topic.

Strategies to improve communication about neurocognitive impacts in pediatric oncology: Quality improvement findings

BACKGROUND

Neurocognitive deficits are common among children who receive central nervous system (CNS)-directed therapy for childhood cancer. Parents report that they lack information from and communication with oncology providers about neurocognitive impacts of therapy. Furthermore, oncology providers report they lack training and institutional support to appropriately address the neurocognitive needs of these patients/families.

METHODS

A parent/provider stakeholder informed, quality improvement (QI) project was conducted to educate providers about neurocognitive impacts, increase parent/provider communication, and improve adherence to supportive care guidelines for neuropsychological assessment for children receiving CNS-directed therapy. A 1-h Continuing Medical Education (CME) course was developed to educate providers about neurocognitive impacts and their relation to schooling. A provider-focused electronic medical record (EMR) strategy was used to deliver parent stakeholder-informed return-to-school "roadmaps," with prompts to scaffold parent/provider communication and enhance documentation of findings.

RESULTS

Hospital-based CME sessions were attended by 76% (41 out of 54) of providers from our institution. Among the 34 who completed both pretest and posttest, the mean knowledge score improved from 56% at pretest to 74% at posttest. Compliance with the EMR strategy was 80% and there was a 42% increase in neuropsychological assessment referrals.

CONCLUSIONS

We conclude that this QI project is an example of a successful parent/provider stakeholder collaboration that achieved demonstrable positive change in the areas of provider knowledge, patient/provider communication, and alignment of neuropsychological assessment referrals with existing guidelines. Our results confirm that improving knowledge, communication, and compliance with neuropsychological standards of care is possible with this evidence-based approach.

[Needs of Children with Oncological Diseases: Psychometric Review of the Survey Instrument "KiWuF-PädOnk" and First Results]

In der vorliegenden Querschnittstudie wurde ein neu konzipierter Bedürfnisfragebogen für 8- bis 13-jährige Krebspatienten psychometrisch überprüft (N=117). Auf der Grundlage einer explorativen Faktorenanalyse wurden 4 Skalen mit insgesamt 19 Items gebildet. Die interne Konsistenz des Fragebogens ist zufriedenstellend. Die Teilnehmenden äußerten ein starkes Bedürfnis nach sozialer Teilhabe, Sicherheit und Kontrollerleben sowie nach Normalität. Der KiWuF-PädOnk liefert Informationen zu Bedürfnissen aus Patientensicht und fördert somit eine individuumszentrierte psychosoziale Versorgung. In the present cross-sectional study, a newly designed needs questionnaire for 8- to 13-year-old cancer patients was psychometrically tested (N=117). Based on an exploratory factor analysis, 4 scales with a total of 19 items were formed. The internal consistency of the questionnaire is satisfactory. Participants expressed a strong need for social participation, safety and experience of control, and normality. The KiWuF-PädOnk provides information on needs from the patient's perspective and thus promotes individual-centered psychosocial care.

Thinking ahead: Parents' worries about late effects of childhood cancer treatment

BACKGROUND

Many childhood cancersurvivors experience at least one late effect of treatment, and both late effects and persistent cancer-related worry can negatively impact quality of life in survivorship. Little is known about the prevalence or impact of parental worry about late effects early in treatment. This study evaluated parental perceived likelihood, impact, and worry about late effects of childhood cancer.

PROCEDURE

We surveyed 96 parents of pediatric cancer patients at Dana-Farber/Boston Children's Cancer and Blood Disorders Center within a year of diagnosis. Parents were asked about their experiences with late effects communication, general worry about late effects, and specific late effect worries.

RESULTS

Most (96%) parents valued information about late effects, and 93% considered late effects in their treatment decision-making. Yet, 24% could not recall receiving any information about late effects, and only 51% felt well prepared for potential late effects. Though only 20% of parents considered their child at high risk of experiencing late effects, 61% were extremely/very worried about late effects. Those who felt their child was at high risk of experiencing late effects were more likely to worry (OR = 4.7, P = 0.02).

CONCLUSIONS

Many parents feel inadequately informed about late effects of cancer treatment, and only one-fifth of parents consider late effects to be likely for their child. However, a majority of parents worry about late effects, including ones they think their child is unlikely to experience. Although some worry is anticipated, disproportionate worry may be mitigated by addressing both educational shortfalls and emotional concerns.

Relationship of race and ethnicity on access, timing, and disparities in pediatric palliative care for children with cancer

PURPOSE

Pediatric palliative care (PPC) improves quality of life for children and adolescents with cancer. Little is known about disparities between different racial and ethnic groups in the frequency and timing of PPC referrals. We evaluated the impact of race and ethnicity on the frequency and timing of PPC referral after initiation of an embedded PPO clinic where no formal consultation triggers exist.

METHODS

Patients with cancer between 0 and 25 years at diagnosis who experienced a high-risk event between July 2015 and June 2018 were eligible. Demographic, disease, and PPC information were obtained. Descriptive statistics and logistic regression were used to assess likelihood of receiving PPC services by race/ethnicity.

RESULTS

Of 426 patients who experienced a high-risk event, 48% were non-Hispanic White, 31% were non-Hispanic Black, 15% were Hispanic of any race, and 4% were non-Hispanic Asian. No significant differences were found between race/ethnicity and age at diagnosis/death, sex, and diagnosis. PPC consultation (p = 0.03) differed by race. Non-Hispanic Black patients were 1.7 times more likely than non-Hispanic White patients to receive PPC after adjustment (p = 0.01). White patients spent less days in the hospital in the last 90 days of life (3.0 days) compared with Black (8.0), Asian (12.5), or Hispanic patients (14.0, p = 0.009) CONCLUSION: Disparities exist in patients receiving pediatric oncology and PPC services. Cultural tendencies as well as unconscious and cultural biases may affect PPC referral by race and ethnicity. Better understanding of cultural tendencies and biases may improve end-of-life outcomes for children and young adults with cancer.

Transition from Acute Treatment to Survivorship: Exploring the Psychosocial Adjustments of Chinese Parents of Children with Cancer or Hematological Disorders

Objectives: Parents of children diagnosed with critical illnesses face multiple challenges during their caregiving experience. However, relevant studies have been limited in the Chinese context. Guided by the stress and coping model, we conducted a qualitative study to identify the stressors, coping strategies, and adjustment experiences of Hong Kong parents of children with cancer or hematological disorders. Methods: We recruited 15 parents of children with cancer or hematological disorders requiring bone marrow transplantation and were currently >2 years post-treatment. They participated in a 30-min semi-structured interview. Thematic analysis was performed using the grounded theory approach. Results: The stressors reported by parents included a high caregiving burden during their children’s diagnosis and treatment stages. The fear of recurrence, the need for information, and concerns about late effects were also common among the parents during their children’s transition/survivorship stage. To cope with these stressors, the parents commonly used problem-focused (e.g., seeking help from professionals and support groups) and emotion-focused (e.g., behavioral distractions, venting, and crying) strategies. Despite these stressors, parents reported positive changes through the caregiving experience, such as improved family relationships, developing health-protective habits, and the reprioritization of different aspects of life. Conclusions: Parents encounter different stressors during the cancer care continuum. Using different coping strategies, parents experience positive changes amidst caregiving. Future studies should explore culturally relevant adaptive coping strategies to enhance parents’ psychosocial adjustment.

Families' experiences of child and adolescent brain tumor: A systematic review and synthesis of qualitative research

OBJECTIVES

Brain tumors are the most common and fatal of all solid tumors for children and adolescents; those who survive live with long-term physical and emotional consequences, as do their families. We aimed to synthesize relevant qualitative evidence on families' experiences and psychosocial service needs across the lifespan to identify gaps in care delivery and research.

METHODS

Searches were conducted in Medline, CINAHL, PsycInfo, Embase, and Web of Science. Identified papers were assessed with the Joanna Briggs Institute Critical Appraisal Tool. Data were extracted into NVivo12 and analyzed by qualitative description and, where appropriate, thematic analysis.

RESULTS

The search yielded 628 papers, of which 40 (33 studies) were eligible (6%). Although the methodological quality of the papers was low, we identified concerns that were consistently reported over time and from different perspectives. Individual family members had varying psychosocial needs to be addressed within healthcare, schooling, and public policy. These include for survivor's mental health (particularly for body image), and to the disproportionate biopsychosocial burden faced by mother-caregivers.

CONCLUSIONS

Addressing the biological aspects of brain tumor cannot be our only focus. We have an obligation to provide services that meet the needs of families across diagnosis, treatment, survivorship, palliative care, and bereavement.

Inception of a pediatric cancer caregiver support group guided by parental needs

BACKGROUND

Survivorship in childhood cancers has steadily improved and increased the need for caregivers to provide a longer duration of care both in the hospital and at home. Involving parents and caregivers to voice their unmet needs could significantly impact and direct the institution of support groups.

AIMS

To ascertain the need for a pediatric caregiver support group based on a survey that explored the unmet needs of caregivers of children with cancer.

METHODS

Caregivers of pediatric patients (n = 17) undergoing treatment at the hospital were requested to complete our Pediatric Caregiver Psycho-social Needs Survey. The survey encompassed questions on different aspects of caregiving and the caveats felt by the caregivers. The needs were categorized into seven main domains (physical, emotional, family-related issues, spiritual, social, logistics, and information) that focused on understanding the importance and the perceived level of professional support that was expected. The data was analyzed using SPSS.

RESULTS

The most often reported needs were (i) emotional concerns with the majority reporting fear (58.8%), (ii) logistics-related needs for play/art-based activities (58.8%), (iii) informational needs focusing on understanding diagnosis/prognosis (47.1%), side-effects of treatment and physical changes (41.2%). Family-related needs escalated when caregivers (23.5%) looked after other ill family members at home. Caregivers (23.5%) also reported Spiritual concerns suggesting the need for religious/spiritual support in the hospital. Majority of caregivers (82.4%) expressed interest to be part of a pediatric caregiver support group. However, professional support sought for was much lesser compared to the percentage of needs/concerns expressed.

CONCLUSION

Our study highlighted the unmet needs of caregivers which included emotional, logistics-related needs, and concerns about information. Hence, the goal is to provide a unified platform through a support group that holistically can address needs and empower caregivers.

Online information related to childhood cancer and COVID-19 pandemic: a thematic analysis

OBJECTIVE

To analyze online information available on the internet about COVID-19 and childhood cancer and discuss its reach potential with regard to supporting family functioning.

METHOD

Documentary research supported by thematic analysis and the concept of family functioning and support. A total of 27 publications available on the websites of reference institutions in pediatric oncology, from March 1 to May 31, 2020, were analyzed.

RESULTS

Two themes guided the presentation of results with emphasis on language and sustainability assumptions to content, and to conveyed meanings and intentionality. The publications prospect families/people with basic knowledge about COVID-19 and have little information specific to the relationship with childhood cancer.

FINAL CONSIDERATIONS

Threatening circumstances require informational support. This study revealed incipient of specificity and a prescriptive tone in the online information available in early times of the pandemic, questioning the scope of support for family functioning.

Feasibility, Acceptability, and Education of Pediatric Oncology Providers Before and After an Embedded Pediatric Palliative Oncology Clinic

PURPOSE

Most pediatric palliative care (PPC) education is trainee-directed, didactic, or simulation-based and therefore limited in scope, realism, and audience. We explored whether an embedded pediatric palliative oncology (PPO) clinic is associated with improved pediatric oncology provider palliative care comfort, knowledge, and attitudes toward PPC and if the model is feasible for both clinical care and education of providers of all levels.

METHODS

Oncology providers (oncologists, advanced practice providers, and fellows) were enrolled in this study. Based on interaction with the PPO clinic, two cohorts were defined: PPO providers (n = 11, 37.9%) and non-PPO providers (n = 18, 62.1%). Providers in both groups responded to qualitative and quantitative questionnaires about the feasibility and acceptability of PPO clinic, their attitudes toward PPC, and knowledge and comfort in PPC concepts at baseline and 1 year. Descriptive statistics were performed; demographic and outcome variables across cohorts by PPO grouping and experience were compared.

RESULTS

All 29 pediatric oncology providers reported acceptability of a PPO clinic and favorable attitudes about PPC. The most feasible clinic model was oncology followed by PPO visits. Non-PPO group and less experienced (≤ 10 years) providers had greater improvement in knowledge and comfort with PPC skills than PPO group or more experienced providers. Providers lacked comfort in non-pain symptom management skills.

CONCLUSION

This embedded PPO clinic model was feasible, acceptable, and highly rated by responding oncology clinicians, but was insufficient as a sole method of educating multidisciplinary oncology providers. Methods of combining clinical and formal education are needed to impart sustained educational change.

Self-efficacy in symptom management for adolescents and young adults with cancer: a systematic review

BACKGROUND

Adolescents and young adults (AYAs) have more frequent and intense adverse effects from cancer therapy than other age groups. Self-efficacy, the ability for persons to maintain health-related behavior change, may assist with symptom management but the role it plays in AYAs with cancer has not been thoroughly investigated. This review explores the role that self-efficacy has in symptom management for AYAs with cancer and provides guidance for clinicians to utilize self-efficacy as a means to reduce side effects of therapy.

METHODS

A systematic review of peer-reviewed literature was conducted to identify works discussing self-efficacy and symptom management for AYAs with cancer. Five databases were searched with key terms and articles that discussed relationships between self-efficacy and cancer therapy symptoms were retained for analysis.

FINDINGS

Twelve manuscripts representing 1180 individuals age 12 to 43 years were identified. Self-efficacy was found to be related to (1) health management behaviors, (2) psychosocial health, (3) sexual and reproductive health, and (4) physical symptoms. Self-efficacy had direct correlations with physical activity, nutritional intake, symptom regulation, mental health, sexual health, and fertility preservation. The included studies did not find significant relationships with medication adherence or pain management.

DISCUSSION

Self-efficacy is an attribute that impacts behavior change, health maintenance, and overall wellness and can be changed over time and through interventions to improve symptoms of cancer therapy. Self-efficacy should be evaluated as a construct in relevant studies aimed at improving side effects of cancer therapy to better understand outcomes from interventions. Symptoms, toxicities, and adverse effects of cancer therapy may be improved by increasing self-efficacy of patients.

Feasibility and acceptability of the "Day 100 Talk": An interdisciplinary communication intervention during the first six months of childhood cancer treatment

BACKGROUND

Communication gaps arise early in the childhood cancer trajectory and may persist. The authors conducted a pilot study of the feasibility and acceptability of a communication intervention, the Day 100 Talk (D100). D100 involves an interprofessional family conference during initial months of treatment between oncologists, psychosocial clinicians, and parents, facilitated by a 3-part conversation tool.

METHODS

The authors enrolled English-speaking parents of children with nonrelapsed, nonprogressive cancer who were receiving continuity care from enrolled pediatric oncologists and psychosocial clinicians at a single site. The a priori feasibility threshold was 60% parent completion of the D100 intervention. Surveys from parents and professionals and debrief interviews with professionals assessed D100 acceptability.

RESULTS

Thirty-seven parents (77%) and 38 oncology professionals (67%) enrolled. Twenty of 33 evaluable parents (61%) participated in a D100 family conference. Most commonly, parents did not complete the D100 intervention because of scheduling difficulties related to clinical team constraints. All 17 parents who completed a post-D100 survey agreed or strongly agreed that D100 participation was helpful. In debrief interviews, professionals identified D100 benefits, namely, stepping back to the big picture and getting on the same page, and barriers related to logistical challenges and professionals' anticipatory dread.

CONCLUSIONS

The D100 intervention pilot demonstrates high acceptability among parents of children with cancer. Despite meeting the prespecified feasibility threshold, findings highlight important barriers to D100 dissemination, namely, perceived burdens on professionals. Potential strategies to reduce burden may include using virtual visit platforms, incorporating D100 elements across multiple visits, or prioritizing intervention delivery to parents with the greatest need for enhanced communication.

Barriers to Schooling in Survivorship: The Role of Neuropsychological Assessment

PURPOSE

Pediatric cancer survivorship rates continue to improve, although disease- and treatment-related neurocognitive impacts substantively affect survivors' educational access and availability for learning. Receiving formal educational supports substantially improves survivors' academic progress and graduation rates; however, parents of survivors report obtaining such support is stressful, in part due to limited knowledge on their part and that of their oncology providers.

METHODS

Parents (N = 195) of pediatric survivors across the United States were surveyed to explore specific barriers to obtaining appropriate educational supports and the facilitating role of the oncologist.

RESULTS

Parent-reported barriers included limited access to formal educational supports, under-referral to neuropsychology services, and need for more information about available supports and how best to advocate for these, when needed. Not only were few survivors (35.4%) referred for neuropsychological evaluation, standard of care for many pediatric survivors, but survivors were more than five times more likely to be retained in grade compared with the national retention rate. When obtained, parents reported that the neuropsychological consultation and associated report were helpful in increasing their own understanding and addressing barriers to obtaining adequate supports for their children.

CONCLUSION

Given the important role of neuropsychological evaluation for survivors and their families, bringing referral rates more in line with national guidelines represents a critical target for oncologists. With adequate training in relevant issues, the oncologist is positioned to be a key support to survivors and their families in ensuring access to neuropsychological services and reducing barriers to an appropriate education.

Assessment of caregiver expectations of physician communication in a pediatric setting

BACKGROUND

In pediatrics, communication often occurs through an intermediary such as a caregiver. The goal of this study is to assess caregiver communication expectations and determine if meeting expectations influences caregiver satisfaction or instruction retention.

METHODS

A survey study was performed at the Children's Hospital of Philadelphia. Before the visit, caregivers completed a survey on communication expectations, Caregiver Expected Kalamazoo Essential Elements Communication Checklist (Caregiver Expected KEECC). After the visit, caregivers were surveyed on their perception of physician communication (Caregiver Perceived KEECC) and satisfaction. Caregivers were contacted 1 week after the clinic visit to assess instruction retention. Meeting of caregiver expectation was calculated by the difference between Caregiver Expected and Caregiver Perceived KEECC scores.

RESULTS

112 caregivers participated in the study. There was no significant difference in Caregiver Expected KEECC versus Caregiver Perceived KEECC score (4.39 vs 4.56). Caregiver communication expectations were exceeded in 51.5% of the visits. Communication expectations were exceeded more among caregivers with at a college education (p <  0.01) and more among White caregivers (p <  0.01). The average caregiver satisfaction score with the clinic visit was 4.67. Higher satisfaction scores were observed in caregivers who had their communication expectations met or exceeded (p <  0.01). Caregivers with communication expectations exceeded had higher percentage recall of physician instructions (p <  0.01).

CONCLUSIONS

Caregiver communication expectations may be influenced by demographic factors. Communication expectation affects visit outcomes including caregiver satisfaction and instruction retention. Therefore, physicians need to be cognizant of caregiver communication expectations, which can impact quality of the healthcare experience.

Communication interventions in adult and pediatric oncology: A scoping review and analysis of behavioral targets

Background

Improving communication requires that clinicians and patients change their behaviors. Interventions might be more successful if they incorporate principles from behavioral change theories. We aimed to determine which behavioral domains are targeted by communication interventions in oncology.

Methods

Systematic search of literature indexed in Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov (2000–October 2018) for intervention studies targeting communication behaviors of clinicians and/or patients in oncology. Two authors extracted the following information: population, number of participants, country, number of sites, intervention target, type and context, study design. All included studies were coded based on which behavioral domains were targeted, as defined by Theoretical Domains Framework.

Findings

Eighty-eight studies met inclusion criteria. Interventions varied widely in which behavioral domains were engaged. Knowledge and skills were engaged most frequently (85%, 75/88 and 73%, 64/88, respectively). Fewer than 5% of studies engaged social influences (3%, 3/88) or environmental context/resources (5%, 4/88). No studies engaged reinforcement. Overall, 7/12 behavioral domains were engaged by fewer than 30% of included studies. We identified methodological concerns in many studies. These 88 studies reported 188 different outcome measures, of which 156 measures were reported by individual studies.

Conclusions

Most communication interventions target few behavioral domains. Increased engagement of behavioral domains in future studies could support communication needs in feasible, specific, and sustainable ways. This study is limited by only including interventions that directly facilitated communication interactions, which excluded stand-alone educational interventions and decision-aids. Also, we applied stringent coding criteria to allow for reproducible, consistent coding, potentially leading to underrepresentation of behavioral domains.