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Graetz DE, Ahmad A, Raza MR, Hameed A, Naheed A, Najmi A, Quanita AT, Munir S, Ahmad S, Ferrara G, Staples C, Rodriguez Galindo C, Ahmer Hamid S, Jeha S, Mack JW. Functions of patient- and family-centered pediatric cancer communication in Pakistan. Front Oncol 2024; 14:1393908. [PMID: 39323999 PMCID: PMC11422343 DOI: 10.3389/fonc.2024.1393908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 08/08/2024] [Indexed: 09/27/2024] Open
Abstract
Background Communication is an essential aspect of high-quality patient- and family-centered care. A model for pediatric cancer communication developed in the United States defined eight communication functions. The purpose of this study was to explore the relevance of these functions in Pakistan as part of an effort to understand the role of culture in communication. Materials and methods Semi-structured interviews were conducted with 20 clinicians and 18 caregivers of children with cancer at two major cancer centers. Interviews were conducted in Urdu or English and transcribed and translated as necessary. Two independent coders used a priori codes related to the communication model as well as novel codes derived inductively. Thematic analysis focused on operationalization of the functional communication model. Results Clinicians and caregivers in Pakistan discussed the importance of all eight communication functions previously identified including: information exchange, decision-making, managing uncertainty, enabling family self-management, responding to emotions, supporting hope, providing validation, and building relationships. The operationalization of these functions was influenced by Pakistani cultural context. For example, information-exchange included the importance of addressing preconceptions and community myths, while managing uncertainty included strong references to religion and faith-based coping. Essential to all eight functions was trust between the family and the medical team. Discussion These findings support the use of this functional communication model in diverse pediatric oncology settings and emphasize the importance of trust. Culturally sensitive operationalization of these functions could inform the adaptation of tools to measure communication and interventions aimed at supporting the needs of parents of children with cancer.
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Affiliation(s)
- Dylan E. Graetz
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Alia Ahmad
- University of Child Health Sciences, Children’s Hospital Lahore, Lahore, Pakistan
| | - Muhammad Rafie Raza
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Ambreen Hameed
- University of Child Health Sciences, Children’s Hospital Lahore, Lahore, Pakistan
| | - Asma Naheed
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Atoofa Najmi
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Afia tul Quanita
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Shabnam Munir
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Safwan Ahmad
- University of Child Health Sciences, Children’s Hospital Lahore, Lahore, Pakistan
| | - Gia Ferrara
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Courtney Staples
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Carlos Rodriguez Galindo
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Syed Ahmer Hamid
- Department of Oncology, Indus Hospital and Health Network, Karachi, Pakistan
| | - Sima Jeha
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jennifer W. Mack
- Department of Oncology, Dana Farber Cancer Institute/Boston Children’s Hospital, Boston, MA, United States
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Buro AW, Stern M. Infection risk among long-term pediatric cancer survivors: conceptual framework for health promotion and call for inquiry. Transl Pediatr 2023; 12:2103-2106. [PMID: 38197099 PMCID: PMC10772843 DOI: 10.21037/tp-23-411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/15/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Acadia W. Buro
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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Marino LV, Collaḉo N, Coyne S, Leppan M, Ridgeway S, Bharucha T, Cochrane C, Fandinga C, Palframan K, Rees L, Osman A, Johnson MJ, Hurley-Wallace A, Darlington ASE. The Development of a Communication Tool to Aid Parent-Centered Communication between Parents and Healthcare Professionals: A Quality Improvement Project. Healthcare (Basel) 2023; 11:2706. [PMID: 37893780 PMCID: PMC10606263 DOI: 10.3390/healthcare11202706] [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] [Received: 09/20/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Good communication is central to good healthcare. As a result of poor communication between parents and healthcare professionals (HCPs) in clinical settings, this study aimed to address this problem by developing a communication tool to empower parents and act as a prompt for HCPs to talk about the child's care and gather information at the point of admission to hospital about what is important to families, therefore supporting patient-centered communication. A design thinking process was used to develop a physical copy of Chloe's card and evaluate its use. Design thinking is a problem-solving approach, which uses an empathetic lens to integrate viewpoints of different stakeholders throughout the process of creating solutions. Design thinking involves five processes: (1) empathise-including a literature review and data synthesis, (2) define-by completing semi-structured interviews with parents about their experience of communication and HCPs perceptions of parent's experience of communication, (3) ideate-iterate the design of Chloe's card with parents and HCPs, (4) prototype-develop the design of Chloe's card, and (5) test-pilot test in clinical practice. Results from this initial study suggest that a small hand-held card, with emoticons and a place to write concerns, was acceptable to parents and feasible to use in clinical practice. Parents do not always feel heard by HCPs and a tool such as Chloe's card may help facilitate sharing of information about matters important to them and their child. However, some HCPs felt the need for a communication tool undermined their clinical skills. Feedback from HCP participants suggests that the idea of Chloe's card was acceptable and perceived as potentially being useful in clinical practice. Further work is required, as part of a larger study, to further refine this communication tool, identify those parents who would benefit most from Chloe's card, as well as to further refine the HCP process prior to implementing it into clinical settings. It was noted future iterations would benefit from a digital version linked with a child's electronic record, as well as multi-language versions and information for parents.
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Affiliation(s)
- Luise V Marino
- Paediatric Intensive Care, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Nicole Collaḉo
- School of Health Sciences, Southampton University, Southampton SO17 1BJ, UK
| | | | | | | | - Tara Bharucha
- Paediatric Cardiology, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Colette Cochrane
- Paediatric Cardiology, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Catarina Fandinga
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Karla Palframan
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Leanne Rees
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Ahmed Osman
- Paediatric Intensive Care, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Mark J Johnson
- Neonatal Medicine, Princess Anne Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
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Afungchwi GM, Kiteni E, Ndagire M, Maliti B, Kunkel R, Challinor JM, Hollis R. Current status and priorities of paediatric oncology nursing in Africa: a synthesis of perspectives from SIOP Africa nurses. Ecancermedicalscience 2023; 17:1585. [PMID: 37799941 PMCID: PMC10550298 DOI: 10.3332/ecancer.2023.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction As African countries adopt the global goal of improving childhood cancer survival to 60% by 2030, intentional actions are required to improve nursing. This report aims to describe the current status of paediatric oncology nursing in Africa. Methods We report on nursing-related aspects of a survey to map paediatric oncology services in Africa (2018-2019), document perceived nursing strengths and weaknesses (2017) and share nurses' research priorities (2019). Additionally, we report on a survey to identify topics for a foundation course (2019) and the expressed perspective of African nurses about the status of paediatric oncology nursing across the continent (2022). Results Only 21% of respondents in the African mapping survey reported having nurses who care for children with cancer at least 75% of the time. Many centres do not have allied health workers like dieticians and play therapists, thus contributing to the nursing burden of care. The main strength of African paediatric oncology nurses was the humanisation of care, while the major weakness was the lack of training follow-up. The top research priorities focused on professional practice and psychosocial support. The Delphi survey identified 57 topic areas grouped into a 12-module curriculum for nurses new to paediatric oncology. The nurses affirmed their dedication to providing compassionate care, however, noted their vulnerability to harm and called for better specialisation, recognition and remuneration. Conclusion This paper amplifies the voice of African paediatric oncology nurses. It illuminates the room for improvement and provides a reference point for future comparison.
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Affiliation(s)
| | | | | | | | - Rachael Kunkel
- Arkansas Children's Hospital, Little Rock, AR 72202, USA
| | - Julia M Challinor
- University of California San Francisco, 2 Koret Way, San Francisco, CA 94143, USA
| | - Rachel Hollis
- Leeds Children's Hospital, Clarendon Wing, LS1 3EX Leeds, UK
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Williams AH, Rivas S, Fuentes L, Cáceres‐Serrano A, Ferrara G, Reeves T, Antillon‐Klussmann F, Rodriguez‐Galindo C, Mack JW, Graetz DE. Understanding hope at diagnosis: A study among Guatemalan parents of children with cancer. Cancer Med 2023; 12:9966-9975. [PMID: 36846975 PMCID: PMC10166945 DOI: 10.1002/cam4.5725] [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: 09/27/2022] [Revised: 01/05/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND In high-income countries, hope facilitates parental coping and builds the clinical relationship between families of children with cancer and their clinicians. However, the manifestation of hope in low- and middle-income countries (LMICs) remains poorly understood. Our study explores Guatemalan parents' experiences with hope during the pediatric oncology diagnostic process and aims to identify discrete actions clinicians take to support hope. METHODS This qualitative study utilized audio-recordings of the diagnostic process and an additional semi-structured interview for 20 families of children with cancer at Unidad Nacional de Oncología Pediátrica in Guatemala. Spanish audio-recordings were translated into English, transcribed, and coded using a priori and novel codes. Thematic content analysis using constant comparative methods explored parents' hopes and concerns. RESULTS At diagnosis, Guatemalan parents expressed both hopes and concerns related to the entire cancer continuum. Throughout the diagnostic process, hope grew as concerns were alleviated. Clinicians supported hope by creating a supportive environment, providing information, affirming religious beliefs, and empowering parents. These strategies helped parents shift their focus from fear and uncertainty toward hope for their child's future. Parents expressed that establishing hope improved mood, promoted acceptance, and enabled them to care for themselves and their children. CONCLUSION These results confirm the relevance of supporting hope in pediatric oncology settings in LMICs and suggest that culture informs hope-related needs. Supporting hope is critical across cultures and can be integrated into clinical conversation using the four processes identified by our results.
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Affiliation(s)
| | - Silvia Rivas
- Unidad Nacional de Oncología PediátricaGuatemala CityGuatemala
| | - Lucia Fuentes
- Unidad Nacional de Oncología PediátricaGuatemala CityGuatemala
| | | | - Gia Ferrara
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Tegan Reeves
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Federico Antillon‐Klussmann
- Unidad Nacional de Oncología PediátricaGuatemala CityGuatemala
- Francisco Marroquin University School of MedicineGuatemala CityGuatemala
| | | | - Jennifer W. Mack
- Dana Farber Cancer Institute/Boston Children's HospitalBostonMassachusettsUSA
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Rapa E, Hanna JR, Pollard T, Santos-Paulo S, Gogay Y, Ambler J, Namukwaya E, Kavuma D, Nabirye E, Kemigisha RM, Namyeso J, Brand T, Walker L, Neethling BG, Downing J, Ziebland S, Stein A, Dalton LJ. Exploring the experiences of healthcare professionals in South Africa and Uganda around communicating with children about life-threatening conditions: a workshop-based qualitative study to inform the adaptation of communication frameworks for use in these settings. BMJ Open 2023; 13:e064741. [PMID: 36707115 PMCID: PMC9884929 DOI: 10.1136/bmjopen-2022-064741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES This study aimed to explore how published communication frameworks could be amended to ensure applicability and cultural appropriateness for professionals to support family-centred conversations by investigating' healthcare professionals' (1) experiences of providing support to families when a caregiver or a dependent child (<18 years old) has a life-threatening condition, (2) perceived challenges for caregivers and healthcare professionals in communicating with children about illness, (3) perceptions of how clinicians could be equipped to facilitate conversations between caregivers and children about an adult or the child's own life-threatening condition and (4) suggestions for amendments to previously published guidelines to ensure cultural relevance in South Africa and Uganda. DESIGN A qualitative study involving two 2-day workshops with embedded focus group discussions, break out rooms and consensus discussions. SETTING Health and social care and third sector organisations in South Africa and Uganda. PARTICIPANTS Thirty-two professionals providing care to families affected by life-threatening conditions in South Africa or Uganda who were aged 18 years or older and able to converse in English. RESULTS Participants identified obstacles to having conversations with caregivers about children and to telling children about serious illness during consultations. These included patients' beliefs about illness, medicine and death, language barriers between families and the healthcare team, and emotional and practical challenges for professionals in having these conversations. Culturally appropriate adaptations were made to previously published communication frameworks for professionals to support family-centred conversations. CONCLUSIONS Culturally sensitive communication frameworks could help healthcare professionals to talk with families about what children need to know when they or a caregiver have a serious illness. More broadly, effective communication could be facilitated by promoting healthcare professionals' and communities' understanding of the benefits of telling children about illness within the family. Together these strategies may mitigate the psychological impact of global disease on children and their families.
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Affiliation(s)
- Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
| | - Jeffrey R Hanna
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Teresa Pollard
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children, London, UK
| | | | - Yasmin Gogay
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Julia Ambler
- Department of Paediatrics, Nelson Mandela Medical School, Durban, South Africa
- Umduduzi - Hospice Care for Children, Durban, South Africa
| | | | - David Kavuma
- Department of Health Sciences, Mildmay Uganda Institute of Health Sciences, Kampala, Uganda
| | | | | | | | - Tracey Brand
- Umduduzi - Hospice Care for Children, Durban, South Africa
| | | | - Beverley G Neethling
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Julia Downing
- Department of Medicine, Makerere University, Kampala, Uganda
- International Palliative Care Network, Durban, South Africa
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alan Stein
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise J Dalton
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
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PENS approach for breaking bad news in the oncology outpatient setting: a real-world report. Support Care Cancer 2023; 31:13. [PMID: 36513796 PMCID: PMC9747823 DOI: 10.1007/s00520-022-07458-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. METHODS This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. RESULTS Fifty patients (mean age 53.7 years, range 28-76) were included in the study. The average duration of BBN was 6.1 (range 2-11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. CONCLUSIONS The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2021/07/034707).
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