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Tafazoli A, Cronin-Wood K. Pediatric Oncology Hospice: A Comprehensive Review. Am J Hosp Palliat Care 2024; 41:1467-1481. [PMID: 38225192 PMCID: PMC11425979 DOI: 10.1177/10499091241227609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Pediatric hospice is a new terminology in current medical literature. Implementation of pediatric hospice care in oncology setting is a vast but subspecialized field of research and practice. However, it is accompanied by substantial uncertainties, shortages and unexplored sections. The lack of globally established definitions, principles, and guidelines in this field has adversely impacted the quality of end-of-life experiences for children with hospice needs worldwide. To address this gap, we conducted a comprehensive review of scientific literature, extracting and compiling the available but sparse data on pediatric oncology hospice from the PubMed database. Our systematic approach led to development of a well-organized structure introducing the foundational elements, highlighting complications, and uncovering hidden gaps in this critical area. This structured framework comprises nine major categories including general ideology, population specifications, role of parents and family, psychosocial issues, financial complications, service locations, involved specialties, regulations, and quality improvement. This platform can serve as a valuable resource in establishing a scientifically reliable foundation for future experiments and practices in pediatric oncology hospice.
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Affiliation(s)
- Ali Tafazoli
- Healthcare administration program, St Lawrence College, Kingston Campus, ON, Canada
- Hospice Kingston, Queen’s University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
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Kingsley J, Taylor M, Bogetz JF, Trowbridge A, Rosenberg AR, Barton KS. Grief Trajectories of Bereaved Parents of Adolescents and Young Adults With Advanced Cancer: A Qualitative Analysis Using Phenomenology. OMEGA-JOURNAL OF DEATH AND DYING 2024; 90:275-301. [PMID: 35575201 DOI: 10.1177/00302228221101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Different parents grieve differently. However, research directed at understanding the important contextual or individual factors that influence the path each bereaved parent takes is lacking. In this qualitative analysis we seek to understand the array of bereaved parent experiences more completely. By deeply diving into one parent dyad using interpretive phenomenology analysis and situating that story within the conventional content analysis of 13 other bereaved parents of adolescents and young adults (AYAs) who died from advanced cancer, we illustrate the roles of religion/spirituality, maintaining a connection, and fulfilling parental roles as elements of grief processing. Clinicians and investigators should consider similar individualized approaches to understanding and supporting the grief experiences of bereaved parents before and after the death of a child.
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Affiliation(s)
- Jenny Kingsley
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, CA, USA
| | - Mallory Taylor
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jori F Bogetz
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amy Trowbridge
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Abby R Rosenberg
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
| | - Krysta S Barton
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA
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Garcia-Quintero X, Pedraza EC, Cuervo-Suarez MI, Correa I, Baker JN, McNeil MJ. Implementation of a hospital-based end-of-life and bereavement care program in a latin American middle-income country. A source of light and compassion in the midst of cloudy times. BMC Palliat Care 2024; 23:190. [PMID: 39075481 PMCID: PMC11285602 DOI: 10.1186/s12904-024-01522-3] [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: 02/04/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The death of a child is one of the most devastating events a family can face, resulting in significant physical and psychosocial morbidity. Bereavement support programs have been developed in high-income contexts to address this need. However, little is known about implementing bereavement programs in low-and middle-income countries (LMICs). Here, we describe the implementation of a bereavement program for parents whose children died due to cancer or other catastrophic illnesses. METHODS We conducted a retrospective analysis to describe the implementation of a hospital-based End of Life (EoL) care and bereavement program. This program was developed in several stages, including an assessment of bereaved families, development program guidelines, staff training, piloting of the program, refinement, and standardization. The program was developed between 2019 and 2021 in a nonprofit, teaching hospital and referral center for southwestern Colombia. RESULTS Several tools were developed as key components of the bereavement program: a virtual bereavement course; guidance for EoL and bereavement communication and care, memory making, and follow-up calls; a condolence letter template, and group support workshops. A total of 956 healthcare professionals were trained, 258 follow-up calls to bereaved parents were made, 150 individual psychological follow-ups to parents with complicated grief occurred, 79 condolence letters were sent, and 10 support group workshops were carried out. Challenges were identified and overcome, such as limited resources and staff, and cultural perceptions of death. In 2021, this program received an award by the hospital as the Best Strategy to Humanize Healthcare. CONCLUSIONS This study highlights the feasibility of developing and implementing EoL and bereavement care programs for parents and families within hospitals in LMICs. Lack of resources, staff, and training are some of the identified challenges to implementation. Utilizing methodological tools allows us to identify facilitator factors and deliverable outcomes of our EoL and bereavement program. This model provides a valuable framework for resource-limited settings.
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Affiliation(s)
- Ximena Garcia-Quintero
- Department of Global Medicine, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, 38105, USA.
| | - Eddy Carolina Pedraza
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Lucerne, 6005, Switzerland
| | - María Isabel Cuervo-Suarez
- Pediatric Palliative Care, Maternal and Child Department, Fundación Valle de Lili, Avenida Simon Bolivar, Cra. 98 # 18-49, Cali, 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, 760032, Colombia
| | - Isabel Correa
- Pediatric Palliative Care, Maternal and Child Department, Fundación Valle de Lili, Avenida Simon Bolivar, Cra. 98 # 18-49, Cali, 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, 760032, Colombia
| | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care, Stanford Medicine Children's Health, Palo Alto, CA, 94304, USA
| | - Michael J McNeil
- Department of Global Medicine, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, 38105, USA
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, USA
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Johnston SE, McAllister S, Norden C, Keens K, Jones K, Smith G, Duncombe R, Barnett L, Krepska A. Child bereavement-what matters to the families. Part 2: The long term. Arch Dis Child Educ Pract Ed 2024; 109:169-173. [PMID: 38071536 DOI: 10.1136/archdischild-2023-326387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/09/2023] [Indexed: 12/22/2023]
Abstract
The death of a child is a devastating event. Families experience profound grief and loss immediately following the death, and this remains and evolves as time progresses. In this, the second in a series, we discuss the importance of longer term bereavement care and how continuing contact with healthcare can be navigated. As bereaved parents who are also doctors, we again share our experiences. The complex nature of parenting, supporting siblings or managing a pregnancy after loss are explored, and we look at the involvement of bereaved parents in developing bereavement services.
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Affiliation(s)
| | - Suzanne McAllister
- Department of Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Catriona Norden
- Department of Obstetrics and Gynaecology, Craigavon Area Hospital, Portadown, UK
| | - Keta Keens
- General Practice, Holland House Surgery, Lytham St Annes, UK
| | - Katharine Jones
- General Practice, Clerklands Surgery, Woodlands & Clerklands Partnership, Horley, UK
| | - Gillian Smith
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, UK
| | - Rebecca Duncombe
- Department of Paediatrics, Buckinghamshire Hospitals NHS Trust, Stoke Mandeville Hospital, Aylesbury, UK
| | - Laura Barnett
- General Practice, Gladstone House Surgery, Ilkeston, UK
| | - Amy Krepska
- Department of Anaesthetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Pedraza EC, Vokinger AK, Cleves D, Michel G, Wrigley J, Baker JN, Garcia-Quintero X, McNeil MJ. Grief and Bereavement Support for Parents in Low- or Middle-Income Countries: A Systematic Review. J Pain Symptom Manage 2024; 67:e453-e471. [PMID: 38244706 DOI: 10.1016/j.jpainsymman.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION The death of a child may be the most traumatic event a family can experience. Bereavement care for parents is essential for their physical and mental well-being and is a psychosocial standard of care. Childhood mortality is higher in low- or middle-income countries (LMICs); however, little is known regarding bereavement support or interventions for parents in LMICs. AIM To identify programs, services, initiatives, or interventions offered to bereaved parents in LMICs in hospital settings. METHODS A systematic search was executed following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles from LMICs describing interventions, programs, or resources provided to parents after the death of a child (0-18 years old) from any cause were included. Extracted data was categorized by demographics, study design, outcomes, and quality assessment using the McGill Mixed Methods Appraisal Tool (MMAT). RESULTS We retrieved 4428 papers and screened their titles and abstracts, 36 articles were selected for full-text assessment, resulting in nine articles included in the final analysis. Most interventions described support for parents whose child died during the prenatal or neonatal period. The primary interventions included psychological counseling, creating mementos (such as photographs or footprints), and bereavement workshops. Only one paper described a fully established bereavement program for parents. Eight of the papers met high-quality criteria. DISCUSSION Although bereavement care is crucial for parents whose child has died, only a few studies have documented bereavement interventions in LMICs. More research may help with bereavement program implementation and improved care for bereaved parents in LMICs.
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Affiliation(s)
- Eddy Carolina Pedraza
- Faculty of Health Sciences and Medicine (P.E.C., V.A.K., M.G.), University of Lucerne, Lucerne, Switzerland.
| | - Anna Katharina Vokinger
- Faculty of Health Sciences and Medicine (P.E.C., V.A.K., M.G.), University of Lucerne, Lucerne, Switzerland
| | - Daniela Cleves
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Gisela Michel
- Faculty of Health Sciences and Medicine (P.E.C., V.A.K., M.G.), University of Lucerne, Lucerne, Switzerland
| | - Jordan Wrigley
- Biomedical Library (W.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Division of Quality of Life and Pediatric Palliative Care (B.J.N.), Stanford Medicine Children's Health, Palo Alto, California, USA
| | - Ximena Garcia-Quintero
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Michael J McNeil
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Morris SE, Ryan AK, Malinowski P, Pozo-Kaderman C, Fasciano KM. The Development of a Bereavement Support Group Curriculum for Bereaved Parents of Young Adult Children: Bridging the Gap. J Adolesc Young Adult Oncol 2024; 13:281-287. [PMID: 37870751 DOI: 10.1089/jayao.2023.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Purpose: There is limited research addressing the bereavement needs of parents whose young adult (YA) children have died from cancer. Research within oncology about the impact of child loss has tended to focus on parents of pediatric aged children. We adapted a general bereavement support group curriculum used with adults to address the unique needs of bereaved parents of YAs. Methods: Using a quality improvement framework, 25 bereaved parents of YA children participated in one of three 6-session bereavement support group programs during 2020 and 2021. Due to the coronavirus disease 2019 (COVID-19) pandemic, the programs were offered virtually. The participants provided feedback and completed an evaluation. Results: Nineteen mothers and six fathers participated with 20 (80%) completing the evaluation. The median time since the death of their child was 6 months. The participants evaluated the program highly, reporting that they felt less isolated (4.25/5 on a 5-point Likert scale); that their concerns were similar to others (4.45/5); and the discussion topics were relevant (4.20/5). Other topics that were identified included the impact on the family of losing a YA child, and how other relationships change. Forty-five percent of participants expressed a preference for a hybrid delivery model, incorporating in-person and virtual sessions. The majority also wished to continue meeting monthly, given they had little contact with other bereaved parents of YAs. Conclusion: The general bereavement support group curriculum was readily adapted for use with bereaved parents of YA children who died from cancer. A hybrid delivery model was the preferred method for future groups.
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Affiliation(s)
- Sue E Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Annelise K Ryan
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Paige Malinowski
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Cristina Pozo-Kaderman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Karen M Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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Fisher RS, Dattilo TM, DeLone AM, Basile NL, Kenney AE, Hill KN, Chang HF, Gerhardt CA, Mullins LL. The study of psychosocial outcomes of parents bereaved by pediatric illness: a scoping review of methodology and sample composition. J Pediatr Psychol 2024; 49:207-223. [PMID: 38423530 DOI: 10.1093/jpepsy/jsae008] [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: 08/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Parents of children who died of a medical condition experience a range of psychosocial outcomes. The current scoping review aims to summarize the outcomes assessed, methodology, and sample characteristics of recent psychosocial research conducted with this population. METHODS Included studies were limited to peer-reviewed, psychosocial outcomes research published between August 2011 and August 2022, written in English, and including caregiver study participants of children who died of a medical condition. Data sources were scholarly journal articles from 9 electronic databases, including Scopus, Web of Science, Academic Search Primer, ProQuest Research Library, PubMed, Embase, PsycINFO, Psychology & Behavioral Sciences Collection, and Health Source: Nursing/Academic Edition. The Mixed Methods Appraisal Tool-2018 evaluated methodological quality. RESULTS The study sample included 106 studies, most of which were either qualitative (60%) or quantitative (29%). Mixed-methods studies (8%) and randomized clinical trials (2%) were also identified. Study quality was variable, but most studies met all quality criteria (73%). Studies primarily represented cancer populations (58%), White participants (71%), and mothers (66%). Risk-based psychosocial outcomes (e.g., grief) were more commonly assessed than resilience-based outcomes. CONCLUSIONS The current scoping review revealed that recent research assessing the psychosocial outcomes of bereaved parents is limited in the representation of diverse populations, primarily qualitative, of broadly strong methodological quality, and oriented to psychosocial risk. To enhance the state of the science and inform evidence-based psychosocial services, future research should consider varied methodologies to comprehensively assess processes of risk and resilience with demographically and medically diverse populations.
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Affiliation(s)
- Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Alexandra M DeLone
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Ansley E Kenney
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Kylie N Hill
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hui-Fen Chang
- William E. Brock Memorial Library, Oklahoma State University, Stillwater, OK, United States
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
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Denhup C. "Trying to Find North": Fathers Voice the Nature of Their Bereavement. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241238383. [PMID: 38445575 DOI: 10.1177/00302228241238383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Fathers' lived experience of bereavement is not well understood. This article presents findings from a Heidegerrian phenomenological study, which aimed to describe fathers' bereavement. Fathers' bereavement is a life-long journey along which a father navigates through devastating and traumatic loss with great strength; has profound grief that mirrors the profound love he has for his child; chooses to live life with intention and engages in meaningful activities that create purpose aimed at honoring his child, continuing his child's legacy, and using his own suffering for the good of others; is anchored by a continuing bond of love that fuels an ongoing relationship with his child; and needs a supportive community to sustain him as he travels down the healing road where it is possible to find faith, hope, and love while being forever transformed by loss. Findings amplify fathers' voice so nurses gain a deeper understanding of their experience.
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Affiliation(s)
- Christine Denhup
- The Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT, USA
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Rasouli O, Vegsund HK, Eilegård Wallin A, Hjemdal O, Reinfjell T, Moksnes UK, Lund B, Eilertsen MEB. Bereaved parents' quality of life: resilience and professional support. BMJ Support Palliat Care 2024; 13:e1029-e1037. [PMID: 34732472 DOI: 10.1136/bmjspcare-2020-002840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 10/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The study aimed to compare the quality of life (QoL) among cancer-bereaved parents with a control group and explore how resilience and support from healthcare professionals associated with QoL of parents 2-8 years after the loss of a child to cancer. METHODS This nationwide, cross-sectional survey was administered among parents (n=161) who lost their child to cancer between 2009 and 2014, compared with a matched control parent group (n=77). A study-specific questionnaire, Resilience Scale for Adults (six factors: 'Perception of self', 'Planned future', 'Social competence', 'Structured style', 'Family cohesion' and 'Social resources'), and a single-item measure of parents' QoL were included for the study. RESULTS There was a lower QoL in both bereaved parents (mean=5.1) compared with the control parents (mean=5.8) (p<0.001). Two resilience factors, 'Perception of self' (OR=1.8, p=0.004) and 'Planned future' (OR=2.05, p<0.001), and given sufficient information during the child's last month (OR=2.63, p=0.003) were positively associated with long-term QoL in cancer-bereaved parents. CONCLUSION The findings indicate lower QoL among both fathers and mothers 2-8 years after losing a child to cancer. The study also highlights the positive role of resilience and the importance of informational support on long-term QoL in cancer-bereaved parents. Bereavement support should be tailored for supporting individual needs.
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Affiliation(s)
- Omid Rasouli
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hilde Kristin Vegsund
- Department of Anaesthesia and Intensive Care, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Odin Hjemdal
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trude Reinfjell
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Unni Karin Moksnes
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bendik Lund
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mary-Elizabeth Bradley Eilertsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Garcia D, Olsavsky AL, Hill KN, Patterson V, Baughcum AE, Long KA, Barrera M, Gilmer MJ, Fairclough DL, Akard TF, Compas BE, Vannatta K, Gerhardt CA. Associations between parental depression, communication, and self-worth of siblings bereaved by cancer. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2023; 37:1190-1199. [PMID: 37676170 PMCID: PMC10841243 DOI: 10.1037/fam0001137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
A child's death from cancer may increase the risk for poor self-worth in bereaved siblings. Furthermore, bereaved parents may experience depressive symptoms and communicate differently with their surviving children. However, limited research has examined family factors associated with self-worth in bereaved siblings. Thus, we examined: (a) differences in parental depressive symptoms, parent-child communication, and sibling self-worth between bereaved and nonbereaved families and (b) indirect effects of parental depressive symptoms and communication quality on the association between bereavement and sibling self-worth. Bereaved parents and siblings were recruited 3-12 months after a child's death from cancer. Bereaved (n = 72) and nonbereaved families of classmates (n = 58) completed home-based questionnaires upon enrollment (T1), and 48 bereaved and 45 nonbereaved families completed 1-year follow-up (T2). Relative to controls at T1 and T2, bereaved mothers, but not fathers, reported more depressive symptoms. Bereaved siblings reported poorer maternal and similar paternal communication, and similar levels of self-worth compared to controls. Both cross-sectional and longitudinal serial mediation models for mothers were significant. Bereaved mothers were at greater risk for depressive symptoms, which adversely affected sibling self-worth over time through disrupted mother-child communication. The father sample was limited, but the cross-sectional model was nonsignificant. Mothers and fathers may grieve differently and may require different therapeutic approaches. Family-centered interventions should target bereaved mothers' emotional adjustment and communication to enhance sibling self-worth. Additionally, clinicians should bolster other sources of support for bereaved siblings to promote adaptive outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Dana Garcia
- Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | - Anna L. Olsavsky
- Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | | | | | - Amy E. Baughcum
- Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | | | | | | | | | | | | | - Kathryn Vannatta
- Abigail Wexner Research Institute at Nationwide Children’s Hospital
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Goldman M, Napolitano S, Roberts KE, Lichtenthal WG. The HAM-D6 through the lens of grief: Clinical considerations for administering the six-item Hamilton Depression Rating Scale in the context of bereavement. Palliat Support Care 2023; 21:1-6. [PMID: 37877263 PMCID: PMC11110716 DOI: 10.1017/s1478951523001487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVES Diagnosing mental health challenges in bereavement is controversial; however, regardless of one's position on this matter, assessments of bereaved individuals continue to occur in clinical and research contexts. It is critical for evaluations to account for contextual factors that are unique to bereavement. This paper summarizes considerations for diagnosing depression in bereaved individuals, focusing on use of the six-item Hamilton Depression Rating Scale (HAM-D6). METHODS Following a literature review of the Hamilton Depression Rating Scale (HAM-D) and various versions, we summarized decision rules we used in scoring the HAM-D6 in a study of parents bereaved by cancer. We expanded on existing scoring guidelines for each of the HAM-D6 items, including depressed mood, work and activities, general somatic symptoms, guilt, psychic anxiety, and psychomotor retardation, and illustrated clinical distinctions and probes for assessors to consider through case examples from our research with bereaved parents. RESULTS Considerations for assessing depressive symptoms and behavior changes in the context of bereavement were summarized. Symptoms that may be diagnostic of depression in some populations may reflect other factors in the bereaved, such as a change in priorities, social expectations surrounding grief, or avoidance of grief activators. Nuanced factors are important for assessors to consider when administering the HAM-D6 to bereaved individuals. SIGNIFICANCE OF RESULTS Our sharing of these considerations is not intended to promote diagnosis of depression in bereavement but to highlight the unique contextual factors that distinguish symptoms of depression from common experiences of grievers when applying an assessment tool such as the HAM-D6. While validated measures can be constraining, they can have clinical utility; they may increase standardization in research, help clinicians communicate with each other, advance the field more generally to understand the varying struggles bereaved individuals experience, and systemically facilitate access to services via managed care.
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Affiliation(s)
- Maya Goldman
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Stephanie Napolitano
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Kailey E. Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
- Clinical Psychology, Yeshiva University Ferkauf Graduate School of Psychology
| | - Wendy G. Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
- Department of Public Health Sciences, University of Miami Miller School of Medicine
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Umaretiya PJ, Koch VB, Flamand Y, Aziz-Bose R, Ilcisin L, Valenzuela A, Cole PD, Gennarini LM, Kahn JM, Kelly KM, Tran TH, Michon B, Welch JJG, Wolfe J, Silverman LB, Bona K. Disparities in parental distress in a multicenter clinical trial for pediatric acute lymphoblastic leukemia. J Natl Cancer Inst 2023; 115:1179-1187. [PMID: 37261858 PMCID: PMC10560600 DOI: 10.1093/jnci/djad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Parent psychological distress during childhood cancer treatment has short- and long-term implications for parent, child, and family well-being. Identifying targetable predictors of parental distress is essential to inform interventions. We investigated the association between household material hardship (HMH), a modifiable poverty-exposure defined as housing, food, or utility insecurity, and severe psychological distress among parents of children aged 1-17 years with acute lymphoblastic leukemia (ALL) enrolled on the multicenter Dana-Farber ALL Consortium Trial 16-001. METHODS This was a secondary analysis of parent-reported data. Parents completed an HMH survey within 32 days of clinical trial enrollment (T0) and again at 6 months into therapy (T1). The primary exposure was HMH at T0 and primary outcome was severe parental distress at T0 and T1, defined as a score greater than or equal to 13 on the Kessler-6 Psychological Distress Scale. Multivariable models were adjusted for ALL risk group and single parent status. RESULTS Among 375 evaluable parents, one-third (32%; n = 120/375) reported HMH at T0. In multivariable analyses, T0 HMH was associated with over twice the odds of severe psychological distress at T0 and T1 HMH was associated with over 5 times the odds of severe distress at T1. CONCLUSIONS Despite uniform clinical trial treatment of their children at well-resourced pediatric centers, HMH-exposed parents-compared with unexposed parents-experienced statistically significantly increased odds of severe psychological distress at the time of their child's leukemia diagnosis, which worsened 6 months into therapy. These data identify a high-risk parental population who may benefit from early psychosocial and HMH-targeted interventions to mitigate disparities in well-being.
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Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Victoria B Koch
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rahela Aziz-Bose
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Ariana Valenzuela
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peter D Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Justine M Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia, University Medical Center, New York, NY, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Thai Hoa Tran
- Division of Pediatric Hematology Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire de Quebec, Saint-Foy, QC, Canada
| | - Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children’s Hospital, Brown University, Providence, RI, USA
| | - Joanne Wolfe
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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13
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Hovén E, Ljungman L, Sveen J, Skoglund C, Ljungman G, Ljung R, Wikman A. Losing a child to adolescent cancer: A register-based cohort study of psychotropic medication use in bereaved parents. Cancer Med 2023; 12:6148-6160. [PMID: 36218005 PMCID: PMC10028064 DOI: 10.1002/cam4.5347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/09/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate the short- and long-term risk of psychotropic medication use in parents who lose a child to cancer diagnosed in adolescence. METHODS This is a Swedish nationwide register-based study including 184 bereaved mothers and 184 bereaved fathers of 184 children diagnosed with cancer in adolescence. Logistic regression analyses, adjusted for sociodemographic characteristics and history of mental health problems, were performed to estimate risk of a prescription of psychotropic medication (anxiolytics, hypnotics/sedatives, antidepressants) in cancer-bereaved parents from 1 year before to 5 years after the child's death, with a general population sample of non-bereaved parents (n = 3291) as referents. RESULTS At the year of the child's death, 28%-36% of mothers and 11%-20% of fathers had a prescription of anxiolytics, hypnotics/sedatives or antidepressants. The corresponding percentages for non-bereaved mothers and fathers were 7%-12% and 4%-7%, respectively. Compared to non-bereaved mothers, bereaved mothers showed higher odds of prescriptions from 1 year before up to four (anxiolytics) and 5 years (hypnotics/sedatives and antidepressants) after the child's death. Bereaved fathers showed higher odds than non-bereaved fathers of prescriptions from 1 year before up to the year of (anxiolytics and hypnotics/sedatives) and 1 year after (antidepressants) the child's death. No differences in odds between bereaved and non-bereaved fathers were found at 2 years after the child's death. Being unmarried, born outside Sweden, and having a history of mental health problems were associated with higher odds of prescribed medications. CONCLUSIONS Indicative of mental health problems of clinical importance, cancer-bereaved parents had a higher prevalence of use of psychotropic medication. A decrease in medication use was evident with time, but still at 5 years after the child's death mothers displayed a higher use while fathers showed no difference to non-bereaved fathers after 2 years.
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Affiliation(s)
- Emma Hovén
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Childhood Cancer Research Unit, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Lisa Ljungman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Josefin Sveen
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Center for Crisis PsychologyUniversity of BergenBergenNorway
| | | | - Gustaf Ljungman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Pediatric OncologyUppsala University HospitalUppsalaSweden
| | - Rickard Ljung
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Anna Wikman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
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14
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Kochen EM, Grootenhuis MA, Teunissen SCCM, Boelen PA, Tataranno ML, Fahner JC, de Jonge RR, Houben ML, Kars MC, van Berkestijn F, Falkenburg J, Frohn-Mulder I, Knoester H, Molderink A, van de Loo M, Michiels E. A grounded theory study on the dynamics of parental grief during the children's end of life. Acta Paediatr 2023; 112:1101-1108. [PMID: 36806310 DOI: 10.1111/apa.16716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
AIM Parents are increasingly confronted with loss during their child's end of life. Healthcare professionals struggle with parental responses to loss. This study aimed to understand parental coping with grief during their child's end of life. METHODS A grounded theory study was performed, using semi-structured interviews with parents during the child's end of life and recently bereaved parents. Data were collected in four children's university hospitals and paediatric homecare services between October 2020 and December 2021. A multidisciplinary team conducted the analysis. RESULTS In total, 38 parents of 22 children participated. Parents strived to sustain family life, to be a good parent and to ensure a full life for their child. Meanwhile parents' grief increased because of their hypervigilance towards signs of loss. Parents' coping with grief is characterised by an interplay of downregulating grief and connecting with grief, aimed at creating emotional space to be present and connect with their child. Parents connected with grief when it was forced upon them or when they momentarily allowed themselves to. CONCLUSION The parents' ability to engage with grief becomes strained during the end of life. Healthcare professionals should support parents in their search for a balance that facilitates creating emotional space.
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Affiliation(s)
- Eline M Kochen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Department of Psycho-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of clinical psychology, Utrecht University, Utrecht, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Maria-Luisa Tataranno
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jurrianne C Fahner
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roos R de Jonge
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L Houben
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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15
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Bourque C, Dumont E, Martisella M, Daoust L, Cantin S, Levasseur MC, de Steur Q, Duval M, Marquis MA, Sultan S. L’expérience à long terme des parents endeuillés en oncologie pédiatrique : une étude rétrospective de 2 à 18 ans après le décès d’un enfant. PSYCHO-ONCOLOGIE 2023. [DOI: 10.3166/pson-2022-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Objectifs : Cette étude rétrospective et transversale vise à comprendre l’expérience à long terme des parents endeuillés en oncologie pédiatrique et les différences du deuil parental en fonction du genre.
Matériel et méthodes : Un questionnaire multisectionnel coconstruit avec des cliniciens et intervenants en suivi de deuil a été tenu en ligne en 2018 et 2019. Les participants au sondage étaient des parents dont l’enfant était décédé au service d’hématologie-oncologie du CHU Sainte-Justine 2 à 18 ans auparavant. Des sections spécifiques sur les réactions, les changements et les souvenirs ont fait l’objet d’analyses descriptives.
Résultats : Les réponses de 48 parents ont été analysées. Les résultats indiquent que les mères ont tendance à modifier certaines de leurs activités sociales, alors que les pères cherchent plutôt à retrouver leurs habitudes. Les réactions initialement fortes des parents s’atténuent au fil du temps sans disparaître, en particulier la tristesse et les troubles du sommeil. Les parents ont des souvenirs apaisants des interactions et des soins reçus des intervenants en milieux clinique et communautaire même plusieurs années après le décès de leur enfant.
Conclusion : L’offre de soutien psychosocial communautaire et professionnel à long terme est pertinente, de même aux besoins des couples et aux besoins individuels des parents en fonction du genre.
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16
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Chavan SS, Mendonca TL. Effectiveness of Psychosocial Intervention on Quality of Life of Mothers of Children with Cancer: A Feasibility Study. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1758527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Background Mothers of children with cancer are reported to experience stress more often. For children with cancer, parents are the primary source of social and emotional support, and they are also in charge of how successfully patients manage their illness. The degree of difficulty parents suffer after learning that their child has cancer significantly influences the child's psychological adjustment.
Aim The study aimed to assess the effectiveness of psychosocial intervention on quality of life (QoL) among mothers of children with cancer.
Materials and Methods Quasi-intervention study design was undertaken, and a purposive sampling technique was used to select the 60 mothers of children with cancer who were assigned randomly to the intervention and control groups. A pretested and validated self-administered questionnaire was used; the sociodemographic, WHOQOL-BREF scale with 26 items was studied.
Statistical Analysis Prevalence, demographic pro forma of mother and child was analyzed in terms of frequency, percentage, mean, and standard deviation. Two-factor repeated measures analysis of variance was used to establish the effectiveness of the psychosocial intervention on QoL. Association was done by using the chi-square test. SPSS package was used for analysis.
Results Psychosocial intervention was found to be effective in improving QoL scores in psychological health domain (p = 0.02*, p < 0.05), social relationship domain (p = 0.04*, p < 0.05), and environmental health domain (p = 0.001**, p < 0.05). A significant association was found between the physical health domain and information on cancer (p = 0.01*), psychological health domain and financial status (p = 0.03*), social relationship domain and cost of treatment (p = 0.04*), Q1 and Q2 with the place of residence (p = 0.004**, p = 0.02*), and Q2 and financial status (p = 0.03*).
Conclusion Mothers of children with cancer undergo a lot of stress and emotional turmoil and are at risk of deteriorating their QoL. Hence, they need to be provided support to address their issues. Thus, health professionals must develop and implement interventions to promote the QoL.
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Affiliation(s)
- Seema S. Chavan
- Department of Pediatric Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
- Department of Pediatric Nursing, Laxmi Memorial College of Nursing, Mangaluru, Karnataka, India
- Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
| | - Theresa L. Mendonca
- Department of Pediatric Nursing, Father Muller College of Nursing, Mangaluru, Karnataka, India
- Department of Pediatric Nursing, Laxmi Memorial College of Nursing, Mangaluru, Karnataka, India
- Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India
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17
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Rasouli O, Øglænd IS, Reinfjell T, Eilertsen MEB. Protective and risk factors in the grieving process among cancer-bereaved parents: A qualitative study. DEATH STUDIES 2022; 47:881-890. [PMID: 36352505 DOI: 10.1080/07481187.2022.2142324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This Norwegian nationwide study explored cancer-bereaved parents' perceptions of protective and risk factors in their grieving process. A total of 162 parents answered two open-ended questions 2-8 years after their child's death due to cancer. Qualitative analysis revealed three main themes: memories of the child's illness and death, going forward in life, and relationships-a resource and a barrier. The results support the perspective of going forward in life and accepting grief as part of life, contrary to the notion of "getting over" or "detaching" from the deceased child. Social support is also crucial for cancer-bereaved parents.
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Affiliation(s)
- Omid Rasouli
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Svela Øglænd
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trude Reinfjell
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mary-Elizabeth Bradley Eilertsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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18
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A multisite randomized controlled trial of an early palliative care intervention in children with advanced cancer: The PediQUEST Response Study Protocol. PLoS One 2022; 17:e0277212. [DOI: 10.1371/journal.pone.0277212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022] Open
Abstract
Background
The Pediatric Quality of Life and Evaluation of Symptoms Technology Response to Pediatric Oncology Symptom Experience (PQ-Response) intervention aims to integrate specialized pediatric palliative care into the routine care of children, adolescents, and young adults (AYAs) with advanced cancer.
Aims
To evaluate whether PQ-Response, compared to usual care, improves patient’s health related quality of life (HRQoL) and symptom burden (aim 1), parent psychological distress and symptom-related stress (aim 2), and family and symptom treatment activation (aim 3).
Design
Multisite, randomized (1:1), controlled, un-blinded, effectiveness trial comparing PediQUEST Response (intervention) vs usual cancer care (control).
Setting
Five US large, tertiary level pediatric cancer centers.
Participants
Children (≥2 years old)/AYAs who receive care at any of the participating sites because of advanced cancer or any progressive/recurrent solid or brain tumor and are palliative care “naïve.” Target: 200 enrolled patient-parent dyads (minimum goal: 136 dyads randomized, N = 68/arm).
Interventions
PediQUEST Response: combines patient-mediated activation (weekly feedback of patient- and parent-reported symptoms and HRQoL to families and providers using the PediQUEST web system) with integration of the palliative care team. Usual Cancer Care: participants receive usual care, which can include palliative care consultation, and use PediQUEST web to answer surveys, with no feedback.
Methods
Following enrollment, patients (if ≥5 years) and one parent receive weekly PediQUEST-Surveys assessing HRQoL (Pediatric Quality of Life Inventory 4.0) and symptom burden (PediQUEST-Memorial Symptom Assessment Scale). After a 2-week run-in period, dyads who answer ≥2 PediQUEST surveys per participant (responders), are randomized (concealed allocation) and followed up for 16-weeks. Parents answer six additional surveys (parent outcomes).
Outcomes
Primary: mean patient HRQoL score over 16-weeks as reported by a) the parent; and b) the patient if ≥5 years-old. Secondary: patient’s symptom burden; parent’s anxiety, depressive symptoms, symptom-related stress; family activation; and symptom treatment activation.
Trial registration
ClinicalTrials.gov (NCT03408314) 1/24/18. https://clinicaltrials.gov/ct2/show/NCT03408314.
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19
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Bingöl H, Aydın A, Kebudi R, Umaç EH, Koç B, Yıldırım ÜM, Zülfikar B. Desires vs. conditions: A qualitative study exploring the factors affecting the place of death of child with cancer in Turkey. Eur J Cancer Care (Engl) 2022; 31:e13703. [PMID: 36131608 DOI: 10.1111/ecc.13703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/15/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to describe factors affecting the place of death of children with cancer at the end of life. METHODS The descriptive phenomenological approach was used. Eighteen mothers who lost their children to cancer participated in in-depth interviews. Data were analysed using MAXQDA software version. Codes and categories were developed inductively from participants' narratives. RESULTS The factors affecting the place of death of children were categorised into two main themes: (1) desires and (2) conditions. Most of the mothers reported that their deceased children wanted to be with their families at the end of life and they wanted to go home. The conditions related to health services were defined as the barriers to the death of their children in the places of death preferred by the mothers. CONCLUSION The desire to be close to the child was the main factor affecting the parents' decisions. The findings revealed the prevailing circumstances in the death place decision beyond parental desires. These were the child's health conditions, physical conditions of hospitals, and the lack of home care and paediatric palliative care services, which were factors related to the system, and the lack of other options for parents.
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Affiliation(s)
- Hülya Bingöl
- Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Ayfer Aydın
- School of Nursing, Istanbul University, Istanbul, Turkey
| | - Rejin Kebudi
- Division of Pediatric Hematology-Oncology & Department of Preventive Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | | | - Başak Koç
- Oncology Institute, Istanbul University, Istanbul, Turkey
| | | | - Bülent Zülfikar
- Division of Pediatric Hematology-Oncology & Department of Preventive Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
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20
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Johnston EE, Davis ES, Bhatia S, Kenzik K. Location of death and hospice use in children with cancer varies by type of health insurance. Pediatr Blood Cancer 2022; 69:e29521. [PMID: 34962704 DOI: 10.1002/pbc.29521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Disparities in end-of-life (EOL) care for children with cancer remain understudied. We addressed this gap by examining patterns of EOL care, with a focus on location of death and hospice utilization. METHODS We used MarketScan - a nationally representative dataset with Medicaid and commercial claims to conduct a retrospective observational study of children with cancer who died between 2011 and 2017 at age ≤21 years. We examined rates of (a) home death, (b) hospice utilization, (c) and medically intense interventions in the last 30 days (e.g., intubation). RESULTS Of the 1492 children in the cohort, 44% had Medicaid and 56% commercial insurance; 71% carried a solid tumor diagnosis, and 37% were between the ages of 15 and 21 years at the time of death. Forty percent died at home; children with Medicaid were less likely to die at home (relative risk [RR] = 0.82, 95% confidence interval [CI]: 0.73-0.92; reference: commercial). Forty-five percent enrolled in hospice, for a median of 2 days. Hospice enrollment rates did not vary with insurance. However, children with Medicaid spent less time enrolled (incidence rate ratio [IRR] = 0.22, 95% CI: 0.17-0.27). Among children with Medicaid, Black children were less likely to die at home (RR = 0.69, 95% CI: 0.52-0.92) and enroll on hospice (RR = 0.71, 95% CI: 0.55-0.91) than non-Hispanic White children. Medically intense interventions did not vary with insurance or race. CONCLUSION Only 40% of children with cancer die at home, and the duration of hospice enrollment is short. EOL care varies significantly with insurance. It is imperative that we determine if these patterns and disparities represent EOL preferences, provider biases, or differences in quality or availability of hospice.
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Affiliation(s)
- Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth S Davis
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelly Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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21
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Sato R, Jamison J, McGee K, Oseni G, Perng J, Tanaka T. The relationships between adverse life events, depression, economic activities, and human capital investment in Nigeria. Med Confl Surviv 2022; 38:170-183. [PMID: 35854674 DOI: 10.1080/13623699.2022.2095963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This paper examines the links between adverse events, depression, and decision-making in Nigeria. It investigates how events such as conflicts, shocks, and deaths of family members can affect short-term mental health, as well as longer-term decisions on economic activities and human capital investments. First, the findings show that exposure to conflict has the largest and strongest relationship with depression, associated with a 21-26 percentage point increase in the probability of depressive symptomatology. Second, depression is associated with lower labour force participation, child educational investment, and annual per capita income, holding constant covariates such as exposure to adverse events. People with depressive symptoms are 8 percentage points less likely to work. In addition, parents exhibiting depressive symptoms spend 18% less on their children's education. These findings show the links between adverse events and important outcomes such as labour and education through mental health. As such, policymakers must consider both the direct and indirect effects that adverse events - particularly conflicts - and depression can have on welfare.
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Affiliation(s)
- Ryoko Sato
- Harvard University T H Chan School of Public Health, Boston, MA, USA
| | | | - Kevin McGee
- Development Data Group, World Bank, Washington DC, USA
| | | | - Julie Perng
- Federal Retirement Thrift Investment Board, Washington DC, USA
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22
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Bronsema A, Theißen T, Oechsle K, Wikert J, Escherich G, Rutkowski S, Bokemeyer C, Ullrich A. Looking back: Identifying supportive care and unmet needs of parents of children receiving specialist paediatric palliative care from the bereavement perspective. Palliat Care 2022; 21:87. [PMID: 35610720 PMCID: PMC9131617 DOI: 10.1186/s12904-022-00971-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examined care needs and utilisation of psychosocial support services among parents of children who had received specialist paediatric palliative care, as well as the relationship between need fulfilment and grief. Possible differences between parents of children who died of cancer versus a non-cancer disease were explored. METHODS This exploratory study, conducted in two specialist paediatric palliative care facilities, included parents who had lost a child within a period of 0.5 to 8 years before this investigation. From the bereavement perspective, parents reported their needs during paediatric palliative care using the Family Inventory of Needs - Peadiatric II (FIN-PED II). Utilisation of psychosocial support services during paediatric palliative care and after the child's death, as well as potential barriers to accessing services were assessed. Grief symptoms were measured using the Inventory of Complicated Grief - German Version (ICG-D). RESULTS Overall, 56 of 157 approached parents participated in the study. Mean time interval after the child's death was 3.2 years. Of the 17 FIN-PED II needs, 13 needs were reported to be very/extremely important to more than 75% of the parents each. Highest ranked needs related to asking questions at any time (100%), sincere care for the child (100%), and information about changes in the child's condition (98%). The highest ranked unmet needs related to hope (61%), interactions with siblings (41-42%), and trust in the health care system (39%). Comparisons showed no significant differences between parents whose child died of cancer (n = 18) versus a non-cancer disease (n = 38). During paediatric palliative care, 61% of the parents had accessed at least one psychosocial support service and 84% had done so after the child's death. The most prominent barriers for accessing services were sufficient informal support (38%), no subjective need (23%), and lack of time (20%). Overall, 52% of the parents showed noticeable symptoms for complicated grief (ICG-D > 25). A higher level of grief symptoms significantly correlated with a lower fulfilment of the need to say goodbye to the child (p = .042) with a medium correlational effect. CONCLUSIONS Our findings may help to guide health care professionals in their assessment of parental needs and provision of support to parents during paediatric palliative care.
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Affiliation(s)
- Annika Bronsema
- Clinic of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Tabea Theißen
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Wikert
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Palliative Medicine, University Hospital LMU, Munich, Germany
| | - Gabriele Escherich
- Clinic of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Stefan Rutkowski
- Clinic of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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van Kempen MM, Kochen EM, Kars MC. Insight into the content of and experiences with follow-up conversations with bereaved parents in paediatrics: A systematic review. Acta Paediatr 2022; 111:716-732. [PMID: 34995378 PMCID: PMC9304260 DOI: 10.1111/apa.16248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Abstract
Aim A follow‐up conversation with bereaved parents is a relatively well‐established intervention in paediatric clinical practice. Yet, the content and value of these conversations remain unclear. This review aims to provide insight into the content of follow‐up conversations between bereaved parents and regular healthcare professionals (HCPs) in paediatrics and how parents and HCPs experience these conversations. Methods Systematic literature review using the methods PALETTE and PRISMA. The search was conducted in PubMed and CINAHL on 3 February 2021. The results were extracted and integrated using thematic analysis. Results Ten articles were included. This review revealed that follow‐up conversations are built around three key elements: (1) gaining information, (2) receiving emotional support and (3) facilitating parents to provide feedback. In addition, this review showed that the vast majority of parents and HCPs experienced follow‐up conversations as meaningful and beneficial for several reasons. Conclusion An understanding of what parents and HCPs value in follow‐up conversations aids HCPs in conducting follow‐up conversations and improves care for bereaved parents by enhancing the HCPs' understanding of parental needs.
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Affiliation(s)
- Merel M. van Kempen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Eline M. Kochen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Marijke C. Kars
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
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24
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Kenney AE, Tutelman PR, Fisher RS, Lipak KG, Barrera M, Gilmer MJ, Fairclough D, Akard TF, Compas BE, Davies B, Hogan NS, Vannatta K, Gerhardt CA. Impact of End-of-Life Circumstances on the Adjustment of Bereaved Siblings of Children Who Died from Cancer. J Clin Psychol Med Settings 2022; 29:230-238. [PMID: 34173900 PMCID: PMC8710186 DOI: 10.1007/s10880-021-09797-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to examine the impact of end-of-life (EoL) circumstances on grief and internalizing symptoms among bereaved siblings. Bereaved families (N = 88) were recruited from three sites 3-12 months (M = 11.57, SD = 3.48) after their child's death from cancer. One sibling per family aged 8-17 years (M = 12.41, SD = 2.64) was randomly selected to participate. Families completed measures of siblings' grief and internalizing symptoms, as well as a structured interview about circumstances surrounding the death. Mother and sibling reports of EoL circumstances were generally concordant, except there was a discrepancy between mothers and children about whether or not children expected their sibling's death (t(75) = 1.52, p = .018). Mother reports of sibling internalizing symptoms were above the normative mean (t(83) = 4.44, p ≤ .001 (M = 56.01 ± 12.48), with 39% (n = 33) in the borderline/clinical range. Sibling opportunity to say goodbye was associated with greater grief-related growth (t(79) = - 1.95, p = .05). Presence at the death and wishing they had done something differently were both associated with greater grief (t(80) = - 2.08, p = .04 and t(80) = - 2.24, p = .028, respectively) and grief-related growth (t(80) = - 2.01, p = .048 and t(80) = - 2.31, p = .024, respectively). However, findings were primarily unique to sibling report, with few mother-reported effects. The adjustment of bereaved siblings may be affected by certain modifiable circumstances surrounding the death of their brother or sister. A proportion of bereaved siblings had elevated internalizing symptoms irrespective of circumstances at EoL. Further work is needed to understand predictors of adjustment among bereaved siblings to provide better support and optimize their outcomes.
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Affiliation(s)
- Ansley E. Kenney
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Rachel S. Fisher
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Keagan G. Lipak
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Maru Barrera
- The Hospital for Sick Children, Toronto, ON, Canada,University of Toronto, Toronto, ON, Canada
| | - Mary Jo Gilmer
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | | | | | - Bruce E. Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | - Nancy S. Hogan
- Professor Emerita, Loyola University Chicago, Chicago, IL, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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25
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Aguilera V, Schaefer MR, Parris K, Long A, Triplett B, Phipps S. Psychosocial outcomes of parents in pediatric haploidentical transplant: parental hematopoietic cell donation as a double-edged sword. Bone Marrow Transplant 2022; 57:377-383. [PMID: 35001081 DOI: 10.1038/s41409-021-01547-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/16/2021] [Accepted: 11/30/2021] [Indexed: 12/26/2022]
Abstract
Parents are increasingly used as donors for their child's haploidentical hematopoietic cell transplant, creating a dual role for parents that may increase the stress of caring for their ill child. Empiric research on the psychological adjustment of parental donors is lacking. We conducted a retrospective survey of parents (n = 136) whose child underwent transplant with a parental donor or a matched-unrelated donor, including both donor and nondonors, and both parents of survivors and bereaved. All parents completed standardized measures of quality of life, depression, anxiety, post-traumatic stress, and life satisfaction. Bereaved parents also completed measures of their grief response, while parents of survivors completed measures of the parent-child relationship. The overall sample reported psychological functioning near normative levels, but bereaved parents demonstrated significantly poorer outcomes across all measures. The effect of donor status differed by transplant outcome: for parents of survivors, donors reported better mental health than nondonors, but amongst bereaved parents, donors fared more poorly than nondonors. Bereaved donors reported greater difficulties with grief than nondonors. Results suggest that serving as donor can be a double-edged sword, acting as a protective factor when there is a successful outcome but a significant risk factor when the child does not survive.
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Affiliation(s)
- Vanessa Aguilera
- Department of Psychology, St. Jude Children's Research Hospital Memphis, Memphis, TN, USA
| | - Megan R Schaefer
- Department of Psychology, St. Jude Children's Research Hospital Memphis, Memphis, TN, USA
| | - Kendra Parris
- Department of Psychology, St. Jude Children's Research Hospital Memphis, Memphis, TN, USA
| | - Alanna Long
- Department of Psychology, St. Jude Children's Research Hospital Memphis, Memphis, TN, USA
| | - Brandon Triplett
- Department of Bone Marrow Transplantation & Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital Memphis, Memphis, TN, USA.
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26
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Lykke C, Sjøgren P, Ekholm O. Losing a child due to a life-limiting diagnosis-parental well-being and quality of life: nationwide survey. BMJ Support Palliat Care 2021:bmjspcare-2021-003251. [PMID: 34969696 DOI: 10.1136/bmjspcare-2021-003251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Losing a child is burdensome with potential long-term impact on the parents' well-being and quality of life. The aim was to investigate parental well-being and quality of life 3-5 years after losing a child due to life-limiting diagnoses and to identify associated factors in order to target future interventions. METHODS All parents, who lost a child (<18 years) due to life-limiting diagnoses in the period 2012-2014 in Denmark, were invited to complete a self-administered questionnaire. A seven-point Visual Digital Scale (VDS) was used to assess issues of well-being and quality of life including physical health, anxiety, depression and sleep quality which were combined into a cumulative symptom index. Associations were assessed by means of ordinal logistic regression models. RESULTS In all, 152 (38%) children were represented by 136 mothers and 57 fathers. Totally, 17.6% of the mothers and 14.0% of the fathers had ≥2 symptoms (assessed by the symptom index). Parents with lower education had 2.11 (95% CI: 1.01 to 4.40) times higher odds of having more symptoms than parents with higher education. Unmarried parents had 2.14 (95% CI: 1.03 to 4.42) times higher odds of having more symptoms than married parents. Ten per cent of the parents reported poor overall quality of life. CONCLUSION According to the VDS, 1 out of 10 parents experienced poor overall quality of life 3-5 years after the loss. Every sixth had two or more symptoms assessed by the symptom index. Associated factors for poor quality of life suggest attention to particularly unmarried parents and parents with lower education.
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Affiliation(s)
- Camilla Lykke
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology and Palliative Care, Nordsjællands Hospital, Hillerod, Denmark
| | - Per Sjøgren
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Region Hovedstaden, Denmark
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27
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Ahmadi F, Zandi S. Meaning-Making Coping Methods among Bereaved Parents: A Pilot Survey Study in Sweden. Behav Sci (Basel) 2021; 11:131. [PMID: 34677224 PMCID: PMC8533093 DOI: 10.3390/bs11100131] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
The death of a child may result in traumatizing forms of grief, and meaning-making coping with loss seems to be important in prevention of intense psychosocial problems among bereaved parents. The aim of this quantitative pilot study was to discover the divergent meaning-making coping methods used by bereaved parents in Sweden. In doing so, 162 respondents were selected using a convenience sampling method, and they responded to the modified version of RCOPE. The study revealed that the strategies talking to others about their feelings, pondering the meaning of life alone, and being in nature for greater emotional affiliation, i.e., what we call secular existential coping methods, have been the most used meaning-making coping methods among Swedish mourning parents. While explaining the results, we considered the respondents' cultural background and speculated about the potential influence of cultural teachings and elements in the selection of ways of coping with bereavement. Further, we compared the results obtained with those of the two other Swedish studies conducted among people coping with cancer and COVID-19 to further discuss the impact of culture on coping with illness, loss, grief, and crisis. The study supports the idea that culture plays an essential role in the choice of coping methods.
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Affiliation(s)
| | - Saeid Zandi
- Department of Social Work and Criminology, Faculty of Health and Occupational Studies, University of Gävle, 80176 Gävle, Sweden;
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28
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Vig PS, Lim JY, Lee RWL, Huang H, Tan XH, Lim WQ, Lim MBXY, Lee ASI, Chiam M, Lim C, Baral VR, Krishna LKR. Parental bereavement - impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review. BMC Palliat Care 2021; 20:136. [PMID: 34481491 PMCID: PMC8418708 DOI: 10.1186/s12904-021-00831-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Losing a child tragically impacts the well-being and functioning of parents. With these effects extending beyond emotional, physical morbidity and compromising self-perceptions, appropriate, longitudinal, timely and personalised support is key to effective care of bereaved parents. However, in the absence of a comprehensive understanding of parental bereavement, effective support of bereaved parents remains suboptimal. To address this gap, we scrutinise prevailing data on the effects of a child's death, aged 0-12 years, through the lens of the Ring Theory of Personhood (RToP). METHODS To study prevailing accounts of bereaved parents following the death of a child, we adopt Krishna's Systematic Evidence Based Approach (SEBA) to structure our Systematic Scoping Review (SSR in SEBA). RESULTS Three thousand seventy-four abstracts were reviewed, 160 full text articles were evaluated, and 111 articles were included and analysed using thematic and content analysis. Four themes/categories were identified relating to the four rings of the RToP. Findings reveal that static concepts of protective and risk factors for grief are misplaced and that the support of healthcare professionals is key to assisting bereaved parents. CONCLUSION In the absence of consistent support of bereaved parents, this study highlights the need for effective training of healthcare professionals, beginning with an appreciation that every aspect of an individual parent's personhood is impacted by the loss of their child. Acknowledging grief as a complex, evolving and personalised process subjected to parental characteristics, settings, context and available support, this SSR in SEBA calls attention to effective nurturing of the relationship between parents and healthcare professionals, and suggests use of the RToP to assess and direct personalised, timely, specific support of parents in evolving conditions. We believe the findings of this review also call for further studies to support healthcare professionals as they journey with bereaved parents.
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Affiliation(s)
- Prachi Simran Vig
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Jia Yin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Randal Wei Liang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Huixin Huang
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Road, Block 3 Level 1, Singapore, 169608 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Vijayendra Ranjan Baral
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Division of Neonatal and Developmental Medicine, Singapore General Hospital, Outram Road, Block 5 Level 4, Singapore, 169608 Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
- Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA UK
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29
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Fladeboe KM, O'Donnell MB, Barton KS, Bradford MC, Steineck A, Junkins CC, Yi-Frazier JP, Rosenberg AR. A novel combined resilience and advance care planning intervention for adolescents and young adults with advanced cancer: A feasibility and acceptability cohort study. Cancer 2021; 127:4504-4511. [PMID: 34358332 DOI: 10.1002/cncr.33830] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/03/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few evidence-based psychosocial programs have been tested among adolescents and young adults (AYAs) with advanced cancer (AC), and early advance care planning (ACP) in this population is rare. The authors aimed to determine the feasibility and acceptability of 1) delivering an established resilience-coaching program, and 2) integrating ACP into that program, among AYAs with AC. METHODS Eligible AYAs were 12 to 24 years old, diagnosed with advanced cancer (recurrent/refractory disease or a diagnosis associated with <50% survival) and fluent in English. The Promoting Resilience in Stress Management-Advanced Cancer (PRISM-AC) program included PRISM's standard sessions targeting stress-management, goal-setting, cognitive-restructuring, and meaning-making, delivered 1:1, 1 to 2 weeks apart, plus a new session involving elements of the AYA-specific Voicing My Choices ACP guide. Participants completed surveys at baseline and 12 weeks, and exit interviews following study completion. Feasibility was defined as ≥70% completion of 1) standard 4-session PRISM and 2) the new ACP session among those completing standard PRISM. Acceptability was defined qualitatively. Trajectories of patient-reported anxiety, depression, and hope were examined descriptively. RESULTS Of 50 eligible, approached AYAs, 26 (52%) enrolled and completed baseline surveys. The AYAs had a mean age of 16 years (SD = 2.7 years), and the majority were male (73%) and White/Caucasian (62%). Twenty-two AYAs (85%) completed standard PRISM, and of those, 18 (82%) completed the ACP session. Feedback was highly positive; 100% and 91% described the overall and ACP programs as valuable, respectively. Anxiety, depression, and hope were unchanged after the program. CONCLUSIONS Resilience coaching followed by integrated ACP is feasible and acceptable for AYAs with AC. Participating did not cause distress or decrease hope. LAY SUMMARY Advance care planning (ACP) among adolescents and young adults (AYAs) with advanced cancer can be difficult to introduce. We investigated whether it is feasible and acceptable to integrate ACP into an existing resilience-coaching program for AYAs. In this cohort study of 26 AYAs with advanced cancer, we found the Promoting Resilience in Stress Management-Advanced Cancer program to be feasible (≥70% intervention-completion) and highly acceptable (positive post-participation feedback, no evidence of participant-distress). We conclude that an intervention integrating resilience coaching and ACP is feasible and acceptable among AYAs with advanced cancer.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - Maeve B O'Donnell
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Krysta S Barton
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Miranda C Bradford
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Children's Core for Biomedical Statistics, Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Angela Steineck
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - Courtney C Junkins
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
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30
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Kochen EM, Boelen PA, Teunissen SCCM, Jenken F, de Jonge RR, Grootenhuis MA, Kars MC. Health Care Professionals' Experiences With Preloss Care in Pediatrics: Goals, Strategies, Obstacles, and Facilitators. J Pain Symptom Manage 2021; 62:107-116. [PMID: 33186732 DOI: 10.1016/j.jpainsymman.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Although parents experience grief when confronted with their child's deterioration and imminent death, most bereavement care is focused on supporting parents after child loss. Insight into intentions and strategies of the health care professionals (HCPs) in preloss care during the end of life is still lacking. OBJECTIVES To create a starting point for improvement of preloss care, this study explores HCPs' experiences with providing support aimed at parental feelings of grief during the child's end of life. METHODS Exploratory qualitative research using individual semistructured interviews with clinicians in pediatrics and neonatology in hospital and homecare settings. Data were thematically analyzed by a multidisciplinary team. RESULTS Nineteen HCPs participated. HCPs tried to ensure that parents could reflect on the care received as concordant to their preferences and were not hindered in their bereavement as a consequence of their professional actions. Strategies included maximizing parental presence, enabling parental involvement in decision making, and ensuring a dignified death. While using these strategies, HCPs faced several difficulties: uncertainty about the illness course, unpredictability of parental grief responses, and being affected themselves by the child's imminent death. It helped HCPs to develop a bond with parents, find comfort with colleagues, and making joint decisions with colleagues. CONCLUSION HCPs strive to improve parental coping after the child's death, yet apply strategies that positively influence parental preparedness and well-being during the end of life as well. Individual HCPs are left with many uncertainties. A more robust approach based on theory, evidence, and training is needed to improve preloss care in pediatrics.
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Affiliation(s)
- Eline M Kochen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floor Jenken
- Department Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roos R de Jonge
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Department of Psycho-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Sveen J, Jernelöv S, Pohlkamp L, Kreicbergs U, Kaldo V. Feasibility and preliminary efficacy of guided internet-delivered cognitive behavioral therapy for insomnia after the loss of a child to cancer: Randomized controlled trial. Internet Interv 2021; 25:100409. [PMID: 34401368 PMCID: PMC8350585 DOI: 10.1016/j.invent.2021.100409] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 11/03/2022] Open
Abstract
Bereaved individuals often experience sleep problems. The aim of this study was to evaluate feasibility and preliminary effects of internet-delivered cognitive behavioral therapy for insomnia (iCBT-i) in bereaved parents. Parents were randomized to iCBT-i (n = 10) or an active control group (n = 11). Primary outcome (insomnia) and secondary outcomes (prolonged grief, depression, posttraumatic stress, and grief rumination) were assessed pre- and post-treatment, with 9- and 18-month follow-ups. Feasibility was assessed post-treatment and one month later. Most parents reported positive effects of the treatment. The intervention group improved significantly from pre- to post-treatment and had a significantly larger reduction of insomnia when analyzed over all four time-points (Wald χ2 = 30.0, p < 0.001), although the effect at post-treatment was very small (d = 0.1) for insomnia. Thus, iCBT-i was feasible and was related to reduced insomnia and psychological distress in bereaved parents, both short- and long-term, but the results regarding the treatment effect are preliminary due to the small sample size.
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Affiliation(s)
- Josefin Sveen
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden,National Center for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden,Corresponding author at: National Center for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala University Hospital entrance 10, 751 85 Uppsala, Sweden.
| | - Susanna Jernelöv
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Lilian Pohlkamp
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden,Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden,Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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Mader L, Frederiksen LE, Bidstrup PE, Hargreave M, Kjær SK, Kuehni CE, Nielsen TT, Krøyer A, Winther JF, Erdmann F. Hospital Contacts for Psychiatric Disorders in Parents of Children With Cancer in Denmark. JNCI Cancer Spectr 2021; 5:pkab036. [PMID: 34085001 PMCID: PMC8164824 DOI: 10.1093/jncics/pkab036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Having a child diagnosed with cancer is a devastating experience that may affect parents' mental health. We aimed to assess the risk of hospital contacts for psychiatric disorders in parents of children with cancer. Methods We conducted a nationwide population-based cohort study using Danish registry data. Parents of children diagnosed with cancer between 1982 and 2014 (n = 6689 mothers, n = 5509 fathers) were matched with comparison parents of cancer-free children (n = 67 544 mothers, n = 55 756 fathers). We used Cox proportional hazards models to estimate the risk of hospital contacts for any psychiatric disorder and specific disorders. Cox models were also used to investigate sociodemographic and cancer-related risk factors for psychiatric disorders. Results Incidence rates of hospital contacts for any psychiatric disorder were 426 per 100 000 person-years in mothers of children with cancer and 345 per 100 000 person-years in comparison mothers. For fathers, the respective incidence rates were 260 and 262 cases per 100 000 person-years. Compared with parents of cancer-free children, mothers of children with cancer were at an increased risk of hospital contacts for any psychiatric disorder (hazard ratio = 1.23, 95% confidence interval = 1.12 to 1.36), whereas no elevated risk was seen in fathers (hazard ratio = 0.99, 95% confidence interval = 0.87 to 1.13). Among mothers, risks were particularly elevated for affective and stress-related disorders. Parents of deceased children and children diagnosed at a younger age were at particular risk of hospital contacts for psychiatric disorders. Conclusion Hospital contacts for psychiatric disorders were overall rare. Health-care professionals should draw attention to subgroups of vulnerable parents to meet their needs of support and adequate treatment.
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Affiliation(s)
- Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Marie Hargreave
- Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjær
- Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | | | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Schuelke T, Crawford C, Kentor R, Eppelheimer H, Chipriano C, Springmeyer K, Shukraft A, Hill M. Current Grief Support in Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2021; 8:278. [PMID: 33916583 PMCID: PMC8066285 DOI: 10.3390/children8040278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
Grief support changes as more is learned from current grief theory and research. The authors provide a comprehensive overview of current grief support as it relates to Pediatric Palliative Care (PPC). The following aspects of grief are addressed: (1) anticipatory grief: the nondeath losses that occur with a complex and chronic illness, as well as the time leading up to death; (2) grief around the time of death: the intense and sacred experience of companioning with a dying child; (3) grief after death: supporting bereavement and mourning through programing and other methods; (4) innovative approaches: the future of grief support. The contents of this article are meant to support and educate programs currently providing grief services and those aiming to begin the meaningful work of grief support.
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Affiliation(s)
- Taryn Schuelke
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Claire Crawford
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Rachel Kentor
- Department of Pediatrics, Baylor College of Medicine, Psychology Service, Texas Children’s Hospital, 6701 Fannin St., Houston, TX 77030, USA;
| | - Heather Eppelheimer
- Memorial Hermann Pediatric Hospice, 902 Frostwood Suite 288, Houston, TX 77024, USA;
| | | | - Kirstin Springmeyer
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Allison Shukraft
- Department of Pediatrics, Pediatric Advanced Care Team, Atrium Health’s Levine Children’s Hospital, MEB 415-F, 1000 Blythe Blvd, Charlotte, NC 28203, USA;
| | - Malinda Hill
- Justin Michael Ingerman Center for Palliative Care, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
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Bogetz JF, Rosenberg AR. Adults are just big children: What we can learn about quality end-of-life care from pediatrics. Cancer 2021; 127:2393-2396. [PMID: 33784414 DOI: 10.1002/cncr.33548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Jori F Bogetz
- Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington
| | - Abby R Rosenberg
- Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington
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Rosenberg AR, Zhou C, Bradford MC, Barton K, Junkins CC, Taylor M, Kross EK, Curtis JR, Dionne-Odom JN, Yi-Frazier JP. Parent Perspectives after the PRISM-P Randomized Trial: A Mixed-Methods Analysis. J Palliat Med 2021; 24:1505-1515. [PMID: 33720787 DOI: 10.1089/jpm.2020.0720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Parents experience high distress following their child's diagnosis of cancer. We previously tested two delivery models (group and one-on-one) of the "Promoting Resilience in Stress Management for Parents" (PRISM-P) intervention in a randomized trial: one-on-one delivery improved resilience and benefit finding at three months when compared to usual care (UC). Objective: The objective of this analysis was to evaluate quantitative and qualitative outcomes at six months. Design: In this single-center, phase 2, parallel, 1:1:1 randomized trial conducted December 2016 to December 2018, English-speaking parents with a 2-24 year-old child diagnosed with new cancer were randomly assigned to UC, one-on-one, or group PRISM-P, a brief, skill-based curriculum targeting stress management, goal setting, cognitive reframing, and meaning making. We collected parent-reported outcomes (resilience, benefit finding, and psychological distress) at baseline and three and six months. We applied linear mixed-effects regression models to examine six-month outcomes among all participants and conducted directed content analyses of exit interviews with the first 12 parents to complete each study arm. Results: The 94 participating parents were median aged 35-38 years and predominantly white, college-educated mothers. At six months, there was no statistically significant difference in parent-reported outcomes. Exit interviews (n = 36) suggested that PRISM-P was highly valued: 100% of interviewed recipients recommended it for other parents. Most suggested more coaching would help them retain skills, and almost all endorsed a combined one-on-one and group program. Conclusions: Although the PRISM-P benefits observed at three months were not sustained for six months, all interviewed parents found it valuable. Additional opportunities to strengthen and sustain resilience resources include longer follow-up, flexible format, and skill reinforcement. Trial Registration: NCT02998086.
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Affiliation(s)
- Abby R Rosenberg
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA.,Division of Hematology/Oncology and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Chuan Zhou
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda C Bradford
- Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Krysta Barton
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA.,Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Courtney C Junkins
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mallory Taylor
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA.,Division of Hematology/Oncology and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Erin K Kross
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - J Nicholas Dionne-Odom
- Department of Acute, Chronic, and Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Research Laboratory, Center for Clinical and Translational Research, Epidemiology, and Analytics in Research Program, Seattle Children's Research Institute, Seattle, Washington, USA
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Rasouli O, Aarseth Bø M, Reinfjell T, Moksnes UK, Eilertsen MEB. Protective and risk factors associated with psychological distress in cancer-bereaved parents: A cross-sectional study. Eur J Oncol Nurs 2021; 51:101929. [PMID: 33713920 DOI: 10.1016/j.ejon.2021.101929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/30/2020] [Accepted: 03/01/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Research shows that knowledge about mental health status, both protective and risk factors, is limited in cancer-bereaved parents. The study aimed to investigate (1) the extent of psychological distress in bereaved parents 2-8 years after the loss of a child to cancer compared to non-bereaved parents, and (2) psychological distress in association with resilience, the extent of having coped with the grief, time since the loss, and past psychological distress in cancer-bereaved parents. DESIGN Retrospective, cross-sectional study. METHODS A Norwegian nationwide study-specific questionnaire was completed by 162 parents who had lost a child to cancer, and 77 matched non-bereaved parents. We used the Cohort Norway-Mental Health Index and Resilience Scale for Adults to measure psychological distress and resilience, respectively. The extent of having coped with grief was also measured. RESULTS Bereaved parents experienced significantly more symptoms of psychological distress, albeit not clinical psychological distress, compared to non-bereaved parents. The bereaved parents who have coped with their grief or had higher resilience reported lower psychological distress. Positive "Perception of self" and well "Planned future" were the strongest predictors of psychological distress in both bereaved fathers and mothers. CONCLUSION Both fathers and mothers experience more psychological distress symptoms 2-8 years after losing a child to cancer than non-bereaved parents. The findings also highlight the need for long-term support to bereaved parents in order to help to improve their resilience and to better cope with their grief.
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Affiliation(s)
- Omid Rasouli
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Malin Aarseth Bø
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Child and Adolescent Psychiatric Out-patient Clinic (BUP) Orkanger, Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway.
| | - Trude Reinfjell
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Unni Karin Moksnes
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Faculty of Nursing and Health Sciences, North University, Norway.
| | - Mary-Elizabeth B Eilertsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
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Tan AJN, Tiew LH, Shorey S. Experiences and needs of parents of palliative paediatric oncology patients: A meta-synthesis. Eur J Cancer Care (Engl) 2020; 30:e13388. [PMID: 33336528 DOI: 10.1111/ecc.13388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/05/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite palliative care being offered to paediatric cancer patients, it has limited utilisation and often excludes parental support. Therefore, this review aims to consolidate evidence regarding experiences and needs of parents of end-of-life palliative paediatric oncology patients. METHODS Six electronic databases were searched as follows: CINAHL, The Cochrane Library, Embase, PubMed, Scopus and PsycINFO. Included studies were appraised using the Critical Appraisal Skills Programme Checklist. They were then analysed using a two-step approach comprising firstly meta-summaries followed by meta-synthesis for generating fresh insights to the topic. RESULTS Thirteen studies were included. Three themes emerged as follows: (1) normalising the pain; (2) failure as a parent; and (3) importance of communication and social support. Parental experiences included moving on despite the pain and harbouring hopes for their children. However, parents felt immense guilt and a sense of failure in carrying out their parental roles. Effective communication with healthcare providers, availability of family support and religion were necessary to help them cope. CONCLUSIONS Given the emotional challenges faced by parents, healthcare policies and practices should be revised to include parental support in paediatric palliative care services. Future healthcare communication trainings should consider parental need for sensitivity in communication, empathy and kindness from healthcare professionals.
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Affiliation(s)
- Amanda Jue Ning Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lay Hua Tiew
- Ang Mo Kio-Thye Hua Kwan Hospital, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Klarare A, Carlsson T, Mattsson E. Belonging to a community of care: Mothers' experiences of online peer support groups for parents having lost a child with congenital heart defects. DEATH STUDIES 2020; 46:1741-1749. [PMID: 33252318 DOI: 10.1080/07481187.2020.1850548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The aim was to study mothers' experiences of online peer support groups after the death of a child. Participants (N = 8) were recruited through a newsletter for the Swedish association for families/children with heart defects, and two closed support groups on Facebook (900 and 100 members) and interviewed by telephone. Transcripts were analyzed with qualitative content analysis. The groups were available around the clock, regardless of support need, and mothers joined both to receive and provide support. Participation in online peer support groups may provide a sense of belonging to a caring community and serve as a valuable complement to healthcare.
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Affiliation(s)
- Anna Klarare
- Clinical psychology in healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Tommy Carlsson
- Clinical psychology in healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- The Swedish Red Cross University College, Huddinge, Sweden
| | - Elisabet Mattsson
- Clinical psychology in healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
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Parents' views on what facilitated or complicated their grief after losing a child to cancer. Palliat Support Care 2020; 19:524-529. [PMID: 33239119 DOI: 10.1017/s1478951520001212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The loss of a child is a devastating event, and bereaved parents often suffer intense and long-lasting grief reactions and are at risk for psychological symptoms. More knowledge about how parents cope with grief may improve the support to bereaved parents. This study, therefore, aimed to explore parents' views on what facilitated or complicated their grief coping after losing a child to cancer. METHODS This study was derived from a nationwide postal survey. Cancer-bereaved parents (n = 161) provided written responses to two open-ended questions: "Is there anything that has helped you cope with your grief after your child's death?" and "Is there anything that made it difficult for you to cope with your grief?" Content analysis was used to analyze the responses. RESULTS Parents reported that a supportive social network of family and friends, and having remaining children, facilitated their coping with grief. Meeting professional counselors and meeting other bereaved parents, connecting to memories of the deceased child in various contexts, including school and pediatric care settings, were also reported facilitating grief coping. Parents stated that the following experiences had complicated grief coping: additional losses in their family or social network; not being able to share emotions with their partner; when they perceived that friends, relatives, or colleagues lacked empathy or patience; when they felt challenging demands from employers at a too early stage. SIGNIFICANCE OF RESULTS This study contributes to the understanding of parents' grief experiences and what has facilitated or complicated their coping with grief, which can help health care professionals and others improve bereavement support services.
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Costa DS, Mercieca‐bebber R, Rutherford C, Gabb L, King MT. The Impact of Cancer on Psychological and Social Outcomes. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12165] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Daniel Sj Costa
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
| | - Rebecca Mercieca‐bebber
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
| | - Claudia Rutherford
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
| | | | - Madeleine T King
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
- Sydney Medical School, University of Sydney,
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Giorgali S. Bereaved parents' needs regarding hospital based bereavement care after the death of a child to cancer. DEATH STUDIES 2020; 46:1472-1480. [PMID: 32972331 DOI: 10.1080/07481187.2020.1824202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this study was to investigate the needs of bereaved parents in Greece (N = 56) regarding the provision of hospital based bereavement services after the death of their child to cancer. The participants did not receive formal or informal hospital based bereavement services. The majority of the parents (84%) stated that, given the opportunity, they would attend a bereavement program. Continuity of care in bereavement from the health care team, availability, individualized care, interdisciplinary approach and contact with other bereaved parents were described as key elements for the provision of bereavement services.
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42
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Dumont É, Bourque CJ, Duval M, Payot A, Sultan S. A Portrait of Self-Reported Health and Distress in Parents Whose Child Died of Cancer. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:958-973. [DOI: 10.1177/0030222820959943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Grieving a child following cancer is a substantially difficult task. The objectives of this research were: 1) to describe current quality of life (QoL), psychological distress and symptoms of grief of bereaved parents, and 2) to explore the role of possible contributors of QoL and psychological distress. Forty-six parents (32 mothers) of children who died of cancer were surveyed on their QoL, distress, and complicated grief. Data were analyzed using multiple linear regression. Parents had a high frequency of grieving symptoms (58%). Mothers reported more retrospective grief symptoms than fathers when describing the year after child death. Current lower mental well-being was associated with experiencing higher retrospective grief symptoms, a shorter period since child death, and being a father. Hence, parents experienced disturbances even long after child death. Mothers and fathers may present specificities that should be considered when developing supportive activities for this vulnerable population.
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Affiliation(s)
- Émilie Dumont
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- Sainte-Justine University Health Center, Montréal, Québec, Canada
| | - Claude Julie Bourque
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Michel Duval
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Antoine Payot
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Serge Sultan
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
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Haegen MV, Etienne AM. [The assessment of somatic symptoms and distress among parents of a childhood cancer survivor]. Bull Cancer 2020; 107:844-853. [PMID: 32680601 DOI: 10.1016/j.bulcan.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Studies on somatic symptoms among parents of a childhood cancer survivor are less developed in the literature. The purpose of the study is to examine the somatic symptoms intensity (i.e. physical symptoms aggravated by emotional or psychological factors) and its associations with anxious and depressive symptoms and worries. METHODS Sixty-one parents of a childhood cancer survivor (since 4-years until 6-years of survivorship) participated in this transversal and quasi-experimental study. Parents filled in three clinical questionnaires assessing their anxious, depressive and somatic symptoms and their worries related to the child's health evolution. RESULTS Parents suffered mainly from a loss of energy and insomnia in the middle of the night. Significant correlations between somatic symptoms and anxious and depressive symptoms were observed. Lastly, depressive symptoms seem to be a significant factor to predict the level of somatic symptoms. CONCLUSION Recommendations for the management of parents of a childhood cancer survivor have been published. However, longitudinal studies focused on parents are still necessary to improve preventive initiatives and the management of these families.
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Affiliation(s)
- Marie Vander Haegen
- Université de Liège, service de psychologie de la santé, unité de recherche interfacultaire santé et société, 4000 Liège, Belgique; Quartier Village 2, rue de l'Aunaie 30-32 (ancien bâtiment B38b), 4000 Liège (Sart Tilman), Belgique.
| | - Anne-Marie Etienne
- Université de Liège, service de psychologie de la santé, unité de recherche interfacultaire santé et société, 4000 Liège, Belgique; Quartier Village 2, rue de l'Aunaie 30-32 (ancien bâtiment B38b), 4000 Liège (Sart Tilman), Belgique
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Weaver MS, October T, Feudtner C, Hinds PS. "Good-Parent Beliefs": Research, Concept, and Clinical Practice. Pediatrics 2020; 145:peds.2019-4018. [PMID: 32439815 PMCID: PMC7263052 DOI: 10.1542/peds.2019-4018] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 01/31/2023] Open
Abstract
Parents of ill children have willingly identified their personal beliefs about what they should do or focus on to fulfill their own internal definition of being a good parent for their child. This observation has led to the development of the good-parent beliefs concept over the past decade. A growing qualitative, quantitative, and mixed-methods research base has explored the ways that good-parent beliefs guide family decision-making and influence family relationships. Parents have expressed comfort in speaking about their good-parent beliefs. Whether parents achieve their unique good-parent beliefs definition affects their sense of whether they did a good job in their role of parenting their ill child. In this state-of-the-art article, we offer an overview of the good-parent beliefs concept over the past decade, addressing what is currently known and gaps in what we know, and explore how clinicians may incorporate discussions about the good-parent beliefs into clinical practice.
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Affiliation(s)
- Meaghann S. Weaver
- Division of Pediatric Palliative Care, Children’s Hospital and Medical Center, Omaha, Nebraska
| | - Tessie October
- Department of Critical Care Medicine, Children’s National Medical Center, Washington, District of Columbia;,Department of Pediatrics, School of Medicine, The George Washington University, Washington, District of Columbia
| | - Chris Feudtner
- Department of Medical Ethics and Pediatric Advanced Care Team, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Pamela S. Hinds
- Department of Pediatrics, School of Medicine, The George Washington University, Washington, District of Columbia;,Department of Nursing Science, Professional Practice and Quality, Children’s National Health System, Washington, District of Columbia
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Kenny M, Darcy-Bewick S, Martin A, Eustace-Cook J, Hilliard C, Clinton F, Storey L, Coyne I, Murray K, Duffy K, Fortune G, Smith O, Higgins A, Hynes G. You are at rock bottom: A qualitative systematic review of the needs of bereaved parents as they journey through the death of their child to cancer. J Psychosoc Oncol 2020; 38:761-781. [PMID: 32419648 DOI: 10.1080/07347332.2020.1762822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PROBLEM IDENTIFICATION This systematic review will examine the social support needs of bereaved parents in the specific context of pediatric cancer by synthesizing the qualitative evidence. Social support encompasses emotional, practical, informational, and meaning-making support needs. LITERATURE SEARCH The Joanna Briggs Institute procedures for conducting qualitative systematic reviews guided every stage of this review. Four databases (PsychInfo, CINAHL, Pubmed, and ASSIA) were systematically searched, in addition to the gray literature and scoping review. Through a five-step critical appraisal process 11 out of 668 potential articles were identified as meeting the inclusion criteria. DATA EVALUATION/SYNTHESIS Relevant findings were synthesized with a thematic-synthesis approach. Findings, which follow the journey of bereaved parents integrated under the core-category "Needs." This encompasses of four higher-level categories: Last days: Parent needs when caring for their dying child Rest in peace: Parent needs during the child's death Feeling abandoned: Parent needs for contact after the child's death Searching for Meaning: Parents needs when making sense of loss. CONCLUSION Informational support needs is largely unexplored in academic literature. Staff in the treating-hospital are central in offering bereavement-support to parents, who may otherwise feel that they have lost their second home (hospital) and second family (staff).
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Affiliation(s)
- Méabh Kenny
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Aoife Martin
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Carol Hilliard
- Nursing Practice Development Unit, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Frieda Clinton
- Nursing, Haematology Oncology - National Paediatric Centre, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Lorna Storey
- Nursing, Haematology Oncology - National Paediatric Centre, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Kim Murray
- Socail Work, Haematology Oncology - National Paediatric Centre, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Katie Duffy
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Gillian Fortune
- Psychology Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Owen Smith
- Medical Haematology Oncology - National Paediatric Centre Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Geralyn Hynes
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Friebert S, Grossoehme DH, Baker JN, Needle J, Thompkins JD, Cheng YI, Wang J, Lyon ME. Congruence Gaps Between Adolescents With Cancer and Their Families Regarding Values, Goals, and Beliefs About End-of-Life Care. JAMA Netw Open 2020; 3:e205424. [PMID: 32427325 PMCID: PMC7237980 DOI: 10.1001/jamanetworkopen.2020.5424] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/13/2020] [Indexed: 11/14/2022] Open
Abstract
Importance Lack of pediatric advance care planning has been associated with poor communication, increased hospitalization, poor quality of life, and legal actions. Clinicians presume that families understand adolescents' treatment preferences for end-of-life care. Objective To examine patient-reported end-of-life values and needs of adolescents with cancer and congruence with their families' understanding of these needs. Design, Setting, and Participants This cross-sectional survey was conducted among adolescent-family dyads from July 16, 2016, to April 30, 2019, at 4 tertiary care pediatric US hospitals. Participants included 80 adolescent-family dyads (160 participants) within a larger study facilitating pediatric advance care planning. Adolescent eligibility criteria included being aged 14 to 21 years, English speaking, being diagnosed with cancer at any stage, and knowing their diagnosis. Family included legal guardians for minors or chosen surrogate decision-makers for those aged 18 years or older. Data analysis was performed from April 2019 to November 2019. Exposure Session 1 of the 3-session Family Centered Pediatric Advance Care Planning for Teens With Cancer intervention. Main Outcomes and Measures The main outcome was congruence between adolescents with cancer and their families regarding adolescents' values, goals, and beliefs about end-of-life care. Prevalence-adjusted and bias-adjusted κ (PABAK) values were used to measure congruence on the Lyon Advance Care Planning Survey-Revised (Patient and Surrogate versions). Results A total of 80 adolescent-family dyads (160 participants) were randomized to the intervention group in the original trial. Among the adolescents, 44 (55.0%) were female and 60 (75.0%) were white, with a mean (SD) age of 16.9 (1.8) years. Among family members, 66 (82.5%) were female and 65 (81.3%) were white, with a mean (SD) age of 45.3 (8.3) years. Family members' understanding of their adolescent's beliefs about the best time bring up end-of-life decisions was poor: 86% of adolescents wanted early timing (before getting sick, while healthy, when first diagnosed, when first sick from a life-threatening illness, or all of the above), but only 39% of families knew this (PABAK, 0.18). Families' understanding of what was important to their adolescents when dealing with their own dying was excellent for wanting honest answers from their physician (PABAK, 0.95) and understanding treatment choices (PABAK, 0.95) but poor for dying a natural death (PABAK, 0.18) and being off machines that extend life, if dying (PABAK, 0). Conclusions and Relevance Many families had a poor understanding of their adolescent's values regarding their own end-of-life care, such as when to initiate end-of-life conversations and preference for being off machines that extend life. Pediatric advance care planning could minimize these misunderstandings with the potential for a substantial impact on quality of care.
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Affiliation(s)
- Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio
| | - Daniel H. Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, St Jude Research Hospital, Memphis, Tennessee
| | - Jennifer Needle
- Center for Bioethics, Department of Pediatrics, University of Minnesota, Minneapolis
| | - Jessica D. Thompkins
- Center for Translational Research, Children’s Research Institute, Children’s National Hospital, Washington, DC
| | - Yao I. Cheng
- Division of Biostatistics and Study Methodology, Center for Translational Research, Children’s Research Institute, Children’s National Hospital, Washington, DC
| | - Jichuan Wang
- Division of Biostatistics and Study Methodology, Center for Translational Research, Children’s Research Institute, Children’s National Hospital, Washington, DC
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Maureen E. Lyon
- George Washington University School of Medicine and Health Sciences, Washington, DC
- Division of Adolescent and Young Adult Medicine, Center for Translational Research, Children’s Research Institute, Children’s National Hospital, Washington, DC
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Baumann I, Künzel J, Goldbeck L, Tutus D, Niemitz M. Prolonged Grief, Posttraumatic Stress, and Depression Among Bereaved Parents: Prevalence and Response to an Intervention Program. OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:837-855. [DOI: 10.1177/0030222820918674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bereaved parents may experience diverse psychological symptoms. Possible interventions are not yet well established. In this study, the psychological symptoms of 323 bereaved parents (mean age = 39.97, SD = 7.21, 52.0% female), referred to a 4-week family-oriented rehabilitation (FOR) program, were assessed. The baseline assessments indicated that 160 (49.5%) parents showed symptoms of prolonged grief disorder (PGD). Complicated grief was indicated in 272 (84.2%), depression in 191 (59.1%), and posttraumatic stress disorder in 242 (74.9%) parents. Mothers were at higher risk of complicated grief ( p ≤ .001), depression ( p = .029), and posttraumatic stress disorder ( p = .004), compared to fathers. Significant remissions of symptoms between admission and discharge from the program are presented as symptoms of complicated grief, depression, and posttraumatic stress. The effect sizes ranged between d = 0.68 and 1.22. In addition, significantly fewer parents fulfilled PGD criteria on discharge from the FOR program ( p ≤ .001). The special FOR program appears promising with regard to improving the bereaved parents’ mental health.
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Affiliation(s)
- Ines Baumann
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University
| | - Jochen Künzel
- Psychosocial department, Family-Oriented Rehabilitation Clinic Tannheim, Tannheim, Germany
| | - Lutz Goldbeck
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University
| | - Dunja Tutus
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University
| | - Mandy Niemitz
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University
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48
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Howard Sharp KM, Meadows EA, Keim MC, Winning AM, Barrera M, Gilmer MJ, Akard TF, Compas BE, Fairclough DL, Davies B, Hogan N, Vannatta K, Gerhardt CA. The Influence of Parent Distress and Parenting on Bereaved Siblings' Externalizing Problems. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:1081-1093. [PMID: 33343178 PMCID: PMC7748062 DOI: 10.1007/s10826-019-01640-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Bereaved siblings experience more externalizing problems compared to non-bereaved peers and norms; however, the mechanisms explaining this phenomenon have not been empirically examined. This study tested the serial indirect effects of sibling bereavement on adolescents' externalizing problems through parent distress (i.e., internalizing symptoms) and parenting (i.e., parenting behaviors, parent-adolescent communication). METHODS During home visits, 72 bereaved adolescents (ages 10-18) whose brother/sister died from cancer and 60 comparison peers reported about their externalizing problems and their mothers' and fathers' parenting behaviors (warmth, behavioral control, psychological control) and parent-adolescent communication (open communication, problematic communication). Mothers and fathers reported their own internalizing symptoms. RESULTS Bereaved siblings reported more externalizing problems (p =.048) and bereaved mothers reported more internalizing symptoms relative to the comparison group (p =.015). Serial multiple mediation models indicated that elevated externalizing problems were partially explained by both bereaved mothers' internalizing symptoms and parenting and communication (less warmth [CI: 0.04, 0.86], more psychological control [CI: 0.03, 0.66], and more problematic mother-adolescent communication [CI: 0.03, 0.79]), with a significant indirect effect also emerging for open mother-adolescent communication [CI: 0.05, 1.59]. Bereaved fathers did not significantly differ in internalizing symptoms from comparison fathers (p =.453), and no significant indirect effects emerged for fathers. CONCLUSIONS Elevated externalizing problems in bereaved siblings may result from mothers' distress and the impact on their parenting and communication. Targeting adjustment and parenting in bereaved mothers following a child's death may reduce externalizing problems in bereaved siblings. Research to evaluate family-centered interventions is needed.
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Affiliation(s)
- Katianne M Howard Sharp
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | | | | | | | | | | | | | | | | | | | | | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
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49
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Hovén E, Hagström J, Pöder U, Grönqvist H, von Essen L. Parents' needs of support following the loss of a child to cancer: a Swedish, prospective, longitudinal, multi-centre study. Acta Oncol 2020; 59:351-357. [PMID: 31702406 DOI: 10.1080/0284186x.2019.1686535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Parents' needs of support following the loss of a child to cancer and whether these needs are met are not fully known. This study aimed to describe parents' needs, opportunity, and benefit of support from healthcare professionals and significant others from shortly after, up to five years after bereavement.Material and methods: Data were collected at nine months (T5, n = 20), eighteen months (T6, n = 37), and five years after the child's death (T7, n = 38). Parents answered questions via telephone about need, opportunity, and benefit of talking to psychologists, social workers, partners, and friends. Needs were examined in relation to parent and child characteristics, including sex, age, and parent posttraumatic stress symptoms (PTSS).Results: The proportion reporting a need of support from psychologists varied from 56% and 46% at T5 to 20% and 6% at T7 (mothers and fathers, respectively). All mothers and 90% of fathers reported a need of support from social workers at T5. At T7, the corresponding percentages were 30% and 6%. More mothers than fathers reported a need of support from friends at T7 (p = .001). The proportion reporting a need of support from psychologists, social workers, and friends decreased over time (all p ≤ .050). Parents reporting a higher level of PTSS were more likely to report a need of support from social workers at T6 (p = .040) and from psychologists (p = .011) and social workers (p = .012) at T7. Opportunities for support from healthcare professionals varied, most reported need of and opportunity for support from significant others. Almost all reported benefit from received support.Conclusion: Bereaved parents need and benefit of support from healthcare professionals and significant others. Results show a need for improved access to psychosocial services, even at five years post bereavement. Large-scale studies are needed to better understand the associations between parent and child characteristics and support needs.
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Affiliation(s)
- Emma Hovén
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Josefin Hagström
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ulrika Pöder
- Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helena Grönqvist
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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50
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Broden EG, Deatrick J, Ulrich C, Curley MAQ. Defining a "Good Death" in the Pediatric Intensive Care Unit. Am J Crit Care 2020; 29:111-121. [PMID: 32114610 PMCID: PMC11288184 DOI: 10.4037/ajcc2020466] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Societal attitudes about end-of-life events are at odds with how, where, and when children die. In addition, parents' ideas about what constitutes a "good death" in a pediatric intensive care unit vary widely. OBJECTIVE To synthesize parents' perspectives on end-of-life care in the pediatric intensive care unit in order to define the characteristics of a good death in this setting from the perspectives of parents. METHODS A concept analysis was conducted of parents' views of a good death in the pediatric intensive care unit. Empirical studies of parents who had experienced their child's death in the inpatient setting were identified through database searches. RESULTS The concept analysis allowed the definition of antecedents, attributes, and consequences of a good death. Empirical referents and exemplar cases of care of a dying child in the pediatric intensive care unit serve to further operationalize the concept. CONCLUSIONS Conceptual knowledge of what constitutes a good death from a parent's perspective may allow pediatric nurses to care for dying children in a way that promotes parents' coping with bereavement and continued bonds and memories of the deceased child. The proposed conceptual model synthesizes characteristics of a good death into actionable attributes to guide bedside nursing care of the dying child.
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Affiliation(s)
- Elizabeth G Broden
- Elizabeth G. Broden is a doctoral student, University of Pennsylvania School of Nursing, and a registered nurse, Pediatric Intensive Care Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Janet Deatrick
- Janet Deatrick is a professor emerita, Department of Family and Community Health, University of Pennsylvania School of Nursing
| | - Connie Ulrich
- Connie Ulrich is a professor, Department of Biobehavioral Health, School of Nursing, and a professor of bioethics, School of Medicine, University of Pennsylvania
| | - Martha A Q Curley
- Martha A.Q. Curley is the Ruth M. Colket Endowed Chair in Pediatric Nursing, Children's Hospital of Philadelphia, and a professor, Department of Family and Community Health, School of Nursing and Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania
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