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Safarifard R, Kiernan G, Corcoran Y, Courtney E, Mitchell J, Akard T, Lambert V. Memory-making interventions for children and their families receiving pediatric palliative or bereavement care: A systematic review protocol. HRB Open Res 2024; 7:30. [PMID: 39071733 PMCID: PMC11282391 DOI: 10.12688/hrbopenres.13891.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 07/30/2024] Open
Abstract
Background In paediatric palliative and bereavement care, providing comprehensive support that extends beyond medical treatment to address the emotional and psychosocial needs of children and their families is essential. Memory-making interventions play a critical role in capturing cherished moments and fostering emotional resilience. However, widespread consensus on the foundation and scope of memory-making interventions for children and young people remains sparse. This review aims to identify, appraise, and synthesise the evidence on memory-making interventions for children and young people with life-limiting or life-threatening conditions and their family members receiving palliative or bereavement care. Methods This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A systematic search will be undertaken from January 1, 1985, to February 27, 2024, across the following databases: PubMed, EMBASE, CINAHL (EBSCO), PsycINFO (EBSCO), Web of Science, the Cochrane Library, and Scopus. Studies across diverse research designs that examine children (0-19 years) with life-limiting or life-threatening conditions undergoing memory-making interventions with psychosocial or other outcomes will be included. Screening, data extraction, and quality appraisal will be performed by two independent reviewers, with a third reviewer resolving discrepancies. Joanna Briggs Institute guidelines for conducting mixed methods systematic reviews will be used to inform the data analysis and synthesis process. Conclusions This review will provide critical insights into the existing evidence base on memory-making interventions in paediatric palliative and bereavement care, highlighting psychosocial and other impacts, implementation factors, and evidence quality. By identifying best practices and gaps in knowledge, this evidence review may inform future research and intervention design, or adaptation, and contribute to the enhancement of healthcare for children and young people with life-limiting and life-threatening conditions and their families as well as families in bereavement. Registration This review was registered in PROSPERO, the International Prospective Register of Systematic Reviews (CRD42024521388; 18/03/2024).
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Affiliation(s)
- Razieh Safarifard
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Leinster, D09 V209, Ireland
| | - Gemma Kiernan
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Leinster, D09 V209, Ireland
| | - Yvonne Corcoran
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Leinster, D09 V209, Ireland
| | - Eileen Courtney
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Leinster, D09 V209, Ireland
| | - John Mitchell
- Head of Partnerships, Barretstown Children’s Charity, Ballymore Eustace, Kildare, W91 RDX6, Ireland
| | - Terrah Akard
- School of Nursing, Vanderbilt University, Nashville, Tennessee, TN 37240, USA
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Leinster, D09 V209, Ireland
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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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3
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Xu DD, Zhang GX, Ding XB, Ma J, Suo YX, Peng YY, Zeng JL, Liu M, Hou RT, Li J, Hu F. Bereaved parents' perceptions of memory making: a qualitative meta-synthesis. BMC Palliat Care 2024; 23:24. [PMID: 38273273 PMCID: PMC10809512 DOI: 10.1186/s12904-024-01339-0] [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: 09/27/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE This study aims to investigate the experiences of parents who have experienced bereavement in their efforts to preserve memories of their deceased child. METHODS Employing a qualitative meta-synthesis approach, this study systematically sought relevant qualitative literature by conducting searches across various electronic databases, including PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Wiley, up until July 2023. RESULTS Nine studies are eligible for inclusion and included in the meta-synthesis. Three overarching categories are identified: (1) Affirming the Significance of Memory Making. (2) Best Practices in Memory Making. (3) Barriers to Effective Memory Making. CONCLUSION Bereaved parents highly value the act of creating lasting memories, emphasizing its profound significance. While forming these memories, it is imperative to offer family-centered care and honor diverse preferences and needs. It is essential to offer effective support to parents, offering them a range of choices. Furthermore, a more comprehensive examination of memory-making practices is required to better understand their influence on parents' recollections of their deceased child.
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Affiliation(s)
- Dan-Dan Xu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Guang-Xiong Zhang
- Department of Anesthesiology, Hubei Province Corps Hospital of The Chinese Armed Police Force (CAPF), Wuhan, China
| | - Xin-Bo Ding
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Ya-Xi Suo
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Yang-Yao Peng
- Department of Neurosurgical Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ji-Li Zeng
- Department of Otorhinolaryngology, General Hospital of Central Theater Command, Wuhan, China
| | - Miao Liu
- Department of Pulmonary Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rui-Tong Hou
- Department of Pulmonary Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jin Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China.
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China.
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4
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Neefjes V. Parental Ethical Decision Making and Implications for Advance Care Planning: A Systematic Review and Secondary Analysis of Qualitative Literature from England and Wales, Germany, and the Netherlands. J Palliat Med 2023; 26:1728-1743. [PMID: 37262127 DOI: 10.1089/jpm.2022.0520] [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: 06/03/2023] Open
Abstract
Background: Clinicians and parents are expected to make medical treatment decisions in the child's best interests. To reach their decisions, clinicians typically apply a principled approach outlined by Beauchamp and Childress. How parents make ethical decisions is an under-researched area. A possible model for parental decision making is the Ethics of Care (EoC) theory. Ethical decision making within this framework aims to preserve the caring relationship. What is right or wrong depends on the circumstances at the time. Objective: To identify the parental ethical values and determine whether parental decision making is consistent with EoC, a systematic review and secondary analysis of qualitative research from England and Wales, the Netherlands, and Germany was performed. As part of a larger project investigating conflicts between parents and clinicians about children's medical treatment, the choice of countries was determined by differences in litigation. Methods: Eight databases were searched for articles published between 2010 and 2020 reporting on at least one medical treatment decision made by parents of a child with any life-limiting condition and analyzed using reflexive thematic analysis. Twelve included articles directly addressing advance care planning (ACP) were reanalyzed to investigate whether this specific decision parents are increasingly being asked to make is also consistent with EoC. Results: Forty-three articles were included. Parents use the same 6 ethical values which, consistent with EoC, are mostly in the context of their relationship with the child. All values contributed to the previously identified theme of "being a good parent/person." Analysis of parental decision making in ACP confirmed consistency with EoC. Conclusion: The parental decision-making process is consistent with EoC. That parental decisions aim to maintain the caring relationship and are dependent on the circumstances at the time has implications for parental decision making in ACP and should be reflected in future policies.
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Affiliation(s)
- Veronica Neefjes
- Center for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Manchester, United Kingdom
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5
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Feifer D, Broden EG, Xiong N, Mazzola E, Baker JN, Wolfe J, Snaman JM. Mixed-methods analysis of decisional regret in parents following a child's death from cancer. Pediatr Blood Cancer 2023; 70:e30541. [PMID: 37414728 DOI: 10.1002/pbc.30541] [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: 05/02/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Decisional regret is common in bereaved parents. We aimed to identify factors associated with and to explain patterns of parental decisional regret. METHODS We used a convergent mixed-methods design including quantitative items and free-text responses from a survey of parents 6-24 months from their child's death from cancer. Parents expressed whether they had regrets about decisions during the end of their child's life (Yes/No/I don't know) and elaborated with free text. Results of qualitative content analysis of free-text responses guided development and interpretation of quantitative multinomial models. RESULTS Parents (N = 123 surveys, N = 84 free text) primarily identified as White (84%), mothers (63%), and primary caregivers (69%) for their children. Forty-seven (38%) parents reported decisional regret, 61 (49%) indicated no regret, and 15 (12%) were unsure. Mothers (relative risk [RR]: 10.3, 95%CI: [1.3, 81.3], p = .03) and parents who perceived greater suffering at the end of their child's life (RR = 3.8, 95%CI: [1.2, 11.7], p = .02) were at increased risk of regret; qualitative evaluation revealed elements of self-blame and difficulty reconciling treatment choices with the ultimate outcome. Preparation for symptoms was associated with decreased risk of regret (RR = 0.1, 95%CI: [0, .3], p < .01) with qualitative reflections focused on balanced teamwork that alerted parents for what to expect and how to make meaningful final memories. CONCLUSIONS Though decisional regret is common among cancer-bereaved parents, mothers and those who perceive more suffering in their children may be at particular risk. Close collaboration between families and clinicians to prepare for symptoms and proactively attend to and minimize suffering may help alleviate decisional regret.
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Affiliation(s)
- Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elizabeth G Broden
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Niya Xiong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Joanne Wolfe
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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6
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Snaman JM, Mazzola E, Helton G, Feifer D, Morris SE, Clark L, Baker JN, Wolfe J. Early Bereavement Psychosocial Outcomes in Parents of Children Who Died of Cancer With a Focus on Social Functioning. JCO Oncol Pract 2023; 19:e527-e541. [PMID: 36724414 DOI: 10.1200/op.22.00538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The early grief experience of parents of children who died of cancer remains understudied. Understanding psychosocial symptomology and functioning of parents early in their bereavement is essential to developing supportive interventions aimed at offsetting poor mental and physical outcomes. METHODS Parents of children from two centers who died of cancer 6 to 24 months before were mailed a survey that included validated tools and additional Likert scale-based questions. We used correlation and univariate and multiple regression analyses to assess the associations between psychosocial and grief outcomes and parental social functioning. RESULTS One hundred twenty-five parents representing 88 children completed the survey. Most respondents identified as female (63%), White (84%), and non-Hispanic (91%). The mean time since child's death was 14.7 (range, 8-26) months. Bereaved parents' mean score for social functioning was only slightly below normative values, and most parents indicated post-traumatic growth and adaptive coping. Parents had high symptom levels for depression, anxiety, post-traumatic stress, and prolonged grief, with those identifying as female having significantly higher symptom scores. Using multivariate analysis, parental scores for resilience and continuing bonds were associated with higher social functioning scores and parental scores for depressive symptoms and prolonged grief were associated with lower social functioning scores. CONCLUSION Although bereaved parents exhibit resilience and positive coping, they also show high levels of psychosocial distress in the first 2 years after their child's death, which may reflect the typical parental bereavement experience. Screening for low parental social functioning may identify parents who would benefit from additional support early in bereavement.
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Affiliation(s)
- Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Gabrielle Helton
- Doctor of Medicine Program, University of Colorado School of Medicine, Aurora, CO
| | - Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Sue E Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Psychiatry, Boston Children's Hospital and Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Lisa Clark
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Pediatrics, Boston Children's Hospital, Boston, MA
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7
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Feifer D, Broden EG, Baker JN, Wolfe J, Snaman J. "It's Hard Not to Have Regrets:" Qualitative Analysis of Decisional Regret in Bereaved Parents. J Pain Symptom Manage 2023; 65:e399-e407. [PMID: 36641003 DOI: 10.1016/j.jpainsymman.2022.12.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/14/2023]
Abstract
CONTEXT Bereaved parents may have heightened risk for decisional regret; however, little is known about regret early in bereavement. OBJECTIVES We characterized decisional regrets endorsed by parents of children who died from cancer within the first two years of their bereavement. METHODS We analyzed responses from a cross-sectional, dual site study of parents six to 24 months from their child's death. Parents indicated whether they had regrets about decisions made at the end of their child's life (yes/no/I don't know) and elaborated with free text. We used content analysis to identify recurrent categories in parents' responses. RESULTS A total of 125 parents of 88 children completed the survey; 123 responded to the decisional regret item and 84 (63%) elaborated with free text. Forty-seven (38%) parents reported decisional regret(s), 61 (50%) indicated no regret(s), and 15 (12%) were unsure. Parental free-text responses related to five categories: treatments, including those pursued and/or not pursued (n = 57), decision-making processes (n = 35), relationships with their child and care team (n = 26), child suffering (n = 10), and end-of-life characteristics (n = 6). The relative frequency of categories was similar in parents with and without decisional regret, but self-blame was more common in responses from parents with decisional regret. CONCLUSION Many bereaved parents endorse decisional regret in early bereavement. Treatments and decision-making processes were most cited among parents both with and without regret. Identifying factors associated with heightened parental risk of decisional regret using longitudinal study is an important focus of future research.
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Affiliation(s)
- Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care (D.F., E.B., J.W., J.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Quality of Life and Palliative Care, Department of Oncology (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics (J.W., J.S.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Elizabeth G Broden
- Department of Psychosocial Oncology and Palliative Care (D.F., E.B., J.W., J.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Quality of Life and Palliative Care, Department of Oncology (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics (J.W., J.S.), Boston Children's Hospital, Boston, Massachusetts, USA.
| | - Justin N Baker
- Department of Psychosocial Oncology and Palliative Care (D.F., E.B., J.W., J.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Quality of Life and Palliative Care, Department of Oncology (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics (J.W., J.S.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care (D.F., E.B., J.W., J.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Quality of Life and Palliative Care, Department of Oncology (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics (J.W., J.S.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer Snaman
- Department of Psychosocial Oncology and Palliative Care (D.F., E.B., J.W., J.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Quality of Life and Palliative Care, Department of Oncology (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics (J.W., J.S.), Boston Children's Hospital, Boston, Massachusetts, USA
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8
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De Clercq E, Grotzer M, Landolt MA, von Helversen B, Flury M, Rössler J, Kurzo A, Streuli J. No wrong decisions in an all-wrong situation. A qualitative study on the lived experiences of families of children with diffuse intrinsic pontine glioma. Pediatr Blood Cancer 2022; 69:e29792. [PMID: 35652529 DOI: 10.1002/pbc.29792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diffuse intrinsic pontine glioma (DIPG) is a rare, but lethal pediatric brain tumor with a median survival of less than 1 year. Existing treatment may prolong life and control symptoms, but may cause toxicity and side effects. In order to improve child- and family-centered care, we aimed to better understand the treatment decision-making experiences of parents, as studies on this topic are currently lacking. PROCEDURE The data for this study came from 24 semistructured interviews with parents whose children were diagnosed with DIPG in two children's hospitals in Switzerland and died between 2000 and 2016. Analysis of the dataset was done using reflexive thematic analysis. RESULTS For most parents, the decision for or against treatment was relatively straightforward given the fatality of the tumor and the absence of treatment protocols. Most of them had no regrets about their decision for or against treatment. The most distressing factor for them was observing their child's gradual loss of independence and informing them about the inescapability of death. To counter this powerlessness, many parents opted for complementary or alternative medicine in order to "do something." Many parents reported psychological problems in the aftermath of their child's death and coping strategies between mothers and fathers often differed. CONCLUSION The challenges of DIPG are unique and explain why parental and shared decision-making is different in DIPG compared to other cancer diagnoses. Considering that treatment decisions shape parents' grief trajectory, clinicians should reassure parents by framing treatment decisions in terms of family's deeply held values and goals.
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Affiliation(s)
- Eva De Clercq
- Institute of Bioethics and History of Medicine, University of Zürich, Zurich, Switzerland
| | - Michael Grotzer
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Markus A Landolt
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | - Maria Flury
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jochen Rössler
- Cancer Center Inselspital UCI, Inselspital University, Bern, Switzerland
| | - Andrea Kurzo
- Cancer Center Inselspital UCI, Inselspital University, Bern, Switzerland
| | - Jürg Streuli
- Institute of Bioethics and History of Medicine, University of Zürich, Zurich, Switzerland.,University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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9
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Lu T, Liang D, Hong M, Sun J. Regret Now, Compensate It Later: The Benefits of Experienced Regret on Future Altruism. Front Psychol 2022; 13:840809. [PMID: 35465568 PMCID: PMC9021411 DOI: 10.3389/fpsyg.2022.840809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
This article explores how experienced regret and relief evoked in a risky gambling task influence subsequent intertemporal pro-social behavior. We apply a dictator game experiment with delayed rewards to investigate the effect on donating behavior by simultaneously the time delay when the recipient accepts the donation and the emotions experienced by the participant. We examine this effect using a choice titration procedure. The results reveal that independent of the prior experienced emotions, participants’ donations decrease as the time delay rises; the hyperbolic model provides a better explanation of this finding. Significantly, experienced regret impacts the shape of the social discount function with delayed rewards, which is reflected in notably different discount rates. Participants who experienced regret exhibit a lower discount rate than those in the relief condition. Note that this distinct type of generosity differs significantly at the 14-day delay but not at the shortest and longest. It follows that regret can promote future altruism and intertemporal pro-social behavior, depending on the delay.
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Affiliation(s)
- Teng Lu
- School of Management, Harbin Institute of Technology, Harbin, China
| | - Dapeng Liang
- School of Management, Harbin Institute of Technology, Harbin, China
| | - Mei Hong
- School of Management, Harbin Institute of Technology, Harbin, China
| | - Jiayin Sun
- School of Humanities, Social Sciences and Law, Harbin Institute of Technology, Harbin, China
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10
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Rapoport A, Gupta S. Children and adolescents with hematologic cancers deserve better end-of-life care. Cancer 2021; 127:3724-3726. [PMID: 34185886 DOI: 10.1002/cncr.33763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Adam Rapoport
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Emily's House Children's Hospice, Toronto, Ontario, Canada
| | - Sumit Gupta
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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11
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Ballantine K, Gooder C, Ryan E, Macfarlane S. Listening to the experts: Parents' perspectives around infection risk and returning to education and social activities following their child's diagnosis of acute lymphoblastic leukemia. Cancer Rep (Hoboken) 2021; 5:e1424. [PMID: 33988314 PMCID: PMC9199503 DOI: 10.1002/cnr2.1424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 01/30/2023] Open
Abstract
Background During a child's prolonged treatment for acute lymphoblastic leukemia (ALL), there is a need to balance their increased risk of developing infection‐related complications with meeting their educational and social needs. Aims To determine the safe timing of return to social activities for children undergoing treatment for ALL and to determine how parents perceive and act on advice related to infection risk while navigating their child's “return to normal.” Methods and results Medical and educational attendance records were reviewed for 47 children who were diagnosed with ALL and 24 semi‐structured qualitative interviews were conducted with a representative sample of their parents. The majority of children (69%) did not return to education prior to the start of maintenance therapy regardless of the advice that the families received from their healthcare team. Those who returned earlier were at no greater risk of major infection complications (mean = 0.5) than those who did not return until after commencing maintenance (mean = 0.4, P = .74). Parents spoke of the difficulty in obtaining practical, consistent, and timely advice and of balancing infection risk with a desire to return to normalcy. Inconsistent advice and constant vigilance placed a burden on parents which often profoundly affected their mental wellbeing. Overall, parents wanted to make their own decisions about how and when their child returned to education and social activities. They made these decisions based on many factors, of which infection risk was just one. Conclusion Following the study conclusion, a national working group was established—including parent representatives—to implement the study recommendations. This includes the development of a range of practical resources to better support families. Health professional guidelines provide quantitative data pertaining to infection risk, while emphasizing that the returning decisions ultimately rest with the families. This research demonstrates that listening to parents—who are the experts through their lived experiences—is a critical element in creating policies that are responsive, meaningful, and widely accepted.
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Affiliation(s)
- Kirsten Ballantine
- National Child Cancer Network, Auckland, New Zealand.,Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Claire Gooder
- National Child Cancer Network, Auckland, New Zealand.,Child Cancer Foundation, Auckland, New Zealand
| | | | - Scott Macfarlane
- National Child Cancer Network, Auckland, New Zealand.,Starship Blood and Cancer Centre, Starship Child Health, Auckland, New Zealand
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Schaefer MR, Kenney AE, Himelhoch AC, Howard Sharp KM, Humphrey L, Olshefski R, Young-Saleme T, Gerhardt CA. A quest for meaning: A qualitative exploration among children with advanced cancer and their parents. Psychooncology 2020; 30:546-553. [PMID: 33230868 DOI: 10.1002/pon.5601] [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: 07/12/2020] [Revised: 11/05/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Meaning-making may assist individuals in adaptation to stressful life events, particularly bereavement. However, few studies have examined meaning-making among pediatric populations with advanced illness to understand how this process unfolds before the child's death. This study explores meaning-making pre-bereavement among children with advanced cancer and their parents. METHODS As part of a larger study examining shared decision-making near the end of life, 24 children with advanced cancer and/or high-risk cancer, 26 mothers, and 11 fathers participated in individual, semi-structured interviews. Analyses focused on questions regarding meaning-making. Four coders analyzed the data via directed content analysis. RESULTS Three major meaning-making themes emerged: (1) sense-making (i.e., unknown, no sense/meaning, religious/spiritual explanations, scientific explanations), (2) benefit-finding, and (3) purpose/legacy. Some stated they were unable to make sense of the diagnosis, because there was no reason, they were not there yet, or they were dealing with the situation and moving forward. Others reported finding meaning through spiritual and scientific explanations. Many identified benefits related to the child's illness, such as personal growth and stronger relationships. Some parents expressed their purpose in life was to live for their children, while others shared their child's legacy as a way to find meaning. CONCLUSIONS Our findings highlight the struggle children and parents often face when attempting to make sense of the child's advanced or high-risk illness. Clinicians might consider if meaning-centered interventions designed for use in adults at the end of life and bereaved parents may be helpful for children with advanced or high-risk cancer and their parents.
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Affiliation(s)
| | - Ansley E Kenney
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | | | - Lisa Humphrey
- Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University, Columbus, Ohio, USA
| | - Randal Olshefski
- Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University, Columbus, Ohio, USA
| | - Tammi Young-Saleme
- Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University, Columbus, Ohio, USA
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University, Columbus, Ohio, USA
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13
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Meisenhelder JB. Maternal grief: analysis and therapeutic recommendations. BMJ Support Palliat Care 2020; 11:101-106. [PMID: 33239325 DOI: 10.1136/bmjspcare-2020-002673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/05/2020] [Indexed: 11/04/2022]
Abstract
The following self-analysis contains key experiences of maternal grief over the course of the first 2 years following the death of a child, with specific examples and observations from bereaved mothers shared with the author. The references provide supporting evidence for commonality of the lived experience and observations. Therapeutic responses for clinicians give concrete direction for providing effective comfort. Self-care suggestions for mothers provide specific guidance for the readers. A 14-year retrospective epilogue puts the charged emotional description into a context of healing.
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