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Skrabal Ross X, Condon P, Yates P, Walker R, Herbert A, Bradford N. Feasibility of Weekly Electronic Patient- and Proxy-Reported Outcome Measures in Pediatric Oncology. Cancer Nurs 2024; 47:E318-E326. [PMID: 37232526 DOI: 10.1097/ncc.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Electronic patient-reported outcome measures (ePROMs) benefit adult cancer care, but their use in pediatric cancer care is limited. OBJECTIVES To explore the feasibility of collecting weekly ePROMs from pediatric cancer patients and/or their caregivers and to describe children's levels of symptom burden, distress, and cancer-related quality of life. METHODS A prospective and longitudinal cohort study was undertaken at one tertiary children's cancer center. Children (2-18 years)/caregivers completed ePROMs with validated measures for distress, symptom burden, and cancer-related quality of life weekly for 8 weeks. RESULTS Seventy children/caregivers participated in the study, and 69% completed ePROMs at all 8 weeks. Distress and cancer-related quality of life significantly improved over time. However, at week 8, almost half of the participants still reported high levels of distress. Symptom burden decreased over time, with the youngest and the oldest age groups (2-3 and 13-18 years) reporting the highest number of symptoms with severe burden. CONCLUSIONS Weekly collection of ePROMs in pediatric cancer care is feasible. Although distress, quality of life, and symptom burden improve over time, there is a need for timely assessment and interventions to improve symptoms, high levels of distress, and issues that negatively affect quality of life. IMPLICATIONS FOR PRACTICE Nurses are ideally placed to intervene, assess, and monitor symptoms and to provide symptom management advice to pediatric cancer patients and caregivers. Findings from this study may inform the design of models of pediatric cancer care to improve communication with the healthcare team and patient experience of care.
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Affiliation(s)
- Xiomara Skrabal Ross
- Author Affiliations: Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation (Drs Skrabal Ross, Yates, and Bradford), and Centre for Children's Health Research (Dr Skrabal Ross, Mrs Condon, Mr Walker, Mr Herbert, and Dr Bradford), Queensland University of Technology, and Oncology Service Group, Queensland Children's Hospital (Mrs Condon, Mr Walker, and Mr Herbert), Children's Health Queensland, South Brisbane, Australia
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Davis KA, Mazzenga M, Hall PB, Buchbinder D, Alderfer MA, Oberoi AR, Sharkey CM, Blakey AO, Long KA. Development of a blueprint for sibling psychosocial services: A nationwide study. Pediatr Blood Cancer 2024; 71:e30993. [PMID: 38605546 DOI: 10.1002/pbc.30993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Siblings of youth with cancer have heightened risk for poor long-term psychosocial outcomes. Although sibling psychosocial care is a standard in pediatric oncology, this standard is among those least likely to be met. To address barriers to providing sibling services, a blueprint for systematic psychosocial screening and support of siblings was developed based on feedback from a national sample of psychosocial providers. PROCEDURE Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N = 27) of various disciplines working in US pediatric cancer centers, varied in size, type, and extent of sibling support. Interviews queried providers' suggestions for the future of sibling psychosocial care and impressions of a blueprint for sibling service delivery, which was iteratively refined based on respondents' feedback. Interviews were analyzed using applied thematic analysis. RESULTS Based on existing literature and refined according to providers' recommendations, the Sibling Services Blueprint was developed to provide a comprehensive guide for systematizing sibling psychosocial care. The blueprint content includes: (i) a timeline for repeated sibling screening and assessment; (ii) a stepped model of psychosocial support; (iii) strategies for circumventing barriers to sibling care; and (iv) recommendations for how centers with varying resources might accomplish sibling-focused care. The blueprint is available online, allowing providers to easily access and individualize the content. Providers indicated enthusiasm and high potential utility and usability of the blueprint. CONCLUSIONS The Sibling Services Blueprint may be a useful tool for systematizing sibling psychosocial care, promoting wider availability of sibling-focused services, and addressing siblings' unmet needs.
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Affiliation(s)
- Kathryn A Davis
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Marcella Mazzenga
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Phoebe Brosnan Hall
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - David Buchbinder
- Division of Hematology, Children's Hospital of Orange County, Orange, California, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anjali R Oberoi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christina M Sharkey
- Department of Psychology, The Catholic University of America, Columbia, Washington, USA
| | - Ariel O Blakey
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Kristin A Long
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
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Robichaud LA, Felipe J, Duval M, Michon B, Olivier-D’Avignon M, Perreault S, Tyo-Gomez M, Marquis MA, Sultan S. Quality-of-Life Assessment in Pediatric Advanced Cancer: Development of the Patient-Reported Outcome Measure Advance QoL. Curr Oncol 2024; 31:2289-2304. [PMID: 38668073 PMCID: PMC11049209 DOI: 10.3390/curroncol31040170] [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: 03/22/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
A recent measure was developed to assess the Quality of Life (QoL) of young people with advanced cancer and is available for parents and professionals (Advance QoL). The present study aimed to elaborate self-reported versions for children and adolescents with advanced cancer. We adopted a four-phase research plan: (1) to elaborate the Advance QoL questionnaire for youth (8-12 and 13-18 years old) with a team of young research partners; (2) to evaluate the understandability of these versions in a sample of 12 young patients from the target population using cognitive interviews; (3) to assess social validity in the same group using a questionnaire and the content validity index (CVI); and (4) to refine the questionnaires according to these results. Four major themes were identified: (1) issues affecting the understanding of the tool; (2) issues that did not affect the understanding of the tool; (3) modifications to improve the tool; and (4) positive features of the tool. Advance QoL was well received, and feedback was positive. Adjustments were made according to young people's comments and two self-reported versions are now available. It is essential to measure the key domains of QoL in advanced cancer. Advance QoL self-report versions will help target the specific needs of young people with this condition and their families.
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Affiliation(s)
- Lye-Ann Robichaud
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada; (L.-A.R.); (J.F.)
- Azrieli Research Centre, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada;
| | - Julie Felipe
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada; (L.-A.R.); (J.F.)
| | - Michel Duval
- Department of Pediatrics, Université de Montréal, Montréal, QC H3C 3J7, Canada; (M.D.); (M.-A.M.)
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Bruno Michon
- Centre Mère-Enfant Soleil, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada;
| | | | - Sébastien Perreault
- Azrieli Research Centre, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada;
- Department of Neurology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Mathias Tyo-Gomez
- Psycho-Oncology Center (CPO), CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada;
| | - Marc-Antoine Marquis
- Department of Pediatrics, Université de Montréal, Montréal, QC H3C 3J7, Canada; (M.D.); (M.-A.M.)
- Department of General Pediatrics, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Serge Sultan
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada; (L.-A.R.); (J.F.)
- Azrieli Research Centre, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada;
- Department of Pediatrics, Université de Montréal, Montréal, QC H3C 3J7, Canada; (M.D.); (M.-A.M.)
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Pedraza EC, Raguindin PF, Hendriks MJ, Vokinger AK, De Clercq E, Rüesch K, Hjorth L, von Bueren AO, Tinner EM, Bergstraesser E, Wiener L, Michel G. Palliative care services in paediatric oncology centres across Europe: A cross-sectional survey. EJC PAEDIATRIC ONCOLOGY 2023; 2:100125. [PMID: 38223237 PMCID: PMC10785771 DOI: 10.1016/j.ejcped.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Background Palliative care (PC) is an integral part of cancer treatment. However, data on service availability is limited in childhood cancers. Aim To describe the availability of PC services in paediatric oncology centres across Europe, and to identify barriers and facilitators for implementing and providing paediatric palliative care (PPC). Methods Paediatric oncology centres across Europe were invited to complete an online questionnaire. Results A total of 158 paediatric oncology centres from 27 European countries participated. More than half of the centres (n=102, 64.6%) reported offering specialised PPC (defined as 24/7 coverage services with specialized physician and a multidisciplinary team). Most centres included a multidisciplinary care team (n=123, 80.9%) and PC at home (n=105, 69.1%). In 38.7% centres, service capacity was reported to be lower than demand. In most centres, PC consultation was initiated for a refractory neoplasm (n=126, 81.2%). Few centres (n=11, 7.1%) offered PC consultation at the time of a new cancer diagnosis. Eighty-two centres (52.6%) reported having bereavement services. Negative parental perception (n=99, 64.7%) and late referrals (n=91, 59.5%) were major barriers to implementation perceived by health care providers. Conclusion Our results suggest that specialised PPC is available in more than half of paediatric oncology settings across Europe. Although half have had PPC available for >10 years, many cannot fulfil the demand for service. Barriers to implementation (i.e., parental education, staff training) should be addressed, with resources and services further expanded to cover the demand for PPC, including bereavement care.
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Affiliation(s)
- Eddy Carolina Pedraza
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Manya Jerina Hendriks
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Eva De Clercq
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Katja Rüesch
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Lars Hjorth
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - André Oscar von Bueren
- Department of Paediatrics, Obstetrics and Gynaecology Division of Paediatric Haematology and Oncology University Hospital of Geneva, Switzerland
| | - Eva Maria Tinner
- Paediatric Haematology/Oncology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eva Bergstraesser
- Department of Paediatrics, Paediatric Palliative Care, University Children’s Hospital Zurich, University of Zurich, Switzerland
| | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Trigoso V, Vásquez L, Fuentes-Alabi S, Pascual C, Méndez T, Maradiegue E, Villegas M, Perina E, Ahumada E, de Bragança J, Zubieta M, Jiménez MDP, Bernedo H, Ruda L, Sierralta M, Motta A, Rossell N, Vargas D, Salazar Y, López M, Plascencia O, Arita A, Molinas R, Salaverria C, Velásquez O, Ugaz C. Standards for psychosocial care in pediatric cancer: adapted proposal for Latin American and Caribbean countries. Rev Panam Salud Publica 2023; 47:e156. [PMID: 37901443 PMCID: PMC10612524 DOI: 10.26633/rpsp.2023.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/07/2023] [Indexed: 10/31/2023] Open
Abstract
Objective To highlight the objectives, achievements, challenges, and next steps for the World Health Organization's Global Initiative for Childhood Cancer (GICC) framework, a project designed to improve psychosocial care (PSC) in pediatric cancer centers across Latin America and the Caribbean (LAC). Methods The project was launched in Peru, the first GICC focal country, in November 2020. The diagnosis phase included a survey and a semistructured interview with health professionals to assess PSC practices in institutions, and a needs assessment survey for caregivers. In the second phase, a strategic plan was developed to address the identified needs, including the adaptation of PSC standards, the establishment of multicenter working groups, the expansion of the proposal, and the development of materials. Results The study found that PSC was not being adequately provided in accordance with international standards. Six adapted standards were proposed and validated, and more than 50 regional health professionals participated in online activities to support the project. The implementation process is currently ongoing, with the establishment of five multidisciplinary working groups, one regional committee, and the production of 16 technical outputs. Conclusion This project represents a substantial step forward to improve PSC for pediatric patients with cancer and their families in LAC countries. The establishment of working groups and evidence-based interventions strengthen the proposal and its implementation. Development of health policies that include PSC according to standards is needed to achieve sustainable results in the quality of life of children with cancer and their families.
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Affiliation(s)
- Viviana Trigoso
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashingtonUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, United States of America.
- Departamento de PsicologíaPontificia Universidad Católica del PerúLimaPeruDepartamento de Psicología, Pontificia Universidad Católica del Perú, Lima, Peru.
- Asociación Nacional de Psicooncología del PerúLimaPeruAsociación Nacional de Psicooncología del Perú, Lima, Peru.
| | - Liliana Vásquez
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashingtonUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, United States of America.
| | - Soad Fuentes-Alabi
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashingtonUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, United States of America.
| | - Claudia Pascual
- Pan American Health Organization PerúNoncommunicable Diseases UnitLimaPeruPan American Health Organization Perú, Noncommunicable Diseases Unit, Lima, Peru.
| | - Teresa Méndez
- Fundación Natali Dafne FlexerBuenos AiresArgentinaFundación Natali Dafne Flexer, Buenos Aires, Argentina.
| | - Essy Maradiegue
- Departamento de Normatividad, Calidad y Control Nacional de los Servicios OncológicosInstituto Nacional de Enfermedades NeoplásicasLimaPeruDepartamento de Normatividad, Calidad y Control Nacional de los Servicios Oncológicos, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru.
| | - Mariela Villegas
- Asociación Nacional de Psicooncología del PerúLimaPeruAsociación Nacional de Psicooncología del Perú, Lima, Peru.
| | - Elisa Perina
- Faculdade de Ciências Médicas de Minas GeraisBelo HorizonteBrazilFaculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.
| | - Eugenia Ahumada
- Unidad de OncologíaHospital de Niños Roberto del RíoSantiagoChileUnidad de Oncología, Hospital de Niños Roberto del Río, Santiago, Chile.
| | - João de Bragança
- Childhood Cancer InternationalAmsterdamNetherlandsChildhood Cancer International, Amsterdam, Netherlands.
| | - Marcela Zubieta
- Childhood Cancer International LATAMChildhood Cancer International LATAM.
- Fundación Nuestros HijosSantiagoChileFundación Nuestros Hijos, Santiago, Chile.
| | - María del Pilar Jiménez
- Servicio de Psicología de la Sub Unidad de Atención Integral Especializada Pediátrica y Sub EspecialidadesInstituto Nacional de Salud del Niño San BorjaLimaPeruServicio de Psicología de la Sub Unidad de Atención Integral Especializada Pediátrica y Sub Especialidades, Instituto Nacional de Salud del Niño San Borja, Lima, Peru.
| | - Hernan Bernedo
- Unidad Funcional de Salud Mental OncológicaInstituto Nacional de Enfermedades NeoplásicasLimaPeruUnidad Funcional de Salud Mental Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru.
| | - Lourdes Ruda
- Departamento de PsicologíaPontificia Universidad Católica del PerúLimaPeruDepartamento de Psicología, Pontificia Universidad Católica del Perú, Lima, Peru.
- Asociación Nacional de Psicooncología del PerúLimaPeruAsociación Nacional de Psicooncología del Perú, Lima, Peru.
| | - Melisa Sierralta
- Asociación Nacional de Psicooncología del PerúLimaPeruAsociación Nacional de Psicooncología del Perú, Lima, Peru.
| | - Alessandra Motta
- Programa de Pós-Graduação em PsicologiaUniversidade Federal do Espírito SantoVitóriaBrazilPrograma de Pós-Graduação em Psicologia, Universidade Federal do Espírito Santo, Vitória, Brazil.
| | - Nuria Rossell
- Independent researcherAmsterdamNetherlandsIndependent researcher, Amsterdam, Netherlands.
| | - Daniela Vargas
- Asociación Nacional de Psicooncología del PerúLimaPeruAsociación Nacional de Psicooncología del Perú, Lima, Peru.
| | - Yurfa Salazar
- Unidad Funcional de Salud Mental OncológicaInstituto Nacional de Enfermedades NeoplásicasLimaPeruUnidad Funcional de Salud Mental Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru.
| | - Marisa López
- Servicio de PsicologíaInstituto Nacional de Salud del Niño BreñaLimaPeruServicio de Psicología, Instituto Nacional de Salud del Niño Breña, Lima, Peru.
| | - Oscar Plascencia
- Servicio de Psicología de la Sub Unidad de Atención Integral Especializada Pediátrica y Sub EspecialidadesInstituto Nacional de Salud del Niño San BorjaLimaPeruServicio de Psicología de la Sub Unidad de Atención Integral Especializada Pediátrica y Sub Especialidades, Instituto Nacional de Salud del Niño San Borja, Lima, Peru.
| | - Armando Arita
- Fundación Niñez PrimeroSan SalvadorEl SalvadorFundación Niñez Primero, San Salvador, El Salvador.
| | - Raquel Molinas
- Instituto Nacional del CáncerAsunciónParaguayInstituto Nacional del Cáncer, Asunción, Paraguay.
| | - Carmen Salaverria
- Fundación Ayúdame a VivirSan SalvadorEl SalvadorFundación Ayúdame a Vivir, San Salvador, El Salvador.
| | - Oscar Velásquez
- Servicio de PsicologíaHospital Nacional Guillermo AlmenaraLimaPeruServicio de Psicología, Hospital Nacional Guillermo Almenara, Lima, Peru.
| | - Cecilia Ugaz
- Departamento de Oncología PediátricaInstituto Nacional de Enfermedades NeoplásicasLimaPeruDepartamento de Oncología Pediátrica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru.
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Kirkpatrick K, Irwin MK, Young-Saleme T, Brown NN, Vannatta K. Universal assessment and tiered intervention: A model of care to meet the pediatric oncology psychosocial standard of care for school support. Psychooncology 2023; 32:1443-1451. [PMID: 37529939 DOI: 10.1002/pon.6197] [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: 03/17/2023] [Revised: 06/21/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE The feasibility and acceptability of a tiered intervention model of school intervention services was investigated in response to the publication of evidence-based Psychosocial Standards of Care for Children with Cancer and their Families. METHOD Children with newly diagnosed malignancy or transitioning to long-term survivorship care were eligible. Families received universal school needs assessment and intervention targeted at the level of risk identified. Academic risk and resource utilization data collected over 1 year were used to evaluate model feasibility and surveys evaluated family and medical provider satisfaction with the model. RESULTS One hundred and eight children were enrolled and had academic risk assessed at enrollment as high (25%), moderate (44.4%) or low (30.6%) risk. School liaison staff time spent providing intervention was related to the level of risk. 54.6% of patients reported a decrease in risk status at the end of 1 year of intervention. Parents (94%) and medical providers (100%) chose responses of "agree" or "strongly agree" when asked if they were satisfied with the intervention received over the year. CONCLUSIONS The tiered model of care identifies the students with the highest need for intervention, allows for more targeted use of resources, and successfully meets the Psychosocial Standard of Care for academic needs.
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Affiliation(s)
| | - Mary Kay Irwin
- 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
| | | | - Kathryn Vannatta
- Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
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Alderfer MA, Amaro CM, Kripalani S, Taggi Pinto A, Lewis AM, Arasteh K, Hildenbrand AK, Lown EA, Long KA. Trajectories of Traumatic Stress Symptoms Among Siblings of Children With Cancer: The First Two Years Post-Diagnosis. J Pediatr Psychol 2023; 48:688-699. [PMID: 37354552 DOI: 10.1093/jpepsy/jsad033] [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: 12/28/2022] [Revised: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE Identify and describe trajectories of cancer-related posttraumatic stress symptoms (PTSS) among siblings of children with cancer within two years of diagnosis. METHOD Siblings (aged 8-18; M = 11.2 years) across the United States, and for each, one caregiver, were recruited for a cohort sequential longitudinal study with three data collection points six months apart beginning at 6- or 12-months after cancer diagnosis. Siblings (N = 229; 42% of eligible/approached; 53% identifying as female; 68% identifying as non-Hispanic White) completed the Child Posttraumatic Stress Disorder Symptom Scale. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ). Latent class growth analysis (LCGA) and growth mixture modeling (GMM) identified PTSS patterns across time. RESULTS Fit statistics supported models with three to five PTSS trajectories. The three-class LCGA model included a large mild PTSS group (61%), a moderate PTSS group (35%), and a small (4%) stable severe PTSS group. The four-class LCGA and three- and four-class GMM included groups improving from moderate to mild PTSS (7-21%) and worsening to moderate PTSS across time (12-17%). Across models, siblings with mild PTSS had fewer caregiver-reported emotional and behavioral difficulties on the SDQ. CONCLUSIONS A large group of siblings of children with cancer demonstrate resiliency, however, substantial subsets experience patterns of PTSS that include levels in the moderate-to-severe range during the first two years post-diagnosis. Future research should examine these patterns in more diverse/representative samples and identify factors associated with increasing and sustained severe PTSS to inform intervention targets and reduce cancer-related burden on families.
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Affiliation(s)
- Melissa A Alderfer
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christina M Amaro
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Simran Kripalani
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Taggi Pinto
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
| | - Amanda M Lewis
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
| | - Kamyar Arasteh
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
| | - Aimee K Hildenbrand
- The Center for Healthcare Delivery Science, Nemours Children's Hospital-Delaware, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - E Anne Lown
- Department of Social and Behavioral Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - Kristin A Long
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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8
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Evans EM, Lin J, Sanchez-Alvarez J, Agrawal AK, Winestone LE. Disparities in household material hardship, financial toxicity, and income loss in pediatric cancer. Pediatr Blood Cancer 2023:e30496. [PMID: 37394628 DOI: 10.1002/pbc.30496] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Based on previous reports of disparities in financial burden following a cancer diagnosis, this study aims to characterize mechanisms of disparities experienced by caregivers of children with cancer, including the impact of work flexibility and social support. METHODS Cross-sectional survey (in English or Spanish) of caregivers of children with cancer that assessed household material hardship (HMH), financial toxicity, and income change. RESULTS Of 156 caregivers surveyed, 32% were Hispanic and 32% were low income. Hispanic caregivers were more likely to report HMH and financial toxicity compared to non-Hispanic White and Asian (HMH: 57% vs. 21% vs. 19%, p < .001; financial toxicity: 73% vs. 52% vs. 53%, p = .07). Low- and middle-income caregivers were more likely to experience HMH and financial toxicity compared to high-income caregivers (HMH: 68% low vs. 38% middle vs. 8.7% high, p < .001; financial toxicity: 81% vs. 68% vs. 44%, p < .001). All income categories demonstrated significant increases in HMH 1 year after diagnosis. Seventeen percent reported more than 40% income loss, more of whom were low income than high income (27% vs. 12%, p = .20). Work flexibility and social support were associated with income and financial toxicity. CONCLUSION HMH, financial toxicity, and income loss are prevalent after a child's cancer diagnosis, suggesting that screening should be incorporated into routine care. This financial burden disproportionately affects low-income and Hispanic caregivers. Further research is needed to elucidate the roles of work flexibility and social support, how safety net services are utilized by families, and how best to support families with HMH.
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Affiliation(s)
- Erica M Evans
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Jackie Lin
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jacklyn Sanchez-Alvarez
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Anurag K Agrawal
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
| | - Lena E Winestone
- Department of Pediatrics, San Francisco Benioff Children's Hospitals, University of California, San Francisco, California, USA
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9
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Young K, Cashion C, Hassall T, Ekberg S, Bradford N. Supporting families through paediatric brain tumour: Unmet needs and suggestions for change. Psychooncology 2023; 32:942-950. [PMID: 37081572 PMCID: PMC10946516 DOI: 10.1002/pon.6136] [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: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE From diagnosis and beyond, a paediatric brain tumour and its treatment impact the child and their family in a myriad of ways. While it is considered best practice to offer ongoing psychosocial support for all family members, there is little scholarly investigation of both families' experiences and the practical implications of offering such care. We aimed to explore families' experiences of paediatric brain tumour and their associated psychosocial health service needs. METHODS Families receiving care at the Queensland Children's Hospital in Brisbane, Australia, for a child (0-18 years) who had been diagnosed with a brain tumour between 2019 and 2022 were invited to be interviewed about their experiences. Using qualitative description, we analysed these interviews to identify families' unmet psychosocial health service needs and their suggestions for improvement. RESULTS Twenty-three clinically and socially diverse families were represented. While parents/carers expressed gratitude for the care their child had received, most also described unmet needs for the broader family. We identified three primary needs to be addressed: (1) parents want accessible psychological/emotional support for themselves; (2) parents/carers want additional guidance to navigate the hospital setting to reduce uncertainty and loss of control; and (3) parents want support to minimise treatment-associated trauma for their child. CONCLUSIONS Our findings evidence the need for improved family-centred psychosocial care within paediatric brain tumour care in Queensland, Australia. We propose a counselling and care coordination intervention to support parents/carers to care for themselves, their child, and their family through an extremely challenging experience.
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Affiliation(s)
- Kate Young
- Cancer and Palliative Care Outcomes CentreCentre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
| | - Christine Cashion
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
- Children's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
| | - Timothy Hassall
- Children's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
| | - Stuart Ekberg
- Children's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
- School of Psychology & CounsellingQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes CentreCentre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
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10
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Davis KA, Alderfer MA, Pariseau E, Lewis AM, Kazak AE, Muriel AC, Long KA. Validation of the Psychosocial Assessment Tool Sibling Module Follow-Up Version. J Pediatr Psychol 2023:7179833. [PMID: 37228163 DOI: 10.1093/jpepsy/jsad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE Psychosocial screening is recommended to connect siblings of youth with cancer to psychosocial services, but the lack of validated sibling-specific screening tools is a barrier to routine screening. The current study aimed to validate and establish a clinical cutoff for the recently developed Psychosocial Assessment Tool (PAT) Sibling Module follow-up version to address this barrier. METHODS Parents (N = 246) completed the PAT Sibling Module follow-up version for all siblings within their families ages 0-17 years (N = 458) at three time points between 6- and 24-month post-cancer diagnosis. For one target sibling within each family aged 8-17 years, parents also completed the Strengths and Difficulties Questionnaire, and the target sibling completed the Child PTSD Symptom Scale. Cross-sectional and longitudinal analyses examined internal consistency and convergent and predictive validity. Receiver operator characteristic analyses were used to establish a maximally sensitive and specific clinical cutoff. RESULTS Internal consistency was acceptable for all age versions (Kuder-Richardson 20s ≥ 0.79), except for the ages 0-2 version, which had low internal consistency at 18 months post-diagnosis (Kuder-Richardson 20 = 0.57). Convergent (r values >0.7, p values <.001) and predictive (r values >0.6, p values <.001) validity were strong at each time point. An optimal clinical cutoff of 0.32 was identified (range: 0.00-1.00). CONCLUSIONS The PAT Sibling Module follow-up version is a reliable and valid screener for sibling psychosocial risk following cancer diagnosis. Validation of a sibling-specific screener and establishment of a clinical cutoff are necessary first steps to addressing siblings' unmet psychosocial needs and improving trajectories of sibling functioning.
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Affiliation(s)
- Kathryn A Davis
- Department of Psychological & Brain Sciences, Boston University, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Emily Pariseau
- Department of Psychological & Brain Sciences, Boston University, USA
| | - Amanda M Lewis
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Anna C Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Kristin A Long
- Department of Psychological & Brain Sciences, Boston University, USA
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11
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Thompson AL, Schaefer MR, McCarthy SR, Hildenbrand AK, Cousino MK, Marsac ML, Majeski J, Wohlheiter K, Kentor RA. Competencies for Psychology Practice in Pediatric Palliative Care. J Pediatr Psychol 2023:7152461. [PMID: 37141582 DOI: 10.1093/jpepsy/jsad007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/10/2023] [Accepted: 01/29/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE Pediatric psychologists have unique expertise to contribute to the care of youth with serious illnesses yet are not routinely integrated into pediatric palliative care (PPC) teams. To better define the role and unique skillset of psychologists practicing in PPC, support their systematic inclusion as part of PPC teams, and advance trainee knowledge of PPC principles and skills, the PPC Psychology Working Group sought to develop core competencies for psychologists in this subspecialty. METHODS A Working Group of pediatric psychologists with expertise in PPC met monthly to review literature and existing competencies in pediatrics, pediatric and subspecialty psychology, adult palliative care, and PPC subspecialties. Using the modified competency cube framework, the Working Group drafted core competencies for PPC psychologists. Interdisciplinary review was conducted by a diverse group of PPC professionals and parent advocates, and competencies were revised accordingly. RESULTS The six competency clusters include Science, Application, Education, Interpersonal, Professionalism, and Systems. Each cluster includes essential competencies (i.e., knowledge, skills, attitudes, roles) and behavioral anchors (i.e., examples of concrete application). Reviewer feedback highlighted clarity and thoroughness of competencies and suggested additional consideration of siblings and caregivers, spirituality, and psychologists' own positionality. CONCLUSIONS Newly developed competencies for PPC psychologists highlight unique contributions to PPC patient care and research and provide a framework for highlighting psychology's value in this emerging subspecialty. Competencies help to advocate for inclusion of psychologists as routine members of PPC teams, standardize best practices among the PPC workforce, and provide optimal care for youth with serious illness and their families.
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Affiliation(s)
| | - Megan R Schaefer
- Department of Pediatric Psychology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Clinical Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Sarah R McCarthy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE, USA
- Division of Behavioral Health, Nemours Children's Hospital, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa K Cousino
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Meghan L Marsac
- Department of Pediatrics, University of Kentucky Healthcare, Lexington, KY, USA
| | - Jill Majeski
- Department of Pediatrics, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Karen Wohlheiter
- Division of Behavioral Health, Nemours Children's Hospital, Wilmington, DE, USA
| | - Rachel A Kentor
- Department of Pediatric Psychology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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12
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Davis KA, Brosnan P, Mazzenga M, Buchbinder D, Alderfer MA, Sharkey CM, Long KA. Inconsistent, uncoordinated, and reactive: The current state of sibling psychosocial care. Pediatr Blood Cancer 2023; 70:e30103. [PMID: 36385588 DOI: 10.1002/pbc.30103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although providing sibling psychosocial services is a standard of care in pediatric oncology, initial survey research suggests that this standard is rarely achieved and siblings' support needs remain unmet. Which sibling psychosocial services are available and how centers provide such services is unknown. To identify targetable services gaps, this qualitative study characterizes current sibling psychosocial care practices at select pediatric cancer centers across the United States. PROCEDURE Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N = 27) working across the United States in pediatric oncology centers of varied sizes. Interviews queried providers regarding sibling-focused parent psychoeducation, psychosocial screening, comprehensive assessment, and psychosocial support offerings. Interview data were analyzed using Applied Thematic Analysis. RESULTS Across cancer centers, sibling care practices did not align with consensus-based recommendations. The nature and availability of sibling-focused psychoeducation, screening, assessment, and support were variable between and within centers. Siblings themselves were largely absent from sibling psychosocial care, and care was rarely sibling-specific. The flow of information about siblings was discontinuous and uncoordinated across the care continuum, resulting in psychosocial care provided reactively, typically in response to parental concerns. CONCLUSIONS Sibling psychosocial care provision falls short of established care recommendations, leaving sibling psychosocial needs unmet. Findings highlight the need for tools and strategies to facilitate the implementation of sibling psychosocial care across the care continuum, to support siblings' psychosocial functioning across the life course.
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Affiliation(s)
- Kathryn A Davis
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Phoebe Brosnan
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Marcella Mazzenga
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - David Buchbinder
- Division of Hematology, Children's Hospital of Orange County, Orange, California, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, Delaware, USA.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christina M Sharkey
- Department of Neurology, Children's National Hospital, Washington, District of Columbia, USA
| | - Kristin A Long
- Department of Psychological & Brain Sciences, Boston University, Boston, Massachusetts, USA
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13
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Davis ES, Wimberly CE, Towry L, Johnston EE, Walsh KM. Financial hardships and psychosocial outcomes among parents of children who die of cancer. Pediatr Blood Cancer 2023; 70:e30066. [PMID: 36510751 DOI: 10.1002/pbc.30066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Caregivers experience financial hardship during a child's cancer treatment and after their child's death. These bereaved caregivers also experience negative psychosocial outcomes following the death of a child, but the relationship between financial hardship and negative psychosocial outcomes is poorly understood in this population. METHODS We surveyed self-selected bereaved caregivers as part of a publicly posted survey through Alex's Lemonade Stand Foundation in order to explore family experiences after losing a child to cancer. The survey contained questions regarding parent psychosocial and financial outcomes following their child's death. RESULTS One-hundred seventy-six caregivers completed the survey a median of 7 years after their child's death. The majority were female (91%), non-Hispanic White (97%), and married or living with a domestic partner (76%). Overall, 31% of caregivers reported that their child's death significantly impacted the financial well-being of their family, 23% experienced a decrease in income following their child's death, and 14% were still paying medical expenses. Financial hardship that the caregiver attributed to the child's death was associated with feeling lonely and isolated (adjusted relative risk [ARR] = 1.7, 95% CI: 1.1-2.7) and living day to day (ARR = 1.8, 95% CI: 1.3-2.5), even after adjustment for household income and time since child's death. CONCLUSIONS Caregivers experience multiple financial hardships following the death of a child to cancer, which endure for years after the child's death. These hardships are associated with negative psychosocial outcomes, demonstrating the need for both financial and psychosocial interventions for caregivers following the death of a child to cancer.
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Affiliation(s)
- Elizabeth S Davis
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Courtney E Wimberly
- Department of Neurosurgery and Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lisa Towry
- Alex's Lemonade Stand Foundation, Bala Cynwyd, Pennsylvania, USA
| | - Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kyle M Walsh
- Department of Neurosurgery and Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA.,Children's Health and Discovery Institute, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
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14
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Jurbergs N, Elliott DA, Browne E, Sirrine E, Brasher S, Leigh L, Powell B, Crabtree VM. How I approach: Defining the scope of psychosocial care across disciplines in pediatric hematology-oncology. Pediatr Blood Cancer 2022; 69:e29809. [PMID: 35674474 DOI: 10.1002/pbc.29809] [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: 12/30/2021] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
To provide the standard of psychosocial care for children with cancer and hematological disorders and their families, multidisciplinary teams must clearly define their scope and collaborate in ways that optimize the quality and efficiency of care. A new organizational structure was leveraged to delineate roles and scope for each psychosocial discipline at our institution. We developed a document, the scope of psychosocial care (SPC), that serves as a platform for making patient care decisions and provides opportunities for the reevaluation of programming. Herein, we present the process and outcome of the SPC and make recommendations for identifying roles in pediatric psychosocial hematology-oncology.
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Affiliation(s)
- Niki Jurbergs
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Emily Browne
- Transition Oncology Program, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erica Sirrine
- Social Work Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Shawn Brasher
- Child Life Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Laurie Leigh
- Formerly of School Program, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brent Powell
- Formerly of Spiritual Care Services, St. Jude Children's Research Hospital, Memphis, Tennessee
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15
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Manikowski A, Williamson Lewis R, Bennett T, Miller H, Mertens A, Wasilewski-Masker K, Escoffery C, Gilleland Marchak J. Implementation of Electronic Psychosocial Screening Among Caregivers in Pediatric Oncology. JCO Oncol Pract 2022; 18:e1198-e1208. [DOI: 10.1200/op.21.00836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: This study aimed to evaluate the reach and implementation of an electronic psychosocial screening program among caregivers of pediatric oncology patients, as well as characterize caregiver distress. METHODS: Participants (N = 2,013) included caregivers of patients age 0-17.99 years presenting across 9,280 outpatient oncology visits (median = 2; range = 1-52) from September 2018 to June 2019. At check-ins, caregivers electronically completed the pediatric distress thermometer via a patient-facing electronic health record (EHR) application. Caregiver distress ratings ≥ 8 triggered electronic alerts to medical teams to refer for social work support at point of care. Patient clinical and demographic differences in reach and fidelity were evaluated using univariate chi-square and t-tests. Caregivers reporting high distress were compared with caregivers without reports of high distress using univariate and multivariable logistic regression. RESULTS: The e-screening program was able to reach a caregiver for nearly all children seen during the study period, with 95.5% (1,923/2,013) of patients having a caregiver-completed pediatric distress thermometer. On screeners where caregivers reported high distress, medical teams made appropriate referrals to social work 95.5% (471/493) of the time. Overall, 16.9% (325/1,923) of caregivers ever indicated high distress (score ≥ 8), with caregivers of newly diagnosed (odds ratio = 3.16; 95% CI, 2.12 to 4.71) and on-therapy (odds ratio = 2.81; 95% CI, 2.11 to 3.76) patients being more likely to report high distress, compared with those who were off-treatment for the entire study. CONCLUSION: Leveraging EHR technology to provide evidence-based psychosocial screening can aid in successfully reaching a significant proportion of caregivers of pediatric oncology patients to identify and respond to ongoing psychosocial distress.
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Affiliation(s)
- Alison Manikowski
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | | | - Tonya Bennett
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | | | - Ann Mertens
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | - Karen Wasilewski-Masker
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | - Cam Escoffery
- Emory University Rollins School of Public Health, Atlanta, GA
| | - Jordan Gilleland Marchak
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
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16
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Hawkins E, Powell B, Spears W, Crabtree VM. A strategic approach to integration of spiritual care into the standards for the psychosocial care of children with cancer and their families. Pediatr Blood Cancer 2022; 69:e29659. [PMID: 35466568 DOI: 10.1002/pbc.29659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/18/2022] [Accepted: 02/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Elizabeth Hawkins
- Spiritual Care Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Brent Powell
- Spiritual Care Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Walter Spears
- Spiritual Care Services, Methodist LeBonheur Healthcare, Memphis, Tennessee, USA
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17
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Phillips CA, Barakat LP, Pollock BH, Bailey LC, Beidas RS. Implementation science in pediatric oncology: A narrative review and future directions. Pediatr Blood Cancer 2022; 69:e29579. [PMID: 35044081 PMCID: PMC8860875 DOI: 10.1002/pbc.29579] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/09/2022]
Abstract
Implementation science (IS) has garnered attention within oncology, and most prior IS work has focused on adult, not pediatric, oncology. This narrative review broadly characterizes IS for pediatric oncology. It includes studies through 2020 using the following search terms in PubMed, Ovid Medline, and Cochrane: "implementation science," "pediatric," "childhood," "cancer," and "oncology." Systematic review was not performed due to the limited number of heterogeneous studies. Of 216 articles initially reviewed, nine were selected as specific to IS and pediatric oncology. All nine examined oncologic supportive care, cancer prevention, or cancer control. The supportive care focus is potentially due to the presence of cooperative study groups such as the Children's Oncology Group, which efficiently drive cancer-directed therapy changes through clinical trials. Future IS within pediatric oncology should embrace this ecosystem and focus on cancer control interventions that benefit patients across multiple cancer types and patients treated outside cooperative group studies.
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Affiliation(s)
- Charles A. Phillips
- Division of Oncology, the Children’s Hospital of Philadelphia, Philadelphia, PA, United States,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States,Department of Biomedical and Health Informatics, the Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Lamia P. Barakat
- Division of Oncology, the Children’s Hospital of Philadelphia, Philadelphia, PA, United States,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Brad H. Pollock
- Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, United States,University of California Davis Comprehensive Cancer Center, Sacramento, CA, United States
| | - L. Charles Bailey
- Division of Oncology, the Children’s Hospital of Philadelphia, Philadelphia, PA, United States,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States,Department of Biomedical and Health Informatics, the Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Rinad S. Beidas
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States,Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States,Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States,Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, United States
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18
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Knott D, Krater C, MacLean J, Robertson K, Stegenga K, Robb SL. Music Therapy for Children with Oncology & Hematological Conditions and Their Families: Advancing the Standards of Psychosocial Care. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:49-59. [PMID: 35722869 PMCID: PMC9839310 DOI: 10.1177/27527530211059726] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Diagnosis and treatment of cancer and blood disorders in childhood, adolescence and young adulthood has a significant impact on patients and families. The Psychosocial Standards of Care project, initiated in 2012, resulted in 15 Psychosocial Standards (PSS) that guide the care patients and families receive throughout treatment. As members of the multidisciplinary psychosocial care team, music therapists play an important role in the advancing the PSS. Most surveys have focused on other commonly provided services (e.g., social work, child life), leaving gaps in our understanding about the availability and use of music therapy services to advance PSS. This paper offers an initial description of how music therapy services contribute to the provision of care under these Standards. Methods: We analyze how music therapy services promote PSS through synthesis of a music therapy clinical practice survey, published literature, and scope of practice documents. A brief overview of music therapy services structure, PSS that music therapy services currently address, and two clinical program descriptions are included. Results: Music therapy services address 9 of the 15 PSS and are well integrated within the larger program of psychosocial care. Findings suggest integration of music therapy services can help ensure personalized, comprehensive care and efficient use of often-limited psychosocial care resources. Discussion: Nurses, as members of the psychosocial and medical teams are uniquely positioned to identify patient and family care needs and refer patients for services. Understanding how music therapy services address PSS and most importantly, the needs of patients and families, will optimize their care.
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Affiliation(s)
- David Knott
- Creative Arts Therapies, Seattle Children's Hospital, Seattle, WA, USA
| | - Caitlin Krater
- Music Therapy, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | | | - Kim Robertson
- Music Therapy and Hospital-Based School Program, Children's Mercy Hospital Kansas City, Kansas City, MO, USA
| | | | - Sheri L. Robb
- Indiana University School of Nursing, Indianapolis, IN, USA
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19
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Hoag JA, Bingen K, Karst J, Palou A, Yan K, Zhang J. Playing With a Purpose: The Impact of Therapeutic Recreation During Hospitalization. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:6-14. [PMID: 35722870 DOI: 10.1177/27527530211059437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Youth undergoing cancer treatment and hematopoietic stem cell transplant (HSCT) spend significant time in the hospital, which is disruptive to their physical, social, and emotional development. Therapeutic recreation (TR) can help individuals with an illness maintain or improve their health, quality of life, and physical functioning. TR is an understudied intervention, particularly with youth in the hospital setting. Methods: Forty-nine children (median age = 12 years, interquartile range [IQR] 11-15 years) hospitalized for cancer treatment or HSCT were assigned to participate in either the historical control or TR intervention. Participants wore a Fitbit charge HR for three days to measure movement. At the end of the study participation, they completed self-report measures of mood, social connectedness, and health-related quality of life. Results: Compared with historical controls, the TR intervention group had improved positive affect and decreased mood disturbance (p = 0.03); had better sleep quality (p = 0.003); and was more satisfied with the leisure activities offered in the hospital (p = 0.01). There were no differences in the number of steps taken per day, somatic distress, cooperation with cares, or interaction with medical personnel or caregivers. Both groups reported poor availability and support of peer companions. Discussion: TR is one avenue to increase leisure activities and positively impact mood. More thought needs to be given to how TR programs can be leveraged to increase physical activity and social connectedness.
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Affiliation(s)
| | | | - Jeffrey Karst
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Akasha Palou
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ke Yan
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jian Zhang
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
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20
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Fair C, Thompson A, Barnett M, Flowers S, Burke J, Wiener L. Utilization of Psychotherapeutic Interventions by Pediatric Psychosocial Providers. CHILDREN 2021; 8:children8111045. [PMID: 34828757 PMCID: PMC8625037 DOI: 10.3390/children8111045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 01/15/2023]
Abstract
One of the Standards of Psychosocial Care for Children with Cancer and their Families recommends that all youth with cancer and their family members have access to psychotherapeutic interventions and support throughout the cancer trajectory. This study was created to identify the psychosocial interventions and services provided to children with cancer and their family members, to ascertain whether there are differences in interventions provided by age of the patient and stage of treatment, and to learn about barriers to psychosocial service provision. An online survey was disseminated to psychosocial providers through the listservs of national and international professional organizations. The majority of the 242 respondents were either psychologists (39.3%) or social workers (26.9%) and 79.7% worked in the United States. The intervention offered most often to pediatric patients, caregivers, and siblings, at every stage of treatment, was psychoeducation (41.7–48.8%). Evidence-based interventions, including cognitive behavioral therapy (56.6%) and mindfulness-based interventions (57.9%) were reported to be frequently used with patients. Interventions designed specifically for the pediatric oncology population were not commonly endorsed. Psychosocial providers reported quality of care would be improved by additional staff, better communication/collaboration with medical team members and increased community-based resources. Future research should focus on improving accessibility to population-specific evidenced-based interventions and translating science to practice.
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Affiliation(s)
- Cynthia Fair
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA;
- Correspondence: ; Tel.: +1-336-278-6457
| | | | - Marie Barnett
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Stacy Flowers
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH 45406, USA;
| | - June Burke
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA;
| | - Lori Wiener
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
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21
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Umaretiya PJ, Revette A, Seo A, Flamand Y, Ilcisin L, Zheng DJ, Bhatia S, Wolfe J, Bona K. PediCARE: Development of a poverty-targeted intervention for pediatric cancer. Pediatr Blood Cancer 2021; 68:e29195. [PMID: 34190405 PMCID: PMC8384686 DOI: 10.1002/pbc.29195] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/29/2021] [Accepted: 05/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Poverty is associated with inferior psychosocial outcomes, higher rates of relapse, and decreased overall survival in children with cancer. Despite this, there are few evidence-based, poverty-targeted interventions and none specific to pediatric oncology. To address this gap, we developed and refined the Pediatric Cancer Resource Equity (PediCARE) intervention, a household material hardship (HMH) targeted intervention providing transportation and groceries to pediatric oncology families. METHODS This was a single-arm pilot study conducted at a single, large, tertiary pediatric cancer center. Newly diagnosed patients with HMH-exposure were directly assigned to receive PediCARE for a total of three months. Quantitative and qualitative approaches were used to evaluate its acceptability and to rapidly refine the intervention. RESULTS Nine families (100% of those approached) consented to enrollment with no attrition over the three-month study period. Families were highly satisfied with the intervention and recommended participation to others. All of the families utilized the grocery delivery component of PediCARE, and seven utilized the transportation component. Qualitative participant feedback was used to rapidly refine the intervention including logistics of intervention delivery, and dose of intervention components. CONCLUSION PediCARE, a poverty-targeted intervention, was highly acceptable to pediatric oncology families. The intervention was refined in real-time utilizing quantitative and qualitative feedback. Next steps include intervention evaluation in a randomized, controlled feasibility study.
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Affiliation(s)
- Puja J. Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA
| | - Anna Revette
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna Seo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA,Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts,Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
| | - Daniel J. Zheng
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Smita Bhatia
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joanne Wolfe
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts,Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, MA
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22
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Bogetz J, Trowbridge A, Kingsley J, Taylor M, Wiener L, Rosenberg AR, Barton KS. Stuck Moments and Silver-Linings: The Spectrum of Adaptation Among Non-Bereaved and Bereaved Parents of Adolescents and Young Adults With Advanced Cancer. J Pain Symptom Manage 2021; 62:709-719. [PMID: 33775813 PMCID: PMC8464607 DOI: 10.1016/j.jpainsymman.2021.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT With advances in treatments that have resulted in children living longer with serious illness, it is essential to understand how parents adapt to changes during the final stages of their child's life or after their child's death. OBJECTIVE To examine the process by which parents adapt to their child's serious illness and death among a group of non-bereaved and bereaved parents of adolescents and young adults (AYAs) with advanced cancer. METHODS Qualitative study exploring the experiences of parents of AYAs who were being treated for recurrent or refractory advanced cancer (nonbereaved parents) or had died from their disease (bereaved parents) at one large academic center. Participants completed demographic surveys and semi-structured interviews to better understand parent adaptation. Data were analyzed using content and thematic approaches. RESULTS Of the 37 participating parents; 22 (59%) were non-bereaved and 15 (41%) were bereaved. The AYAs predominantly had hematologic malignancies (n = 18/34, 53%). Across both cohorts, parents described the process of adapting to their child's worsening health or death as moments of feeling stuck and moments of gratitude and meaning. CONCLUSION Adaptation to a child's serious illness and death likely occurs on a dynamic spectrum and parents may oscillate both cognitively and emotionally. This has important implications for how clinicians and communities support parents. Greater comfort with and normalization of the adaptation process may enable parents to more openly share both the unimaginable hardships and unexpected silver-linings that are part of their parenting experiences during their child's illness and death.
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Affiliation(s)
- Jori Bogetz
- Division of Bioethics and Palliative Care, Department of Pediatrics (J.B.), University of Washington School of Medicine; Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.
| | - Amy Trowbridge
- Divisions of Bioethics and Palliative Care/Hospital Medicine, Department of Pediatrics (A.T.), University of Washington School of Medicine; Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Jenny Kingsley
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine (J.K.), Keck School of Medicine at the University of Southern California; Los Angeles, California
| | - Mallory Taylor
- Division of Hematology/Oncology, Department of Pediatrics (M.T.), University of Washington School of Medicine; Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Lori Wiener
- Behavioral Health Core and Director (L.W.), Psychosocial Support and Research Program, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics (A.R.R.), University of Washington School of Medicine; Director, 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 (K.S.B.), Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
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23
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Hjelmstedt S, Forinder U, Montgomery S, Lindahl Norberg A, Hovén E. Facilitators and barriers to return to work and meet financial needs in parents of children with cancer. Pediatr Blood Cancer 2021; 68:e29245. [PMID: 34318997 DOI: 10.1002/pbc.29245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to explore what facilitators and barriers parents of children with cancer identify for their ability to return to work and meet financial needs. PROCEDURE Nine focus groups (21 mothers; 11 fathers) were performed across Sweden in 2015 and 2019. A deductive content analysis approach was used. A preconstructed matrix consisting of 12 codes based on previous literature was used to organize the data. The codes were grouped into subcategories, which were abstracted to four generic categories. RESULTS Facilitators for a return to work were covered in the category "Flexibility and understanding from employers and social services," and barriers in the category "Pressure to return without consideration of the consequences." Facilitators to meeting financial needs were covered in the category "Available public, private, and employer support," and barriers in the category "Lack of organized and efficient support from employers and social services." CONCLUSIONS The identified barriers suggest that there is room for improvement in the provision of psychosocial support, which relates to a perceived lack of organized support regarding practical, financial, and occupational matters. The results show a need for a coordinated support system that includes major stakeholders, such as the health care, welfare agencies, and employers. Moreover, employers should consider how to implement more workplace flexibility and involvement of occupational health services. Importantly, to be able to return to work and achieve a sustainable financial situation, it is necessary for all stakeholders to recognize the long-term impact of parenting a child with cancer.
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Affiliation(s)
- Sofia Hjelmstedt
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulla Forinder
- Department of Social Work and Criminology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Annika Lindahl Norberg
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.,Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Emma Hovén
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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