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Robertson EG, Komesaroff R, Eisenstat DD, Robertson A, Ludlow LE. A Pilot Evaluation of an Educational Video to Support Consent to a Pediatric Malignancy Biobank. Biopreserv Biobank 2024. [PMID: 38800954 DOI: 10.1089/bio.2024.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Introduction: The collection of biological specimens is necessary to support basic and translational research. However, the complexity of biobanking introduces numerous ethical issues, particularly regarding informed consent. Objective: To evaluate the acceptability and perceived benefits of an educational video facilitating the consent process for the Children's Cancer Centre Biobank. Methods: We invited individuals who had previously consented to be (or their child to be) part of the Biobank, and health professionals who were involved in obtaining consent. Participants watched the video and completed a purpose-designed online survey. Results: A total of 16 health professionals (invited = 30) and 15 patients/caregivers (invited = 127) participated. Most patients/caregivers felt informed about the Biobank at consent, however, noted how overwhelmed they were at the time and that they did not engage with the written information. Overall, both patients/caregivers and health professionals rated the video favorably regarding the information provided and format. Participants valued that it was simple and clear, with several health professionals noting the need for linguistic translations to better support the families they work with. Most patients/caregivers agreed that the video provided enough information to begin considering participation. This aligned with the health professionals' feedback that the video was most effective when used as a conversation starter to help formalize the written consent. Conclusion: Our findings suggest that our video is an acceptable and beneficial tool to assist in the Biobank consenting process, from both the perspective of decision-makers and health professionals obtaining consent. It appears particularly valuable as a precursor to an interactive, formal consent discussion. Further work is required to determine whether our video has a significant impact on outcomes such as decision-making satisfaction and knowledge, and to determine the value to adolescents.
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Affiliation(s)
- Eden G Robertson
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
| | - Rebecca Komesaroff
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - David D Eisenstat
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Alexandra Robertson
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Louise E Ludlow
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
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Gereis JM, Hetherington K, Robertson EG, Daly R, Donoghoe MW, Ziegler DS, Marshall GM, Lau LMS, Marron JM, Wakefield CE. Parents' and adolescents' perspectives and understanding of information about childhood cancer precision medicine. Cancer 2023; 129:3645-3655. [PMID: 37376781 DOI: 10.1002/cncr.34914] [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: 09/27/2022] [Revised: 03/24/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Precision medicine is projected to become integral to childhood cancer care. As such, it is essential to support families to understand what precision medicine entails. METHODS A total of 182 parents and 23 adolescent patients participating in Precision Medicine for Children with Cancer (PRISM), an Australian precision medicine clinical trial for high-risk childhood cancer, completed questionnaires after study enrollment (time 0 [T0]). Of the parents, 108 completed a questionnaire and 45 completed an interview following return of precision medicine results (time 1 [T1]). We analyzed the mixed-methods data comprising measures exploring families' perceptions and understanding of PRISM's participant information sheet and consent form (PISCF), and factors associated with understanding. RESULTS Most parents were satisfied with the PISCF, rating it as at least "somewhat" clearly presented (n = 160/175; 91%) and informative (n = 158/175; 90%). Many suggested improvements including the use of clearer language and a more visually engaging format. Parents' actual understanding of precision medicine was low on average, but scores improved between T0 and T1 (55.8/100-60.0/100; p = .012). Parents from culturally and/or linguistically diverse backgrounds (n = 42/177; 25%) had lower actual understanding scores than those from a Western/European background whose first language was English (p = .010). There was little correlation between parents' perceived and actual understanding scores (p = .794; Pearson correlation -0.020; 95% CI, -0.169 to 0.116). Most adolescent patients read the PISCF either "briefly" or "not at all" (70%) and had a perceived understanding score of 63.6/100 on average. CONCLUSIONS Our study revealed gaps in families' understanding of childhood cancer precision medicine. We highlighted areas for potential intervention such as through targeted information resources. PLAIN LANGUAGE SUMMARY Precision medicine is projected to become part of the standard of care for children with cancer. Precision medicine aims to give the right treatment to the right patient and involves several complex techniques, many of which may be challenging to understand. Our study analyzed questionnaire and interview data from parents and adolescent patients enrolled in an Australian precision medicine trial. Findings revealed gaps in families' understanding of childhood cancer precision medicine. Drawing on parents' suggestions and the literature, we make brief recommendations about improving information provision to families, such as through targeted information resources.
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Affiliation(s)
- Jessica M Gereis
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Kate Hetherington
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Eden G Robertson
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rebecca Daly
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Mark W Donoghoe
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - David S Ziegler
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, Australia
| | - Glenn M Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, Australia
| | - Loretta M S Lau
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, UNSW Sydney, Sydney, Australia
| | - Jonathan M Marron
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
| | - Claire E Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
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Plummer K, McCarthy M, Newall F, Manias E. The management of pain during pediatric hematopoietic stem cell transplantation: A qualitative study of contextual factors that influenced pain management practices. Pediatr Blood Cancer 2023; 70:e30614. [PMID: 37548486 DOI: 10.1002/pbc.30614] [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: 02/02/2023] [Revised: 06/29/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Children hospitalized following hematopoietic stem cell transplantation (HSCT) experience complex and prolonged pain in response to the intensity of this treatment. OBJECTIVES To describe how pain was managed for children during HSCT therapy and how contextual factors related to the clinical environment influenced healthcare providers' and parents' pain management practices. METHODS A qualitative case study was conducted and involved semi-structured interviews at two time points following transplantation (30 and 90 days) with parents (n = 10) and naturalistic observations of pain-related care provided to children (n = 29) during HSCT therapy by their healthcare providers (n = 10). Semi-structured interviews were also conducted with healthcare providers (n = 14). RESULTS The effectiveness of pain management interventions was hindered by the multifactorial nature of pain children experienced, a gap in the provision of psychosocial interventions for pain and a lack of evidence-based guidelines for the sustained, and often long-term, administration of opioids and adjuvant medications. Misconceptions were demonstrated by healthcare providers about escalating pain management according to pain severity and differentiating between opioid tolerance and addiction. Parents were active in the management of pain for children, especially the provision of nonpharmacological interventions. Collaboration with external pain services and the impact of caring for children in protective isolation delayed timely management of pain. CONCLUSIONS There is a pressing need to create evidence-based supportive care guidelines for managing pain post transplantation to optimize children's relief from pain. If parents and children are to be involved in managing pain, greater efforts must be directed toward building their capacity to make informed decisions.
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Affiliation(s)
- Karin Plummer
- Department of Nursing, University of Melbourne, Carlton, Melbourne, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
- Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, Australia
| | - Maria McCarthy
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Newall
- Department of Nursing, University of Melbourne, Carlton, Melbourne, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Nursing Research, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Sandhu S, Hickey M, Lew R, Hammarberg K, Braat S, Agresta F, Parle A, Allingham C, Peate M. The development and phase 1 evaluation of a Decision Aid for elective egg freezing. BMC Med Inform Decis Mak 2023; 23:83. [PMID: 37147687 PMCID: PMC10161420 DOI: 10.1186/s12911-023-02178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Elective egg freezing decisions are complex. We developed a Decision Aid for elective egg freezing and conducted a phase 1 study to evaluate its acceptability and utility for decision-making. METHODS The online Decision Aid was developed according to International Patient Decision Aid Standards and evaluated using a pre/post survey design. Twenty-six Australian women aged 18-45 years, interested in receiving elective egg freezing information, proficient in English, and with access to the internet were recruited using social media and university newsletters. Main outcomes were: acceptability of the Decision Aid; feedback on the Decision Aid design and content; concern raised by the Decision Aid, and; utility of the Decision Aid as measured by scores on the Decisional Conflict Scale and on a study-specific scale assessing knowledge about egg freezing and age-related infertility. RESULTS Most participants found the Decision Aid acceptable (23/25), balanced (21/26), useful for explaining their options (23/26), and for reaching a decision (18/26). Almost all reported satisfaction with the Decision Aid (25/26) and the level of guidance it provided (25/26). No participant reported serious concerns about the Decision Aid, and most would recommend it to other women considering elective egg freezing (22/26). Median Decisional Conflict Scale score decreased from 65/100 (Interquartile range: 45-80) pre-Decision Aid to 7.5/100 (Interquartile range: 0-37.5) post-Decision Aid review (p < 0.001). Median knowledge score increased from 8.5/14 (Interquartile range: 7-11) pre-Decision Aid to 11/14 (Interquartile range: 10-12) post-Decision Aid review (p = 0.01). CONCLUSION This elective egg freezing Decision Aid appears acceptable and useful for decision-making. It improved knowledge, reduced decisional conflict and did not raise serious concerns. The Decision Aid will be further evaluated using a prospective randomised control trial. STUDY REGISTRATION ACTRN12618001685202 (retrospectively registered: 12 October 2018).
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Affiliation(s)
- Sherine Sandhu
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia.
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Raelia Lew
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- MISCH (Methods and Implementation Support for Clinical and Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Anna Parle
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Catherine Allingham
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
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Larocca V, Oltean I, Grandpierre V, Nasr A. Development and evaluation of a patient decision aid for pediatric interval appendectomy. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000466. [DOI: 10.1136/wjps-2022-000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectiveOne option for the treatment of perforated appendicitis in pediatric patients is interval appendectomy (IA). A patient decision aid (PDA) can be useful in the decision-making process regarding IA. The purpose of this study was to evaluate parents’ decisional conflict before and after engaging with a developed PDA.MethodsParticipants included (a) parents who are considering IA surgery for their child, (b) have not yet had their follow-up appointment postdischarge, and (c) were fluent in either the official languages of English or French. This study used a pretest and post-test design to measure participants’ decisional conflict and treatment option choice. Perceptions and acceptability of the PDA were also assessed.ResultsA total of 18 participants completed the study (16 mothers). Major findings include significant decreases in all Decisional Conflict Scale items from pre-PDA to post-PDA engagement, except for one item. The majority of participants perceived the PDA to be useful, easy to find information regarding risks and provided enough information to help them make a decision regarding their child’s treatment.ConclusionsThis is the first study to develop and evaluate a PDA among parents who are making a decision regarding IA surgery. The results showed a significant decrease in decisional conflict after using the PDA. The results also showed that the PDA was generally accepted among parents and had positive perceptions regarding length, content, and balance. The use of PDA for this population can help ease feelings of decisional conflict and equip parents with the information to make informed decisions.
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Shepherd V, Wood F, Robling M, Randell E, Hood K. Development of a core outcome set for the evaluation of interventions to enhance trial participation decisions on behalf of adults who lack capacity to consent: a mixed methods study (COnSiDER Study). Trials 2021; 22:935. [PMID: 34924004 PMCID: PMC8684591 DOI: 10.1186/s13063-021-05883-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/26/2021] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Trials involving adults who lack capacity to provide consent rely on proxy or surrogate decision-makers, usually a family member, to make decisions about participation. Interventions to enhance proxy decisions about trial participation are now being developed. However, a lack of standardised outcome measures limits evaluation of these interventions. The aim of this study was to establish an agreed standardised core outcome set (COS) for use when evaluating interventions to improve proxy decisions about trial participation. METHODS We used established methods to develop the COS including a consensus study with key stakeholder groups comprising those who will use the COS in research (researchers and healthcare professionals) and patients or their representatives. Following a scoping review to identify candidate items, we used a modified two-round Delphi survey to achieve consensus on core outcomes, with equivocal items taken to a consensus meeting for discussion. The COS was finalised following an online consensus meeting in October 2020. RESULTS A total of 28 UK stakeholders (5 researchers, 10 trialists, 3 patient/family representatives, 7 recruiters and 3 advisors/approvers) participated in the online Delphi survey to rank candidate items from the scoping review (n = 36) and additional items proposed by participants (n = 1). Items were broadly grouped into three categories: how family members make decisions, their experiences of making decisions, and the personal aspects that influence the decision. Following the Delphi survey, 27 items were included and ten items exhibited no consensus which required discussion at the consensus meeting. Sixteen participants attended the meeting, including additional patient/family representatives invited to increase representation from this key group (n = 2). We reached consensus for the inclusion of 28 outcome items, including one selected at the consensus meeting. CONCLUSIONS The study identified outcomes that should be measured as a minimum in all evaluations of interventions to enhance proxy decisions about trials. These relate to the process of decision-making, proxies' experience of decision-making, and factors that influence decision-making such as understanding. Further work with people with impairing conditions and their families is needed to explore their views about the COS and to identify appropriate outcome measures and timing of measurement. TRIAL REGISTRATION The study is registered on the COMET database ( https://www.comet-initiative.org/Studies/Details/1409 ).
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Affiliation(s)
- V Shepherd
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F Wood
- Division of Population Medicine, Cardiff University, Cardiff, UK
- PRIME Centre Wales, Cardiff, UK
| | - M Robling
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - E Randell
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
- PRIME Centre Wales, Cardiff, UK
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Lipstein EA, Breslin M, Dodds CM, Kappelman MD, Ollberding NJ, Margolis P, Xu Y, Brinkman WB. Integrating shared decision making into trial consent: A nested, cluster-randomized trial. PATIENT EDUCATION AND COUNSELING 2021; 104:1575-1582. [PMID: 33386187 DOI: 10.1016/j.pec.2020.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/03/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Using a nested, cluster-randomized trial, we tested the hypothesis that a shared decision-making intervention, as part of consent, would improve study-related knowledge. METHODS We developed a shared decision-makingintervention then randomized sites in a clinical trial to intervention or control (standard consent). We collected participants' knowledge (primary outcome) and decisional support data. Other data came from a clinical registry and research coordinator surveys. We compared outcomes between study arms using generalized estimating equation models, accounting for clustering. We used qualitative description to understand variation in intervention use. RESULTS 265 individuals, from 34 sites, enrolled in the parent trial during our study period. Of those, 241 participants completed our survey. There was no knowledge difference between arms (mean difference = 0.56 (95 %CI: -3.8, 4.9)). Both groups had a considerable number of participants with misunderstandings. We also found no difference for decisional support (mean difference = 1.5 (95 %CI: -1.8, 4.8)) or enrollment rate between arms. Clinician use of the intervention varied between sites. CONCLUSIONS We found no differences in outcomes but demonstrated the feasibility and acceptability of incorporating a shared decision-making intervention into consent. PRACTICE IMPLICATIONS Future work should consider adapting our intervention to other trials and more robust measurement strategies.
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Affiliation(s)
- Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, USA.
| | | | - Cassandra M Dodds
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Michael D Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC, USA
| | - Nicholas J Ollberding
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Peter Margolis
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Yingying Xu
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - William B Brinkman
- Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, USA; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
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Robertson EG, Wakefield CE, Tsoli M, Kellie SJ, Alvaro F, Gifford AJ, Weber MA, Rodriguez M, Kirby M, Ziegler DS. Parents' experiences of postmortem tumor donation for high-grade gliomas: benefits and suggested improvements. Neurooncol Adv 2021; 3:vdab087. [PMID: 34458732 PMCID: PMC8386242 DOI: 10.1093/noajnl/vdab087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pediatric high-grade glioma is a devastating diagnosis. There has been no improvement in outcomes for several decades, with few children surviving 2 years postdiagnosis. Research progress has been hampered by a lack of tumor samples, which can be used to develop and test novel therapies. Postmortem tumor donations are therefore a valuable opportunity to collect tissue. In this study, we explored Australian parents' experiences of donating their child's tumor for research after their child had died. METHODS We collected qualitative data from 11 bereaved parents who consented to donate samples of their child's high-grade glioma for research postmortem. We asked parents about their perceived benefits/burdens of the autopsy, recommendations for improving consent discussions, and decision regret. RESULTS Parents hoped that their donation would help to find a cure for future children with high-grade glioma. They described feeling comforted knowing that their child's suffering may help others. Some parents also felt that the donation would help them better understand their child's tumor. Although some parents described discomfort about procedures leading up to the autopsy, parents reported minimal regret regarding their decision to donate their child's tumor. Parents provided recommendations to improve consent discussions, such as providing more information about the autopsy logistics and why the donation was needed. CONCLUSION Parents consented to autopsy for altruistic reasons, although donation may also assist parents in their grieving. There is a strong need to improve access to tumor donations for any family who wishes to donate.
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Affiliation(s)
- Eden G Robertson
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, New South Wales, Australia
| | - Maria Tsoli
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Children’s Cancer Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Stewart J Kellie
- Children’s Cancer Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Frank Alvaro
- Children’s Cancer and Blood Disorders, John Hunter Children’s Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Andrew J Gifford
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Children’s Cancer Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Anatomical Pathology, NSW Health Pathology East (Prince of Wales Hospital), Sydney, New South Wales, Australia
| | - Martin A Weber
- Anatomical Pathology, NSW Health Pathology East (Prince of Wales Hospital), Sydney, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Michael Rodriguez
- Anatomical Pathology, NSW Health Pathology East (Prince of Wales Hospital), Sydney, New South Wales, Australia
| | - Maria Kirby
- Department of Haematology and Oncology, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
| | - David S Ziegler
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Children’s Cancer Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
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Buchhorn-White J, Robertson EG, Wakefield CE, Cohen J. A Decision Aid for Nutrition Support is Acceptable in the Pediatric Hospital Setting. J Pediatr Nurs 2020; 55:165-173. [PMID: 32950824 DOI: 10.1016/j.pedn.2020.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Incorporating a Decision Aid (DA) about nutrition support into the general pediatric healthcare setting may improve parent and patient understanding about the risks and benefits of nutrition support options. We aimed to evaluate the acceptability and usability of our newly developed DA for parents of children in the general pediatric healthcare setting who require nutrition support. DESIGN AND METHODS Participants were 18 parents with a child who had received nutrition support; and 12 Healthcare Professionals (HCPs) involved in pediatric nutrition support discussions. Parents' and HCPs' ratings of acceptability and feasibility of the booklet, and parents' perceived knowledge acquisition after reading the booklet were assessed. RESULTS Parents were satisfied with the DA, reporting that it was an appropriate length and unbiased. Most parents felt the DA was relevant to their decision-making, improved understanding, and would recommend it to other parents. HCPs felt that the booklet clearly described the essential information for nutrition support options, but less certain of the booklets' impact on parent decision-making. Regardless, most HCPs would recommend the booklet to other clinicians. CONCLUSION Our decision aid appears to be acceptable and useful for parents deciding on nutrition support for their child in the general pediatric hospital setting. PRACTICE IMPLICATIONS A DA may facilitate shared decision-making through improved understanding of the risks and benefits of different nutrition support options in the pediatric setting. Further evaluation is required with specific pediatric conditions, to determine the effectiveness for parents actively deciding on their child's nutrition support.
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Affiliation(s)
| | - Eden G Robertson
- School of Women's and Children's Health, The University of New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Australia; Starlight Children's Foundation, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, The University of New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Australia
| | - Jennifer Cohen
- School of Women's and Children's Health, The University of New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Australia.
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10
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Robertson EG, Cohen J, Signorelli C, Grant DM, Fardell JE, Wakefield CE. What instruments should we use to assess paediatric decision-making interventions? A narrative review. J Child Health Care 2020; 24:458-472. [PMID: 31450963 DOI: 10.1177/1367493519869717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is an increasing number of shared decision-making (SDM) interventions in paediatrics. However, there is little consensus as to the best instruments to assess the feasibility and impact of these interventions. This narrative review aims to answer: (1) what feasibility, knowledge and decision-making instruments have been used to assess paediatric SDM interventions and (2) what are the psychometric properties of used decision-making instruments, guided by the 'consensus-based standards for the selection of health measurement instrument' criteria. We conducted a review of the peer-reviewed literature. We identified 23 studies that evaluated a paediatric intervention to facilitate SDM for a specific health decision. Eighteen studies assessed intervention feasibility, with a wide variability in assessment between studies. Twelve studies assessed objective knowledge, and four studies assessed subjective knowledge with all but one study aggregating correct responses. We identified nine decision-making instruments that had been assessed psychometrically, although few had been thoroughly evaluated. The Decisional Conflict Scale was the most commonly-used instrument and the only instrument evaluated in paediatrics. Our study revealed a lack of consistency in the instruments used to evaluate decision-making interventions in paediatrics, making it difficult to compare interventions. We provide several recommendations for researchers to improve the assessment of SDM interventions in paediatrics.
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Affiliation(s)
- Eden G Robertson
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Jennifer Cohen
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Christina Signorelli
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - David M Grant
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia
| | - Joanna E Fardell
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
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Medeiros C, Buckley L, Metcalfe K, Narayanan UG, Widger K. Decision aids available for parents making end-of-life or palliative care decisions for children: A scoping review. J Paediatr Child Health 2020; 56:692-703. [PMID: 32281164 DOI: 10.1111/jpc.14885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify and assess the quality of decision aids that align the decision, values and information provided for parents making end-of-life or palliative care decisions for children with life-threatening conditions. METHODS Six databases and the grey literature were searched in December 2018. Two reviewers independently reviewed database citations, and one reviewed grey literature citations. Citation chaining via Scopus was conducted. Quality was assessed using IPDAS Collaboration Criteria. RESULTS After reviewing 18 671 database citations and 10 988 grey literature citations, 18 citations describing 11 decision aids remained. Decision aids targeted premature infants, children requiring airway management, children with cancer and children with scoliosis. Three aids underwent testing beyond initial development. Quality scores averaged 27 of 50 points. CONCLUSIONS There are few high-quality decision aids available for use and a lack evidence of widespread clinical use. Additional research is needed to support systematic development and the use of decision aids with families.
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Affiliation(s)
- Christina Medeiros
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Laura Buckley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Paediatric Intensive Care Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Familial Breast Cancer Research Institute, Women's College Research Institute, Toronto, Ontario, Canada
| | - Unni G Narayanan
- Department of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Digital interventions for adolescent and young adult cancer survivors. Curr Opin Support Palliat Care 2020; 14:51-59. [DOI: 10.1097/spc.0000000000000480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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