1
|
Champagne E, Chénard J, Simard C, Bonanno M, Bogossian A, Roberge V, Olivier-d'Avignon M, Ummel D, Fortin G, Bergeron F, Bonenfant F. Scoping Review on Transitions in the Context of Pediatric Palliative Care. J Palliat Med 2024. [PMID: 39047058 DOI: 10.1089/jpm.2023.0673] [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: 07/27/2024] Open
Abstract
Background: Children with complex and chronic conditions receiving palliative care will likely experience many transitions during their life and their treatments. Transition periods for children with life-limiting conditions and their families can be bewildering and highly anxiety-inducing. However, clinical observations seem to point to a more heterogenous care offer, including a lack or discontinuity of services, at the expense of their quality of life. Objective: This paper aims to establish a portrait of the existing literature and identify research gaps on the multiple transitions experienced by this population. Design: A scoping review is provided, following a PRISMA protocol. MEDLINE, PubMed and CINAHL were consulted. The search strategy is based on three key concepts: (1) palliative care/complex condition, (2) child/adolescent, and (3) transition. Articles were screened with the help of Covidence. Results: A total of 72 articles are included for analysis. The aimed population is either identified by age group or by medical status. Respondents are most often parents rather than the children themselves. Transitions include: reaching adulthood, changes in care environment, changes in medical status, and school integration. Conclusion: The discussion notices a definitional murkiness about transitions and highlights the fact that the multifaceted and complex nature of transition over time is largely ignored. New research should involve a diversity of participants and include children's voices. Recommendations include clearer concept definitions, health care policies that adopt an ecosystemic approach, and professional training in the systemic family approach in palliative care.
Collapse
Affiliation(s)
- Elaine Champagne
- Chair of Religion, spirituality and health, Faculty of theology and religious sciences, Université Laval, Québec Canada
| | - Josée Chénard
- Social Work Department, Université du Québec en Outaouais, St-Jérôme Canada
| | - Chantale Simard
- Department of health sciences, Université du Québec à Chicoutimi, Canada
| | | | - Aline Bogossian
- School of Social Work, Université de Montréal, Montréal, Canada
| | - Véronique Roberge
- Department of health sciences, Université du Québec à Chicoutimi, Canada
| | | | - Deborah Ummel
- Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | | |
Collapse
|
2
|
Dannenberg VC, Rovedder PME, Carvalho PRA. Long-term functional outcomes of children after critical illnesses: A cohort study. Med Intensiva 2023; 47:280-288. [PMID: 36344345 DOI: 10.1016/j.medine.2022.02.022] [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: 10/13/2021] [Accepted: 02/17/2022] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To assess children's functional outcomes one year after critical illness and identify which factors influenced these functional outcomes. DESIGN Ambispective cohort study. SETTING Pediatric intensive care unit (PICU) in a tertiary academic center. PARTICIPANTS Children (1 month-17-year-old) and their caregivers. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Demographic, clinical, and functional status. RESULTS Of 242 patients screened, 128 completed the year follow-up. These children had significant changes in functional status over time (p<0.001). The functional decline occurred in 62% of children at discharge and, after one year, was persistent in 33%. Age>12 months was a protective factor against poor functional outcomes in two regression models (p<0.05). A moderately abnormal functional status and a severely/very severely abnormal functional status at discharge increased the risks of poor functional outcomes by 4.14 (95% CI 1.02-16.72; p=0.04), and 4.76 (CI 95% 1.19-19.0; p=0.02). A functional decline at discharge increased by 6.86 (95%CI: 2.16-21.79; p=0.001) the risks of children's long-term poor functional outcomes, regardless of the FSS scores. CONCLUSION This is the first study evaluating long-term functional outcomes after pediatric critical illnesses in Latin America. Our findings show baseline data and raise relevant questions for future multicentre studies in this field in Latin America, contributing to a better understanding of the effects of critical illnesses on long-term functional outcomes in children.
Collapse
Affiliation(s)
- V C Dannenberg
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.
| | - P M E Rovedder
- Escola de Educação Física, Fisioterapia e Dança, (ESEFID), Universidade Federal do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - P R A Carvalho
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil; Departamento de Pediatria, Unidade de Terapia Intensiva Pediátrica, Hospital de Clínicas de Porto Alegre, Brazil
| |
Collapse
|
3
|
Rizk S, Kaelin VC, Sim JGC, Murphy NJ, McManus BM, Leland NE, Stoffel A, James L, Barnekow K, Papautsky EL, Khetani MA. Implementing an Electronic Patient-Reported Outcome and Decision Support Tool in Early Intervention. Appl Clin Inform 2023; 14:91-107. [PMID: 36724883 PMCID: PMC9891850 DOI: 10.1055/s-0042-1760631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The aim of the study is to identify and prioritize early intervention (EI) stakeholders' perspectives of supports and barriers to implementing the Young Children's Participation and Environment Measure (YC-PEM), an electronic patient-reported outcome (e-PRO) tool, for scaling its implementation across multiple local and state EI programs. METHODS An explanatory sequential (quan > QUAL) mixed-methods study was conducted with EI families (n = 6), service coordinators (n = 9), and program leadership (n = 7). Semi-structured interviews and focus groups were used to share select quantitative pragmatic trial results (e.g., percentages for perceived helpfulness of implementation strategies) and elicit stakeholder perspectives to contextualize these results. Three study staff deductively coded transcripts to constructs in the Consolidated Framework for Implementation Research (CFIR). Data within CFIR constructs were inductively analyzed to generate themes that were rated by national early childhood advisors for their relevance to longer term implementation. RESULTS All three stakeholder groups (i.e., families, service coordinators, program leadership) identified thematic supports and barriers across multiple constructs within each of four CFIR domains: (1) Six themes for "intervention characteristics," (2) Six themes for "process," (3) three themes for "inner setting," and (4) four themes for "outer setting." For example, all stakeholder groups described the value of the YC-PEM e-PRO in forging connections and eliciting meaningful information about family priorities for efficient service plan development ("intervention characteristics"). Stakeholders prioritized reaching families with diverse linguistic preferences and user navigation needs, further tailoring its interface with automated data capture and exchange processes ("process"); and fostering a positive implementation climate ("inner setting"). Service coordinators and program leadership further articulated the value of YC-PEM e-PRO results for improving EI access ("outer setting"). CONCLUSION Results demonstrate the YC-PEM e-PRO is an evidence-based intervention that is viable for implementation. Optimizations to its interface are needed before undertaking hybrid type-2 and 3 multisite trials to test these implementation strategies across state and local EI programs with electronic data capture capabilities and diverse levels of organizational readiness and resources for implementation.
Collapse
Affiliation(s)
- Sabrin Rizk
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, United States
| | - Vera C. Kaelin
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Julia Gabrielle C. Sim
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Natalie J. Murphy
- Department of Health Systems, Management, and Policy, University of Colorado, Aurora, Colorado, United States
| | - Beth M. McManus
- Department of Health Systems, Management, and Policy, University of Colorado, Aurora, Colorado, United States
| | - Natalie E. Leland
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Ashley Stoffel
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, United States
| | - Lesly James
- Department of Occupational Therapy, Lenoir-Rhyne University, Columbia, South Carolina, United States
| | - Kris Barnekow
- Department of Occupational Therapy, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, United States
| | - Elizabeth Lerner Papautsky
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Mary A. Khetani
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, United States,Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,CanChild Centre for Childhood Disability Research, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada,Address for correspondence Mary A. Khetani, ScD, OTR/L Department of Occupational Therapy, University of Illinois Chicago1919 West Taylor Street, Room 316A, Chicago, IL 60612-7250United States
| |
Collapse
|
4
|
Dannenberg V, Rovedder P, Carvalho P. Long-term functional outcomes of children after critical illnesses: A cohort study. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
Vieira DKR, Ribeiro CTM, Ribeiro RDL, Cabral LCJ. Chronic Diseases of Childhood and the International Classification of Functioning, Disability, and Health: A Systematic Review. Health (London) 2022. [DOI: 10.4236/health.2022.147054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
6
|
Jarvis JM, Fink EL. More than a feeling: understanding function and health related quality of life after pediatric neurocritical illness. Neurocrit Care 2021; 35:308-310. [PMID: 34286460 PMCID: PMC9558587 DOI: 10.1007/s12028-021-01270-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Jessica M Jarvis
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ericka L Fink
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
7
|
Serum Biomarkers of Regeneration and Plasticity are Associated with Functional Outcome in Pediatric Neurocritical Illness: An Exploratory Study. Neurocrit Care 2021; 35:457-467. [PMID: 33665769 PMCID: PMC9344468 DOI: 10.1007/s12028-021-01199-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVE Pediatric neurocritical care survivorship is frequently accompanied by functional impairments. Lack of prognostic biomarkers is a barrier to early identification and management of impairment. We explored the association between blood biomarkers and functional impairment in children with acute acquired brain injury. METHODS This study is a secondary analysis of a randomized control trial evaluating early versus usual care rehabilitation in the pediatric intensive care unit (PICU). Forty-four children (17 [39%] female, median age 11 [interquartile range 6-13] years) with acute acquired brain injury admitted to the PICU were studied. A single center obtained serum samples on admission days 0, 1, 3, 5, and the day closest to hospital discharge. Biomarkers relevant to brain injury (neuron specific enolase [NSE], S100b), inflammation (interleukin [IL-6], C-reactive protein), and regeneration (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF]) were collected. Biomarkers were analyzed using a Luminex® bioassay. Functional status scale (FSS) scores were abstracted from the medical record. New functional impairment was defined as a (worse) FSS score at hospital discharge compared to pre-PICU (baseline). Individual biomarker fluorescence index (FI) values for each sample collection day were correlated with new functional impairment using Spearman rank correlation coefficient (ρ). Trends in repeated measures of biomarker FI over time were explored graphically, and the association between repeated measures of biomarker FI and new functional impairment was analyzed using covariate adjusted linear mixed-effect models. RESULTS Functional impairment was inversely correlated with markers of regeneration and plasticity including BDNF at day 3 (ρ = - 0.404, p = .015), day 5 (ρ = - 0.549, p = 0.005) and hospital discharge (ρ = - 0.420, p = 0.026) and VEGF at day 1 (ρ = - 0.282, p = 0.008) and hospital discharge (ρ = - 0.378, p = 0.047), such that lower levels of both markers at each time point were associated with greater impairment. Similarly, repeated measures of BDNF and VEGF were inversely correlated with new functional impairment (B = - 0.001, p = 0.001 and B = - 0.001, p = 0.003, respectively). NSE, a biomarker of acute brain injury, showed a positive correlation between day 0 levels and new functional impairment (ρ = 0.320, p = 0.044). CONCLUSIONS Blood-based biomarkers of regeneration and plasticity may hold prognostic utility for functional impairment among pediatric patients with neurocritical illness and warrant further investigation.
Collapse
|
8
|
Jarvis JM, Fayed N, Fink EL, Choong K, Khetani MA. Caregiver dissatisfaction with their child's participation in home activities after pediatric critical illness. BMC Pediatr 2020; 20:415. [PMID: 32878614 PMCID: PMC7466418 DOI: 10.1186/s12887-020-02306-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric critical care is often accompanied by a variety of functional impairments. Preliminary evidence suggests children's participation in home activities has a slow trajectory post-pediatric intensive care unit (PICU) discharge, however, additional and more granular knowledge on specific problematic activities is needed to inform patient-centric rehabilitative care. The objectives of this study are to identify common home activities in which caregivers' report dissatisfaction and to determine predictors of caregivers' dissatisfaction with their child's participation in home activities post-PICU discharge. METHODS Secondary analyses of data from a prospective cohort study, the Wee-Cover study, using a subsample of caregivers (N = 170) of children 1-17 years, admitted to a PICU ≥48 h with data on our primary outcome measure from at least one time point. Data were gathered at enrollment and at 3 and 6 months post-PICU discharge. Caregivers reported on their dissatisfaction with their child's participation in home activities via the Participation and Environment Measure. Common activities were identified by plotting caregiver dissatisfaction for each activity pre-and post-PICU, reporting activities in which ≥50% of caregivers reported dissatisfaction with post-PICU, and assessing for significantly different dissatisfaction levels between time-points for each activity. Predictors of caregiver dissatisfaction were assessed using Poisson generalized estimated equation models. RESULTS There was variability in reported dissatisfaction across all activities; ≥50% of caregivers reported dissatisfaction with five activities, including getting clean, personal care management, and mealtime for younger children and household chores and homework for school-aged children and youth. Four activities had significantly higher caregiver dissatisfaction post-PICU: sleep (children < 5 years), homework, indoor play and games, and computer/video games (children ≥5 years). Home environmental support and the interaction of having participation-focused strategies with receiving PICU-based rehabilitation services were negatively associated with caregiver dissatisfaction. Increased caregiver stress and functional performance were associated with increased dissatisfaction. CONCLUSIONS Individualized PICU-based rehabilitation services to determine family priorities and develop participation-focused strategies, specifically those increasing environmental supports within the home, may ease the family's transition home post-PICU. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02148081 05/28/2014.
Collapse
Affiliation(s)
- Jessica M Jarvis
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor Street, AHSB 316A, Chicago, IL, 60612, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Karen Choong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mary A Khetani
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor Street, AHSB 316A, Chicago, IL, 60612, USA.
| |
Collapse
|