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Ruiz-Gil T, Ródenas-Rigla F. Quality of Care in Pediatric Palliative Care: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1922. [PMID: 38136124 PMCID: PMC10741525 DOI: 10.3390/children10121922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Palliative care (PC) enhances the quality of life for patients and families facing life-threatening conditions. While PC is well-established for adults, not all practices apply to pediatrics. Consequently, specific quality indicators for Pediatric Palliative Care (PPC) must be identified. This scoping review aimed to identify the variables associated with the quality of care of PPC patients in Spain, focusing specifically on three areas: structure and process of care, psychological aspects of care, and care of patients approaching the end of life. The review was conducted following PRISMA-ScR guidelines. Searches were performed in the PubMed, Scopus, Web of Science, Embase, ProQuest, and Dialnet databases covering the period extending from January 2000 to May 2023. Finally, 35 studies were identified for the complete review. A total of 30 studies include variables associated with the structure and process of care, 20 include variables associated with psychological aspects of care, and 23 studies integrate variables related to patient care at the end of life. Analysis suggests that enhancing professional training in aspects such as communication with patients and families, creating intimate spaces with flexible visiting hours, increasing emotional support, promoting frequent contact with healthcare teams, and transparently communicating about illness and imminent death to both families and minors could improve the quality of PPC.
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Affiliation(s)
- Tania Ruiz-Gil
- Polibienestar Research Institute, University of Valencia, 46022 Valencia, Spain;
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2
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Lyons KA, Middleton AA, Farley AA, Henderson NE, Peterson EB. End-of-Life Care Education in Pediatric Critical Care Medicine Fellowship Programs: Exploring Fellow and Program Director Perspectives. J Palliat Med 2023; 26:1217-1224. [PMID: 37093219 DOI: 10.1089/jpm.2022.0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Background/Objectives: The aim of this study is to describe the current state of end-of-life (EOL) care education within pediatric critical care medicine (PCCM) fellowship programs and explore potential differences in beliefs on EOL care education between program directors (PDs) and fellows. Design: A mixed-methods study based on data obtained through a nationally distributed, web-based cross-sectional survey of PCCM fellowship PDs and PCCM fellows was performed. Setting: Accreditation Council for Graduate Medical Education (ACGME)-accredited PCCM fellowships in the United States. Subjects: PCCM fellows and PDs participated in this study. Measurements and Results: The total number of survey respondents was 124 (94/654 fellows and 30/96 PDs), representing 39% of ACGME-accredited PCCM programs. Bedside teaching and lecture-based modalities were the most commonly used methods to teach EOL care. Most fellows and PDs reported a perceived need for additional EOL education within their respective training programs (fellows 91%, n = 86/94; PDs 67%, n = 20/30). A thematic analysis of curriculum structure questions revealed significant similarities between PDs and fellows, including the perceived need for education in communication, medical management, and cultural awareness. Dealing with uncertainty and resiliency were identified as themes among PDs only, and emotional/moral and legal issues were identified as themes solely by fellows. Conclusions: Our study describes the current state of EOL care education within a sample of PCCM fellowship programs. We highlight the perceived need for additional EOL education and identify areas within EOL care that deserve more focus by PCCM fellows and PDs. Future studies with focus on EOL curriculum development in PCCM EOL training are needed.
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Affiliation(s)
- Kelly A Lyons
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky, USA
| | - Alyssa A Middleton
- Doctor of Social Work Department, Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Alyssa A Farley
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Natalie E Henderson
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky, USA
| | - Eleanor B Peterson
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky, USA
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Rico-Mena P, Güeita-Rodríguez J, Martino-Alba R, Chocarro-Gonzalez L, Sanz-Esteban I, Palacios-Ceña D. Understanding pediatric palliative care within interdisciplinary palliative programs: a qualitative study. BMC Palliat Care 2023; 22:80. [PMID: 37355579 DOI: 10.1186/s12904-023-01194-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/07/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE To describe the process of delivery of pediatric palliative care from the perspective of a pediatric interdisciplinary team and the children's parents. METHODS A qualitative descriptive case study was conducted. Purposeful sampling took place within a specialized pediatric palliative care Unit in Madrid (Spain), located at the Niño Jesus Hospital. The study participants included a specialized pediatric palliative care team from Madrid's pediatric palliative care program, other professional teams involved in interdisciplinary care and parents of children under pediatric palliative care. Data were collected via semi-structured interviews, focus groups and researchers' field notes. A thematic analysis was performed. RESULTS This study included 28 participants (20 women, 8 men), of whom 18 were professionals who belonged to the pediatric palliative care interdisciplinary team, 4 professionals were from other units that collaborated with the pediatric palliative care, and 6 were parents (5 women, 1 man). The mean age of the pediatric palliative care members was 38.2 years (SD ± 7.9), that of the collaborating professionals was 40.5 (SD ± 6.8), and that of the parents was 44.2 (SD ± 5.4). Two main themes emerged: a) Pediatric palliative care has a distinct identity, associated with life. It represents the provision of special care in highly complex children, in the context of the home, far from the hospital environment; b) The team is key: its interdisciplinary organization provides a more comprehensive view of the child and their family, fosters communication among professionals, and improves coordination with other services involved in the care of children. The mindset shift experienced by ID-PPC professionals towards a palliative approach makes them more sensitive to the needs of their patients and leads them to develop specific skills in areas such as communication, decision-making, and adaptability that were identified as differentiating aspects of pediatric palliative care. CONCLUSIONS Describing pediatric palliative care from the professional and parental perspective helps to establish realistic and comprehensive goals for the care of children and their parents. The findings of this study may help with the establishment of a pediatric palliative care team, as a necessary organizational change in a health care system that cares for children with complex and life-threatening conditions. Promoting training in pediatric palliative care, prioritizing more horizontal organizations, providing tools and spaces for coordination and communication between professionals from different services, together with the creation of a position of case coordinator in the care process of children could enhance the understanding of pediatric palliative care services.
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Affiliation(s)
- Patricia Rico-Mena
- Department of Physiotherapy, Chiropody and Dance, Physical Therapy and Health Sciences Research Group, Universidad Europea de Madrid, C. Tajo, S/N, 28670 Villaviciosa de Odón, Madrid, Spain
- International Doctorate School, Rey Juan Carlos University, Madrid, Spain
| | - Javier Güeita-Rodríguez
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Humanities and Qualitative Research in Health Science Research Group, Universidad Rey Juan Carlos, Madrid, Spain.
| | - Ricardo Martino-Alba
- Pediatric Palliative Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Ismael Sanz-Esteban
- Department of Physiotherapy, Chiropody and Dance, Physical Therapy and Health Sciences Research Group, Universidad Europea de Madrid, C. Tajo, S/N, 28670 Villaviciosa de Odón, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Humanities and Qualitative Research in Health Science Research Group, Universidad Rey Juan Carlos, Madrid, Spain
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Bonete Román MC, Campos Rivera G. [The Death of Children: Ethical dilemmas about the limitation of therapeutic effort]. J Healthc Qual Res 2023; 38:180-185. [PMID: 36646591 DOI: 10.1016/j.jhqr.2022.11.010] [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: 04/21/2022] [Revised: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 01/16/2023]
Abstract
Ethical dilemmas take importance in current medical practice, especially at the end of life. Limitation of therapeutic effort, understood as not starting or withdrawing life support measures, is an alternative to preserve patient dignity when death approaches. Ethical dilemmas in this context have been widely studied in adults; not in children, in which the big psychological tension experienced by parents and professionals makes difficult to take accepted and consensual ethical decisions. The objective of this work has been to understand the concept of limitation of therapeutic effort and the deontological principles that support them in the pediatric field. The purpose was none other than to establish improvements in dying children whom peculiar life-end makes necessary a different approach of adults and an ethical conceptual clarification which justify LET practice in youngers.
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Lauderbaugh DL, Popien T, Doshi A. Effect of end-of-life care education on perceived self-efficacy of the pediatric respiratory therapist. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:66-69. [PMID: 36874476 PMCID: PMC9980158 DOI: 10.29390/cjrt-2022-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background End-of-life care (EoLC) is difficult for respiratory therapists (RTs), causing struggles with providing EoLC and grief during and after the death. Objective The objective of the study was to determine if EoLC education can increase RTs' perception of knowledge of EoLC, respiratory therapy as a valuable EoLC service, comfort providing EoLC, and knowledge of ways to deal with grief. Methods One hundred and thirty pediatric RTs completed a 1 h EoLC education session. Afterwards, a single-centre descriptive survey was administered to the 60 volunteers out of the 130 attendees. To determine RTs' self-rated change in knowledge of EoLC, perception of respiratory therapy as a valuable EoLC service, comfort with EoLC, and knowledge of ways to cope with grief. Statistical analysis included percent change. Results Overall, 96% of surveyed RTs agree they had an increase in knowledge, perception of RT services, comfort with providing care, and coping. Only 4% felt that this course had little benefit overall but still perceived value in RT EoLC and increased knowledge of long- and short-term ways to deal with grief. Conclusion Education on EoLC practices increased pediatric RTs' perception of knowledge, perceived value of respiratory therapy in EoLC, comfort with EoLC, and knowledge of coping resources.
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Affiliation(s)
- Denise L Lauderbaugh
- Department of Respiratory Therapy, Rady Children's Hospital - San Diego, San Diego, CA
| | - Toni Popien
- Department of Respiratory Therapy, Rady Children's Hospital - San Diego, San Diego, CA
| | - Ami Doshi
- Department of Palliative Care, Rady Children's Hospital - San Diego, San Diego, CA
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Hirata M, Kobayashi K. Experiences with the end-of-life decision-making process in children with cancer, their parents, and healthcare professionals: A systematic review and meta-ethnography. J Pediatr Nurs 2022; 69:e45-e64. [PMID: 36586777 DOI: 10.1016/j.pedn.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Decision-making during the end-of-life (EOL) phase for children with cancer is extremely difficult for parents. We synthesized the qualitative experiences of children with cancer, parents, and healthcare professionals (HCPs), and their social interactions during the EOL decision-making process in the pediatric oncology setting. METHODS Meta-ethnography was used to conduct a systematic review and meta-synthesis. We searched four online databases to identify original studies published in English and Japanese and examined 21 relevant studies. Two Japanese reviewers discussed the differences/relationships and included studies that synthesized the translated qualitative findings. A conceptual model of social interactions was created. RESULTS We identified four themes regarding children's, parents', and HCPs' experiences: hope and confrontation with the child's death, guidance and support during uncertainty, awareness of being protected and having hope, and mutual unspoken integration of values. CONCLUSIONS These themes evince the experiences of children, parents, and HCPs during the EOL decision-making process and suggests a complex three-way social interaction model. While considering such distinctive social interactions during a child's EOL, this study revealed the sharing of prudent information and psychosocial support by HCPs. The findings indicate that hope and uncertainty are key elements for effectively understanding the experiences of children and parents and that EOL decision-making should not be rushed but should be supported by leaving room for uncertainty and acknowledging parents' emotional needs and fostering new hope. Further research into how hope can be further supported in situations that are rife with uncertainty is needed.
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Affiliation(s)
- Mika Hirata
- Department of Nursing, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama 343-8540, Japan.
| | - Kyoko Kobayashi
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
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Elhemaly A, Refaey OE, Rizkallah RS, Zagulol MS. Palliative and end-of-life symptoms management for children with diffuse intrinsic pontine glioma. Future Oncol 2022; 18:1943-1950. [PMID: 35193393 DOI: 10.2217/fon-2021-1455] [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: 11/21/2022] Open
Abstract
Background: This study aimed to investigate diffuse intrinsic pontine glioma-specific symptoms in the last 12 weeks before death and to describe current palliative care. Materials & methods: A retrospective study included 80 pediatric diffuse intrinsic pontine glioma patients diagnosed between January 2018 and December 2019. Results: The most frequently encountered symptoms were headache, gait disturbance, vomiting, dysphagia, sensory loss, seizures and constipation. Steroids were used in 96% of patients with a high success rate, as well as analgesics (67.5%), antiemetics (59%), neuropathic medication (42.5%) and anticonvulsants (37.5%). Re-irradiation improved symptoms in 50% of patients. Conclusion: Steroids were efficient in managing many symptoms, with tolerated side effects. The symptomatic treatment succeeded in relieving end-of-life symptoms. Re-irradiation should be considered a good palliative tool in addition to regular symptomatic treatment.
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Affiliation(s)
- Ahmed Elhemaly
- Department of Pediatric Oncology, National Cancer Institute, Cairo University & Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Osama El Refaey
- Department of Pediatric Oncology & Palliative Care, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Reda Samuel Rizkallah
- Department of Palliative Care, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Mohamed S Zagulol
- Department of Radiation Oncology, National Cancer Institute, Cairo University & Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
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Sabouneh R, Lakissian Z, Hilal N, Sharara-Chami R. The State of the Do-Not-Resuscitate Order in a Pediatric Intensive Care Unit in the Middle East: A Retrospective Study. J Palliat Care 2022; 37:99-106. [PMID: 35014894 DOI: 10.1177/08258597211073228] [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: 11/16/2022]
Abstract
OBJECTIVES The Do-Not-Resuscitate (DNR) order is part of most hospitals' policies on the process of making and communicating decisions about a patient's resuscitation status. Yet it has not become a part of our society's ritual of dying in the Middle East especially among children. Given the diversity of pediatric patients, the DNR order continues to represent a challenge to all parties involved in the care of children including the medical team and the family. METHODS This was a retrospective review of the medical charts of patients who had died in the pediatric intensive care unit (PICU) of a tertiary academic institution in Beirut, Lebanon within the period of January 2012 and December 2017. RESULTS Eighty-two charts were extracted, 79 were included in the analysis. Three were excluded as one patient had died in the Emergency Department (ED) and 2 charts were incomplete. Most patients were male, Lebanese, and from Muslim families. These patients clinically presented with primary cardiac and oncological diseases or were admitted from the ED with respiratory distress or from the operating room for post-operative management. The primary cause of death was multiorgan failure and cardiac arrest. Only 34% of families had agreed to a DNR order prior to death and 10% suggested "soft" resuscitation. Most discussions were held in the presence of the parents, the PICU team and the patient's primary physician. CONCLUSIONS The DNR order presents one of the most difficult challenges for all care providers involved, especially within a culturally conservative setting such as Lebanon. As the numbers suggest, it is difficult for parents to reach the decision to completely withhold resuscitative measures for pediatric patients, instead opting for "soft" resuscitations like administering epinephrine without chest compressions.
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Affiliation(s)
- R Sabouneh
- American University of Beirut Medical Centre (AUBMC)
| | - Z Lakissian
- Dar Al-Wafaa Simulation in Medicine (DAWSIM), AUBMC
| | - N Hilal
- American University of Beirut Medical Centre (AUBMC)
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Zahedi F, Kadivar M, Khanali Mojen L, Asadabadi M, Tajalli S, Ilkhani M, Barasteh S, Elahikhah M, Larijani B. The ethical challenges of palliative care from the perspectives of pediatricians: A qualitative study in Iran. Front Pediatr 2022; 10:928476. [PMID: 36105856 PMCID: PMC9464941 DOI: 10.3389/fped.2022.928476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adherence to ethical principles is a requirement for palliative care delivery to children and a main concern of healthcare providers. Physicians usually face ethical challenges during their daily practice in hospitals and need adequate skills and the ability to identify and manage them. This study sought to explore the ethical challenges of palliative care from the perspectives of pediatricians. METHODS This qualitative study was conducted between April and July 2019 using the content analysis approach. Participants were fifteen pediatric medical residents, specialists, and subspecialists purposively recruited from pediatric hospitals in Tehran, Iran. Data were collected using in-depth semi-structured interviews and were analyzed using Graneheim and Lundman's approach to conventional content analysis. Trustworthiness was ensured through the four criteria proposed by Guba and Lincoln. RESULTS Participants' experiences of the ethical challenges of palliative care for children were grouped into two main categories, namely "bewilderment in dealing with children and their families" (with two subcategories) and "conflicts in decision making" (with three subcategories). The final five subcategories were: (a) inability to effectively communicate with children and their families, (b) inability to tell the truth about the disease, (c) physician-parent conflicts, (d) parent-child conflicts, and (e) physician-physician conflicts. CONCLUSION The main ethical challenges of palliative care from the perspectives of Iranian pediatricians are the inability to effectively communicate with children and their families, the inability to tell them the truth, and the inability to manage physician-parent, parent-child, and physician-physician conflicts. Identification and management of these challenges may help improve the quality of pediatric palliative care in Iran. Further studies are needed to confirm these findings in other settings.
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Affiliation(s)
- Farzaneh Zahedi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maliheh Kadivar
- Division of Neonatology, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khanali Mojen
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Asadabadi
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleheh Tajalli
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran
| | - Mahnaz Ilkhani
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Elahikhah
- Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Medical Ethics and History of Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Thomas A, Rubenstein J, Jarrell JA. Principles of Pediatric Palliative Care #405. J Palliat Med 2021; 24:133-134. [PMID: 33393892 DOI: 10.1089/jpm.2020.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dreisinger N, Moore D. Ethics in the PED: An Untimely Death. Pediatr Emerg Care 2021; 37:320-322. [PMID: 30921264 DOI: 10.1097/pec.0000000000001828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Death is an uncommon event in the pediatric emergency department. The sudden end of a young life is always an undesirable event. Staff and family members are never prepared. Although staff in the emergency department can become routinized to caring for acutely ill and dying patients, family members may become shocked by this novel and terrible experience. Whether the patient is old or young, previously sick or healthy, it is important to stop and consider how hard it must be for the assembled family. As frontline clinicians, we all deeply care about the outcome of our patients and their families, yet for them to feel they have been understood and well cared for, it is recognized that clinicians must attend to health care conversations on a deeper and more relational level. Consideration that these events happen and reinforcing that it is difficult for all involved ensure staff that their challenges are recognized.
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Affiliation(s)
| | - David Moore
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Akdeniz M, Yardımcı B, Kavukcu E. Ethical considerations at the end-of-life care. SAGE Open Med 2021; 9:20503121211000918. [PMID: 33786182 PMCID: PMC7958189 DOI: 10.1177/20503121211000918] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022] Open
Abstract
The goal of end-of-life care for dying patients is to prevent or relieve
suffering as much as possible while respecting the patients’ desires.
However, physicians face many ethical challenges in end-of-life care.
Since the decisions to be made may concern patients’ family members
and society as well as the patients, it is important to protect the
rights, dignity, and vigor of all parties involved in the clinical
ethical decision-making process. Understanding the principles
underlying biomedical ethics is important for physicians to solve the
problems they face in end-of-life care. The main situations that
create ethical difficulties for healthcare professionals are the
decisions regarding resuscitation, mechanical ventilation, artificial
nutrition and hydration, terminal sedation, withholding and
withdrawing treatments, euthanasia, and physician-assisted suicide.
Five ethical principles guide healthcare professionals in the
management of these situations.
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Affiliation(s)
- Melahat Akdeniz
- Department of Family Medicine, Faculty of Medicine, Akdeniz University Hospital, Akdeniz University, Antalya, Turkey
| | | | - Ethem Kavukcu
- Department of Sports Medicine, Faculty of Medicine, Akdeniz University Hospital, Akdeniz University, Antalya, Turkey
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Neonatal palliative care: perception differences between providers. J Perinatol 2020; 40:1802-1808. [PMID: 32661367 DOI: 10.1038/s41372-020-0714-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/14/2020] [Accepted: 06/24/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study was to describe differences and identify education gaps in the perception of palliative care (PC) between neonatal care providers in a Level IV Neonatal intensive care unit. STUDY DESIGN This is a descriptive survey mixed methods study. Email surveys were sent to social workers, pharmacists, dieticians, nurses, respiratory therapists, fellows and faculty in November of 2018. Total number of respondents was 181 with a response rate of 56%. RESULTS Statistically significant differences between faculty and non-faculty were found in regards to benefits of early PC consults, need for automatic consults for certain diagnosis and the frequency of PC consults. CONCLUSION The perception of PC differs greatly between faculty and non-faculty. Educational initiatives surrounding PC and communication along with instituting automatic consults for certain diagnosis could help bridge this difference in perception and educational gap.
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Lazzarin P, Giacomelli L, Terrenato I, Benini F. A Tool for the Evaluation of Clinical Needs and Eligibility to Pediatric Palliative Care: The Validation of the ACCAPED Scale. J Palliat Med 2020; 24:205-210. [PMID: 32640899 DOI: 10.1089/jpm.2020.0148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Despite their importance, pediatric palliative care (PPC) services are still scantly diffused. In addition, eligibility criteria for PPC are quite complex. Consequently, clinicians require a tool that suggests how to refer patients with life-limiting diseases to the most appropriate service and how to properly allocate health care resources. Objective: Recently, the Accertamento dei bisogni Clinico-Assistenziali Complessi in PEDiatria (ACCAPED) scale has been developed by a group of experts in PPC to evaluate the specific clinical needs of pediatric patients with a life-limiting disease. This study presents the validation of the ACCAPED scale. Design: Validation of ACCAPED scale was pursued by means of description and analysis of clinical vignettes representing patients with challenging-to-evaluate needs who have to be referred to the most appropriate service (community care, general PPC, and specialized PPC). The evaluation of vignettes according to the clinical experience of the experts represented the gold standard against which the validity of the ACCAPED scale was tested by groups with different levels of experience (experts, pediatricians, and health care providers (HCPs) not involved in PPC). Results: Results show a very high concordance between the evaluation of the vignettes through the ACCAPED scale and the evaluation by the clinical experience for experts in PPC and pediatricians. A less favorable grade of concordance has been recorded for HCPs not involved in PPC, suggesting that educational efforts to improve basic knowledge of PPC within the medical community are needed. Conclusions: Overall, this study suggests that the ACCAPED scale is a useful tool to improve rationalization of resources and eligibility criteria for PPC.
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Affiliation(s)
- Pierina Lazzarin
- Centro Regionale Veneto di Terapia del Dolore and Cure Palliative Pediatriche, Hospice Pediatrico, Padua, Italy
| | - Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Polistudium SRL, Milano, Italy
| | - Irene Terrenato
- Biostatistics and Bioinformatic Unit, Scientific Direction, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Franca Benini
- Centro Regionale Veneto di Terapia del Dolore and Cure Palliative Pediatriche, Hospice Pediatrico, Padua, Italy
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WUWHS 2020 Global Healing Changing Lives, Abu Dhabi, UAE March 8-12. J Wound Care 2020; 29:1-314. [PMID: 32686975 DOI: 10.12968/jowc.2020.29.sup7b.1] [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: 11/11/2022]
Abstract
The abstract book contains the abstracts of keynote lectures, global gelebration, focus sessions, symposia, regional view, workshops, sponsored symposia, oral presentations, posters and the index.
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den Hollander D, Albertyn R, Amber J. Palliation, end-of-life care and burns; concepts, decision-making and communication - A narrative review. Afr J Emerg Med 2020; 10:95-98. [PMID: 32612916 PMCID: PMC7320205 DOI: 10.1016/j.afjem.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 12/03/2022] Open
Abstract
Palliative care is the turn from cure as the priority of care to symptom relief and comfort care. Although very little is published in the burn literature on palliative care, guidelines can be gleaned from the general literature on palliative care, particularly for acute surgical and critical care patients. Palliative care may be started because of futility, on request of the patient, or because of limited resources. The SPIKES acronym is a useful guide to avoid errors in communication with terminal patients and their relatives.
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Affiliation(s)
- Daan den Hollander
- Burns Unit Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- Department of Surgery, University of KwaZulu Natal, South Africa
| | - Rene Albertyn
- Red Cross Memorial Children's Hospital, South Africa
| | - Julia Amber
- Palliative Care Practitioner, Department of Pediatrics, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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18
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Harris KW, Brelsford KM, Kavanaugh-McHugh A, Clayton EW. Uncertainty of Prenatally Diagnosed Congenital Heart Disease: A Qualitative Study. JAMA Netw Open 2020; 3:e204082. [PMID: 32369178 PMCID: PMC7201310 DOI: 10.1001/jamanetworkopen.2020.4082] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Parents who receive a prenatal diagnosis of congenital heart disease may experience more short- and long-term stress than those who receive a postnatal diagnosis. To identify potential interventions to ameliorate that stress, the longitudinal emotional experience of parents must first be understood. OBJECTIVE To better understand parents' accounts of their own prenatal experience, particularly aspects they found to be stressful or challenging, and to identify strategies to improve support. DESIGN, SETTING, AND PARTICIPANTS This qualitative study included analysis of transcripts of audio recorded telephone interviews with pregnant mothers and their support persons, as applicable, who were referred to and seen at the Fetal Cardiology Clinic at Vanderbilt Children's Hospital from May 2019 to August 2019 with an initial likely diagnosis of complex congenital heart disease at any gestational age. Data analysis was conducted from August 2019 to November 2019. MAIN OUTCOMES AND MEASURES An applied thematic analysis approach was used to code and analyze professionally transcribed interviews. Coding and codebook revisions occurred iteratively; intercoder reliability was assessed and confirmed routinely. One author coded all transcripts; a second author independently reviewed one-fifth of the transcripts at fixed intervals to ensure that interrater reliability remained greater than 80%. RESULTS Twenty-seven individuals from 17 families participated in 42 phone interviews during pregnancy, 27 conducted at the first time point after the initial prenatal cardiology consultation and 15 at the second time point after a follow-up prenatal cardiology visit. Most interviewees were mothers (16 interviewees [59%]; median [interquartile range] age, 30.0 [27.3-34.8] years) or fathers (8 interviewees [30%)], with a few support individuals (3 interviewees [11%]) (median [interquartile range] age of family member or support individual, 30.0 [26.0-42.0] years). Initial fetal diagnoses included a range of severe congenital heart disease. Uncertainty was identified as a pervasive central theme and was related both to concrete questions on scheduling, logistics, or next steps, and long-term unknown variables concerning the definitiveness of the diagnosis or overall prognosis. Practitioners helped families through their framing of uncertainty at various time points including before, during, and after the clinic visit. CONCLUSIONS AND RELEVANCE Families walk an uncertain path following a fetal diagnosis of severe congenital heart disease. The challenges faced by the cardiologists caring for them overlap in many ways with those experienced by pediatric palliative care practitioners. Potential future interventions to improve parental support were identified in the areas of expectation setting before the referral visit, communication in clinic, and identity formation after the new diagnosis.
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Affiliation(s)
- Kelly W. Harris
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Kavanaugh-McHugh
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ellen Wright Clayton
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
- School of Law, Vanderbilt University, Nashville, Tennessee
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19
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Humbles P, Band ME. Saying Goodbye. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.11.009] [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]
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Baenziger PH, Moody K. Palliative Care for Children with Central Nervous System Malignancies. Bioengineering (Basel) 2018; 5:bioengineering5040085. [PMID: 30322131 PMCID: PMC6315897 DOI: 10.3390/bioengineering5040085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023] Open
Abstract
Children with central nervous system (CNS) malignancies often suffer from high symptom burden and risk of death. Pediatric palliative care is a medical specialty, provided by an interdisciplinary team, which focuses on enhancing quality of life and minimizing suffering for children with life-threatening or life-limiting disease, and their families. Primary palliative care skills, which include basic symptom management, facilitation of goals-of-care discussions, and transition to hospice, can and should be developed by all providers of neuro-oncology care. This chapter will review the fundamentals of providing primary pediatric palliative care.
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Affiliation(s)
- Peter H Baenziger
- Peyton Manning Children's Hospital, Ascension St. Vincent, 2001 West 86th Street, Indianapolis, IN 46260, USA.
| | - Karen Moody
- MD Anderson Cancer Center, University of Texas, 1515 Holcomb Blvd., Unit 87, Houston, TX 77030, USA.
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21
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Cooper E, Hutchinson A, Sheikh Z, Taylor P, Townend W, Johnson MJ. Palliative care in the emergency department: A systematic literature qualitative review and thematic synthesis. Palliat Med 2018; 32:1443-1454. [PMID: 30028242 DOI: 10.1177/0269216318783920] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Despite a fast-paced environment, the emergency clinician has a duty to meet the palliative patient's needs. Despite suggested models and interventions, this remains challenging in practice. AIM To raise awareness of these challenges by exploring the experience of palliative care patients and their families and informal carers attending the emergency department, and of the clinicians caring for them. DESIGN Qualitative systematic literature review and thematic synthesis. Search terms related to the population (palliative care patients, family carers, clinicians), exposure (the emergency department) and outcome (experience). The search was international but restricted to English and used a qualitative filter. Title, abstracts and, where retrieved, full texts were reviewed independently by two reviewers against predefined inclusion criteria arbitrated by a third reviewer. Studies were appraised for quality but not excluded on that basis. DATA SOURCES MEDLINE [1946-], Embase[1947-], CINAHL [1981-] and PsycINFO [1987-] with a bibliography search. RESULTS 19 papers of 16 studies were included from Australia ( n = 5), the United Kingdom ( n = 5), and United States ( n = 9) representing 482 clinical staff involved in the emergency department (doctors, nurses, paramedics, social workers, technicians), 61 patients and 36 carers. Nine descriptive themes formed three analytic themes: 'Environment and Purpose', 'Systems of Care and Interdisciplinary Working' and 'Education and Training'. CONCLUSION In the included studies, provision of emergency palliative care is a necessary purpose of the emergency department. Failure to recognise this, gain the necessary skills or change to systems better suited to its delivery perpetuates poor implementation of palliative care in this environment.
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Affiliation(s)
- Esther Cooper
- 1 Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Mersey Deanery, Health Education England, UK.,2 Hull York Medical School, University of Hull, Hull, UK
| | - Ann Hutchinson
- 3 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Zain Sheikh
- 4 Head and Neck Specialities, York Hospital, York Teaching Hospitals NHS Foundation Trust, York, UK.,5 Department of Health Sciences, Hull York Medical School, University of York, York, UK
| | - Paul Taylor
- 6 School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK.,7 St Luke's Hospice, Sheffield, UK
| | - Will Townend
- 8 Department of Emergency Medicine, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Miriam J Johnson
- 3 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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22
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Kim MS, Lim NG, Kim HJ, Kim C, Lee JY. Pediatric Deaths Attributed to Complex Chronic Conditions over 10 Years in Korea: Evidence for the Need to Provide Pediatric Palliative Care. J Korean Med Sci 2018; 33:e1. [PMID: 29215810 PMCID: PMC5729636 DOI: 10.3346/jkms.2018.33.e1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/30/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pediatric palliative care (PPC) is the active total care of children suffering from life-threatening illnesses. Palliative care includes symptom management, psychosocial support, and end-of-life care. Despite significant advances in disease diagnosis and treatment, resources for PPC of children with serious illnesses are limited in Korea. This study aimed to investigate the scale, time trends, disease composition, regional distribution, and unmet needs of children dying from complex chronic conditions (CCCs). METHODS We examined available information on children who died of CCCs from 2005 to 2014 using the cause of death statistics in Korea. RESULTS There were 36,808 cases of pediatric deaths in Korea during that 10-year period, one-third (12,515 cases, 34.0%) of which were due to CCCs. In 2014, there were 1,044 cases of pediatric deaths due to CCCs (9.8 deaths per 100,000 children) in Korea. The rate of pediatric deaths due to CCCs has declined over this 10-year period. Among CCCs, malignancy was the most common cause of death overall, as well as in children and adolescents, whereas neonatal disorders were the most common cause of death in infants. Although over 1,000 children die from chronic illnesses each year, there are no hospitals or institutes in Korea that meet the minimum standards for specialized PPC. CONCLUSION To improve the quality of life of children suffering from CCCs and to support their families who face enormous distress, children with CCCs should be able to access adequate palliative care services. Health authorities should consider supporting the establishment of PPC centers and increasing PPC accessibility in Korea.
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Affiliation(s)
- Min Sun Kim
- Institute of Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Nam Gu Lim
- Department of Medical Administration, Daejeon Health Sciences College, Daejeon, Korea
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin, Korea
| | - Chohee Kim
- College of Nursing, Seoul National University, Seoul, Korea
| | - Jin Yong Lee
- Public Health Medical Service, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea.
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Sasaki H, Bouesseau MC, Marston J, Mori R. A scoping review of palliative care for children in low- and middle-income countries. BMC Palliat Care 2017; 16:60. [PMID: 29178866 PMCID: PMC5702244 DOI: 10.1186/s12904-017-0242-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ninety-eight percent of children needing palliative care live in low- and middle-income countries (LMICs), and almost half of them live in Africa. In contrast to the abundance of data on populations in high income countries, the current data on populations in LMICs is woefully inadequate. This study aims to identify and summarize the published literature on the need, accessibility, quality, and models for palliative care for children in LMICs. METHODS A scoping review was performed following the method of Arksey and O'Malley. Systematic searches were conducted on PubMed and Google Scholar using the main keywords, 'children AND palliative care OR terminal care OR hospice OR end of life AND developing countries OR LMICs.' Additional publications were obtained by handsearching. Papers were only included if they reported on the need, accessibility, quality, and models for palliative care for children in LMICs. RESULTS Fifteen papers met the inclusion criteria for review. Of these, 10 assessed need, seven examined availability and/or accessibility, one assessed quality, and one examined the models. We found an urgent need for palliative care, particularly in the training for health workers and improving poor availability and/or accessibility to palliative care in terms of factors such as medication and bereavement support. The best practice models demonstrated feasibility and sustainability through cooperation with governments and community organizations. The quality of pain management and emotional support was lower in LMICs compared to HICs. CONCLUSION Although we found limited evidence in this review, we identified common challenges such as the need for further training for health workers and greater availability of opioid analgesics. While efforts to change the current systems and laws applying to children in LMICs are important, we should also tackle underlying factors including the need to raise awareness about palliative care in public health and improve the accuracy of data collection.
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Affiliation(s)
- Hatoko Sasaki
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, 157-8535 Japan
| | - Marie-Charlotte Bouesseau
- Service Delivery and Safety, World Health Organization, 20 Avenue Appia, 1211, 27 Geneva, Switzerland
| | - Joan Marston
- International Children’s Palliative Care Network, 2 Langenhoven Street, Dan Pienaar, Bloemfontein, 9301 South Africa
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, 157-8535 Japan
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24
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Penman J. Finding Paradise Within: How Spirituality Protects Palliative Care Clients and Caregivers From Depression. J Holist Nurs 2017; 36:243-254. [DOI: 10.1177/0898010117714665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aims of this article are to explore the experience of depression among palliative care clients and caregivers, describe the strategies they use in coping with depression, and clarify the role of spirituality in preventing and/or overcoming depression. This article discusses an aspect of the findings of a larger doctoral study that explored the nature of spirituality and spiritual engagement from the viewpoint of individuals with life-limiting conditions and their caregivers. van Manen’s phenomenology was used in the study. The data generated from the doctoral study were subjected to secondary analysis to uncover the experience of depression. The methodology underpinning the secondary analysis was phenomenology also by van Manen. Fourteen clients and caregivers from across regional and rural South Australia informed the study. Data collection involved in-depth nonstructured home-based interviews that were audiotaped and transcribed verbatim. The findings highlighted relate to participants succumbing to depression, but having spiritual beliefs and practices helped them cope. One of the most insightful understanding was the role spirituality played in protecting individuals from depression, encapsulated in the theme “finding paradise within.” Spirituality, understood from a religious or secular perspective, must be embedded in palliative care as it assisted in preventing and overcoming depression.
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Elements of Family-Centered Care in the Pediatric Intensive Care Unit: An Integrative Review. J Hosp Palliat Nurs 2017; 19:238-246. [PMID: 28496382 DOI: 10.1097/njh.0000000000000335] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper reports result from a systematic search and thematic analysis of qualitative literature to identify key issues related to family-centered care, behaviors, and communication skills that support the parental role and improve patient and family outcomes in the PICU. Five themes were identified: 1) sharing information; 2) hearing parental voices; 3) making decisions for or with parents; 4) negotiating roles; and 5) individualizing communication. These themes highlight several gaps between how parents want to be involved and perceive clinicians engage them in the care of their child. Parental preferences for involvement differ in the domains of information sharing, decision making, and power-sharing across a spectrum of parental roles from parents as care provider to care recipient. The PICU setting may place clinicians in a double bind trying to both engage families and protect them from distress. Asking families of critically ill children about their preferences for participation across these domains may improve clinician-family relationships.
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Abstract
PURPOSE AND OBJECTIVES This article: PRIMARY PRACTICE SETTINGS(S) : Applicable to all health care sectors where case management is practiced. FINDINGS/CONCLUSION Few topics are more intimate and multifaceted for case managers than engaging with today's culturally diverse patient populations around end-of-life processes. The already prominent focus of this issue has been further elevated by a series of events to receive public attention. These include the Institute of Medicine's 2014 report-Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, rising numbers of patients around the globe requesting to end life on their own terms, and corresponding death with dignity initiatives and legislation.Another vital factor in the end-of-life equation involves how the latest generation of shared decision making influences the management of treatment dialogues among practitioners, patients, as well as insurance companies. Case managers are at the intersection of these complex interactions, working to achieve ethical, as well as legal accountability to the patient, employer, and profession while balancing personal perspectives. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Professionals strive to effectively intervene with patients and their support systems facing end-of-life care decisions. It is essential case managers actively consider the intricacies of ethical practice and current contexts including death with dignity legislation, shared decision making, and shifts in regulations and reimbursement for end-of-life care.Case management's ethical envelope will continue to be pushed. To that end amid shifting societal constructs, professionals must have mastery of applicable codes, standards, principles, and rules essential for adherence to ethical practice.
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28
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Wiegand DL, MacMillan J, dos Santos MR, Bousso RS. Palliative and End-of-Life Ethical Dilemmas in the Intensive Care Unit. AACN Adv Crit Care 2016; 26:142-50. [PMID: 25898882 DOI: 10.1097/nci.0000000000000085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Critical care nurses and advanced practice registered nurses frequently face bioethical dilemmas in clinical practice that are related to palliative and end-of-life care. Many of these dilemmas are associated with decisions made concerning continuing, limiting, or withdrawing life-sustaining treatments. The purpose of this article is to describe common ethical challenges through case study presentations and discuss approaches that critical care nurses and advanced practice registered nurses in collaboration with the interdisciplinary team can use to address these challenges. Resources that may be helpful in managing ethical dilemmas are identified.
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Affiliation(s)
- Debra L Wiegand
- Debra L. Wiegand is Associate Professor, University of Maryland School of Nursing, 655 West Lombard Street, Office 404P, Baltimore, MD 21201 . Julia MacMillan is Palliative Care Coordinator and Co-Chair Danbury Hospital Ethics Committee, Chair Nursing Ethics Committee, Danbury Hospital, Western Ct. Health Network, Danbury Hospital, Danbury, Connecticut. Maiara Rogrigues dos Santos is Doctoral Student, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil. Regina Szylit Bousso is Associate Professor, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
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Neonatal Death in the Emergency Department: When End-of-Life Care Is Needed at the Beginning of Life. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Snaman JM, Torres C, Duffy B, Levine DR, Gibson DV, Baker JN. Parental Perspectives of Communication at the End of Life at a Pediatric Oncology Institution. J Palliat Med 2016; 19:326-32. [DOI: 10.1089/jpm.2015.0253] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jennifer M. Snaman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carlos Torres
- Department of Psychology, University of Memphis, Memphis, Tennessee
| | | | - Deena R. Levine
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Deborah V. Gibson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Justin N. Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee
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Abstract
Pain and symptom management is considered one of the cornerstones of palliative and hospice medicine. However, general clinicians and specialists are not usually comfortable addressing the most common forms of pain seen in the pediatric population. In addition, non-pain symptom management, especially when related to underlying chronic medical conditions, can be managed by the general clinician and specialists. The goal of this article is to educate clinicians about pain categories, taking a detailed pain history, and developing a plan for treatment, including nonpharmacologic methods. Finally, we discuss common symptoms in patients with chronic medical conditions, including first-line treatment options.
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Affiliation(s)
- Kelly Komatz
- Division of Community & Societal Pediatrics, University of Florida College of Medicine, Jacksonville, FL
| | - Brian Carter
- Division of Neonatology & Bioethics Center, University of Missouri-Kansas City & Children's Mercy Hospital, Kansas City, MO
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32
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Veldhuijzen van Zanten SEM, van Meerwijk CLLI, Jansen MHA, Twisk JWR, Anderson AK, Coombes L, Breen M, Hargrave OJ, Hemsley J, Craig F, Cruz O, Kaspers GJL, van Vuurden DG, Hargrave DR. Palliative and end-of-life care for children with diffuse intrinsic pontine glioma: results from a London cohort study and international survey. Neuro Oncol 2015; 18:582-8. [PMID: 26459800 DOI: 10.1093/neuonc/nov250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/04/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND More than 90% of patients with diffuse intrinsic pontine glioma (DIPG) will die within 2 years of diagnosis. Patients deteriorate rapidly during the disease course, which severely impairs their quality of life. To date, no specific research on this clinically important subject has been conducted. This study aimed to compile an inventory of symptoms experienced, interventions applied, and current service provision in end-of-life care for DIPG. METHODS We performed a retrospective cohort study of children with DIPG, aged 0-18 years, who received treatment under the care of 2 London hospitals. Symptoms, interventions, and services applied during the 12 weeks before death were analyzed. In addition, we conducted a global questionnaire-study among health care professionals. RESULTS In more than 78% of DIPG patients, problems concerning mobility, swallowing, communication, consciousness, and breathing arose during end-stage disease. Supportive drugs were widely prescribed. The use of medical aids was only documented in <15% of patients. Palliative and end-of-life care was mostly based on the health care professional's experience; only 21% of the questionnaire respondents reported to have a disease-specific palliative care guideline available. CONCLUSIONS This research assessed the current state of palliative and end-of-life care for children with DIPG. Our results show the variability and complexity of symptoms at end-stage disease and the current lack of disease-specific guidelines for this vulnerable group of patients. This first descriptive paper is intended to act as a solid basis for developing an international clinical trial and subsequent guideline to support high-quality palliative and end-of-life care.
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Affiliation(s)
- Sophie E M Veldhuijzen van Zanten
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Charlotte L L I van Meerwijk
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Marc H A Jansen
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Jos W R Twisk
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Anna-Karenia Anderson
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Lucy Coombes
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Maggie Breen
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Olivia J Hargrave
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - June Hemsley
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Finella Craig
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Ofelia Cruz
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Gertjan J L Kaspers
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Dannis G van Vuurden
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Darren R Hargrave
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
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Bateman LB, Tofil NM, White ML, Dure LS, Clair JM, Needham BL. Physician Communication in Pediatric End-of-Life Care: A Simulation Study. Am J Hosp Palliat Care 2015; 33:935-941. [PMID: 26169522 DOI: 10.1177/1049909115595022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life. METHODS Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent. RESULTS Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely. CONCLUSION Findings indicate that effective physician-parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units. PRACTICE IMPLICATIONS The findings in this study, particularly that physician-parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care.
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Affiliation(s)
- Lori Brand Bateman
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nancy M Tofil
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marjorie Lee White
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leon S Dure
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Belinda L Needham
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Wiegand DL, MacMillan J, dos Santos MR, Bousso RS. Palliative and End-of-Life Ethical Dilemmas in the Intensive Care Unit. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Critical care nurses and advanced practice registered nurses frequently face bioethical dilemmas in clinical practice that are related to palliative and end-of-life care. Many of these dilemmas are associated with decisions made concerning continuing, limiting, or withdrawing life-sustaining treatments. The purpose of this article is to describe common ethical challenges through case study presentations and discuss approaches that critical care nurses and advanced practice registered nurses in collaboration with the interdisciplinary team can use to address these challenges. Resources that may be helpful in managing ethical dilemmas are identified.
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Affiliation(s)
- Debra L. Wiegand
- Debra L. Wiegand is Associate Professor, University of Maryland School of Nursing, 655 West Lombard Street, Office 404P, Baltimore, MD 21201
| | - Julia MacMillan
- Julia MacMillan is Palliative Care Coordinator and Co-Chair Danbury Hospital Ethics Committee, Chair Nursing Ethics Committee, Danbury Hospital, Western Ct. Health Network, Danbury Hospital, Danbury, Connecticut
| | - Maiara Rogrigues dos Santos
- Maiara Rogrigues dos Santos is Doctoral Student, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
| | - Regina Szylit Bousso
- Regina Szylit Bousso is Associate Professor, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
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Ito Y, Okuyama T, Ito Y, Kamei M, Nakaguchi T, Sugano K, Kubota Y, Sakamoto N, Saitoh S, Akechi T. Good death for children with cancer: a qualitative study. Jpn J Clin Oncol 2015; 45:349-55. [PMID: 25628351 DOI: 10.1093/jjco/hyu223] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aims to explore the characteristics of a good death for children with cancer. METHODS A total of 10 pediatric cancer survivors, 10 bereaved family members and 20 medical professionals participated in in-depth interviews. Qualitative content analysis was performed on the transcribed data obtained from semi-structured interviews. RESULTS Thirteen characteristics including unique and specific for children of a good death were identified: (i) sufficient opportunities to play freely, (ii) peer supporters, (iii) continued access to the patient's usual activities and relationships, (iv) assurance of privacy, (v) respect for the patient's decisions and preferences, (vi) a sense that others acknowledge and respect the patient's childhood, (vii) comfort care to minimize distressing symptoms, (viii) hope, (ix) not aware of the patient's own impending death, (x) constant dignity, (xi) strong family relationships, (xii) no sense of being a burden to family members and (xiii) good relationships with medical staffs. CONCLUSIONS This study identifies important characteristics of a good death for children with cancer. These findings may help medical staffs provide optimal care for children with cancer and their families, enabling them to achieve a good death.
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Affiliation(s)
- Yoshinori Ito
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya
| | - Toru Okuyama
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya
| | - Yasuhiko Ito
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Michi Kamei
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomohiro Nakaguchi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya
| | - Koji Sugano
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya
| | - Yosuke Kubota
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Nobuhiro Sakamoto
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya
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Valadares MTM, Mota JAC, de Oliveira BM. Palliative care in pediatric hematological oncology patients: experience of a tertiary hospital. Rev Bras Hematol Hemoter 2014; 36:403-8. [PMID: 25453649 PMCID: PMC4318475 DOI: 10.1016/j.bjhh.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/25/2014] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the approach to palliative care for hematological oncology patients in the pediatric ward of a tertiary hospital. Methods This was a retrospective, descriptive study of 29 hematological oncology patients who died between 2009 and 2011. Data regarding the approach and prevalence of pain, prevalence of other symptoms, multidisciplinary team participation, communication between staff and family and limited invasive therapy were collected from the medical records. Results Twenty-seven (93.1%) patients displayed disease progression unresponsive to curative treatment. The median age at death was ten years old. Pain was the most prevalent symptom with all patients who reported pain receiving analgesic medications. The majority took weak (55.2%) and/or strong (65.5%) opioids. The patients were followed by pediatricians and a pediatric hematologist/oncologist. Participation of other professionals was also documented: 86.2% were followed by social services and 69% by psychologists, among others. There were explicit descriptions of limitation of invasive therapy in the medical records of 26 patients who died with disease progression. All these decisions were shared with the families. Conclusion Although the hospital where this study was conducted does not have a specialized team in pediatric palliative care, it meets all the requirements for developing a specific program. The importance of approaching pain and other prevalent symptoms in children with cancer involving a comprehensive multidisciplinary team is evident. Discussions were had with most of the families on limiting invasive therapy, but no record of a well-defined and coordinated treatment plan for palliative care was found.
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Palliative care clients' and caregivers' notion of fear and their strategies for overcoming it. Palliat Support Care 2014; 13:777-85. [PMID: 24892738 DOI: 10.1017/s1478951514000571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This paper aims to clarify our understanding of fear and explore the strategies employed by people with life-limiting conditions and their caregivers in addressing the emotion of fear as they journey through the dying process. The role of fear is discussed: different kinds of fear, the tangible and intangible measures by which people manage their fear, and the ways of transcending fear. METHOD The findings of a larger research project funded by the Australian Department of Health and Ageing are drawn upon. In-depth interviews were conducted with clients and caregivers relating to the psychosocial and emotional issues in palliative care. Secondary analysis was utilized to examine the perceptions of fear in this cohort. RESULTS While there were many other findings, the results highlighted in this paper relate to the notion of fear among interview participants. Interview data showed that people with life-limiting conditions and their caregivers had different types of fear and employed a variety of strategies to deal with fear. Four themes emerged embodying these strategies: calling on their own resilience and inner resources, maintaining human relationships, gaining the ability to "keep one step ahead" in the dying process, and engaging in spirituality and religion. SIGNIFICANCE OF RESULTS The implications of the findings for healthcare professionals are highlighted. The recognition of emotions is embedded in palliative care; healthcare professionals should view the management of emotions as an integral part of professional practice. Addressing fear is essential because unresolved fear can impinge on one's ability to cope. Our paper brings together different perspectives on fear and how vulnerable individuals attempt to cope with it while at the same time providing a view of the challenges confronting healthcare professionals who are engaged with them and committed to optimizing health outcomes for palliative care clients and their caregivers.
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Peng NH, Chen CH, Huang LC, Liu HL, Lee MC, Sheng CC. The educational needs of neonatal nurses regarding neonatal palliative care. NURSE EDUCATION TODAY 2013; 33:1506-1510. [PMID: 23683813 DOI: 10.1016/j.nedt.2013.04.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 04/14/2013] [Accepted: 04/23/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Studies have shown that education can improve the knowledge, attitudes, and beliefs of neonatal nurses regarding neonatal palliative care. However, no study has investigated the need for neonatal nurse education in neonatal palliative care in Taiwan. OBJECTIVE The purpose of this study was to explore neonatal nurses' experiences in caring for dying neonates and their educational backgrounds regarding palliative care, as well as to assess their educational needs. METHODS A cross-sectional survey was used for this research. A research structural questionnaire was used to investigate the research goals. RESULTS One hundred fifteen nurses participated in this survey. Few participants indicated having received neonatal palliative care education (13%), but most responded that palliative care is necessary in neonatal nursing education (97.4%). Participants also responded that they were often or always exposed to death in NICU (62.6%), but few reported providing pain management to dying neonates (8.7%) and few had experience providing symptomatic care for dying neonates (19.1%). Fifty percent ranked "pain control" as the area in which they most required training. Another high-ranked need was in discussing with parents and families the outcomes of CPR and their neonate's progress. CONCLUSION Research indicates that the education currently provided to neonatal nurses does not meet their distinctive needs. Neonatal nurses in Taiwan expressed an urgent desire for training in pain control and communication. Research suggests that the most important topics to trainees are pain management and end-of-life communication. Additionally, non-pharmacological pain control interventions are valuable and should be included in an educational program.
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Affiliation(s)
- Niang-Huei Peng
- Nursing College in Central Taiwan University of Science and Technology, Taiwan, ROC.
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Abstract
Hospitalized children constitute most annual pediatric deaths in the United States. The details of "how-to" provide end-of-life (EOL) care are not consistently taught to staff and therefore the actual delivery of EOL care is often inconsistent and invariably negatively associated with the long-term mental health of both the patient's family and care providers. This review describes the pertinent aspects of end-of-life care in pediatrics. Finally, a framework to optimize the quality of death is described, which underscores the importance of synchrony between the care team and the family at the end of a child's life.
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Affiliation(s)
- Rajit K Basu
- Division of Critical Care, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH 45229, USA.
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Kumar SP. Reporting of pediatric palliative care: a systematic review and quantitative analysis of research publications in palliative care journals. Indian J Palliat Care 2012; 17:202-9. [PMID: 22347775 PMCID: PMC3276817 DOI: 10.4103/0973-1075.92337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
CONTEXT Pediatric palliative care clinical practice depends upon an evidence-based decision-making process which in turn is based upon current research evidence. AIMS This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting characteristics of articles on pediatric palliative care. SETTINGS AND DESIGN This was a systematic review of palliative care journals. MATERIALS AND METHODS Twelve palliative care journals were searched for articles with "paediatric" or "children" in titles of the articles published from 2006 to 2010. The reporting rates of all journals were compared. The selected articles were categorized into practice, education, research, and administration, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original articles' category was further classified according to study designs. STATISTICAL ANALYSIS USED Descriptive analysis using frequencies and percentiles was done using SPSS for Windows, version 11.5. RESULTS The overall reporting rate among all journals was 2.66% (97/3634), and Journal of Hospice and Palliative Nursing (JHPN) had the highest reporting rate of 12.5% (1/8), followed by Journal of Social Work in End-of-Life and Palliative Care (JSWELPC) with a rate of 7.5% (5/66), and Journal of Palliative Care (JPC) with a rate of 5.33% (11/206). CONCLUSIONS The overall reporting rate for pediatric palliative care articles in palliative care journals was very low and there were no randomized clinical trials and systematic reviews found. The study findings indicate a lack of adequate evidence base for pediatric palliative care.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Hirani SAA, Rahman A. Child with idiopathic pulmonary hemosiderosis: a case report from Pakistan with multiple ethical and moral issues. J Pediatr Nurs 2012; 27:e22-8. [PMID: 21968218 DOI: 10.1016/j.pedn.2011.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 08/12/2011] [Accepted: 08/30/2011] [Indexed: 10/16/2022]
Abstract
This report discusses the case of a young Pakistani child diagnosed with idiopathic pulmonary hemosiderosis (IPH). The key features of IPH were iron deficiency anemia and pulmonary symptoms due to recurrent pulmonary hemorrhages. The child showed complications of the disease process because of late diagnosis. Because various ethical and moral issues were associated with the diagnosis and management of IPH, this case provides insights about the care burden of health care professionals and a child's parents in a Pakistani pediatric setting. During the course of the child's treatment at one of the private tertiary care settings of Karachi, Pakistan, the key challenges were as follows: declaring the diagnosis to the parents, dealing with the request of the child's parents for withdrawal of ventilatory support and withholding treatment, deciding the code status of the child, and ensuring the quality of the child's life after discharge from the hospital. It was learned from this case report that shared decision making and open communication with the child's family enabled the pediatric health care professionals to determine what was in the best interest of the child, resulting in provision of effective palliative care to the child. Moreover, it was realized that early detection of the disease and availability of hospice care can facilitate palliative care of children diagnosed with IPH.
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Longden JV. Parental perceptions of end-of-life care on paediatric intensive care units: a literature review. Nurs Crit Care 2011; 16:131-9. [PMID: 21481115 DOI: 10.1111/j.1478-5153.2011.00457.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM AND OBJECTIVE The aim of this study was to review the literature relating to parental perceptions on what constitutes quality end-of-life care (ELC) at the time of their child's death in paediatric intensive care units (PICUs). BACKGROUND There are few issues in medicine as complex as those involving ELC provision and within paediatric intensive care, these decisions are particularly emotive. Improving the quality of ELC has become a national priority and an understanding of the reality of parents during and after the loss of a child is a mandatory step in achieving this. Efforts to improve ELC in PICU must be based on an understanding of the issues and problems that are unique to parents within this environment and cannot simply be extrapolated from other settings. It is imperative that this has a high priority in training, clinical practice and research for all members of the intensive care team. SEARCH STRATEGY Databases were systematically searched to identify primary research that related specifically to parental needs during the death of their child on PICU and published between 2000 to the present. CONCLUSIONS Although the retrospective nature of the studies reviewed presents some limitations, it does provide a broad overview of the characteristics of parental needs, indicating the scope for further empirical research. The identification and acknowledgement of the fundamental needs of parents at this time can enable health professionals to provide competent and compassionate ELC which is as focussed and evidence based as other aspects of paediatric critical care medicine.
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Affiliation(s)
- Jennifer V Longden
- Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Oxford Road, Manchester, UK.
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43
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Brien IO, Duffy A, Shea EO. Medical futility in children’s nursing: making end-of-life decisions. ACTA ACUST UNITED AC 2010; 19:352-6. [DOI: 10.12968/bjon.2010.19.6.47234] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Irene O Brien
- Lady’s Hospital for Sick Children in Crumlin, Dublin
| | - Anita Duffy
- The School of Nursing and Midwifery, Trinity College Dublin
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Savory EA, Marco CA. End-of-life issues in the acute and critically ill patient. Scand J Trauma Resusc Emerg Med 2009; 17:21. [PMID: 19386133 PMCID: PMC2678074 DOI: 10.1186/1757-7241-17-21] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 04/22/2009] [Indexed: 11/24/2022] Open
Abstract
The challenges of end-of-life care require emergency physicians to utilize a multifaceted and dynamic skill set. Such skills include medical therapies to relieve pain and other symptoms near the end-of-life. Physicians must also demonstrate aptitude in comfort care, communication, cultural competency, and ethical principles. It is imperative that emergency physicians demonstrate a fundamental understanding of end-of-life issues in order to employ the versatile, multidisciplinary approach required to provide the highest quality end-of-life care for patients and their families.
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Affiliation(s)
- Eric A Savory
- University of Toledo College of Medicine, Mail Stop 1114, 3045 Arlington Avenue, Toledo, Ohio 43614, USA
| | - Catherine A Marco
- Professor, Department of Surgery, Emergency Medicine, Director of Medical Ethics Curriculum, University of Toledo College of Medicine, Mail Stop 1114, 3045 Arlington Avenue, Toledo, Ohio 43614, USA
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