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Pangarso AWS, Mulatsih S, Sitaresmi MN, Verhulst S, Kaspers G, Mostert S. Discovering needs for palliative care in children with cancer in Indonesia. Pediatr Blood Cancer 2024; 71:e30985. [PMID: 38627891 DOI: 10.1002/pbc.30985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/25/2024] [Accepted: 03/18/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND Although most children with cancer die in low- and middle-income countries, palliative care receives limited attention in these settings. This study explores parents' perspectives on experiences and needs of children dying from cancer. METHODS Home visits were conducted to interview parents of children, who were treated for cancer at an Indonesian academic hospital and died between 2019 and 2020, using semi-structured questionnaires. RESULTS Parents of 49 children (response rate 74%) were interviewed. While all children died in hospital, 37% of parents stated their child preferred to die at home. The most common symptoms during final illness were breathing difficulties (82%), pain (80%), and appetite loss (80%). Psychological symptoms received the least support from the medical team. No intervention was given to 46% of children with depression, 45% of children with anxiety, and 33% with sadness. Boys suffered more often from anxiety (68%) than girls (37%; p = .030). Parents (57%) were not always informed about their child's condition, and doctors gave confusing information (43%). The families' choice of treatment while dying was relieving pain or discomfort (39%) and extending life (33%), while for 29% it was unknown. However, many parents (51%) did not discuss these treatment wishes with doctors. Many children (45%) felt lonely wanting more interactions with school (71%), friends (63%), and family (57%). CONCLUSION Relieving suffering of children with cancer requires regular physical, psychological, social, and spiritual needs assessment. Families should actively participate in deciding whether to extend life or relieve pain and discomfort. This can importantly improve the quality of life of children and families.
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Affiliation(s)
- Alexandra Widita Swipratami Pangarso
- Department of Child Health, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sri Mulatsih
- Department of Child Health, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mei Neni Sitaresmi
- Department of Child Health, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susanne Verhulst
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gertjan Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Sinnathamby A, Lee LY, Ng GMC. " Why Are we Giving up on my Brother?"-The Unmet Needs of the Adolescent Facing End-of-Life Care in a Sibling. J Palliat Med 2024. [PMID: 38905128 DOI: 10.1089/jpm.2023.0395] [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: 06/23/2024] Open
Abstract
Adolescence is a challenging time at baseline, and a sibling receiving end-of-life care can alter an adolescent's life irrevocably. It is imperative for the medical team to understand the unique needs and perspectives of such an adolescent sibling. This in turn facilitates the anticipation of an adolescent's grief response, and allows for parents to be appropriately guided. However, more can be done to evaluate the needs of adolescent siblings and improve their support. This can be through establishing a validated needs-based questionnaire, empowering families and the multidisciplinary team to engage siblings, and diverting resources toward culturally sensitive support groups for siblings with critical illness. A framework to involve key players in the adolescent's circle is presented.
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Affiliation(s)
- Annushkha Sinnathamby
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Division of Palliative Care, National University Cancer Institute, Singapore, Singapore
| | - Le Ye Lee
- Foundation Healthcare Holdings, Singapore, Singapore
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3
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Tafazoli Moghadam E, Tafazoli A. Providing care for siblings of children on hospice. Palliat Support Care 2024; 22:417-418. [PMID: 37818646 DOI: 10.1017/s1478951523001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Affiliation(s)
| | - Ali Tafazoli
- Hospice Kingston, Queen's University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Department of Health Care Administration, Kingston Campus, St Lawrence College, Kingston, ON, Canada
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4
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Garcia D, Olsavsky AL, Hill KN, Patterson V, Baughcum AE, Long KA, Barrera M, Gilmer MJ, Fairclough DL, Akard TF, Compas BE, Vannatta K, Gerhardt CA. Associations between parental depression, communication, and self-worth of siblings bereaved by cancer. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2023; 37:1190-1199. [PMID: 37676170 PMCID: PMC10841243 DOI: 10.1037/fam0001137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
A child's death from cancer may increase the risk for poor self-worth in bereaved siblings. Furthermore, bereaved parents may experience depressive symptoms and communicate differently with their surviving children. However, limited research has examined family factors associated with self-worth in bereaved siblings. Thus, we examined: (a) differences in parental depressive symptoms, parent-child communication, and sibling self-worth between bereaved and nonbereaved families and (b) indirect effects of parental depressive symptoms and communication quality on the association between bereavement and sibling self-worth. Bereaved parents and siblings were recruited 3-12 months after a child's death from cancer. Bereaved (n = 72) and nonbereaved families of classmates (n = 58) completed home-based questionnaires upon enrollment (T1), and 48 bereaved and 45 nonbereaved families completed 1-year follow-up (T2). Relative to controls at T1 and T2, bereaved mothers, but not fathers, reported more depressive symptoms. Bereaved siblings reported poorer maternal and similar paternal communication, and similar levels of self-worth compared to controls. Both cross-sectional and longitudinal serial mediation models for mothers were significant. Bereaved mothers were at greater risk for depressive symptoms, which adversely affected sibling self-worth over time through disrupted mother-child communication. The father sample was limited, but the cross-sectional model was nonsignificant. Mothers and fathers may grieve differently and may require different therapeutic approaches. Family-centered interventions should target bereaved mothers' emotional adjustment and communication to enhance sibling self-worth. Additionally, clinicians should bolster other sources of support for bereaved siblings to promote adaptive outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Dana Garcia
- Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | - Anna L. Olsavsky
- Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | | | | | - Amy E. Baughcum
- Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | | | | | | | | | | | | | - Kathryn Vannatta
- Abigail Wexner Research Institute at Nationwide Children’s Hospital
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Hill KN, Olsavsky A, Barrera M, Gilmer MJ, Fairclough DL, Akard TF, Compas BE, Vannatta K, Gerhardt CA. Factors associated with mental health service use among families bereaved by pediatric cancer. Palliat Support Care 2023; 21:829-835. [PMID: 35938399 PMCID: PMC9905324 DOI: 10.1017/s1478951522001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We identified types of interventions used by bereaved family members and examined associations with demographic and medical factors. Furthermore, we examined associations between distress and intervention use among bereaved families. METHODS Bereaved families (n = 85) were recruited from three children's hospitals 3-12 months after their child died of cancer. One eligible sibling (ages 8-17) per family was randomly selected for participation. During home visits 1-year post-death, parents reported on their own and the sibling's intervention use, helpfulness, and dose (self-help books, support groups, therapy, medication), and distress, defined as internalizing, externalizing, and total problems (Adult Self Report, Child Behavior Checklist). RESULTS Fifty percent of mothers used medications (n = 43); utilization was low among fathers (17%, n = 9) and siblings (5%, n = 4). Individuals with more total problems were more likely to use medications (mothers: rpb = 0.27; p = 0.02; fathers: rpb = 0.32; p = 0.02; siblings: rpb = 0.26; p = 0.02). Mothers and siblings with more total problems used more services (r = 0.24; p = 0.03 and r = 0.29; p = 0.01, respectively). Among mothers, the overall regression was significant, R2 = 0.11, F(2, 80) = 4.954, p = 0.01; the deceased child's age at death was significantly associated with total services used (b = 0.052, p = 0.022). Among fathers, the overall regression was significant, R2 = 0.216, F(3, 49) = 4.492, p = 0.007; race and years of education were significantly associated with total services used (b = 0.750, p = 0.030 and b = 0.154, p = 0.010). Among siblings, the overall regression was significant R2 = 0.088, F(2, 80) = 3.867, p = 0.025; greater total problems were significantly associated with total services used (b = 0.012, p = 0.007). SIGNIFICANCE OF RESULTS Although few background factors were related to intervention use, bereaved mothers and siblings may seek services if they have more distress. Healthcare providers should be aware of the types of services that are most often utilized and helpful to bereaved families to connect them with appropriate resources. Future research should investigate other predictors of intervention use and outcomes after the death of a child.
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Affiliation(s)
- Kylie N. Hill
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Anna Olsavsky
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- The Ohio State University College of Medicine, Columbus, OH
| | - Maru Barrera
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Kathryn Vannatta
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Cynthia A. Gerhardt
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- The Ohio State University College of Medicine, Columbus, OH
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Widger K, Brennenstuhl S, Tanuseputro P, Nelson KE, Rapoport A, Seow H, Siden H, Vadeboncoeur C, Gupta S. Location of death among children with life-threatening conditions: a national population-based observational study using the Canadian Vital Statistics Database (2008-2014). CMAJ Open 2023; 11:E298-E304. [PMID: 37015742 PMCID: PMC10079309 DOI: 10.9778/cmajo.20220070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Patterns in location of death among children with life-threatening conditions (e.g., cancer, genetic disorders, neurologic conditions) may reveal important inequities in access to hospital and community support services. We aimed to identify demographic, socioeconomic and geographic factors associated with variations in location of death for children across Canada with life-threatening conditions. METHODS We used a retrospective observational cohort design and the Canadian Vital Statistics Database to identify children aged 19 years or younger who died from a life-threatening condition between Jan. 1, 2008, and Dec. 31, 2014. We used multivariable logistic regression to determine predictors of in-hospital death for children aged 1 month to 19 years, and for neonates younger than 1 month. RESULTS Overall, 13 115 decedents younger than 19 years had life-threatening conditions. Of 5250 children and 7865 neonates, 74.2% and 98.1%, respectively, died in hospital. Among children, we found a higher proportion of hospital deaths in the lowest (v. highest) income quintile (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.28-1.97), and a lower proportion among children living more than 400 km (v. < 50 km) from a pediatric hospital (OR 0.73, 95% CI 0.65-0.86). Compared with Ontario, hospital death was most common in Quebec (OR 1.38, 95% CI 1.14-1.67) and least common in British Columbia (OR 0.43, 95% CI 0.34-0.53). Compared with an oncologic cause of death, all causes except neurologic and metabolic conditions had significantly higher odds of dying in hospital. INTERPRETATION In addition to demographics, we identified socioeconomic and geographic differences in location of death, suggesting potential inequities in access to high-quality care at the end of life. Health care policies and practices must ensure equitable access to services for children across Canada, particularly at the end of their life.
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Affiliation(s)
- Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont.
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Peter Tanuseputro
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Katherine E Nelson
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Adam Rapoport
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Hsien Seow
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Harold Siden
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Chris Vadeboncoeur
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Sumit Gupta
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
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Tureluren E, Claes L, Andriessen K. Factors Associated With Alcohol and Substance Use in Bereaved College and University Students. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221132904. [PMID: 36214171 DOI: 10.1177/00302228221132904] [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: 12/22/2023]
Abstract
Experiencing the death of a loved one increases the risk of developing mental health problems. Students are vulnerable to developing mental health problems, to which substance use can contribute. Still, few studies have examined substance use in bereaved students. Using an online survey, we collected data about the impact of the death of a loved one on Belgian students' (N = 666) substance use. Using regression analysis we examined its relation to social support, grief, mental health and personal growth. A significant number of students indicated that the death affected their substance use. Feelings of grief and mental health distress played a significant role in students whose substance use increased after the death. There was no significant relationship between social support and personal growth and substance use. Our findings indicate that mental health professionals must address substance use when working with bereaved students to ensure early intervention and adequate support.
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Affiliation(s)
- Emilie Tureluren
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Belgium
| | - Karl Andriessen
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
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Wei D, Janszky I, Ljung R, Fang F, Li J, László KD. Bereavement and Prognosis After a First Acute Myocardial Infarction: A Swedish Register-Based Cohort Study. J Am Heart Assoc 2022; 11:e027143. [PMID: 36056733 PMCID: PMC9496408 DOI: 10.1161/jaha.122.027143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite accumulating evidence suggesting that bereavement is associated with increased risks of cardiovascular morbidity and mortality, the association between bereavement and prognosis after acute myocardial infarction (AMI) has not been well documented. We investigated the association by using Swedish register data. METHODS AND RESULTS We studied 266 651 patients with a first AMI included in the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) quality register from 1991 to 2018. We obtained information on bereavement (ie, death of a partner, child, grandchild, sibling, or parent), on primary (nonfatal recurrent AMI and death attributed to ischemic heart disease) and secondary outcomes (total mortality, heart failure, and stroke) and on covariates from several national registers. The association was analyzed using Poisson regression. The bereaved patients had a slightly increased risk of the primary outcome; the corresponding risk ratio (RR) was 1.02 (95% CI, 1.00-1.04). An increased risk was noted any time bereavement occurred, except if the loss was in the year after the first AMI. The association was strongest for the loss of a partner, followed by the loss of a child, grandchild, sibling, or parent. We also observed increased risks for total mortality (RR, 1.14 [95% CI, 1.12-1.16]), heart failure (RR, 1.05 [95% CI, 1.02-1.08]), and stroke (RR, 1.09 [95% CI, 1.05-1.13]) following bereavement. CONCLUSIONS Bereavement was associated with an increased risk of poor prognosis after a first AMI. The association varied by the relationship to the deceased.
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Affiliation(s)
- Dang Wei
- Department of Global Public Health Karolinska Institutet Stockholm Sweden.,Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
| | - Imre Janszky
- Department of Global Public Health Karolinska Institutet Stockholm Sweden.,Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden.,Swedish Medical Products Agency Uppsala Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology Aarhus University Aarhus Denmark
| | - Krisztina D László
- Department of Global Public Health Karolinska Institutet Stockholm Sweden
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9
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Ananth P, Lindsay M, Nye R, Mun S, Feudtner C, Wolfe J. End-of-life care quality for children with cancer who receive palliative care. Pediatr Blood Cancer 2022; 69:e29841. [PMID: 35686746 PMCID: PMC10498672 DOI: 10.1002/pbc.29841] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND We previously developed stakeholder-informed quality measures to assess end-of-life care quality for children with cancer. We sought to implement a subset of these quality measures in the multi-center pediatric palliative care (PPC) database. PROCEDURES We utilized the Shared Data and Research database to evaluate the proportion of childhood cancer decedents from 2017-2021 who, in the last 30 days of life, avoided chemotherapy, mechanical ventilation, intensive care unit admissions, and > 1 hospital admission; were enrolled in hospice services, and reported ≤ 2 highly distressing symptoms. We then explored patient factors associated with the attainment of quality benchmarks. RESULTS Across 79 decedents, 82% met ≥ 4 quality benchmarks. Most (76%) reported > 2 highly distressing symptoms; 17% were enrolled in hospice. In univariable analyses, patients with an annual household income ≤$50,000 had lower odds of hospice enrollment and avoidance of mechanical ventilation or intensive care unit admissions near end of life (odds ratio [OR] 0.10 [95% confidence interval (C.I.) 0.01, 0.86], p = 0.04; OR 0.13 [0.02, 0.64], p = 0.01; OR 0.36 [0.13, 0.98], p = 0.04, respectively). In multivariable analyses, patients with an income ≤$50,000 remained less likely to enroll in hospice, after adjusting for cancer type (OR 0.10 [0.01, 0.87]; p = 0.04). CONCLUSIONS Childhood cancer decedents who received PPC met a large proportion of quality measures near the end of their life. Yet, many reported highly distressing symptoms. Moreover, patients with lower household incomes appeared less likely to enroll in hospice and more likely to receive intensive hospital services near the end of life. This study identifies opportunities for palliative oncology quality improvement.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA
| | - Meghan Lindsay
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Russell Nye
- Justin Michael Ingerman Center for Palliative Care, Children’s Hospital of Philadelphia; Departments of Pediatrics, Medical Ethics, and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sophia Mun
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Chris Feudtner
- Justin Michael Ingerman Center for Palliative Care, Children’s Hospital of Philadelphia; Departments of Pediatrics, Medical Ethics, and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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10
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D'Alton SV, Ridings L, Williams C, Phillips S. The bereavement experiences of children following sibling death: An integrative review. J Pediatr Nurs 2022; 66:e82-e99. [PMID: 35660123 DOI: 10.1016/j.pedn.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
PROBLEM Sibling bereavement is one of the most distressing adverse life events during childhood but has received less attention in research than other forms of childhood bereavement. This integrative review identifies potential risk and protective factors for maladaptive coping following sibling bereavement and the influence of these factors on adjustment to loss. ELIGIBILITY CRITERIA Articles were limited to peer-reviewed studies, published in English in 2000 and beyond. Target population was bereaved siblings 0-18 years, and outcomes examined grief experiences by child self-report or parent-proxy report. SAMPLE The Whittemore and Knafl integrative framework was applied. Multidimensional Grief Theory guided the review with twenty-five studies synthesized across its domains: Separation Distress, Existential/Identity Crisis, and Circumstance-Related Distress. RESULTS Adjustment following sibling death is a complex process associated with a host of risk and protective factors that contribute to the bereavement process for this population. Age, sex, circumstance-related factors, continuing bonds, parental distress, and limited social support were critical influencing factors. CONCLUSION Definitive predictor variables were not identified but a combination of variables that influence the adjustment of bereaved siblings are discussed. IMPLICATIONS Future research is needed to explore the risk and protective factors of maladaptive coping to inform intervention development to promote individual and family adjustment following sibling death.
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Affiliation(s)
- Shannon V D'Alton
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, United States of America.
| | - Leigh Ridings
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, United States of America.
| | - Conrad Williams
- Medical University of South Carolina, Department of Pediatrics, 125 Doughty Street, MSC 917, Charleston, SC 29425, United States of America.
| | - Shannon Phillips
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, United States of America.
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11
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Tureluren E, Claes L, Andriessen K. Help-seeking behavior in bereaved university and college students: Associations with grief, mental health distress, and personal growth. Front Psychol 2022; 13:963839. [PMID: 35992443 PMCID: PMC9381721 DOI: 10.3389/fpsyg.2022.963839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Many students have experienced the death of a loved one, which increases their risk of grief and mental health problems. Formal and social support can contribute to better coping skills and personal growth in bereaved students. The purpose of this study was to examine the support that students received or wanted to receive and its relation to students’ mental health. We also looked at students’ needs when receiving support and barriers in seeking formal and social support. Participants (N = 666) completed an online survey consisting of questions about their sociodemographic characteristics, the support they received or wanted to receive, and support needs and barriers in seeking support. The survey also included three scales assessing grief, mental health distress, and personal growth. First, we analyzed the data descriptively. Next, we used MANCOVA to examine whether students who did or did not receive or wanted more support differed in terms of their grief, mental health distress, or personal growth. About 30% of students needed more support and experienced more grief and mental health distress than students who had their support needs met. Students who received support experienced more personal growth and grief than students who did not receive support. Students indicated a need for feeling acknowledged and safe. Feeling like a burden to others and perceiving their problems as not serious enough to warrant support were common barriers to seeking support. Our results indicate that support should be provided actively to students after the death of a loved one, and support being available on an ongoing basis.
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Affiliation(s)
- Emilie Tureluren
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Karl Andriessen
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- *Correspondence: Karl Andriessen,
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12
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Gregory D, Van Puymbroeck M, Crowe B, Garst B, Amylon M. The Lived Experience of Siblings of Children With Cancer Who Attended a Peer Support Camp in the United States. QUALITATIVE HEALTH RESEARCH 2022; 32:1342-1355. [PMID: 35621300 DOI: 10.1177/10497323221095478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Childhood cancer has a profound and negative impact on siblings, yet there are limited studies exploring lived experiences from their perspective. This qualitative study examined the perceptions and experiences of siblings of children with cancer who attended a peer support camp. Semi-structured interviews were conducted three to six weeks after the weeklong peer support camp with a stratified random sample of 10 siblings (six non-bereaved and four bereaved) ages 8 to 16 years. The qualitative data were analyzed using conventional content analysis and an inductive data-driven approach. Four themes emerged: social connection (subthemes: support/feeling of belonging, mentorship, and expressing feelings), personal growth, identity, and freedom to have fun and relax. These findings add to the scant body of research by providing enhanced understanding of the siblings' experiences and new insights into their perceptions of meaning and outcomes associated with participation in a peer support camp. These findings have implications for peer support camp programs and the well-being of siblings of children with cancer.
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Affiliation(s)
- Donna Gregory
- Recreational Therapy Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Marieke Van Puymbroeck
- College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA
| | - Brandi Crowe
- College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA
| | - Barry Garst
- College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC, USA
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13
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Faith MA, Boone DM, Healy A, Davila E. Parent coping, emotion socialization beliefs, and sibling relationship quality in pediatric cancer. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2076682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Melissa A. Faith
- Center for Behavioral Health, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dianna M. Boone
- Center for Behavioral Health, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
| | - Ashly Healy
- Center for Behavioral Health, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
| | - Esther Davila
- Department of Psychology, University of South Florida, Tampa, FL, USA
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14
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Rasouli O, Moksnes UK, Reinfjell T, Hjemdal O, Eilertsen MEB. Impact of resilience and social support on long-term grief in cancer-bereaved siblings: an exploratory study. BMC Palliat Care 2022; 21:93. [PMID: 35641943 PMCID: PMC9158362 DOI: 10.1186/s12904-022-00978-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background Bereavement research has mainly explored potential risk factors associated with adverse outcomes, and the role of protective factors has received less attention. More knowledge is needed about factors related to unresolved grief in bereaved siblings. This study aimed to assess grief adjustment and possible gender differences among bereaved young adults 2–10 years after losing a brother or sister to cancer. We also sought to explore how resilience and social support influenced their grief. Methods A total of 99 young adults (18–26 years) who had lost a brother or sister to cancer between the years 2009 and 2014 were invited to participate in this Norwegian nationwide study. The study-specific questionnaire was completed by 36 participants (36.4%). Social support during the sibling's illness, after the death, and during the past year, in addition to grief and resilience, were measured. Results Overall, the prevalence of unresolved grief was 47.2% among bereaved siblings, whereas 52.8% had worked through their grief. The level of having worked through grief and resilience was similar between male and female siblings. Bereaved siblings with higher Personal Competence reported lower unresolved grief. Conclusion Approximately half of the young adults experience unresolved grief 2–10 years after losing a sibling to cancer. The findings also highlight the need for long-term support for bereaved siblings to help improve their resilience and better have worked through their grief.
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Affiliation(s)
- Omid Rasouli
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Unni Karin Moksnes
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trude Reinfjell
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mary-Elizabeth Bradley Eilertsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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15
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Tureluren E, Claes L, Andriessen K. Personal growth in bereaved students: Associations with support, grief, and distress. DEATH STUDIES 2022; 47:307-314. [PMID: 35435135 DOI: 10.1080/07481187.2022.2063457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Experiencing the death of a loved one can have a substantial negative impact on the grief and mental health of students. However, the bereavement can also lead to personal growth. We investigated the association between personal growth and support, grief, and distress. Bereaved students (N = 666) at Flemish universities and colleges (Belgium) completed an online survey with sociodemographic questions and four scales assessing personal growth, support, grief, and distress. Support and grief positively predicted personal growth. Emotional closeness correlated positively with personal growth. Our findings indicate a need for supporting bereaved students in their process of personal growth.
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Affiliation(s)
- Emilie Tureluren
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Karl Andriessen
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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16
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Requena ML, Avery M, Feraco AM, Uzal LG, Wolfe J, Dussel V. Normalization of Symptoms in Advanced Child Cancer: The PediQUEST-Response Case Study. J Pain Symptom Manage 2022; 63:548-562. [PMID: 35031505 DOI: 10.1016/j.jpainsymman.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022]
Abstract
CONTEXT Children, adolescents and young adults with cancer continue to experience significant symptom suffering throughout their illness. OBJECTIVES To identify barriers to effective symptom management in pediatric advanced cancer. METHODS Using a qualitative multiple case study we refined the Pediatric Quality of Life and Evaluation of Symptoms Technology Response to the Pediatric Oncology Symptom Experience (PediQUEST Response), a pediatric palliative care (PPC) intervention. Twenty-three children aged ≥2 years old with advanced cancer, their parents and primary and PPC clinicians were enrolled. Children and parents reported symptoms weekly over 4-months using the Memorial Symptom Assessment Scale (MSAS) administered by an electronic system (PediQUEST). When symptom distress episodes (SDEs) were reported (MSAS symptom score ≥33) we studied symptom management processes using interviews of family members/clinicians, and chart abstractions. Data were coded and analyzed using grounded theory and NVivo software. RESULTS Children reported 308 SDEs within 193 surveys and parents 529 SDEs in 165 surveys administered. We conducted 85 and 88 interviews with families and clinicians respectively. While we confirmed the presence of known barriers, we identified a prominent theme, that symptoms were "normalized." Patients, parents, and all clinicians, including PPC specialists, got accustomed to high symptom burden and lacked expectations that distress could be alleviated. We defined "normalization of symptoms," as the process by which symptom related suffering is appraised as unavoidable. CONCLUSION Normalization of symptoms is a pervasive barrier enacted by all involved in caring for children with advanced cancer. Strategies to overcome normalization are critical to ease child distress.
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Affiliation(s)
- Maria Laura Requena
- Center for Research and Implementation in Palliative Care, Institute for Clinical Effectiveness and Health Policy (M.L.R., L.G.U., V.D.), Buenos Aires, Argentina
| | - Madeline Avery
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (M.A., J.W.), Boston, Massachusetts, USA
| | - Angela M Feraco
- Department of Pediatric Oncology, Dana-Farber Cancer Institute (A.M.F., J.W.), Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital (A.M.F., J.W.), Boston, Massachusetts, USA; Harvard Medical School (A.M.F., J.W.), Boston, Massachusetts, USA
| | - Luciano G Uzal
- Center for Research and Implementation in Palliative Care, Institute for Clinical Effectiveness and Health Policy (M.L.R., L.G.U., V.D.), Buenos Aires, Argentina
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (M.A., J.W.), Boston, Massachusetts, USA; Department of Pediatric Oncology, Dana-Farber Cancer Institute (A.M.F., J.W.), Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital (A.M.F., J.W.), Boston, Massachusetts, USA; Harvard Medical School (A.M.F., J.W.), Boston, Massachusetts, USA
| | - Veronica Dussel
- Center for Research and Implementation in Palliative Care, Institute for Clinical Effectiveness and Health Policy (M.L.R., L.G.U., V.D.), Buenos Aires, Argentina; Dana-Farber / Boston Children's Cancer and Blood Disorders Center (V.D.), Boston, Massachusetts, USA.
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17
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Kenney AE, Tutelman PR, Fisher RS, Lipak KG, Barrera M, Gilmer MJ, Fairclough D, Akard TF, Compas BE, Davies B, Hogan NS, Vannatta K, Gerhardt CA. Impact of End-of-Life Circumstances on the Adjustment of Bereaved Siblings of Children Who Died from Cancer. J Clin Psychol Med Settings 2022; 29:230-238. [PMID: 34173900 PMCID: PMC8710186 DOI: 10.1007/s10880-021-09797-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to examine the impact of end-of-life (EoL) circumstances on grief and internalizing symptoms among bereaved siblings. Bereaved families (N = 88) were recruited from three sites 3-12 months (M = 11.57, SD = 3.48) after their child's death from cancer. One sibling per family aged 8-17 years (M = 12.41, SD = 2.64) was randomly selected to participate. Families completed measures of siblings' grief and internalizing symptoms, as well as a structured interview about circumstances surrounding the death. Mother and sibling reports of EoL circumstances were generally concordant, except there was a discrepancy between mothers and children about whether or not children expected their sibling's death (t(75) = 1.52, p = .018). Mother reports of sibling internalizing symptoms were above the normative mean (t(83) = 4.44, p ≤ .001 (M = 56.01 ± 12.48), with 39% (n = 33) in the borderline/clinical range. Sibling opportunity to say goodbye was associated with greater grief-related growth (t(79) = - 1.95, p = .05). Presence at the death and wishing they had done something differently were both associated with greater grief (t(80) = - 2.08, p = .04 and t(80) = - 2.24, p = .028, respectively) and grief-related growth (t(80) = - 2.01, p = .048 and t(80) = - 2.31, p = .024, respectively). However, findings were primarily unique to sibling report, with few mother-reported effects. The adjustment of bereaved siblings may be affected by certain modifiable circumstances surrounding the death of their brother or sister. A proportion of bereaved siblings had elevated internalizing symptoms irrespective of circumstances at EoL. Further work is needed to understand predictors of adjustment among bereaved siblings to provide better support and optimize their outcomes.
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Affiliation(s)
- Ansley E. Kenney
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Rachel S. Fisher
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Keagan G. Lipak
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Maru Barrera
- The Hospital for Sick Children, Toronto, ON, Canada,University of Toronto, Toronto, ON, Canada
| | - Mary Jo Gilmer
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | | | | | - Bruce E. Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | - Nancy S. Hogan
- Professor Emerita, Loyola University Chicago, Chicago, IL, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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18
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Uber A, Ebelhar JS, Lanzel AF, Roche A, Vidal-Anaya V, Brock KE. Palliative Care in Pediatric Oncology and Hematopoietic Stem Cell Transplantation. Curr Oncol Rep 2022; 24:161-174. [DOI: 10.1007/s11912-021-01174-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
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Hiratsuka R, Aoyama M, Masukawa K, Shimizu Y, Hamano J, Sakaguchi Y, Watanabe M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. The Association of Family Functioning With Possible Major Depressive Disorders and Complicated Grief Among Bereaved Family Members of Patients With Cancer: Results From the J-HOPE4 Study, a Nationwide Cross-Sectional Follow-Up Survey in Japan. J Pain Symptom Manage 2021; 62:1154-1164. [PMID: 34118370 DOI: 10.1016/j.jpainsymman.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT Family functioning is a modifiable factor associated with major depressive disorder (MDD) and complicated grief (CG) among the bereaved families of patients with advanced cancer; however, the evidence regarding this association is limited. OBJECTIVES We aimed to explore the association of family functioning with possible MDD and CG among the bereaved families of patients with advanced cancer who died in palliative care units. METHODS This study is a part of the J-HOPE4 study, a nationwide cross-sectional multi-purpose questionnaire survey conducted in 2018. We recruited potential participants from 164 inpatient palliative care units in Japan and assessed family functioning with the Family Relations Index (FRI). Family functioning was classified into three categories (Well-functioning: FRI ≥ 10, Intermediate: FRI = 8〜9, Dysfunctioning ≤ 7). The Patient Health Questionnaire 9 (PHQ-9) and the Brief Grief Questionnaire (BGQ) were used to assess depression (PHQ-9 score ≥ 10) and complicated grief (BGQ score ≥ 8), respectively. Multinomial logistic regression analysis was performed with possible MDD and CG and factors the family functioning. RESULTS A total of 615 questionnaires were returned, of which 54.0 % (n = 510) age of questionnaires could be used. Although family functioning was associated with possible MDD (21.1% in Dysfunctional; 9.3% in Well-functional, P = 0.016), it was not associated with possible CG (14.8% in Dysfunctional; 9.9% in Well-functional, P = 0.929). Possible MDD and CG were significantly associated with deteriorated family relationships (OR:8.29; P = 0.004 and OR:34.00; P < 0.001, respectively), and consulting with health care providers about their concerns (OR:0.23; P = 0.003 and OR:0.23; P = 0.003, respectively). CONCLUSIONS Family function was affected by post-bereavement possible MDD and not by CG. Our findings suggest that health care providers can identify risk factors for MDD among bereaved, dysfunctional family members.
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Affiliation(s)
- Ryoko Hiratsuka
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoichi Shimizu
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukihiro Sakaguchi
- School of Human Welfare Studies, Kwansei Gakuin University, Nishinomiya, Japan
| | - Miwa Watanabe
- Department of Nursing, Makuhari Faculty of Human Care, Tohto University, Chiba, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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20
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Eche IJ, Yusufov M, Isibor DA, Wolfe J. A systematic review and meta-analytic evaluation of psychosocial interventions in parents of children with cancer with an exploratory focus on minority outcomes. Pediatr Blood Cancer 2021; 68:e29328. [PMID: 34523798 DOI: 10.1002/pbc.29328] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/28/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022]
Abstract
Parents of children with cancer are prone to psychosocial distress, yet little is known about intervention response among diverse parents. Our systematic review and meta-analysis evaluated the efficacy of psychosocial interventions on anxiety and depression among parents of children with cancer and explored race and/or ethnicity differences in the efficacy of these interventions. Twenty articles met inclusion. The aggregate effect size on anxiety (-0.01, 95% CI: -0.95, 0.93, p = .97) and depression (-0.56, 95% CI: -1.65, 0.54, p = .32) showed micro to medium effects, with larger negative effect sizes indicating that anxiety and depression scores after treatment were lower for parents in intervention group as compared to control group. Neither aggregate effect size was statistically significantly different from zero. Due to underrepresentation of minorities, we could not perform subgroup or moderator analyses. Several efficacious psychosocial interventions were found to reduce parental anxiety. Future studies to examine psychosocial interventions in minority parents are warranted.
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Affiliation(s)
- Ijeoma Julie Eche
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Miryam Yusufov
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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21
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Porter AS, Weaver MS, Snaman JM, Li C, Lu Z, Baker JN, Kaye EC. "Still Caring for the Family": Condolence Expression Training for Pediatric Residents. J Pain Symptom Manage 2021; 62:1188-1197. [PMID: 34062219 DOI: 10.1016/j.jpainsymman.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
CONTEXT Insufficient communication from the medical team following a child's death may compound parental grief. Pediatric residents care for children who die, yet the landscape of condolence expression education within residency programs has not been studied. OBJECTIVES The objective of this study was to evaluate pediatric residents' levels of experience and comfort with condolence expression and to assess their needs and desires for training in condolence expression. METHODS A cross-sectional, mixed-methods survey was developed by palliative care clinicians in collaboration with bereaved parents. In 2020, following pilot testing, an electronic survey measuring resident experience with, comfort with, and training on condolence expression was distributed to 202 third-year pediatric residents across 17 Accreditation Council for Graduate Medical Education-accredited programs representing varying sizes and geographic regions. RESULTS Ten percent of pediatric residents surveyed reported having training on condolence expression. Almost all residents considered condolence expression to be beneficial for bereaved families and most for clinicians, too, yet very very few had formally expressed condolences in their roles as physicians: 83.1% had never written a condolence letter; 85% had never made a condolence phone call; and 90.5% had never attended a memorial event. Commonly reported barriers to condolence expression included lack of experience and training, as well as concern about upsetting families. CONCLUSIONS Pediatric residents lack comfort with and training in condolence expression and desire education to address these gaps. These findings should inform development and investigation of educational resources and training opportunities for residents to learn and practice compassionate provision of condolences to grieving families.
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Affiliation(s)
- Amy S Porter
- St. Jude Children's Research Hospital (A.S.P., C.L., Z.L., J.N.B., E.C.K.), Memphis, Tennessee, USA.
| | - Meaghann S Weaver
- Department of Pediatrics, Children's Hospital and Medical Center (M.S.W.), Omaha, Nebraska, USA; National Center for Ethics in Healthcare (M.S.W.), Washington, District of Columbia, USA
| | - Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.M.S.), Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital (J.M.S.), Boston, Massachusetts, USA
| | - Chen Li
- St. Jude Children's Research Hospital (A.S.P., C.L., Z.L., J.N.B., E.C.K.), Memphis, Tennessee, USA
| | - Zhaohua Lu
- St. Jude Children's Research Hospital (A.S.P., C.L., Z.L., J.N.B., E.C.K.), Memphis, Tennessee, USA
| | - Justin N Baker
- St. Jude Children's Research Hospital (A.S.P., C.L., Z.L., J.N.B., E.C.K.), Memphis, Tennessee, USA
| | - Erica C Kaye
- St. Jude Children's Research Hospital (A.S.P., C.L., Z.L., J.N.B., E.C.K.), Memphis, Tennessee, USA
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22
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Fair C, Thompson A, Barnett M, Flowers S, Burke J, Wiener L. Utilization of Psychotherapeutic Interventions by Pediatric Psychosocial Providers. CHILDREN 2021; 8:children8111045. [PMID: 34828757 PMCID: PMC8625037 DOI: 10.3390/children8111045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 01/15/2023]
Abstract
One of the Standards of Psychosocial Care for Children with Cancer and their Families recommends that all youth with cancer and their family members have access to psychotherapeutic interventions and support throughout the cancer trajectory. This study was created to identify the psychosocial interventions and services provided to children with cancer and their family members, to ascertain whether there are differences in interventions provided by age of the patient and stage of treatment, and to learn about barriers to psychosocial service provision. An online survey was disseminated to psychosocial providers through the listservs of national and international professional organizations. The majority of the 242 respondents were either psychologists (39.3%) or social workers (26.9%) and 79.7% worked in the United States. The intervention offered most often to pediatric patients, caregivers, and siblings, at every stage of treatment, was psychoeducation (41.7–48.8%). Evidence-based interventions, including cognitive behavioral therapy (56.6%) and mindfulness-based interventions (57.9%) were reported to be frequently used with patients. Interventions designed specifically for the pediatric oncology population were not commonly endorsed. Psychosocial providers reported quality of care would be improved by additional staff, better communication/collaboration with medical team members and increased community-based resources. Future research should focus on improving accessibility to population-specific evidenced-based interventions and translating science to practice.
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Affiliation(s)
- Cynthia Fair
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA;
- Correspondence: ; Tel.: +1-336-278-6457
| | | | - Marie Barnett
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Stacy Flowers
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH 45406, USA;
| | - June Burke
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA;
| | - Lori Wiener
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
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Çaksen H. Religious Coping in Children With Grief After a Sibling Death Because of Cancer. J Pediatr Hematol Oncol 2021; 43:e1261-e1262. [PMID: 34133391 DOI: 10.1097/mph.0000000000002244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hüseyin Çaksen
- Department of Pediatrics, Division of Behavioral-Developmental Pediatrics Necmettin Erbakan University, Meram Medical Faculty, Meram, Konya, Turkey
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Ridley A, Revet A, Raynaud JP, Bui E, Suc A. Description and evaluation of a French grief workshop for children and adolescents bereaved of a sibling or parent. BMC Palliat Care 2021; 20:159. [PMID: 34649560 PMCID: PMC8518298 DOI: 10.1186/s12904-021-00861-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/24/2021] [Indexed: 12/04/2022] Open
Abstract
Background Childhood bereavement is common, and is associated with elevated symptoms of grief with distress and impairment. However, few developmentally appropriate interventions to support grieving children are available to date. In Toulouse, France we developed an innovative four-session group intervention to support grieving families and evaluated its feasibility and acceptability. Methods The workshop consists of four sessions over 4 months, open to children bereaved of a sibling or parent, and co-facilitated by two mental health professionals. After an intake assessment, children were placed into closed groups according to age and relation to the deceased. The session content was balanced between creative activities and grief-related discussions. Overall satisfaction was evaluated in March-April of 2020 by an 8-question online survey of children and parents having participated between 2011 and 2019. Freeform commentaries were analysed using the thematic synthesis process. Results Of the 230 emails sent in March 2020, 46 children and 81 parents agreed to participate (55% response rate). The families reported an overall high level of satisfaction regarding the intervention that was rated as good to excellent. A majority of respondents considered their participation in the workshop helpful and in accordance with their expectations. Most would recommend the workshop to a friend, and would participate again in the group if needed. The group intervention helped reduce social isolation, facilitated grief expression, and supported the creation of a sense of community among bereaved families. Conclusions Encouraging community and mutual support among grieving families is fundamental in bereavement care. Our four-session workshop held over 4 months and led by mental health professionals aimed to help reduce social isolation and foster coping skills through artistic creation and group discussion. Our results highlight the potential need for family bereavement support over a longer period and a provision of a variety of services. Our intervention model is feasible for families, and further studies examining its efficacy are warranted.
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Affiliation(s)
- Ashley Ridley
- Department of Paediatric Palliative Care, Toulouse University Hospital, Toulouse, France
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France.,Centre for Epidemiology and Population Research, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Jean-Philippe Raynaud
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France.,Centre for Epidemiology and Population Research, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,University of Caen Normandy & Caen University Hospital, Caen, France
| | - Agnès Suc
- Department of Paediatric Palliative Care, Toulouse University Hospital, Toulouse, France.
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Helligsoe ASL, Henriksen LT, Kenborg L, Dehlendorff C, Winther JF, Hasle H. Factors influencing participation rates in clinical late-effect studies of childhood cancer survivors. Pediatr Blood Cancer 2021; 68:e29098. [PMID: 34022113 DOI: 10.1002/pbc.29098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/17/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022]
Abstract
To ensure external validation of a study population in clinical late-effect studies of childhood cancer, the participation rate must be high. This study investigated demographic data in Nordic late-effect studies and potential factors impacting participation rates such as cancer type, time since diagnosis, and duration of clinical examinations. We found 80 published studies originating from 16 cohorts, with median follow-up of 6.0 years (range 3-14). The overall participation rates ranged from 27% to 100%. The highest participation rates were seen in studies of survivors with solid tumors (92%) and the lowest in hematologic malignancies (67%) and central nervous system tumors (73%). The clinical examination in 10 studies (62.5%) lasted for more than 3 hours. Neither duration of the clinical examination nor time since diagnosis seemed to affect the participation rate. We encourage future studies to describe the recruitment process more thoroughly to improve understanding of the factors influencing participation rates.
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Affiliation(s)
- Anne Sophie Lind Helligsoe
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Louise Tram Henriksen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Survivorship Research Group, Danish Cancer Society Research Center, Aarhus, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Aarhus, Denmark
| | - Jeanette Falck Winther
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Childhood Cancer Survivorship Research Group, Danish Cancer Society Research Center, Aarhus, Denmark
| | - Henrik Hasle
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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Multifaceted Support Interventions for Siblings of Children With Cancer: A Systematic Review. Cancer Nurs 2021; 44:E609-E635. [PMID: 34406189 DOI: 10.1097/ncc.0000000000000966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND When a child is given a diagnosis of cancer, the impact reverberates through the family unit. Siblings, in particular, experience an accumulation of distress. Siblings of children with cancer can experience both short- and long-term difficulties in psychosocial and physical functioning, and professional bodies have called for interventions targeted at their needs. OBJECTIVE The aim of this study was to describe outcomes, core components, and general characteristics of effective interventions intended to support sibling well-being and psychosocial health in pediatric oncology. METHODS MEDLINE (Ovid), EMBASE, CINAHL, PsycINFO, and Cochrane CENTRAL databases were searched in September 2019 and July 2020. Studies were included if they focused on interventions for siblings or family in pediatric cancer, had quantitative data to describe the effect or impact of the intervention, and were published in English. Included studies underwent quality appraisal, data extraction, and data synthesis. RESULTS Twenty articles fit inclusion criteria. Most interventions focused on 6- to 18-year-old siblings within a group setting. Most were theory based. Group format with multiple sessions was the most common approach. The most frequently assessed outcomes were depression, anxiety, posttraumatic stress symptoms, and health-related quality of life. CONCLUSIONS Understanding outcomes, core components, and characteristics of effective interventions is important to translate sibling-support interventions into standard practice. Such considerations are important in delivering equitable family-centered care to siblings of children with cancer. IMPLICATIONS FOR PRACTICE As institutions create mechanisms to support siblings, it may be important to target high-risk siblings initially, partner with community resources, attend to underrecognized populations of siblings, and more fully incorporate family into sibling support.
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Providing Palliative and Hospice Care to Children, Adolescents and Young Adults with Cancer. Semin Oncol Nurs 2021; 37:151166. [PMID: 34175165 DOI: 10.1016/j.soncn.2021.151166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To describe palliative, concurrent, and hospice care in pediatric oncology in the United States (US), we present a clinical scenario illustrating palliative and hospice care, including eligibility for concurrent care, insurance coverage and billing, barriers to accessing quality pediatric palliative and hospice care, and implications for oncology nursing practice. DATA SOURCES Peer-reviewed articles, clinical practice guidelines, professional organizations, and expert clinical opinion examining pediatric oncology, palliative care, and hospice care. CONCLUSION Understanding the goals of palliative and hospice care and the differences between them is important in providing holistic, goal-directed care. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses play a pivotal role in supporting the goals of pediatric palliative care and hospice care and in educating patients and their families. Nurses form trusting relationships with pediatric oncology patients and their families and are in a position to advocate for best palliative care practices as disease progresses to end of life, including when appropriate concurrent care or hospice.
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Effectiveness of Theraplay in Internalizing and Externalizing Problems in Bereaved Siblings of Children with Cancer. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2021. [DOI: 10.5812/ijpbs.103992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Sibling relationships are very significant relationships, and their termination due to death will have profound long-term effects on the life of the surviving children. Objectives: The purpose of the current study was to determine the effectiveness of theraplay on internalizing and externalizing problems in bereaved siblings. Methods: This study was carried out using a single-subject multiple baseline design with follow-up. The statistical population included siblings and mothers of children aged 6 - 10 years who were on treatment at Mahak Pediatric Cancer Hospital and died one or two years ago. From this population, four mother-child pairs were selected as the study sample by convenience sampling. Each mother-child pair participated in 15 theraplay sessions once a week (45-min sessions). The assessments were carried out using the Child Behavior Checklist (CBCL) at baseline and in the intervention sessions and follow-up. Visual analysis of graphic displays of level, Reliable Change Index (RCI), and clinical significance were used to analyze the data. Data analysis and drawing the graphs were performed in Microsoft Excel 2016. Results: The results of the visual and quantitative data analysis showed a significant reduction in the four participants' internalizing problems during therapy. The reduction in the scores of this subscale in participants 1, 2, and 3 continued into the follow-up period and was noticeable. The results also showed that theraplay reduced the externalizing problems of most participants. A large proportion of these results persisted into the follow-up period. Conclusions: Theraplay appears to effectively reduce the internalizing and externalizing problems of bereaved siblings.
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Carreño-Moreno S, Arias-Rojas M, Chaparro-Díaz L. Seeking an Adjustment from the Unnatural to the Supernatural: The Experience of Losing a Child from Cancer in Colombia. Indian J Palliat Care 2021; 27:23-30. [PMID: 34035613 PMCID: PMC8121221 DOI: 10.4103/ijpc.ijpc_72_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/19/2020] [Accepted: 07/01/2020] [Indexed: 11/04/2022] Open
Abstract
Aims The death of a child with cancer can be devastating for his or her parents. This study sought to understand the way in which the process of parental grief develops after the death of a child with cancer. Methods The research used a grounded theory approach, in which 18 participants were enrolled including parents whose child died from cancer 5 months to 5 years before. In-depth interviews were conducted, which were analyzed using constant comparisons until theoretical saturation was reached. Results Fifteen subcategories were identified and grouped into three categories that explain what the grieving process represents to the parents over time (a) crossing a desert, (b) dying while alive, and (c) coming back to life. From the emerging relationships among the categories, the core category "seeking adjustment from the unnatural to the supernatural" arises. The results show that grief begins from the moment of diagnosis until long after the child's death. For parents, it entails understanding the disruption in the natural course of life, going through indescribable pain, and being spiritually reconnected with their child. Conclusions These results enable nurses to design comprehensive interventions that meet the described needs of these parents.
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Affiliation(s)
- Sonia Carreño-Moreno
- Research Group Nursing Care for the Chronic Patient, Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Mauricio Arias-Rojas
- Department of Vocational Training, Faculty of Nursing, Universidad de Antioquia, Antioquia, Colombia
| | - Lorena Chaparro-Díaz
- Research Group Nursing Care for the Chronic Patient, Facultad de Enfermería, Universidad Nacional de Colombia, Bogotá, Colombia
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Schuelke T, Crawford C, Kentor R, Eppelheimer H, Chipriano C, Springmeyer K, Shukraft A, Hill M. Current Grief Support in Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2021; 8:278. [PMID: 33916583 PMCID: PMC8066285 DOI: 10.3390/children8040278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
Grief support changes as more is learned from current grief theory and research. The authors provide a comprehensive overview of current grief support as it relates to Pediatric Palliative Care (PPC). The following aspects of grief are addressed: (1) anticipatory grief: the nondeath losses that occur with a complex and chronic illness, as well as the time leading up to death; (2) grief around the time of death: the intense and sacred experience of companioning with a dying child; (3) grief after death: supporting bereavement and mourning through programing and other methods; (4) innovative approaches: the future of grief support. The contents of this article are meant to support and educate programs currently providing grief services and those aiming to begin the meaningful work of grief support.
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Affiliation(s)
- Taryn Schuelke
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Claire Crawford
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Rachel Kentor
- Department of Pediatrics, Baylor College of Medicine, Psychology Service, Texas Children’s Hospital, 6701 Fannin St., Houston, TX 77030, USA;
| | - Heather Eppelheimer
- Memorial Hermann Pediatric Hospice, 902 Frostwood Suite 288, Houston, TX 77024, USA;
| | | | - Kirstin Springmeyer
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Allison Shukraft
- Department of Pediatrics, Pediatric Advanced Care Team, Atrium Health’s Levine Children’s Hospital, MEB 415-F, 1000 Blythe Blvd, Charlotte, NC 28203, USA;
| | - Malinda Hill
- Justin Michael Ingerman Center for Palliative Care, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
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Tutelman PR, Lipak KG, Adewumi A, Fults MZ, Humphrey LM, Gerhardt CA. Concerns of Parents With Children Receiving Home-Based Pediatric Palliative Care. J Pain Symptom Manage 2021; 61:705-712. [PMID: 32931905 DOI: 10.1016/j.jpainsymman.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/03/2023]
Abstract
CONTEXT Caring for a child who will die from a life-limiting illness is one of the most difficult experiences a parent may face. Pediatric palliative care (PPC) has grown as a specialty service to address the unique needs of children and families with serious illness. However, gaps remain between the needs of families in PPC and the support received. OBJECTIVES The objective of this study was to explore the concerns of parents who have a child in home-based PPC. METHODS Semistructured interviews were conducted with 25 mothers and 10 fathers from 25 families shortly after their child's referral to home-based PPC. Children (57% male, Mage = 10.5 years, SD = 3.95, range = 4-18 years) had a range of diagnoses. Data were analyzed using inductive content analysis. RESULTS Parents' concerns clustered into four main themes: 1) ensuring that their child's remaining days were spent living well physically, emotionally, and socially; 2) uncertainty regarding their child's diagnosis, prognosis, and treatments; 3) their child's death (e.g., the process of dying and when it will occur); and 4) the family, including the impact of the child's illness and death on siblings and wanting to cherish as much time together with family as possible. CONCLUSION Parents of children receiving home-based PPC expressed concerns across a range of domains, both about their seriously ill child and the broader family. These results highlight salient worries among parents of children in PPC and point to critical areas for intervention for seriously ill children and the broader family.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Keagan G Lipak
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Aminat Adewumi
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marci Z Fults
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa M Humphrey
- Division of Palliative Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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Marusak HA, Iadipaolo AS, Cohen C, Goldberg E, Taub JW, Harper FWK, Bluth MH, Rabinak CA. Martial Arts-Based Therapy Reduces Pain and Distress Among Children with Chronic Health Conditions and Their Siblings. J Pain Res 2020; 13:3467-3478. [PMID: 33402843 PMCID: PMC7778380 DOI: 10.2147/jpr.s283364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/18/2020] [Indexed: 01/14/2023] Open
Abstract
Objective Test whether a martial arts-based therapy, Kids Kicking Cancer (KKC), can reduce pain and emotional distress in children with cancer, other chronic health conditions (e.g., sickle cell), and healthy siblings. Methods This study surveyed children’s pain and distress levels immediately before and after a 1-hr in-person KKC class. Eligible participants were enrolled in standard KKC classes, were diagnosed with a chronic health condition (e.g., cancer, sickle cell) or were the sibling of a child diagnosed and were between the ages of 5–17 years (inclusive). Children reported on their pain and distress using Likert-style scales (Coloured Analog Scale and modified FACES scale, respectively). Friedman test was used to test for overall changes in pain and distress, and within subgroups. Age and sex effects were evaluated using Spearman’s rank-order correlation. Additional Yes/No questions were administered regarding KKC satisfaction and use of techniques. Results Fifty-nine youth (19 cancer patients, 17 non-cancer patients, 23 siblings; 5–17 yrs, 26 females) completed this study. Overall, there was a significant reduction in pain (p = 0.033) and emotional distress (p < 0.001) after a 1-hr class, with 50% and 89% of youth reporting a reduction in pain and distress, respectively. On average, pain levels remained within the mild/moderate range on average (i.e., pre vs. post levels; pre: M = 1.67, post: M = 1.33) and emotional distress went from mild/moderate to none/mild distress, on average (pre: M = 1.92, post: M = 1.08). Youth with higher pre-class pain and distress reported greater reductions (p = 0.001 and p < 0.001, respectively). The reduction in pain appeared to be most pronounced with cancer and non-cancer patients. In contrast, the reduction in distress appeared to be most pronounced among healthy siblings. However, overall, reductions in pain and distress did not significantly differ among subgroups (i.e., cancer patients, non-cancer patients, siblings), and change in pain and distress was not associated with age or sex. Ninety-six percent of youth would recommend KKC to others and 81% reported using KKC techniques (e.g., the Breath BrakeTM or other martial arts techniques) outside of class, such as at home. Conclusion Results support the more widespread application of KKC as a psychosocial intervention for reducing pain and distress in various pediatric populations.
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Affiliation(s)
- Hilary A Marusak
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA.,Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
| | - Allesandra S Iadipaolo
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | | | - Elimelech Goldberg
- Kids Kicking Cancer, Southfield, MI, USA.,Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Jeffrey W Taub
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA.,Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Felicity W K Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Martin H Bluth
- Kids Kicking Cancer, Southfield, MI, USA.,Department of Pathology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Christine A Rabinak
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA.,Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA.,Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.,Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
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Ridley A, Frache S. Bereavement care interventions for children under the age of 18 following the death of a sibling: a systematic review. Palliat Med 2020; 34:1340-1350. [PMID: 32807009 DOI: 10.1177/0269216320947951] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Childhood bereavement after sibling death is common, but often unrecognized. The psychosomatic and socioeconomic outcomes of bereaved children can be compromised if appropriate care is unavailable during the formative years leading into adulthood. AIM This review aims to describe the methods, structures and procedures of bereavement care for children and adolescents after the loss of a sibling, and the impact on the families benefiting from these interventions. DESIGN A systematic review without restriction on study design was conducted. DATA SOURCES Four databases (MEDLINE, PsycINFO, EMBASE, Cochrane Library) were searched for articles published from 2000 to 2019. The search was conducted according to PRISMA guidelines and the protocol is registered on PROSPERO under number CRD42019124675. Articles were assessed against eligibility criteria by both authors, and quality was appraised using CASP checklists and NHMRC grading guidelines. RESULTS Twenty-three studies met inclusion criteria. Bereavement care was most often accessed by children ages 6-18 who lost a sibling to cancer 6-12 months prior. The interventions were typically group sessions or weekend camps, run predominantly by unpaid staff from a variety of backgrounds. Some staff members received priori specific training. Grief education is taught through mediated discussion and bereavement-centered activities balanced with playful and relaxed activities. Several services have effectuated evaluations of their interventions, and preliminary results show a positive effect for families. CONCLUSION Existing literature most likely gives an incomplete picture of appropriate childhood bereavement care, and many interventions possibly remain unpublished or published in other non-scientific sources. An effective response to childhood grief would involve collaboration between medical resources and community services, reinforced through the development of outreach and training programs.
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Howard Sharp KM, Meadows EA, Keim MC, Winning AM, Barrera M, Gilmer MJ, Akard TF, Compas BE, Fairclough DL, Davies B, Hogan N, Vannatta K, Gerhardt CA. The Influence of Parent Distress and Parenting on Bereaved Siblings' Externalizing Problems. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:1081-1093. [PMID: 33343178 PMCID: PMC7748062 DOI: 10.1007/s10826-019-01640-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Bereaved siblings experience more externalizing problems compared to non-bereaved peers and norms; however, the mechanisms explaining this phenomenon have not been empirically examined. This study tested the serial indirect effects of sibling bereavement on adolescents' externalizing problems through parent distress (i.e., internalizing symptoms) and parenting (i.e., parenting behaviors, parent-adolescent communication). METHODS During home visits, 72 bereaved adolescents (ages 10-18) whose brother/sister died from cancer and 60 comparison peers reported about their externalizing problems and their mothers' and fathers' parenting behaviors (warmth, behavioral control, psychological control) and parent-adolescent communication (open communication, problematic communication). Mothers and fathers reported their own internalizing symptoms. RESULTS Bereaved siblings reported more externalizing problems (p =.048) and bereaved mothers reported more internalizing symptoms relative to the comparison group (p =.015). Serial multiple mediation models indicated that elevated externalizing problems were partially explained by both bereaved mothers' internalizing symptoms and parenting and communication (less warmth [CI: 0.04, 0.86], more psychological control [CI: 0.03, 0.66], and more problematic mother-adolescent communication [CI: 0.03, 0.79]), with a significant indirect effect also emerging for open mother-adolescent communication [CI: 0.05, 1.59]. Bereaved fathers did not significantly differ in internalizing symptoms from comparison fathers (p =.453), and no significant indirect effects emerged for fathers. CONCLUSIONS Elevated externalizing problems in bereaved siblings may result from mothers' distress and the impact on their parenting and communication. Targeting adjustment and parenting in bereaved mothers following a child's death may reduce externalizing problems in bereaved siblings. Research to evaluate family-centered interventions is needed.
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Affiliation(s)
- Katianne M Howard Sharp
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | | | | | | | | | | | | | | | | | | | | | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH
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DeMuth M, Taggi-Pinto A, Miller EG, Alderfer MA. Bereavement Accommodations in the Classroom: Experiences and Opinions of School Staff. THE JOURNAL OF SCHOOL HEALTH 2020; 90:165-171. [PMID: 31957037 DOI: 10.1111/josh.12870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/19/2019] [Accepted: 01/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Bereaved children often struggle in the school environment and school personnel often feel inadequately prepared to support them. This pilot study explored the experiences and opinions of school staff regarding approaches to addressing the needs of bereaved students in the classroom. METHODS Teachers/school personnel (N = 29) completed written open-ended questions about their experiences with bereaved students and opinions regarding a bereavement-focused accommodation (ie, 504) plan. Responses were summarized using qualitative content analysis. RESULTS Most participants (93%) reported interacting with bereaved students and: (1) providing emotional support; (2) making classroom accommodations; (3) collaborating with the family/community; and (4) referring the student for counseling. Many (72%) expressed interest in a templated bereavement plan (21% did not respond; 7% said no) with education/resources for school personnel and suggested accommodations for students. CONCLUSIONS Teachers encountering grieving students would welcome a templated bereavement plan to help meet students' needs. Such a plan would allow staff to become more knowledgeable about grief and provide guidance for developing specific strategies to accommodate grieving students both emotionally and academically.
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Affiliation(s)
- Michele DeMuth
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA, 19107
| | - Alison Taggi-Pinto
- Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803
| | - Elissa G Miller
- Sidney Kimmel Medical College at Thomas Jefferson University, Chief, Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803
| | - Melissa A Alderfer
- Sidney Kimmel Medical College at Thomas Jefferson University, Center Director (Delaware Valley) and Principal Research Scientist, Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803
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Abstract
BACKGROUND Limited research has examined the impact of a child's death from cancer on siblings. Even less is known about how these siblings change over time. OBJECTIVE This study compared changes in siblings 1 (T1) and 2 (T2) years after the death of a brother or sister from cancer based on bereaved parent and sibling interviews. METHODS Participants across 3 institutions represented 27 families and included bereaved mothers (n = 21), fathers (n = 15), and siblings (n = 26) ranging from 8 to 17 years old. Participants completed semistructured interviews. Content analysis identified emerging themes and included frequency counts of participant responses. McNemar tests examined differences in the frequency of responses between T1 and T2 data. RESULTS Participants reported similar types of changes in bereaved siblings at both time points, including changes in sibling relationships, life perspectives, their personal lives, and school performance. A new theme of "openness" emerged at T2. Frequencies of responses differed according to mother, father, or sibling informant. Overall, participants less frequently reported changes at T2 versus T1. Compared with findings in the first year, participants reported greater sibling maturity at follow-up. CONCLUSION Overall changes in bereaved siblings continued over 2 years with less frequency over time, with the exception of increases in maturity and openness. IMPLICATIONS FOR PRACTICE Providers can educate parents regarding the impact of death of a brother or sister over time. Nurses can foster open communication in surviving grieving siblings and parents as potential protective factors in families going through their grief.
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Patterson P, McDonald FEJ, Costa DSJ, Tindle R, Allison KR, Morris SE. Initial validation of a needs instrument for young people bereaved by familial cancer. Support Care Cancer 2019; 28:3637-3648. [PMID: 31811484 DOI: 10.1007/s00520-019-05104-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to validate the Bereaved Cancer Needs Instrument (BCNI), an instrument designed to assess the unmet psychosocial needs of adolescents and young adults (AYAs, 12-25 years) who have experienced the death of a parent or sibling to cancer. METHODS In total, 335 participants aged 12 to 25 (M = 15.80, SD = 3.32) who had experienced the death of a parent (N = 297) or sibling (N = 38) from cancer took part in this study. Participants completed the BCNI, the Kessler-10 psychological distress scale (K10), and several items assessing the acceptability of the BCNI. RESULTS Exploratory factor analysis indicated that a seven-factor structure best fit the BCNI, accounting for 56.65% of the variance in unmet psychosocial needs of cancer-bereaved AYAs. The measure had good psychometric properties, high levels of internal consistency for all domains, and correlated strongly with the K10 (r = .59, p < .001). Item response theory analysis demonstrated that the response scale was appropriate, with strong discrimination indices. Analyses also indicated the potential to reduce the BCNI from 58 items to a 37-item short-form, although this will require further validation. CONCLUSIONS The BCNI is the first psychometrically validated instrument to identify the unmet psychosocial needs of bereaved AYAs who have experienced the death of a parent or sibling to cancer. The instrument can be used in research and health care settings to identify the unmet needs of young people bereaved by cancer and provide targeted support to reduce psychological distress.
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Affiliation(s)
- Pandora Patterson
- Research, Evaluation and Social Policy, CanTeen Australia, M: GPO Box 3821, Sydney, NSW, 2001, Australia. .,Cancer Nursing Research Unit, The University of Sydney, PO Box M30, Missenden Road, Sydney, NSW, 2050, Australia.
| | - Fiona E J McDonald
- Research, Evaluation and Social Policy, CanTeen Australia, M: GPO Box 3821, Sydney, NSW, 2001, Australia.,Cancer Nursing Research Unit, The University of Sydney, PO Box M30, Missenden Road, Sydney, NSW, 2050, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, Sydney, NSW, Australia.,School of Psychology, University of Sydney, Sydney, NSW, Australia.,School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Richard Tindle
- Research, Evaluation and Social Policy, CanTeen Australia, M: GPO Box 3821, Sydney, NSW, 2001, Australia.,Faculty of Business, Justice, and Behavioural Sciences, School of Psychology, Charles Sturt University, Port Macquarie, NSW, 2444, Australia
| | - Kimberley R Allison
- Research, Evaluation and Social Policy, CanTeen Australia, M: GPO Box 3821, Sydney, NSW, 2001, Australia
| | - Sue E Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Department of Psychiatry, Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02215, USA
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Patterson P, Noke M, McDonald FEJ, Kelly-Dalgety E, Sidis A, Jones BL. Life Imprint and meaning reconstruction for young people who have experienced the death of a family member from cancer. Psychooncology 2019; 28:1938-1941. [PMID: 31237725 DOI: 10.1002/pon.5159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Pandora Patterson
- Research, Evaluation and Social Policy Team, CanTeen Australia, Sydney, New South Wales, Australia.,Cancer Nursing Research Unit, The University of Sydney, Sydney, New South Wales, Australia
| | - Melissa Noke
- Research, Evaluation and Social Policy Team, CanTeen Australia, Sydney, New South Wales, Australia
| | - Fiona E J McDonald
- Research, Evaluation and Social Policy Team, CanTeen Australia, Sydney, New South Wales, Australia.,Cancer Nursing Research Unit, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Kelly-Dalgety
- Research, Evaluation and Social Policy Team, CanTeen Australia, Sydney, New South Wales, Australia
| | - Anna Sidis
- Research, Evaluation and Social Policy Team, CanTeen Australia, Sydney, New South Wales, Australia
| | - Barbara L Jones
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas
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McDonald FEJ, Patterson P, Tindle R. What young people need when a family member dies of cancer. Support Care Cancer 2019; 28:1631-1638. [PMID: 31280364 DOI: 10.1007/s00520-019-04973-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/28/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE This study uses the newly developed Bereaved Cancer Needs Inventory to identify the unmet psychosocial needs of adolescents and young adults who have experienced the death of a parent or sibling to cancer, and to explore the relationship between unmet needs and psychological distress. METHODS In total, 278 bereaved offspring and 38 bereaved siblings (12-25 years) completed the 58-item Bereaved Cancer Needs Inventory (BCNI) and the Kessler psychological distress scale (K10). RESULTS Bereaved offspring reported 27 unmet needs on average (SD = 16.87, range: 0-58); 94% indicated at least one unmet need, with 80% indicating 10 or more needs. Bereaved siblings reported 23 unmet needs on average (SD = 17.30, range: 0-57); 97% indicated at least one unmet need, with 68% indicating 10 or more needs. For both bereaved offspring and siblings, the needs for "support from other young people" and "time out and recreation" were most frequently reported as unmet. Approximately half of all participants reported high to very high levels of psychological distress. There was a significant positive relationship between the number of unmet needs and the psychological distress score on the K10 for both groups. CONCLUSIONS Bereaved offspring and bereaved siblings report unmet psychosocial needs across many domains, which are associated with their levels of psychological distress. Findings suggest the BCNI may be used by healthcare professionals to identify unmet needs and direct clients to the appropriate services, resources, or support; with the intent to reduce their risk of mental illness and psychological distress.
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Affiliation(s)
- Fiona E J McDonald
- CanTeen Australia, M: GPO Box 3821, Sydney, NSW, 2001, Australia. .,Cancer Nursing Research Unit, Sydney Nursing School, University of Sydney, Sydney, Australia.
| | - Pandora Patterson
- CanTeen Australia, M: GPO Box 3821, Sydney, NSW, 2001, Australia.,Cancer Nursing Research Unit, Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Richard Tindle
- CanTeen Australia, M: GPO Box 3821, Sydney, NSW, 2001, Australia.,School of Psychology, Charles Sturt University, Port Macquarie, Australia
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Zernikow B, Szybalski K, Hübner-Möhler B, Wager J, Paulussen M, Lassay L, Jorch N, Weber C, Schneider DT, Janßen G, Oommen PT, Kuhlen M, Brune T, Wieland R, Schündeln M, Kremens B, Längler A, Prokop A, Kiener R, Niehues T, Rose M, Baumann-Köhler M, Pöppelmann M, Thorer H, Irnich M, Sinha K, Wolfe J, Schmidt P. Specialized pediatric palliative care services for children dying from cancer: A repeated cohort study on the developments of symptom management and quality of care over a 10-year period. Palliat Med 2019; 33:381-391. [PMID: 30537890 DOI: 10.1177/0269216318818022] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: About one quarter of children affected with cancer die. For children and their families, the end-of-life period is highly distressing. Aim: This study focused on how end-of-life care in pediatric cancer patients changed over a period of 10 years and if changes in pediatric palliative care structures were associated with quality of care. Design: Over a 10-year period, all pediatric oncology departments in one German federal state were invited to participate in a repeated cross-sectional cohort study at three time-points (2005, 2010, 2015). Departments invited parents whose children died due to cancer 5 years earlier to participate. Identical semi-structured interviews were conducted with each cohort by the Survey of Caring for Children with Cancer. In addition, departments provided information on their pediatric palliative care infrastructure. Participants: In total, 124 families participated; 73% of interviews were conducted with mothers, 18% with fathers, and 9% with both parents. Results: Parents’ perception of symptom occurrence, symptom burden, and effectiveness of symptom-related treatment remained stable over the 10-year period. Over time, the availability of pediatric palliative care ( p < 0.001) as well as quality and satisfaction ratings of care ( p < 0.001) increased significantly. A growing number of children received specialized pediatric palliative care at home during the end-of-life period ( p = 0.009). Along with this development, more families had the chance to plan the location of death ( p = 0.003), and more children died at the preferred location ( p = 0.001). Conclusion: Advances in the availability of pediatric palliative care were associated with improvement in some aspects of quality of care (e.g. location of death) while other aspects, such as effectiveness of symptom management, remained unchanged. Further research is required to determine whether additional improvement in structural quality may increase the effectiveness of symptom management.
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Affiliation(s)
- Boris Zernikow
- 1 Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,2 Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
| | - Katharina Szybalski
- 1 Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,2 Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
| | - Bettina Hübner-Möhler
- 1 Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,2 Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
| | - Julia Wager
- 1 Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,2 Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
| | - Michael Paulussen
- 3 Children's and Adolescents' Hospital Datteln and Department of Pediatrics, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
| | - Lisa Lassay
- 4 University Hospital Aachen, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, RWTH Aachen University, Aachen, Germany
| | - Norbert Jorch
- 5 Department of Pediatrics, Protestant Hospital Bielefeld, Bielefeld, Germany
| | - Carola Weber
- 6 Department of Pediatric Oncology, Hematology and Immunology, University Hospital Bonn, Bonn, Germany
| | - Dominik T Schneider
- 7 Division of Pediatric Hematology and Oncology, Department of Pediatrics, Hospital Dortmund, Dortmund, Germany
| | - Gisela Janßen
- 8 Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Prasad T Oommen
- 8 Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michaela Kuhlen
- 8 Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Brune
- 9 Department of Pediatrics, Hospital Lippe-Detmold, Detmold, Germany
| | - Regina Wieland
- 10 Hematology/Oncology, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Michael Schündeln
- 10 Hematology/Oncology, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Bernhard Kremens
- 10 Hematology/Oncology, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Alfred Längler
- 11 Gemeinschaftskrankenhaus Herdecke and Integrative Pediatrics, School of Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Aram Prokop
- 12 Department of Pediatric Hematology/Oncology, Children's Hospital Köln, Köln, Germany
| | - Rita Kiener
- 13 Department of Paediatric Oncology and Hematology, Policlinic for Children and Adolescents, University Hospital Köln, Köln, Germany
| | - Tim Niehues
- 14 Centre for Pediatrics and Adolescent Medicine, HELIOS Hospital Krefeld, Krefeld, Germany
| | - Martina Rose
- 15 Department for Children and Adolescents, Johannes Wesling Hospital Minden, Bochum University, Minden, Germany
| | - Margit Baumann-Köhler
- 16 Department of Paediatric Hematology and Oncology, Policlinic for Children and Adolescents, University Hospital Münster, Münster, Germany
| | - Monika Pöppelmann
- 16 Department of Paediatric Hematology and Oncology, Policlinic for Children and Adolescents, University Hospital Münster, Münster, Germany
| | - Heike Thorer
- 16 Department of Paediatric Hematology and Oncology, Policlinic for Children and Adolescents, University Hospital Münster, Münster, Germany
| | - Martin Irnich
- 17 Department of Paediatric Hematology and Oncology, Asklepios Hospital Sankt Augustin GmbH, Sankt Augustin, Germany
| | - Kumar Sinha
- 18 Department of Pediatrics, Helios Medical Centre, Witten-Herdecke University, Wuppertal, Germany
| | - Joanne Wolfe
- 19 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pia Schmidt
- 1 Paediatric Palliative Care Centre and German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,2 Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Datteln, Germany
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Weiner JA, Woodley LK. An integrative review of sibling responses to childhood cancer. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 31:109-119. [PMID: 30548360 DOI: 10.1111/jcap.12219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Abstract
TOPIC Siblings of children with cancer experience extraordinary responses and changes to their lives over the course of their family's cancer journey. PURPOSE The purpose of this paper is to conduct an integrative literature review to synthesize and analyze relevant findings related to the siblings' experiences of childhood cancer. SOURCES USED CINAHL, PubMed, Embase, MEDLINE, and PsycINFO were searched using the key terms: "sibling*" AND "pediatric*" AND "cancer" AND "experienc*" OR "experience*." Inclusion criteria for this review were research studies focused on sibling responses to having a brother or sister with cancer, published in English between January 1, 2012 and December 31, 2017. CONCLUSIONS Siblings of children with cancer experience many changes to their emotions, relationships, family and home life, school life, and extracurricular activities. They have specific needs and desires including the need for information. Whereas they undergo many changes during the cancer journey, siblings often demonstrate resilience and personal growth and find ways to problem-solve and cope.
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Affiliation(s)
- Jamie A Weiner
- University of North Carolina at Chapel Hill School of Nursing, Undergraduate Division, Chapel Hill, North Carolina
| | - Lisa K Woodley
- University of North Carolina at Chapel Hill School of Nursing, Undergraduate Division, Chapel Hill, North Carolina
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42
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Hulsey EG, Hill RM, Layne CM, Gaffney DA, Kaplow JB. Calculating the incidence rate of sibling bereavement among children and adolescents across the United States: A proposed method. DEATH STUDIES 2018; 44:303-311. [PMID: 30513272 DOI: 10.1080/07481187.2018.1541946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/04/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
This study proposes a method for calculating the annual incidence rate of sibling bereavement among US youth using national epidemiological data. The proposed model combines data on family household size with national death statistics to calculate the number of siblings affected by the death of a child annually. From 2012 to 2015, an average of 61,389 children per year experienced the death of a sibling, resulting in an estimate of 0.0832% of children bereaved by the death of a sibling annually. Data indicate a need for greater awareness and dialog concerning the frequency with which children experience the death of a sibling.
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Affiliation(s)
- Eric G Hulsey
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Allegheny County Department of Human Services Office of Data Analysis, Research, and Evaluation, Pittsburgh, PA, USA
| | - Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Christopher M Layne
- UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Donna A Gaffney
- Family Bereavement Program, Arizona State University, Tempe, AZ, USA
| | - Julie B Kaplow
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Howard Sharp KM, Russell C, Keim M, Barrera M, Gilmer MJ, Foster Akard T, Compas BE, Fairclough DL, Davies B, Hogan N, Young-Saleme T, Vannatta K, Gerhardt CA. Grief and growth in bereaved siblings: Interactions between different sources of social support. ACTA ACUST UNITED AC 2018; 33:363-371. [PMID: 30234359 DOI: 10.1037/spq0000253] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objective was to characterize the relation between different sources of school-based social support (friends, peers, and teachers) and bereaved siblings' grief and grief-related growth and to examine whether nonparental sources of social support buffer the effects of low parent support on bereaved siblings. Families (N = 85) were recruited from cancer registries at 3 pediatric institutions 3-12 months after a child's death. Bereaved siblings were 8-18 years old (M = 12.39, SD = 2.65) and majority female (58%) and White (74%). During home visits, siblings reported their perceptions of social support from parental and nonparental sources using the Social Support Scale for Children, as well as grief and grief-related growth using the Hogan Sibling Inventory of Bereavement. Parent, friend, and teacher support were positively correlated with grief-related growth, whereas parent and peer support were negatively correlated with grief for adolescents. Teacher and friend support significantly moderated the association between parent support and grief such that teacher and friend support accentuated the positive effects of parent support. Friend and peer support moderated associations between parent support and grief/growth for adolescents but not children. School-based social support, namely from friends, peers, and teachers, appears to facilitate the adjustment of bereaved siblings. Findings suggest that bereaved siblings may benefit from enhanced support from teachers and friends regardless of age, with middle/high school students particularly benefitting from increased support from close friends and peers. (PsycINFO Database Record
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Affiliation(s)
| | - Claire Russell
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital
| | | | - Maru Barrera
- Department of Psychology, Hospital for Sick Children
| | | | | | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University
| | - Diane L Fairclough
- Department of Biostatistics and Informatics, Colorado School of Public Health
| | | | - Nancy Hogan
- Marcella Niehoff School of Nursing, Loyola University Chicago
| | - Tammi Young-Saleme
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital
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Integrating palliative and oncology care: paediatric considerations. Lancet Oncol 2018; 19:e572-e573. [DOI: 10.1016/s1470-2045(18)30568-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/19/2018] [Indexed: 11/22/2022]
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Hoffmann R, Kaiser J, Kersting A. Psychosocial outcomes in cancer-bereaved children and adolescents: A systematic review. Psychooncology 2018; 27:2327-2338. [PMID: 30120901 DOI: 10.1002/pon.4863] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Due to the unique importance of parental and sibling relationships and concurrently existing developmental challenges, the loss of a parent or sibling due to cancer is a highly stressful event for children and adolescents. This is the first systematic review that integrates findings on psychosocial outcomes after parental or sibling cancer bereavement. METHODS A systematic search of Web of Science, PubMed, PsycINFO, and PubPsych was conducted, last in December 2017. Quantitative studies on psychosocial outcomes of children and adolescents who lost a parent or sibling due to cancer were included. RESULTS Twenty-four studies (N = 10 parental and N = 14 sibling bereavement), based on 13 projects, were included. Ten projects had cross-sectional designs. Only 2 projects used large, population-based samples and nonbereaved comparison groups. Outcomes were partially measured by single-item questions. Bereaved children and adolescents showed similar levels of depression and anxiety compared with nonbereaved or norms. Severe behavioral problems were found rarely. However, in 2 large, population-based studies, about half of the bereaved individuals reported unresolved grief. Bereaved adolescents had a higher risk for self-injury compared with the general population in one large, population-based study. Communication with health-care professionals, family, and other people; social support; distress during illness; age; gender; and time because loss were associated with psychosocial bereavement outcomes. CONCLUSIONS Results indicate a high level of adjustment in cancer-bereaved children and adolescents. A modifiable risk factor for adverse psychosocial consequences is poor communication. Prospective designs, representative samples, and validated instruments, eg, for prolonged grief, are suggested for future research.
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Affiliation(s)
- Rahel Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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Navea Martín A, Tamayo Hernández JA. Características de la resiliencia familiar en pacientes oncológicos pediátricos: una revisión sistemática. PSICOONCOLOGIA 2018. [DOI: 10.5209/psic.61431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: la resiliencia familiar consiste en la adaptación positiva a la adversidad, implicando el cambio de su dinámica y su funcionamiento, permitiendo resolver cualquier estresor que se encuentre durante la vida de sus miembros. Objetivo: conocer las características de la resiliencia familiar en el ámbito de la oncología pediátrica. Método: mediante una revisión sistemática, se realiza una búsqueda en las bases de datos Medline, SCOPUS/Sciencedirect, Academic Search complete, Psychology and Behavioral Sciences Collection, CINAHL y E-Journals, para conocer las últimas investigaciones acerca de modelos, variables, instrumentos e intervenciones de resiliencia familiar, obteniéndose 13 artículos. Resultados: un 84,7% de las investigaciones son de tipo cuantitativo y presentan factor de impacto. La mayor parte de los estudios utilizan la Escala Connor-Davidson Resilience y obtienen que la mayoría de las familias de niños con cáncer son resilientes. Dos artículos presentan modelos de resiliencia familiar. Conclusión: El constructo de resiliencia familiar es complejo y es estudiado desde diferentes perspectivas. Un modelo que resuma todos los aspectos que influyen en el mismo, puede ayudar a la intervención del psicólogo con las familias de niños con cáncer.
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Brooten DA, Youngblut JM, Roche RM, Caicedo CL, Page TF. Surviving Siblings' Illnesses, Treatments/Health Services over 13 Months after a Sibling's Death. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:2049-2056. [PMID: 30766016 PMCID: PMC6370309 DOI: 10.1007/s10826-018-1044-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Two million children experience sibling death annually and have problems that require clinical intervention although few receive such help. Effects on surviving siblings' mental health has been well documented, however their physical health has not. This study described surviving siblings' illnesses, treatments/health services at 2, 4, 6, and 13 months post-sibling death. The 132 children (76 girls, 56 boys, M 10.6 years, SD 3.43); 30% Hispanic, 51% Black, 26% White were recruited via hospital ICUs and published obituaries. Using a longitudinal design, parents reported types and numbers of surviving siblings' illnesses, treatments/health services, and dates post-sibling death. Most of the 207 illnesses and 674 treatments/health services occurred in the first 6 months post-sibling death. While girls had more illnesses (131) than boys (76) and Hispanic children had more illnesses than White or Black children, these differences were not statistically significant. Girls accounted for 66% of the treatments/health services and boys 34%. There was no significant difference in treatments/health service use by gender of the children (F = 1.00, p = .32). Hispanic children had significantly more treatments/health service use than Black children (F = 6.81, p = .002). Sibling death affects surviving siblings' physical health. Study data document the importance of monitoring the health, treatments and health service use of surviving siblings especially in the first 6 months after a sibling death, regardless of the child' s gender. On average, Hispanic children had greater health service use, which may warrant greater attention.
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Affiliation(s)
- Dorothy A. Brooten
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida, USA
| | - JoAnne M. Youngblut
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida, USA
| | - Rosa M. Roche
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida, USA
| | - Carmen L. Caicedo
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida, USA
| | - Timothy F. Page
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, USA
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Kaye EC, Gushue CA, DeMarsh S, Jerkins J, Sykes A, Lu Z, Snaman JM, Blazin L, Johnson LM, Levine DR, Morrison RR, Baker JN. Illness and end-of-life experiences of children with cancer who receive palliative care. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26895. [PMID: 29218773 PMCID: PMC6159948 DOI: 10.1002/pbc.26895] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The field of pediatric palliative oncology is newly emerging. Little is known about the characteristics and illness experiences of children with cancer who receive palliative care (PC). METHODS A retrospective cohort study of 321 pediatric oncology patients enrolled in PC who died between 2011 and 2015 was conducted at a large academic pediatric cancer center using a comprehensive standardized data extraction tool. RESULTS The majority of pediatric palliative oncology patients received experimental therapy (79.4%), with 40.5% enrolled on a phase I trial. Approximately one-third received cancer-directed therapy during the last month of life (35.5%). More than half had at least one intensive care unit hospitalization (51.4%), with this subset demonstrating considerable exposure to mechanical ventilation (44.8%), invasive procedures (20%), and cardiopulmonary resuscitation (12.1%). Of the 122 patients who died in the hospital, 44.3% died in the intensive care unit. Patients with late PC involvement occurring less than 30 days before death had higher odds of dying in the intensive care unit over the home/hospice setting compared to those with earlier PC involvement (OR: 4.7, 95% CI: 2.47-8.97, P < 0.0001). CONCLUSIONS Children with cancer who receive PC experience a high burden of intensive treatments and often die in inpatient intensive care settings. Delayed PC involvement is associated with increased odds of dying in the intensive care unit. Prospective investigation of early PC involvement in children with high-risk cancer is needed to better understand potential impacts on cost-effectiveness, quality of life, and delivery of goal concordant care.
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Affiliation(s)
| | - Courtney A. Gushue
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Samantha DeMarsh
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Jonathan Jerkins
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - April Sykes
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Zhaohua Lu
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer M. Snaman
- Dana-Farber Cancer Institute, Boston, MA
- Boston Children’s Hospital, Boston, MA
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49
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Long KA, Lehmann V, Gerhardt CA, Carpenter AL, Marsland AL, Alderfer MA. Psychosocial functioning and risk factors among siblings of children with cancer: An updated systematic review. Psychooncology 2018; 27:1467-1479. [DOI: 10.1002/pon.4669] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Affiliation(s)
| | - Vicky Lehmann
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | - Cynthia A. Gerhardt
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | | | | | - Melissa A. Alderfer
- Nemours Children's Health System/A.I. duPont Hospital for Children; Wilmington DE USA
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia PA USA
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50
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Nelson KE, Feinstein JA, Gerhardt CA, Rosenberg AR, Widger K, Faerber JA, Feudtner C. Emerging Methodologies in Pediatric Palliative Care Research: Six Case Studies. CHILDREN-BASEL 2018; 5:children5030032. [PMID: 29495384 PMCID: PMC5867491 DOI: 10.3390/children5030032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 12/17/2022]
Abstract
Given the broad focus of pediatric palliative care (PPC) on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery.
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Affiliation(s)
- Katherine E Nelson
- Pediatric Advanced Care Team, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
| | - James A Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Children's Hospital Colorado, Aurora, CO 80045, USA.
- Division of General Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH 43210, USA.
| | - Abby R Rosenberg
- Department of Pediatrics, University of Washington School of Medicine; Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA 98101, USA.
| | - Kimberley Widger
- Pediatric Advanced Care Team, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada.
| | - Jennifer A Faerber
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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