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Paul TK, Daniels S, Love A, Hart K, Kaye EC. Storytelling to support legacy making for bereaved parents of children with cancer. Pediatr Blood Cancer 2024:e31272. [PMID: 39138603 DOI: 10.1002/pbc.31272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/22/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
Honoring a child's legacy is an essential aspect of meaning-making for bereaved parents, yet little is known about storytelling as a mechanism. Through narrative analysis of 19 bereaved parent interviews focused on legacy, we examined the role of storytelling in creating and sustaining legacy. Most participants (89%) told stories centered around the child's impact and parent's coping, including the child's character and interpersonal relationships during and after their lifetime as well as how the child's legacy influenced parents' grief experiences. Future research is needed to explore the potential impact of storytelling initiatives to support legacy-making for bereaved caregivers.
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Affiliation(s)
- Trisha K Paul
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sarah Daniels
- Child Life and Music Therapy Program, Department of Psychosocial Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amy Love
- Child Life and Music Therapy Program, Department of Psychosocial Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Katherine Hart
- Child Life and Creative Arts Therapy Program, UC Davis Children's Hospital, Sacramento, California, USA
| | - Erica C Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Daniels S, Franqui-Rios ND, Mothi SS, Gaitskill E, Cantrell K, Kaye EC. Access to legacy-oriented interventions at end of life for pediatric oncology patients: A decedent cohort review. Pediatr Blood Cancer 2024; 71:e31066. [PMID: 38757484 DOI: 10.1002/pbc.31066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/13/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Legacy-oriented interventions have the potential to offer pediatric oncology patients and families comfort at end of life and during bereavement. Certified child life specialists often provide these services, and presently little is known about whether disparities exist in the provision of legacy-oriented interventions. METHODS In this retrospective decedent cohort study, we examined demographic and clinical characteristics from a sample of 678 pediatric oncology patients who died between 2015 and 2019. Bivariate analysis assessed differences between patients who received any versus no legacy-oriented intervention. Uni- and multivariable logistic regression models assessed associations of baseline characteristics and likelihood of receiving legacy-oriented intervention. Further multivariable analysis explored joint effects of significant variables identified in the univariable analysis. RESULTS Fifty-two percent of patients received a legacy-oriented intervention. Older adolescents (≥13 years) were less likely (odds ratio [OR]: 1.73, p = .007) to receive legacy-oriented interventions than younger ones. Patients with home/hospice deaths were also less likely (OR: 19.98, p < .001) to receive interventions compared to patients who passed away at SJCRH locations. Hispanic patients (OR: 1.53, p = .038) and those in palliative care (OR: 10.51, p < .001) were more likely to receive interventions. No significant race association was noted. CONCLUSION All children and adolescents with cancer deserve quality care at end of life, including access to legacy-oriented interventions, yet nearly half of patients in this cohort did not receive these services. By identifying demographic and clinical characteristics associated with decreased odds of receiving legacy-oriented interventions, healthcare professionals can modify end-of-life care processes to improve access. Introducing legacy-oriented interventions early and increasing exposure in community spaces may enhance access to legacy-oriented interventions for pediatric oncology patients.
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Affiliation(s)
- Sarah Daniels
- Child Life Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Nelson D Franqui-Rios
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico, Puerto Rico
| | - Suraj S Mothi
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Elizabeth Gaitskill
- Child Life Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kathryn Cantrell
- Department of Human Development, Family Studies, and Counseling, Texas Woman's University, Denton, Texas, USA
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Polara N. Legacy Building: The Experience of Heartbeat Recordings for Bereaved Caregivers in Pediatrics. Crit Care Nurs Clin North Am 2024; 36:281-287. [PMID: 38705694 DOI: 10.1016/j.cnc.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The death of a child is a devastating event that can lead to chronic sorrow and great stress among parents and caregivers. Legacy-building and memory-making experiences for anticipatory grief and bereavement have become increasingly popular in pediatric hospitals, including the use of heartbeat recordings. This intervention created by Brian Schreck at Cincinnati Children's Hospital Medical Center involves audio recording the patient's heartbeat or other respiratory sounds with a digital stethoscope to construct and preserve the patient's legacy, as well as to act as a therapeutic tool.
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Affiliation(s)
- Nicole Polara
- Department of Child Life and Integrative Care, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5003, Cincinnati, OH 45229, USA.
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Keller BP, Akard TF, Boles JC. Legacy in paediatrics: A concept analysis. J Adv Nurs 2024; 80:948-957. [PMID: 37921200 DOI: 10.1111/jan.15922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
AIM To provide an analysis of legacy and legacy-oriented interventions in paediatric healthcare. DESIGN Walker and Avant's method of concept analysis. METHODS Using Walker and Avant's method, three defining attributes of the concept were determined, followed by antecedents, consequences, and empirical referents of legacy. RESULTS In paediatrics, legacy is co-authored in relationships, has the capability to outlive the person or event it represents, and elicits the essence of a person or experience. Receiving legacy-oriented interventions are not a prerequisite for having a legacy, nor is death. CONCLUSION Engaging in purposeful, individualized legacy-oriented interventions can improve coping in paediatric patients, families, and providers. By understanding the concept of legacy, providers are better equipped to provide care honouring the unique personhood, relationships, and strengths of children and families in even the most dire circumstances. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Understanding the scope and purpose of legacy in paediatrics assists providers in improving patient- and family-centred outcomes by designing interventions that facilitate long-term coping in patients facing a loss of or significant change in health, normalcy, or life. IMPACT Legacy-oriented interventions are provided at most children's hospitals in the United States, yet no widespread consensus on foundation or scope has been determined. This concept analysis provides evidence-based guidelines for policy and practice in creating legacy for and with children, providing opportunities to improve quality of care for young patients and their families around the world. REPORTING METHOD N/A. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Briana P Keller
- Vanderbilt University Peabody College, Nashville, Tennessee, USA
| | - Terrah F Akard
- Vanderbilt University Graduate School, Nashville, Tennessee, USA
| | - Jessika C Boles
- Vanderbilt University Peabody College, Nashville, Tennessee, USA
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Xu DD, Zhang GX, Ding XB, Ma J, Suo YX, Peng YY, Zeng JL, Liu M, Hou RT, Li J, Hu F. Bereaved parents' perceptions of memory making: a qualitative meta-synthesis. BMC Palliat Care 2024; 23:24. [PMID: 38273273 PMCID: PMC10809512 DOI: 10.1186/s12904-024-01339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE This study aims to investigate the experiences of parents who have experienced bereavement in their efforts to preserve memories of their deceased child. METHODS Employing a qualitative meta-synthesis approach, this study systematically sought relevant qualitative literature by conducting searches across various electronic databases, including PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Wiley, up until July 2023. RESULTS Nine studies are eligible for inclusion and included in the meta-synthesis. Three overarching categories are identified: (1) Affirming the Significance of Memory Making. (2) Best Practices in Memory Making. (3) Barriers to Effective Memory Making. CONCLUSION Bereaved parents highly value the act of creating lasting memories, emphasizing its profound significance. While forming these memories, it is imperative to offer family-centered care and honor diverse preferences and needs. It is essential to offer effective support to parents, offering them a range of choices. Furthermore, a more comprehensive examination of memory-making practices is required to better understand their influence on parents' recollections of their deceased child.
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Affiliation(s)
- Dan-Dan Xu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Guang-Xiong Zhang
- Department of Anesthesiology, Hubei Province Corps Hospital of The Chinese Armed Police Force (CAPF), Wuhan, China
| | - Xin-Bo Ding
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Ya-Xi Suo
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Yang-Yao Peng
- Department of Neurosurgical Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ji-Li Zeng
- Department of Otorhinolaryngology, General Hospital of Central Theater Command, Wuhan, China
| | - Miao Liu
- Department of Pulmonary Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rui-Tong Hou
- Department of Pulmonary Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jin Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China.
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China.
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Figueroa Gray M, Randall S, Banegas M, Ryan GW, Henrikson NB. Personal legacy and treatment choices for serious illness: a scoping review. BMJ Support Palliat Care 2024:spcare-2023-004439. [PMID: 38267198 PMCID: PMC11266526 DOI: 10.1136/spcare-2023-004439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Legacy-how one hopes to be remembered after death-is an unexplored and important dimension of decision-making for people facing serious illness. OBJECTIVES We conducted a scoping review to answer the following research questions: (1) How do people making treatment choices conceive of legacy? and (2) What treatment choices do people make with legacy in mind? ELIGIBILITY CRITERIA Participants included people facing serious illness who discussed how they wanted to be remembered after their own death, or how they hoped to impact others, as they made treatment choices. Studies in English published between 1990 and 2022 were included. SOURCES OF EVIDENCE We conducted searches in electronic databases including Medline/PubMed, CINAHL, PsycInfo, SocialWork, AnthropologyPlus, Web of Science, ProQuest and EMBASE databases. DATA SYNTHESIS We used an electronic screening tool to screen abstracts and review full-text articles suitable for inclusion. We analysed included articles using Atlas.ti. We constructed tables and narratively synthesised the findings. RESULTS We identified three major intersecting legacy goals that influence choices people facing serious illness make about their treatment and health behaviours, and the types of choices people make with legacy in mind. The three legacy goals are: remembrance of the individual self, remembrance of the social self and impact on others' well-being. CONCLUSIONS We identify the importance of legacy to patient treatment choices. Understanding for whom this construct is important, what types of legacy goals people hold and how those goals impact treatment choices is necessary to provide patient-centred whole-person care to people facing serious illness.
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Affiliation(s)
| | | | - Mateo Banegas
- Radiation Medicine and Applied Science, University of California San Diego, La Jolla, California, USA
| | - Gery W Ryan
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Thorn AC, Brown K, Tolland M, Read J. Pediatric staff and their perceptions of music therapy services. J Pediatr Nurs 2023; 73:e138-e145. [PMID: 37567856 DOI: 10.1016/j.pedn.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To reveal the benefits, needs, and limitations of music therapy observed by clinical pediatric staff at a children's hospital in the United States of America. DESIGN AND METHODS Researchers developed an electronic 13-question survey and distributed the survey in the fall of 2022. Questions included demographics, Likert-type scale, and open-ended queries. Data was collected via Qualtrics and analyzed using descriptive statistics and content analysis. RESULTS A total of 83 pediatric staff completed the survey. Staff observed positive benefits, where the highest reported areas were opportunities for dealing with anxiety/stress (94.7%), opportunities for social interaction (93.3%), and quality of life (89.3%). Analysis of free-response questions suggest that staff expect expertise and a nuanced understanding of the needs of each of their clinical units. CONCLUSION Results suggest that staff possess an overall positive attitude toward music therapy in all settings served. Music therapists may be valuable for psychosocial and rehabilitative support to hospitalized children and their families. PRACTICE IMPLICATIONS Nursing staff may utilize music therapists to improve patient outcomes and reduce the negative effects of hospitalization.
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Affiliation(s)
| | - Kristin Brown
- Nemours Children's Hospital, Orlando, FL, United States.
| | | | - Jenna Read
- Nemours Children's Hospital, Orlando, FL, United States
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Engel M, Brouwer MA, Jansen N, Leget C, Teunissen SCCM, Kars MC. The spiritual dimension of parenting a child with a life-limiting or life-threatening condition: A mixed-methods systematic review. Palliat Med 2023; 37:1303-1325. [PMID: 37461310 PMCID: PMC10548770 DOI: 10.1177/02692163231186173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Spirituality refers to the dynamic dimension of human life that relates to the way that persons experience meaning, purpose, and transcendence. The complex task of parenting a child with a life-limiting condition may raise existential questions, which are easily overlooked by healthcare professionals. AIM We explored how the spiritual dimension becomes manifest in parents of children in pediatric palliative care. DESIGN A mixed-methods systematic review was conducted, registered in Prospero (2021 CRD42021285318). DATA SOURCES PubMed, CINAHL, Embase, PsycInfo, and Cochrane were searched for articles published between January 1, 2015 and January 1, 2023. We included original empirical studies that reported on spirituality of parents of seriously ill children, from parents' perspectives. RESULTS Sixty-three studies were included: 22 North-American, 19 Asian, 13 European, 9 other. Studies varied in defining spirituality. We identified five different aspects of spirituality: religion, hope, parental identity, personal development, and feeling connected with others. All aspects could function as source of spirituality or cause of spiritual concern. Sources of spirituality helped parents to give meaning to their experiences and made them feel supported. However, parents also reported struggling with spiritual concerns. Several parents highlighted their need for professional support. CONCLUSIONS Although studies vary in defining spirituality, reports on spirituality focus on how parents connect to their faith, others, and themselves as parents. Healthcare professionals can support parents by paying attention to the spiritual process parents are going through. More research is needed into how healthcare professionals can support parents of seriously ill children in this process.
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Affiliation(s)
- Marijanne Engel
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije A Brouwer
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nienke Jansen
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Carlo Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia CCM Teunissen
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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