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Tan WL, Sambhi SK, Shorey S. Experiences of paediatric terminal oncology patients and their parents in palliative care: A qualitative systematic review. J Pediatr Nurs 2024:S0882-5963(24)00267-7. [PMID: 39025711 DOI: 10.1016/j.pedn.2024.07.005] [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: 04/11/2024] [Revised: 07/05/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
PROBLEM The terminal phase of childhood cancer poses profound physical and mental challenges for children, simultaneously influencing parents and rendering them particularly susceptible to psychosocial issues. ELIGIBILITY CRITERIA This review included studies exploring the experiences of either: (1) paediatric terminal oncology patients aged under 18 years, (2) parents with a child facing terminal cancer undergoing palliative care, or (3) parents with a child who had undergone palliative care and died. English language, qualitative journal studies or grey literature of any care settings, geographical locations and publication years were included. Studies exploring the experiences of (1) paediatric terminal oncology not receiving palliative care from qualified healthcare professionals, and (3) non-biological parents or non-parental family members, were excluded. SAMPLE A total of 22 studies were included, published between January 2000 and December 2023. Seventy-two children (aged between 5 and 18 years old) and 236 parents (aged between 24 and 57 years old) participated across all studies. Palliative care settings mostly comprised oncology centres, hospitals and homes. RESULTS Two themes were identified from the 22 included studies: (1) Navigating rough waters and enduring hardships, and (2) Preparing for end-of-life amidst the looming threat of death. CONCLUSIONS This review underscored the importance of integrating palliative childhood cancer care in a holistic, age-specific, family-centred, person-centred and timely manner. IMPLICATIONS Paediatric oncology nurses should attend to physical and psychosocial needs of children and parents, fostering familial and social ties while recognising cultural and spiritual needs. Future research could recruit participants of varying ages, genders, and cultures.
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Affiliation(s)
- Wei Ling Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sharan Kaur Sambhi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Holistic Initiatives for Learning and Development (CHILD), Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Atout M, Hasan AAH, Alkharabsheh AAH, Al-Tobasi AM, Ali AM. A narrative inquiry into the communication experiences of mothers caring for children with cancer in Jordan. J Pediatr Nurs 2024; 76:e132-e139. [PMID: 38453545 DOI: 10.1016/j.pedn.2024.02.021] [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: 08/15/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND This study aims to investigate the parenting experiences of mothers who care for children with cancer in Jordan and specifically focuses on the communication experiences of mothers who care for children with cancer. METHODOLOGY A qualitative research design employing a narrative inquiry methodology was adopted; it employed the implementation of twenty semi-structured interviews with the mothers of children with cancer recruited from one pediatric hospital located in Amman, Jordan. FINDINGS The findings of this study reveal that the majority of mothers attempted to conceal or delay any discussion regarding the diagnosis with their child, particularly during the immediate post-diagnosis period. Additionally, the mothers expressed that their relationships with the parents of children diagnosed with the same illness contain positive and negative aspects. Finally, most mothers participating in this study praised the role of hope in helping them cope with the challenging health condition of their children. CONCLUSIONS The findings of this study reveal that mothers would withhold diagnostic information from their children for several reasons: firstly, they wished to safeguard their children from feelings of distress; secondly, they perceived that their children were too immature to fully comprehend the seriousness of their diagnosis; and, finally, they desired to protect their children from unnecessary fear and negative emotions. PRACTICAL IMPLICATIONS Pediatric cancer care requires effective communication between physicians, pediatric nurses, caregivers, and children; clear and accurate communication between healthcare providers and parents of children with cancer ensures that they fully understand the diagnosis and can make values-based decisions.
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Affiliation(s)
- Maha Atout
- Faculty of Nursing, Philadelphia University, Jarash Road, P.O. Box 19392, Amman, Jordan.
| | - Abd Al-Hadi Hasan
- Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia.
| | | | - Adnan Mahmmoud Al-Tobasi
- Faculty of Arts, Department of Counseling Psychology, Philadelphia University, Jarash Road, P.O. Box 19392, Amman, Jordan.
| | - Amira M Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt.
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Sadler K, Khan S, AlGhamdi K, Alyami HH, Nancarrow L. Addressing 10 Myths About Pediatric Palliative Care. Am J Hosp Palliat Care 2024; 41:193-202. [PMID: 37144635 DOI: 10.1177/10499091231174202] [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: 05/06/2023] Open
Abstract
With advances in biomedical sciences, a growing number of conditions affecting children have evolved from being considered life-limiting to almost chronic diseases. However, improvements in survival rates often come at a cost of increased medical complexity and lengthy hospitalizations, which can be associated with a poorer quality of life. This is where pediatric palliative care (PPC) can play a significant role. PPC is a specialty of healthcare that focuses on the prevention and relief of suffering in children with serious conditions. Unfortunately, despite the well-identified need for PPC services across pediatric specialties, multiple misconceptions persist. Common myths about palliative care are identified and deconstructed in light of the most recent evidenced-based references in the field to provide guidance to healthcare providers to address these. PPC is often associated with end-of-life care, loss of hope, and cancer. Some healthcare providers and parents also believe that information like diagnosis should be withheld from children for their emotional protection. These examples of misconceptions hinder the integration of pediatric palliative care and its additional layer of support and clinical expertise. PPC providers have advanced communication skills, are able to instill hope in the face of uncertainty, are trained to initiate and implement individualized pain and symptom management plans, and understand how to improve the quality of life in children with serious illnesses. Improved awareness about the scope of PPC is needed to ensure that children benefit from the maximum expertise and support throughout their complex health trajectories.
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Affiliation(s)
- Kim Sadler
- Oncology and Liver Diseases Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saadiya Khan
- Pediatric Hematology-Oncology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khaled AlGhamdi
- General Pediatrics Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hamad Hussain Alyami
- Pediatric Hematology-Oncology Nursing Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Lori Nancarrow
- Children's Palliative Care Department, Whittington Health NHS Trust, London, UK
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Su-Russell C, Russell LT, Ermer AE, Greiner C, Gregory R. Parents' Anticipated Discussions About Death With Young Children. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1181-1202. [PMID: 34923873 DOI: 10.1177/00302228211057735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Guided by family communication patterns theory and terror management theory this mixed-methods investigation explored how parents (N = 112) of young children (ages 3-6) described the way they would discuss death when it comes up in conversations. Responses were coded inductively, resulting in four themes: explanations that death is inevitable, explanations that death is in the distance, the use of religion to frame discussions of death, and finally, discussing afterlife connections to deceased family members. Logistic regression analyses were used to evaluate whether parents' conformity or conversation orientations were associated with the frequency with which parents discussed death with their child and the content of parent vignette responses. Quantitative analysis revealed parents' conversation orientations were associated with the frequency with which they discussed death with their child and conformity orientations were associated with parents' use of religion and discussing afterlife connections to deceased family members in their responses.
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Affiliation(s)
- Chang Su-Russell
- Department of Family and Consumer Sciences, Illinois State University, Normal, IL, USA
| | - Luke T Russell
- Department of Family and Consumer Sciences, Illinois State University, Normal, IL, USA
| | - Ashley E Ermer
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Csilla Greiner
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Rebecca Gregory
- Department of Family and Consumer Sciences, Illinois State University, Normal, IL, USA
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Ayoub M, Udo C, Årestedt K, Kreicbergs U, Lövgren M. The Family Talk Intervention in Pediatric Oncology: Potential Effects Reported by Parents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:95. [PMID: 38255408 PMCID: PMC10814711 DOI: 10.3390/children11010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Childhood cancer impacts the family system and has psychosocial consequences for all family members. For the parents, the ill child, and the siblings to be able to adjust to this challenging situation, the whole family needs access to psychosocial support. However, only a few such family interventions in pediatric oncology have been evaluated. The aim of this study was to explore the potential effects of a family-centered intervention, the Family Talk Intervention (FTI), in pediatric oncology from the parents' perspectives. METHODS A concurrent mixed methods design was used for this study. Data were derived from a pilot study of 26 families recruited from one pediatric oncology center in Sweden. This study focused on questionnaire and interview data from 52 parents. RESULTS After participation in FTI, the parents felt more satisfied with the conversations within the family about the illness. FTI also contributed to strengthened family togetherness, including more open communication and improved family relations, as described by the parents. Parents further expressed that they felt more empowered in their parenting role following FTI. CONCLUSIONS The findings regarding FTI's ability to improve family communication and family relations, thus strengthening family togetherness in families with childhood cancer, are promising. This provides motivation for a large-scale study of FTIs in pediatric oncology.
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Affiliation(s)
- Maria Ayoub
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden;
| | - Camilla Udo
- School of Health and Welfare, Dalarna University, 791 88 Falun, Sweden;
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 116 28 Stockholm, Sweden; (U.K.); (M.L.)
- Center for Clinical Research Dalarna, Uppsala University, 791 82 Falun, Sweden
| | - Kristofer Årestedt
- Department of Health and Caring Sciences, Faculty of Health and Life Science, Linnaeus University, 352 52 Växjö, Sweden;
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 116 28 Stockholm, Sweden; (U.K.); (M.L.)
- Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institute, 171 77 Solna, Sweden
- Louis Dundas Center, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, 116 28 Stockholm, Sweden; (U.K.); (M.L.)
- Advanced Pediatric Home Care, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, 171 64 Solna, Sweden
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Hirata M, Kobayashi K. Experiences with the end-of-life decision-making process in children with cancer, their parents, and healthcare professionals: A systematic review and meta-ethnography. J Pediatr Nurs 2022; 69:e45-e64. [PMID: 36586777 DOI: 10.1016/j.pedn.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Decision-making during the end-of-life (EOL) phase for children with cancer is extremely difficult for parents. We synthesized the qualitative experiences of children with cancer, parents, and healthcare professionals (HCPs), and their social interactions during the EOL decision-making process in the pediatric oncology setting. METHODS Meta-ethnography was used to conduct a systematic review and meta-synthesis. We searched four online databases to identify original studies published in English and Japanese and examined 21 relevant studies. Two Japanese reviewers discussed the differences/relationships and included studies that synthesized the translated qualitative findings. A conceptual model of social interactions was created. RESULTS We identified four themes regarding children's, parents', and HCPs' experiences: hope and confrontation with the child's death, guidance and support during uncertainty, awareness of being protected and having hope, and mutual unspoken integration of values. CONCLUSIONS These themes evince the experiences of children, parents, and HCPs during the EOL decision-making process and suggests a complex three-way social interaction model. While considering such distinctive social interactions during a child's EOL, this study revealed the sharing of prudent information and psychosocial support by HCPs. The findings indicate that hope and uncertainty are key elements for effectively understanding the experiences of children and parents and that EOL decision-making should not be rushed but should be supported by leaving room for uncertainty and acknowledging parents' emotional needs and fostering new hope. Further research into how hope can be further supported in situations that are rife with uncertainty is needed.
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Affiliation(s)
- Mika Hirata
- Department of Nursing, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama 343-8540, Japan.
| | - Kyoko Kobayashi
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
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Yamaji N, Nagamatsu Y, Kobayashi K, Hasegawa D, Yuza Y, Ota E. Information needs of children with leukemia and their parents' perspectives of their information needs: a qualitative study. BMC Pediatr 2022; 22:414. [PMID: 35831839 PMCID: PMC9277964 DOI: 10.1186/s12887-022-03478-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite the potential benefits of effective communication, telling a child that they have a life-threatening condition is one of the most daunting challenges. This study aimed to explore the information needs of children with leukemia from the perspectives of children and their parents at the time of diagnosis. Methods We conducted an exploratory qualitative study using semi-structured individual interviews with children diagnosed with leukemia between seven and 13 years old (n = 7) and their parents (n = 9). Children and parents’ interview data were analyzed using thematic analysis. Results We identified three themes for the information needs of children with leukemia, 1) beginning to cope, 2) avoiding disclosure – protecting child, and 3) informational support. The children and their parents needed to receive understandable information at the best time to cope with cancer. However, the children and parents expressed different views about children’s information needs. The children needed clear information about the disease, treatment, hospitalization, and the benefits of hospitalization from the time of diagnosis. In contrast, the parents felt they should not tell their children about the disease if they were in shock by their child’s cancer diagnosis. Moreover, the parents believed that information that would be incomprehensible to the child and distress should be avoided to protect their children. Conclusions While the information needs of children with leukemia are varied, children and their parents need the information to cope with cancer. However, if the parents believe that the information would be distressful, they might manage communication with their children. Healthcare professionals should explore the motivations behind parents’ attitudes against communication with children and confront conflict. Healthcare professionals also should communicate with the children and their parents to understand their information needs and respect children’s views.
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Affiliation(s)
- Noyuri Yamaji
- Global Health Nursing, Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan.
| | - Yasuko Nagamatsu
- Global Health Nursing, Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Kyoko Kobayashi
- Child Health Nursing, Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Yuki Yuza
- Department of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8561, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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Eklund R, Lövgren M. The Family Talk Intervention in Pediatric Oncology: Ill Children's Descriptions of Feasibility and Potential Effects. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:143-154. [PMID: 35467434 DOI: 10.1177/27527530221068423] [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: 06/14/2023]
Abstract
Background: There are few scientifically evaluated psychosocial interventions in pediatric oncology, despite the needs for families. The family-based psychosocial intervention "The Family Talk Intervention" (FTI) has shown promising results in other care contexts and was therefore pilot-tested in pediatric oncology. In this study, we examined the experiences of participating in FTI from ill children's perspectives regarding feasibility and potential effects. Methods: This pilot study involved 26 families in pediatric oncology that had participated in FTI. The paper is focused on those ill children who answered surveys (n = 19) and/or participated in interviews (n = 11) when FTI had ended. Data were analyzed with descriptive statistics and thematic analysis. Results: For most ill children, FTI came at the right time, included a reasonable number of meetings, and the length of the meetings was appropriate. The children felt listened to and understood by the interventionists and almost all children reported that FTI had helped them in some way. The children's perceptions indicated that FTI improved communication within the family and strengthened family relations. Children reported that the parents and their siblings seemed to feel better after participation and became more understanding. Discussion: The findings of this pilot study indicated that a full-scale study could be valuable from the ill children's perspective, as FTI was reported as feasible and had positive effects. The findings showed that FTI gave families an opportunity to open up communication about the illness, adjust their behaviors, and strengthen family relationships. Trial registration: ClinicalTrials.gov Identifier NCT03650530.
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Affiliation(s)
- Rakel Eklund
- 7643Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, Stockholm, Sweden
- Department of Neuroscience, National Centre for Disaster Psychiatry, 8097Uppsala University, Uppsala, Sweden
| | - Malin Lövgren
- 7643Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, Stockholm, Sweden
- Advanced Pediatric Home Care, Astrid Lindgren Children's Hospital, 59562Karolinska University Hospital, Stockholm, Sweden
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Job MK, Schumacher P, Müller G, Kreyer C. The social and spiritual dimensions of parental experiences on end-of-life care of their child with cancer: A narrative review. Palliat Support Care 2022; 21:1-12. [PMID: 35048846 DOI: 10.1017/s1478951521001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Having a child with cancer is a burdensome experience for parents. Nurses need to better understand beliefs, hopes, and values of parents to holistically support them, which may have an impact on grief and depression. Thus, the aim of this paper was to highlight the social and spiritual dimensions of parental experiences on end-of-life care of their child with cancer. METHOD A narrative literature review was conducted by systematically searching databases (CINAHL Complete, Academic Search Elite, MEDLINE) for relevant literature. The contents of included studies were critically appraised regarding their methodological quality. RESULTS Eleven studies were included. In terms of the social dimension, three categories emerged that are important for parents: Being a Parent, Being in Relationship with the Child, and Being in Relationship with Health Professionals. Parents tried to maintain normality and joy for their child, but also kept control over the situation. They wanted to protect their child from suffering but also felt the need to talk to them about dying. Parents had ambivalent experiences with helpful but also burdensome staff. The spiritual dimension comprised two main categories, Hope and Faith and a Unique Bond. Hope was found to be an important source of strength, while Faith was only mentioned by some parents. For parents the emotional connection with their child constituted a source of meaning as well as a foundation, on which they based their decisions on. SIGNIFICANCE OF RESULTS A therapeutic relationship and a supportive environment can be established by healthcare professionals by noticing, encouraging the unique bond between parents and their children, as well as by reflecting and addressing the parents' challenging situation.
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Affiliation(s)
- Maria Katharina Job
- Hospital of St. John of God in Vienna, Johannes-von-Gott Platz 1, A-1020 Vienna, Austria
| | - Petra Schumacher
- Fachhochschule Krems - University of Applied Sciences Krems, Department of Health Sciences, Institute of Nursing Science, Am Campus Krems, A-3500 Krems, Austria
| | - Gerhard Müller
- UMIT - Private University for Health Sciences, Medical Informatics and Technology, Department of Nursing Science and Gerontology, Institute of Nursing Science, Eduard Wallnoefer-Zentrum 1, A-6060 Hall in Tyrol, Austria
| | - Christiane Kreyer
- UMIT - Private University for Health Sciences, Medical Informatics and Technology, Department of Nursing Science and Gerontology, Institute of Nursing Science, Eduard Wallnoefer-Zentrum 1, A-6060 Hall in Tyrol, Austria
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Cowfer BA, Dietrich MS, Akard TF. Effect of time on quality of parent-child communication in pediatric cancer. Pediatr Blood Cancer 2021; 68:e29091. [PMID: 34165883 DOI: 10.1002/pbc.29091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND A diagnosis of childhood cancer results in new parent-child communication challenges. Little is known about how communication changes over time after diagnosis or relapse. The objective of this study was to determine the effect of time since diagnosis and relapse on quality of parent-child communication. We hypothesized that there would be a positive correlation between time and quality of parent-child communication. METHODS Cross-sectional study in children (7-17 years) with relapsed/refractory cancer and their caregivers, who spoke English, were not cognitively impaired, and had internet access. Parents were recruited through Facebook ads. Parents and children completed the Parent-Adolescent Communication Scale (PACS), a 20-item measure of communication quality, with openness and problem subscales. Spearman's rho (rs ) coefficients assessed correlations between PACS scores and time since diagnosis/relapse. RESULTS There was a statistically significant negative correlation between parent PACS scores and time since child's cancer diagnosis (rs = -0.21, p = .02), indicating a tendency for overall worsening communication as time since diagnosis increased. There was a positive correlation between the parent PACS problem scores and time since diagnosis (rs = +0.22, p = .01), indicating more problematic communication as time since diagnosis increased. Correlations of time since relapse and PACS scores were small and not statistically significant. CONCLUSION Parent-child communication worsens over time following a child's cancer diagnosis with more communication problems, contrary to our hypothesis. Future studies are needed to evaluate intervention timing to best support parent-child communication beyond the new-diagnosis period.
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Affiliation(s)
- Brittany A Cowfer
- Department of Pediatric Hematology/ Oncology , Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Mary S Dietrich
- Vanderbilt University Schools of Nursing and Medicine, Nashville, Tennessee, USA
| | - Terrah Foster Akard
- Vanderbilt University Schools of Nursing and Medicine, Nashville, Tennessee, USA
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Vig PS, Lim JY, Lee RWL, Huang H, Tan XH, Lim WQ, Lim MBXY, Lee ASI, Chiam M, Lim C, Baral VR, Krishna LKR. Parental bereavement - impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review. BMC Palliat Care 2021; 20:136. [PMID: 34481491 PMCID: PMC8418708 DOI: 10.1186/s12904-021-00831-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Losing a child tragically impacts the well-being and functioning of parents. With these effects extending beyond emotional, physical morbidity and compromising self-perceptions, appropriate, longitudinal, timely and personalised support is key to effective care of bereaved parents. However, in the absence of a comprehensive understanding of parental bereavement, effective support of bereaved parents remains suboptimal. To address this gap, we scrutinise prevailing data on the effects of a child's death, aged 0-12 years, through the lens of the Ring Theory of Personhood (RToP). METHODS To study prevailing accounts of bereaved parents following the death of a child, we adopt Krishna's Systematic Evidence Based Approach (SEBA) to structure our Systematic Scoping Review (SSR in SEBA). RESULTS Three thousand seventy-four abstracts were reviewed, 160 full text articles were evaluated, and 111 articles were included and analysed using thematic and content analysis. Four themes/categories were identified relating to the four rings of the RToP. Findings reveal that static concepts of protective and risk factors for grief are misplaced and that the support of healthcare professionals is key to assisting bereaved parents. CONCLUSION In the absence of consistent support of bereaved parents, this study highlights the need for effective training of healthcare professionals, beginning with an appreciation that every aspect of an individual parent's personhood is impacted by the loss of their child. Acknowledging grief as a complex, evolving and personalised process subjected to parental characteristics, settings, context and available support, this SSR in SEBA calls attention to effective nurturing of the relationship between parents and healthcare professionals, and suggests use of the RToP to assess and direct personalised, timely, specific support of parents in evolving conditions. We believe the findings of this review also call for further studies to support healthcare professionals as they journey with bereaved parents.
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Affiliation(s)
- Prachi Simran Vig
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Jia Yin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Randal Wei Liang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Huixin Huang
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Road, Block 3 Level 1, Singapore, 169608 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Vijayendra Ranjan Baral
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Division of Neonatal and Developmental Medicine, Singapore General Hospital, Outram Road, Block 5 Level 4, Singapore, 169608 Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
- Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA UK
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Atout MM, Carter B. Communication styles between family carers and children with leukaemia in occupied Palestinian territory. J Child Health Care 2021; 25:427-441. [PMID: 32783747 DOI: 10.1177/1367493520949318] [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] [Indexed: 11/17/2022]
Abstract
This study explores the experience of communication regarding the care of children with cancer, from the perspective of family carers, children and health professionals in occupied Palestinian territory. This study employed an ethnographic collective qualitative case study approach, which was applied in one oncology unit in a Palestinian hospital. Participant observation and semi-structured interviews were used. This study only reports the findings of the interviews with the participating family carers. Fifteen interviews were conducted with family carers (n = 14 children), namely mothers (n = 7), grandmothers (n = 7) and a father (n = 1). The findings reveal that styles of information were given to children by their family carers: minimal/practical information, gradual information, false information, reassuring information and several sources of information. The term cancer was avoided in the discussion of the disease to ameliorate the negative effect of this term, which is considered taboo in the studied culture. Despite the recent trend emphasising the importance of parents communicating openly with their children with cancer, the findings of this study suggest that such open communication is not accepted by all parents. Hence, a case-by-case strategy could be adopted to treat each child in a way that is individual to that child and their culture.
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Affiliation(s)
- Maha M Atout
- Nursing School, 74428Philadelphia University, Jordan
| | - Bernie Carter
- Children's Nursing, Faculty of Health, Social Care and Medicine, 6249Edge Hill University, UK
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Kim JY, Park BK. The Most Important Aspects for a Good Death: Perspectives from Parents of Children with Cancer. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211028580. [PMID: 34218697 PMCID: PMC8261844 DOI: 10.1177/00469580211028580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A good death is an important concept in pediatric palliative care. To improve the
quality of pediatric palliative care, it is imperative to identify which domain
is most important for a good death among children with cancer and their parents.
This study aimed to (1) assess the essential domains for a good death from the
perspectives of parents whose children have cancer using the Good Death
Inventory (GDI) and (2) examine which characteristics are associated with the
perception of a good death. An anonymous cross-sectional questionnaire was
administered to 109 parents of children with cancer. Data were collected using a
validated Korean version of the GDI. Descriptive statistics,
t-test, and ANOVA were used to identify the preferred GDI
domains. Multiple linear regression analysis was performed to identify factors
associated with the GDI scores. The most essential domains for a good death
included “maintaining hope and pleasure” and “being respected as an individual.”
The factors most strongly associated with the perception of a good death were
end-of-life plan discussion with parents or others and parental agreement with
establishing a living will. Encouraging families to discuss end-of-life care and
establish a living will in advance can improve the quality of death among
children with cancer.
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Affiliation(s)
- Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Bu Kyung Park
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
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Palliative Care for Children with Lung Diseases. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Tan AJN, Tiew LH, Shorey S. Experiences and needs of parents of palliative paediatric oncology patients: A meta-synthesis. Eur J Cancer Care (Engl) 2020; 30:e13388. [PMID: 33336528 DOI: 10.1111/ecc.13388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/05/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite palliative care being offered to paediatric cancer patients, it has limited utilisation and often excludes parental support. Therefore, this review aims to consolidate evidence regarding experiences and needs of parents of end-of-life palliative paediatric oncology patients. METHODS Six electronic databases were searched as follows: CINAHL, The Cochrane Library, Embase, PubMed, Scopus and PsycINFO. Included studies were appraised using the Critical Appraisal Skills Programme Checklist. They were then analysed using a two-step approach comprising firstly meta-summaries followed by meta-synthesis for generating fresh insights to the topic. RESULTS Thirteen studies were included. Three themes emerged as follows: (1) normalising the pain; (2) failure as a parent; and (3) importance of communication and social support. Parental experiences included moving on despite the pain and harbouring hopes for their children. However, parents felt immense guilt and a sense of failure in carrying out their parental roles. Effective communication with healthcare providers, availability of family support and religion were necessary to help them cope. CONCLUSIONS Given the emotional challenges faced by parents, healthcare policies and practices should be revised to include parental support in paediatric palliative care services. Future healthcare communication trainings should consider parental need for sensitivity in communication, empathy and kindness from healthcare professionals.
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Affiliation(s)
- Amanda Jue Ning Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lay Hua Tiew
- Ang Mo Kio-Thye Hua Kwan Hospital, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Son H, Yang Y, Crego N, Docherty SL. Communication Challenges in Korean Families Coping With Adolescent Cancer. Oncol Nurs Forum 2020; 47:E190-E198. [PMID: 33063788 DOI: 10.1188/20.onf.e190-e198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the family communication experience of Korean adolescents with cancer and their parents, including how adolescents and their parents verbally share feelings and concerns related to the adolescent's cancer diagnosis with one another, and how emotional communication affects parent-adolescent relationships and the family's coping abilities. PARTICIPANTS & SETTING 20 participants (10 adolescents with cancer, aged 13-19 years, and their parents) at a university-affiliated hospital in Seoul, South Korea. METHODOLOGIC APPROACH Individual, semistructured interviews were conducted and analyzed based on a qualitative descriptive approach. Conventional content analysis was employed to analyze the data. FINDINGS The overarching core theme developed from the content analysis and theme generation was "I cannot share my feelings." This core theme is represented by three main themes. IMPLICATIONS FOR NURSING Increased need for nursing awareness and culturally relevant assessment of emotional family communication needs between Korean adolescents with cancer and their family caregivers are necessary.
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Schuelke T, Rubenstein J. Dignity Therapy in Pediatrics: A Case Series. Palliat Med Rep 2020; 1:156-160. [PMID: 34223470 PMCID: PMC8241326 DOI: 10.1089/pmr.2020.0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/12/2022] Open
Abstract
Objective: To report our first case series of Dignity Therapy modified for a pediatric palliative care population. Background: Dignity Therapy has been utilized successfully with terminally ill adult patients to help restore a sense of dignity and personhood as well as cope with existential distress near the end of life. To our knowledge, there are no published reports of this treatment modality in pediatric patients. Methods: The authors report the experience of a single-center case series of Dignity Therapy in a pediatric palliative care population. The adult Dignity Therapy process was adapted to fit the pediatric population and their families. Modifications are explained in some detail, and specific cases are shared to illustrate the process. The goal of this case series is to report on the application of Dignity Therapy to the pediatric population. Setting/subjects: Inclusion criteria for the cases series consisted of children and their families who were aware that death may occur soon, were English speaking, admitted to the hospital, and receiving care from the palliative care service. Results: Eight patients or their caregivers have completed Dignity Therapy thus far through our program. Four consented to publication of their experience. Three patients were adolescents and told their own story and the story of one younger nonverbal child was told by her family. All four participants reported that the intervention was acceptable and expressed gratitude for their final generativity document. No patient or family reported distress or negative effects from participation in Dignity Therapy. Conclusions: This case series describes how Dignity Therapy is possible with adaptations in the pediatric population, and how Dignity Therapy by proxy may be possible for caregivers of patients unable to tell their own story.
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Affiliation(s)
- Taryn Schuelke
- Palliative Care, Texas Children's Hospital, Houston, Texas, USA
| | - Jared Rubenstein
- Palliative Care, Texas Children's Hospital, Houston, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
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Blake J, Bayliss A, Callow B, Futter G, Harikrishnan N, Peryer G. Using a storytelling intervention in schools to explore death, dying, and loss. JOURNAL OF PUBLIC MENTAL HEALTH 2020. [DOI: 10.1108/jpmh-04-2020-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Experiencing bereavement in childhood can cause profound changes to developmental trajectories. This paper aims to evaluate the feasibility of implementing a public health intervention in schools to encourage pupils aged 12-15 years to independently explore ideas of death, dying, loss and end of life care in a structured and creative format.
Design/methodology/approach
A co-produced storytelling intervention was implemented in an independent school in Norwich, UK. Pupils wrote up to 1,000 words in response to the title, “I Wish We’d Spoken Earlier”. Their participation was voluntary and extra-curricular. Stakeholder feedback was used in addition to the submissions as a measure of acceptability, appropriateness, adoption and feasibility.
Findings
In total, 24 entries were submitted. Pupils demonstrated their ability to engage thoughtfully and creatively with the subject matter. Feasibility for the storytelling intervention was demonstrated. Importantly, the intervention also prompted family conversations around preferences and wishes for end of life care.
Research limitations/implications
To determine whether the intervention has psychological and social benefits will require further study.
Practical implications
Educational settings can be considered as anchor institutions to support a public health approach to end of life care.
Originality/value
The positive response from all stakeholders in delivering and supporting the intervention indicates that schools are a community asset that could be further empowered to support children and families affected by death, dying and loss.
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Cai S, Guo Q, Luo Y, Zhou Y, Abbas A, Zhou X, Peng X. Spiritual needs and communicating about death in nonreligious theistic families in pediatric palliative care: A qualitative study. Palliat Med 2020; 34:533-540. [PMID: 31971068 DOI: 10.1177/0269216319896747] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spiritual support should be offered to all patients and their families regardless of their affiliated status with an organized religion. AIM To understand nonreligious theistic parents' spirituality and to explore how parents discuss death with their terminally ill children in mainland China. DESIGN Qualitative study. SETTING/PARTICIPANTS This study was conducted in the hematology oncology center at Beijing Children's Hospital. Participants in this study included 16 bereaved parents. RESULTS Participants described themselves as nonreligious but showed a tendency toward a particular religion. Parents sought religious support in the face of the life-threatening conditions that affected their child and regarded the religious belief as an important way to get psychological and spiritual comfort after experiencing the death of their child. Religious support could partially address parents' spiritual needs. Parents' spiritual needs still require other supports such as bereavement services, death education, and family support groups. Some parents stated that it was difficult to find a way to discuss death with their children. For patients who come from nonreligious theistic families, their understanding of death was more complex and may be related to atheism. CONCLUSION Religious support could be an element of spiritual support for nonreligious theistic parents of terminally ill children. Multiple strategies including religious supports and nonreligious supports should be rationally integrated into spiritual support of nonreligious theistic family. Patient's personal belief in death should be assessed before discussing death with them.
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Affiliation(s)
- Siyu Cai
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qiaohong Guo
- School of Nursing, Capital Medical University, Beijing, China
| | - Yanhui Luo
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuchen Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ali Abbas
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuan Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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20
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Mooney-Doyle K, Ulrich CM. Parent moral distress in serious pediatric illness: A dimensional analysis. Nurs Ethics 2020; 27:821-837. [PMID: 32138577 DOI: 10.1177/0969733019878838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Moral distress is an important and well-studied phenomenon among nurses and other healthcare providers, yet the conceptualization of parental moral distress remains unclear. OBJECTIVE The objective of this dimensional analysis was to describe the nature of family moral distress in serious pediatric illness. DESIGN AND METHODS A dimensional analysis of articles retrieved from a librarian-assisted systematic review of Scopus, CINAHL, and PsychInfo was conducted, focusing on how children, parents, other family members, and healthcare providers describe parental moral distress, both explicitly through writings on parental moral experience and implicitly through writings on parental involvement in distressing aspects of the child's serious illness. ETHICAL CONSIDERATIONS To promote child and family best interest and minimize harm, a nuanced understanding of the moral, existential, emotional, and spiritual impact of serious pediatric illness is needed. The cases used in this dimensional analysis come from the first author's IRB approved study at the Children's Hospital of Philadelphia and subsequent published studies; or have been adapted from the literature and the authors' clinical experiences. FINDINGS Three dimensions emerged from the literature surrounding parent moral distress: an intrapersonal dimension, an interpersonal dimension, and a spiritual/existential dimension. The overarching theme is that parents experience relational solace and distress because of the impact of their child's illness on relationships with themselves, their children, family, healthcare providers, their surrounding communities, and society. DISCUSSION Elucidating this concept can help nurses and other professionals understand, mitigate, or eliminate antecedents to parental moral distress. We discuss how this model can facilitate future empirical and conceptual bioethics research, as well as inform the manner in which healthcare providers engage, collaborate with, and care for families during serious pediatric illness. CONCLUSION Parent moral distress is an important and complex phenomenon that requires further theoretical and empirical investigation. We provide an integrated definition and dimensional schematic model that may serve as a starting point for future research and dialogue.
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Snaman J, McCarthy S, Wiener L, Wolfe J. Pediatric Palliative Care in Oncology. J Clin Oncol 2020; 38:954-962. [PMID: 32023163 DOI: 10.1200/jco.18.02331] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pediatric palliative care aims to alleviate suffering and improve the quality of life of children with serious disease and increase support for their parents and other family members. Integration of palliative care into the routine care of children, adolescents, and young adults with cancer has resulted in improved outcomes in patients and their families. The field of pediatric palliative oncology-encompassing primary palliative care provided by the multidisciplinary oncology team as well as subspecialty palliative care provided by the palliative care team for more complex cases-is unique from palliative care in adults given its focus on care of the child and the larger family. In this review, we focus on advancements in the specific domains within pediatric palliative oncology care including family-centered communication, assessment and management of physical symptoms and distress, psychosocial concerns, and spiritual considerations of the patient, parents, and siblings.
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Affiliation(s)
- Jennifer Snaman
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
| | | | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
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Smith LE, Maybach AM, Feldman A, Darling A, Akard TF, Gilmer MJ. Parent and Child Preferences and Styles of Communication About Cancer Diagnoses and Treatment. J Pediatr Oncol Nurs 2019; 36:390-401. [DOI: 10.1177/1043454219859235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Communication challenges frequently occur among families and health care providers of children with life-threatening conditions. These obstacles compound concerns related to children’s diagnoses and treatment, the family’s quality of life, and delivery of care. Developmentally appropriate and validated methods of addressing the communication preferences of families with chronically ill children are limited. This study used six focus groups to determine child and parent preferences and styles of communication centering on new diagnoses and changes in prognosis. Hypothetical situations were used to minimize feelings of self-consciousness among school-aged and adolescent participants. Qualitative analyses (interrater reliability 75%) of child and parent responses revealed 3 categories and 11 subcategories or themes. The category of Characteristics of Communication Exchange included (1) how to tell, (2) who should tell, (3) when to tell, (4) who should be included, and (5) what to tell. The Knowledge and Understanding category included themes of (1) side effects of treatment, (2) what children understand, and (3) questions when being diagnosed. The category of Feelings and Emotions included themes of (1) feelings about changes in prognosis, (2) children’s feelings on being informed, and (3) coping and emotional regulation. Results reveal a need for developmentally appropriate, evidence-based education to inform parents on how, what, and when to communicate information concerning their child’s disease, as well as instructions around facilitating those discussions. Moreover, a need for professional education and training programs for providers is demonstrated by some parental dissatisfaction with bedside manner and disclosure of information. The data collected from this study lay a foundation for future research in communication as a principal factor in quality of life for pediatric patients and their families.
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Affiliation(s)
| | | | - Amanda Feldman
- Vanderbilt University, Nashville, TN, USA
- James Madison University, Nashville, TN, USA
| | - Austin Darling
- Vanderbilt University, Nashville, TN, USA
- Southern Illinois University Edwardsville, Nashville, TN, USA
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Stein A, Dalton L, Rapa E, Bluebond-Langner M, Hanington L, Stein KF, Ziebland S, Rochat T, Harrop E, Kelly B, Bland R. Communication with children and adolescents about the diagnosis of their own life-threatening condition. Lancet 2019; 393:1150-1163. [PMID: 30894271 DOI: 10.1016/s0140-6736(18)33201-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 01/10/2023]
Abstract
When a child is diagnosed with a life-threatening condition, one of the most challenging tasks facing health-care professionals is how to communicate this to the child, and to their parents or caregivers. Evidence-based guidelines are urgently needed for all health-care settings, from tertiary referral centres in high-income countries to resource limited environments in low-income and middle-income countries, where rates of child mortality are high. We place this Review in the context of children's developing understanding of illness and death. We review the effect of communication on children's emotional, behavioural, and social functioning, as well as treatment adherence, disease progression, and wider family relationships. We consider the factors that influence the process of communication and the preferences of children, families, and health-care professionals about how to convey the diagnosis. Critically, the barriers and challenges to effective communication are explored. Finally, we outline principles for communicating with children, parents, and caregivers, generated from a workshop of international experts.
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Affiliation(s)
- Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Louise Dalton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Myra Bluebond-Langner
- The Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lucy Hanington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tamsen Rochat
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Human Sciences Research Council, Johannesburg, South Africa
| | - Emily Harrop
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Helen & Douglas House, Oxford, UK
| | - Brenda Kelly
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Bland
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Institute of Health and Wellbeing, Glasgow, UK; University of Glasgow and Royal Hospital for Children, Glasgow, UK
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Atout M, Hemingway P, Seymour J. The Practice of Mutual Protection in the Care of Children with Palliative Care Needs: A Multiple Qualitative Case Study Approach from Jordan. J Pediatr Nurs 2019; 45:e9-e18. [PMID: 30579650 DOI: 10.1016/j.pedn.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE This study explores the experience of disclosing critical information in the care of children with palliative care needs, from the perspective of physicians, nurses, and mothers in Jordan. DESIGN AND METHODS This study employed a qualitative case study approach. It was conducted in three paediatric units in a Jordanian hospital. Each case comprised a child aged 1-12 years with a condition eligible for palliative care who received health care in one of these units, and their most involved carers (e.g. mother, physician and nurse). Two data collection methods were employed: participant observation and semi-structured interviews with three categories of participants: mothers, physicians, and nurses. Ethical approval was obtained from the hospital ethical review board. Written consent was obtained from all participants. RESULTS Qualitative case studies were developed around 15 children (aged 1-12 years, nine were boys and six were girls, with varying diagnoses: renal disease, neurological conditions, and congenital heart defects). A total of 197 observational hours and 60 interviews were completed (15 mothers, 12 physicians and 21 nurses). The findings demonstrate that the practice of 'mutual protection' dominated communication between children, parents and clinical staff. Parents protected their children by disclosing only partial information about their disease, and by avoiding any information they thought would cause the child distress or loss of hope. Similarly, children avoided expression to their parents of their anxieties or fears, in order to protect them. In turn, nurses attempted to ensure observance of professional boundaries with children and mothers to avoid a sense of loss when a child died. CONCLUSION The findings of the current study indicate that while open and honest communication between parents and children is generally recommended by literature, not all mothers agree with adopting open communication with their children concerning their illnesses. Therefore, any future intervention planned for them should respect parents' autonomy and decisions in addition to their cultural backgrounds. PRACTICAL IMPLICATIONS The provision of ongoing education and specialised training for professionals to provide them with culturally sensitive skills in communication and provision of emotional support for children and parents is needed to improve clinical practice in healthcare settings with limited access to specialist palliative care such as Jordan.
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Affiliation(s)
- Maha Atout
- Nursing School, Philadelphia University, Amman, Jordan.
| | - Pippa Hemingway
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jane Seymour
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
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Carreño-Moreno S, Chaparro-Díaz L, Carrillo GM, Gómez-Ramírez OJ. Duelo en el cuidador del niño fallecido por cáncer: revisión exploratoria. DUAZARY 2019. [DOI: 10.21676/2389783x.2755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
El objetivo de esta revisión fue sintetizar el abordaje metodológico de estudio e integrar los hallazgos del proceso de duelo en cuidadores de niños fallecidos por cáncer. Se realizó una revisión exploratoria de literatura de 19 estudios publicados en revistas indexadas entre el 2010 y 2017. Los hallazgos fueron tratados con técnicas de codificación abierta inductiva. Los resultados evidenciaron un abordaje mayormente cualitativo, con participación de padre y madre, con un año entre la muerte del niño y el ingreso al estudio. Los resultados de los estudios revelaron que debido a que el duelo se vive como respuesta a la ruptura física del vínculo con el niño, es a través del trabajo sobre vínculos que el duelo puede superarse. Los vínculos clave son los que se tienen con el niño fallecido, con los hijos vivos, con el cónyuge, con la familia y el equipo de salud. Por lo que se requiere acompañamiento continuo y compasivo al cuidador desde el momento del diagnóstico del niño con cáncer, que permita construir vínculos asertivos. Posterior a la muerte del niño, es necesario mantener la continuidad del cuidado y propender por que el cuidador participe en grupos de apoyo.
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Parents’ Experience of Caring Children with Cancer: A Qualitative Study with Phenomenological Approach. ACTA ACUST UNITED AC 2018. [DOI: 10.5812/compreped.65545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Farber JG, Prieur MG, Roach C, Shay R, Walter M, Borowitz D, Dellon EP. Difficult conversations: Discussing prognosis with children with cystic fibrosis. Pediatr Pulmonol 2018; 53. [PMID: 29528566 PMCID: PMC5904004 DOI: 10.1002/ppul.23975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Background Despite the chronic, progressive, and life-threatening nature of cystic fibrosis (CF), there are no guidelines for when and how to communicate prognosis to children with CF. METHODS Semi-structured interviews with young adults with CF, parents of young adults with CF, and multidisciplinary CF health care providers assessed recall of and practices for communicating about prognosis. Recommendations for improvements were also solicited. RESULTS Young adults with CF recalled learning that life expectancy is limited by CF between the ages of 8 and 16 years, and that CF is a progressive disease between the ages of 7 and 19 years. They reported that the information often came from CF physicians or from online resources. Patients and parents reported earlier knowledge of prognosis than providers assumed. While learning about prognosis caused sadness and stress for some patients and families, others denied negative feelings. Interestingly, most patients reported that disclosure of prognosis had minimal impact on their adherence and treatment goals. Patients and parents reported wanting physicians to be involved in conversations about prognosis. However, providers noted several barriers to discussing prognosis, including their own reluctance, time limitations, and uncertainty about appropriate timing and content of communication. CONCLUSIONS Communication about prognosis is important but also difficult for providers, patients, and families. Appropriately timed conversations, using tools to facilitate communication, could ensure patients receive timely, accurate information.
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Affiliation(s)
- Julia Gray Farber
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mary G Prieur
- Departments of Psychiatry and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Christine Roach
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo of State University of New York, Buffalo, New York
| | - Rosemary Shay
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michelle Walter
- Department of Geriatrics and Palliative Medicine, Jacobs School of Medicine, University at Buffalo of State University of New York, Buffalo, New York
| | - Drucy Borowitz
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo of State University of New York, Buffalo, New York.,Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Elisabeth P Dellon
- Division of Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Blazin LJ, Cecchini C, Habashy C, Kaye EC, Baker JN. Communicating Effectively in Pediatric Cancer Care: Translating Evidence into Practice. CHILDREN-BASEL 2018. [PMID: 29534479 PMCID: PMC5867499 DOI: 10.3390/children5030040] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers. This review aims to identify key communication skills that healthcare providers can employ throughout the illness journey to provide information, encourage shared decision-making, promote therapeutic alliance, and empathically address end-of-life concerns. By reviewing the relevant evidence and providing practical tips for skill development, we strive to help healthcare providers understand the value of effective communication and master these critical skills.
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Affiliation(s)
- Lindsay J. Blazin
- Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (L.J.B.); (E.C.K.)
| | - Cherilyn Cecchini
- Department of Pediatrics, Children’s National Medical Center, Washington, DC 20010, USA; (C.C); (C.H.)
| | - Catherine Habashy
- Department of Pediatrics, Children’s National Medical Center, Washington, DC 20010, USA; (C.C); (C.H.)
| | - Erica C. Kaye
- Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (L.J.B.); (E.C.K.)
| | - Justin N. Baker
- Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (L.J.B.); (E.C.K.)
- Correspondence: ; Tel.: +1-901-595-4446
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No child is an island: ethical considerations in end-of-life care for children and their families. Curr Opin Support Palliat Care 2018; 10:196-200. [PMID: 27359076 DOI: 10.1097/spc.0000000000000226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Ethical challenges are commonly encountered when caring for children with life-threatening conditions. RECENT FINDINGS Controversial end-of-life issues, such as physician-assisted death and medical futility, may also arise in children. The approach to these issues in children may be guided by the 'adult' medical literature; the age of the patient should not be a relevant factor in determining the morality of these acts. As such, the focus of this review is on ethical issues unique to children and adolescents by nature of their dependence on their parents. Appreciation that child well-being is best promoted when care aligns with parental beliefs, values and culture has given rise to the practice of family-centred care, which we prefer to call 'family-partnered' care. Occasionally, a family-partnered approach may challenge fundamental paediatric ethical principles, including best interests, developing autonomy, and the importance of honesty and truth-telling. SUMMARY This article explores the challenges that may arise when there is disagreement between the child, the parents, and the healthcare providers about care at the end-of-life and provides suggestions to clinicians about how to help resolve these conflicts.
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Cicero-Oneto CE, Valdez-Martinez E, Bedolla M. Decision-making on therapeutic futility in Mexican adolescents with cancer: a qualitative study. BMC Med Ethics 2017; 18:74. [PMID: 29228962 PMCID: PMC5724238 DOI: 10.1186/s12910-017-0231-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 11/27/2017] [Indexed: 11/24/2022] Open
Abstract
Background The world literature shows that empirical research regarding the process of decision-making when cancer in adolescents is no longer curable has been conducted in High-income, English speaking countries. The objective of the current study was to explore in-depth and to explain the decision-making process from the perspective of Mexican oncologists, parents, and affected adolescents and to identify the ethical principles that guide such decision-making. Methods Purposive, qualitative design based on individual, fact-to-face, semi-structured, in-depth interviews. The participants were thirteen paediatric oncologists, 13 parents or primary carers, and six adolescents with incurable cancer. The participants were recruited from the paediatric oncology services of three national tertiary-care medical centres in Mexico City. Results The oncologists stated that they broach the subject of palliative management when they have determined that curative treatment has failed. Respect for autonomy was understood as the assent of the parent/adolescent to what the oncologist determined to be in the best interest of the adolescent. The oncologists thought that the adolescent should be involved in the decision-making. They also identified the ability to count on a palliative care clinic or service as an urgent need. For the parents, it was essential that the oncologist be truly interested in their adolescent child. The parents did not consider it necessary to inform the child about impending death. The adolescents stated that the honesty of their oncologists was important; however, several of them opted for a passive role in the decision-making process. Conclusion The findings of this study evidence that to achieve good medical practice in low-middle income countries, like Mexico, it is urgent to begin effective implementation of palliative care, together with appropriate training and continuing education in the ethics of clinical practice. Electronic supplementary material The online version of this article (10.1186/s12910-017-0231-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlo Egysto Cicero-Oneto
- Haemato-Oncology Department Hospital Infantil de Mexico "Federico Gómez", National Health Institute of the Secretariat of Health, Mexico City, Mexico
| | - Edith Valdez-Martinez
- Health Research Council of the Mexican Institute of Social Security, Centro Medico Nacional Siglo XXI, Av. Cuauhtemoc #330. Col. Doctores, C.P. 06720 Ciudad de Mexico, Mexico City, Mexico.
| | - Miguel Bedolla
- Policy Studies Centre of the College of Public Policy, University of Texas in San Antonio, San Antonio Texas, USA
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Palliative care in children with cancer: implications for general practice. Br J Gen Pract 2017; 66:599-600. [PMID: 27884889 DOI: 10.3399/bjgp16x688009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Arruda-Colli MNF, Weaver MS, Wiener L. Communication About Dying, Death, and Bereavement: A Systematic Review of Children's Literature. J Palliat Med 2017; 20:548-559. [PMID: 28346862 PMCID: PMC5704745 DOI: 10.1089/jpm.2016.0494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Children's books have the potential to facilitate communication about death for children living with a serious illness and for children coping with the death of a loved one. OBJECTIVES This study examines the content of children's literature relevant to the topic of dying and death and identifies books providers can share with children and their families. DESIGN A search of children's literature was conducted using four electronic databases and one additional search engine using the word "Death" or "Dying." Storybooks about dying, death, and bereavement published in English, French, or Spanish between 1995 and 2015 were included. MEASUREMENTS Each book underwent content analysis by at least two independent reviewers. Strict PRISMA standard was followed. Full protocol is available as PROSPERO #CRD42016042129. RESULTS Two hundred ten books met inclusion criteria. The dying subject was primarily a grandparent (n = 78) or pet (n = 44). Books on the experience of a child dying were scarce (n = 5). The word death or dying was used in 75% of the books (n = 158), while others utilized euphemisms. The majority of books featured animals (n = 40) or Caucasian subjects (n = 122) and included spiritual elements such as heaven (n = 122). Less than one-quarter of the books included tools for readers to address the topic of death. CONCLUSIONS Storybooks can be a helpful tool to introduce communication about dying and death with children. Gaps exist in current children's literature to effectively enable children to reflect on their own dying process. A general summary of available books is provided to assist those caring for children and families facing end-of-life issues.
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Affiliation(s)
- Marina N. F. Arruda-Colli
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Meaghann S. Weaver
- Pain and Palliative Care Division, National Institutes of Health, Bethesda, Maryland
| | - Lori Wiener
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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De Clercq E, Elger B, Wangmo T. Missing life stories. The narratives of palliative patients, parents and physicians in paediatric oncology. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12651] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Affiliation(s)
- E. De Clercq
- Institute for Biomedical Ethics; University of Basel; Basel Switzerland
| | - B.S. Elger
- Institute for Biomedical Ethics; University of Basel; Basel Switzerland
| | - T. Wangmo
- Institute for Biomedical Ethics; University of Basel; Basel Switzerland
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Penser, annoncer et vivre la mort d’un enfant atteint de cancer. PSYCHO-ONCOLOGIE 2016. [DOI: 10.1007/s11839-016-0562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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