An Analytic Review of Clinical Implications From Nursing and Psychosocial Research Within Swedish Pediatric Oncology

Everyday life during the childhood cancer trajectory-childhood cancer survivors' descriptions of the role of caring support

Background

Being diagnosed with cancer in childhood often has a direct impact on the child's opportunities to participate in activities and the child's sense of belonging in different life situations. Experiences of illness in youth affect the lives of these individuals in numerous ways and they need pronounced support to regain their normal life after treatment.

Purpose

To illustrate how childhood cancer survivors describe the role of the caring support provided by healthcare professionals at diagnosis and during the cancer trajectory.

Methods

A mixed methods approach was applied. Swanson's Theory of Caring was used to deductively analyze the answers in a study-specific questionnaire with Likert scales (1-5). Descriptive and comparative statistics and exploratory factor analyses were performed.

Results

Sixty-two former patients, diagnosed with solid tumors/lymphoma in 1983 to 2003 in Sweden, participated. The mean time passed since treatment was 15.7 years. Swanson's caring processes Being with and Doing for were the most prominent loading categorical factor indicators. Higher scores for healthcare professionals being emotionally present (Being with), doing for others what they would do for themselves (Doing for) and being willing to understand the sick child's situation (Knowing) were highlighted by survivors older than 30 years, compared to those younger than 30 years (p = 0.041, p = 0.045, and p = 0.013, respectively). An increased vulnerability regarding their ability to cope with difficulties (Maintain belief) was found among participants who were treated during adolescence, related to schoolchildren (p = 0.048), and among those who had been treated with extra-cranial irradiation in comparison with no extra-cranial irradiation (p = 0.004). The role of having a partner in comparison with being single was underlined among those who felt they had acquired the tools they needed to take care of themselves (Enabling) (p = 0.013). The total explained variance was 63%.

Conclusions

A person-centered care approach during treatment for childhood cancer, reflected by a caring model, highlights the role of healthcare professionals being emotionally present, involving children, performing actions, and with an approach that has potential long-term implications. Childhood cancer patients and survivors need not only clinically competent professionals, but professionals who provide caring interactions with compassion.

Addressing the psychosocial needs of patients: Challenges for nursing students

PURPOSE

To evaluate the ability of nursing students to determine the psychosocial needs of patients and identify the needs and problems encountered by nursing students.

DESIGN AND METHODS

This study is a mixed method research. The nursing care plans of 40 nursing students that provided care to 129 patients with chronic medical diseases were examined retrospectively. Individual interviews were also conducted with five nursing students and six academicians.

FINDINGS

It was determined that nursing students defined an average of 15.77 ± 11.55 physiological and an average of 3.05 ± 2.28 psychosocial nursing diagnoses for 129 patients. Data analysis of individual interviews revealed two main themes: (1) identifying psychosocial diagnoses: teaching difficulties and (2) identifying psychosocial diagnoses: learning difficulties.

PRACTICE IMPLICATIONS

This can facilitate the learning process of each student to include physiological and a psychosocial care focus in their nursing care through discussions and evaluation with their mentors and instructors.

Difficulties faced by long-term childhood cancer survivors: A qualitative study

PURPOSE

Due to improved survival rates of childhood cancer, there has been growing attention to survivors. In addition, experiences of illness in youth, during growth and development, affect the lives of these individuals in numerous ways. With a sample of long-term survivors of childhood cancer, this study investigated their difficult experiences after treatment completion and provided fundamental data for intervention programs that can assist growth.

METHODS

Data from 15 survivors aged 15-28 years old were collected through face-to-face interviews; analysis used Giorgi's phenomenological method.

RESULTS

The long-term survivors' lives involved a process of struggle to overcome the difficulties. Survivors had physical vestiges of cancer treatments, such as physical strength limitations, appearance changes, and sexual problems. Additionally, they experienced social withdrawal and awkwardness due to adaptation difficulties caused by social life interruption, family issues, social prejudice, and discrimination. These physical and social struggles led to experiences of mental stress and psychological withdrawal, but were followed by rebound.

CONCLUSIONS

Long-term survivors of childhood cancer experienced physical, social, and emotional struggles following treatment completion. These results can yield improved understanding of this population, facilitate attention to their challenges, and contribute to their more effective integration into society, helping them live healthy and positive lives.

Family Health Conversations at a Pediatric Oncology Center - A Way for Families to Rebalance the Situation

PURPOSE

The study aimed to describe and understand adult family members' experiences of participating in a Family Health Conversation (FamHC) when a child is diagnosed with cancer.

DESIGN AND METHODS

Twelve individual interviews were performed with adult family members who had participated in a FamHC. During the interviews each interviewee was a spokesman for his or her respective family. Thereby the family was included as a system. The interviews were analyzed using a hermeneutic approach.

RESULTS

The analysis resulted in four themes: "To unburden the burden," "Seeing things in a new light," "To be seen the way you are," and "Talking to someone who is both within and alongside." Finally an overarching theme evolved, "To rebalance the situation" revealing the meaning of taking part in the FamHC.

CONCLUSION

All participants considered the FamHC to be valuable. It was surprising that such a relatively small investment of two family conversations and a closing letter could have such significance for the families in their difficult situation.

PRACTICE IMPLICATIONS

With training, clinical nurses can use a well-established structured interview process such as the Family Health Conversation to help family members to gain insight into each other's experiences, which increase their ability to cope and regain control.

Following Young Children’s Health and Functioning in Everyday Life Through Their Cancer Trajectory

Background: Knowledge of living with childhood cancer, through the trajectory, is sparse. Aim: The aim of this study was to follow young children’s health and functioning in everyday life through their cancer trajectory. Methods: Data were gathered longitudinally from a group of 13 young children and their parents connected to a pediatric oncology unit in Sweden. The International Classification of Functioning, Disability and Health for Children and Youth structure was used to identify difficulties in health and functioning in everyday life, in interview and questionnaire data. Descriptive statistical analysis was performed to show patterns of difficulty over a 3-year period from diagnosis. Results: Difficulties experienced by children declined and changed over time. An increase in difficulties with personal interactions with others and access to and support from health care professionals was seen 2 to 3 years after diagnosis and start of treatment. Similar patterns are seen within individual children’s trajectories in relation to diagnosis but individual patterns were seen for each child. Conclusions and Clinical Implications: Health care professionals need to plan for ongoing contact with school services and information and support pathways, beyond the treatment period. A person-centered philosophy of care is required throughout the cancer trajectory.