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Gressel O, Ofir R, Ash S, Ben-Arush M, Samuels N, Ben-Arye E. An Integrative Pediatric Oncology Program Addressing Parents' Quality of Life-Related Concerns. J Pain Symptom Manage 2024:S0885-3924(24)00992-8. [PMID: 39218124 DOI: 10.1016/j.jpainsymman.2024.08.035] [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: 06/11/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Parents of children with cancer face bio-psycho-social-spiritual concerns which can significantly reduce quality of life (QoL). We examined the impact of an integrative oncology (IO) intervention on QoL-related concerns among parents of children in a pediatric hematology-oncology department. MEASURES The study was prospective, controlled, nonrandomized and patient-preferenced. Parents of children recently (≤6 weeks) diagnosed with cancer were assessed using the measure yourself concerns and wellbeing (MYCaW), Edmonton Symptom Assessment Scale (ESAS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Parents in both groups were reassessed after three weeks. INTERVENTION An IO consultation was provided, with training in daily relaxation-breathing and manual treatments, and guidance on herbal medicine. OUTCOMES Of 68 parents consenting to participate, 37 (54%) underwent the intervention with 31 serving as controls. Multivariate analysis found the IO intervention group to contain more Hebrew-speakers (OR=5.96, 95% CI=1.3-27.3, P=0.022); females (OR=5.23, 95% CI=1.1-24.8, P=0.038); and report pain (OR=1.2, 95% CI=1.0-1.4, P=0.045) and impaired appetite on ESAS (OR=1.23, 95% CI=1.01-1.48, P=0.034) when compared to controls. Only the intervention group showed improved baseline-to-3-week scores for physical functioning (P<0.001), cognitive functioning (0=0.018) and fatigue on EORTC (P<0.001); and for ESAS appetite (P<0.001) and anxiety (P=0.02). ESAS sleep increased only in controls (P=0.029). CONCLUSIONS/LESSONS LEARNED IO interventions in pediatric hematology-oncology addressing QoL-related concerns among parents are feasible, potentially increasing predominantly physical symptoms and functioning. Further research is needed to confirm these "real-world" clinical outcomes, and the role of IO in "Caring for the Caregiver".
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Affiliation(s)
- Orit Gressel
- Rappaport Faculty of Medicine (O.G., S.A., M.B.A., E.B.A.), Technion-Israel Institute of Technology, Haifa, Israel; Division of Pediatric Hematology Oncology and Bone Marrow Transplantation (O.G., S.A., M.B.A.), Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel; Integrative Oncology Program (O.G., E.B.A.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Ruth Ofir
- Division of Pediatric Hematology Oncology and Bone Marrow Transplantation (O.G., S.A., M.B.A.), Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Shifra Ash
- Rappaport Faculty of Medicine (O.G., S.A., M.B.A., E.B.A.), Technion-Israel Institute of Technology, Haifa, Israel; Division of Pediatric Hematology Oncology and Bone Marrow Transplantation (O.G., S.A., M.B.A.), Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Myriam Ben-Arush
- Rappaport Faculty of Medicine (O.G., S.A., M.B.A., E.B.A.), Technion-Israel Institute of Technology, Haifa, Israel; Division of Pediatric Hematology Oncology and Bone Marrow Transplantation (O.G., S.A., M.B.A.), Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Noah Samuels
- Center for Integrative Complementary Medicine (N.S.), Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Haifa, Israel
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine (O.G., S.A., M.B.A., E.B.A.), Technion-Israel Institute of Technology, Haifa, Israel; Integrative Oncology Program (O.G., E.B.A.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.
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Van Orne JA, Clutter P, Fredland N, Schultz R. Caring for the child with a tracheostomy through the eyes of their caregiver: A photovoice study. J Pediatr Nurs 2024; 79:59-68. [PMID: 39213803 DOI: 10.1016/j.pedn.2024.08.024] [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: 06/26/2024] [Revised: 08/14/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This qualitative descriptive study aimed to explore the daily experiences of caregivers of children with medical complexity with a tracheostomy at home. METHODS This study used photovoice, a participatory action research methodology. Adult English-speaking caregivers of children with a tracheostomy, living in Texas, with access to a smartphone were recruited. Photographs taken by participants and an interview guide were used to guide semi-structured interviews with caregivers. RESULTS Eight participants were recruited. After analyzing photographs and caregiver interviews, four main themes were identified: role transition, daily challenges, finding support, and thriving in the new normal. CONCLUSIONS Caregivers take on multiple roles, including providing medical care, advocating for their children, and educating others. While facing emotional challenges such as guilt, fear, and exhaustion, caregivers rely on external support systems, emphasizing the need for nurses and healthcare providers to provide comprehensive support and improve the accessibility of home nursing services. PRACTICE IMPLICATIONS The findings of this study can inform nurse-led interventions and advocacy efforts aimed at supporting marginalized children with medical complexity with a tracheostomy and their families. These efforts may include enhancing communication and collaboration between families, healthcare workers, and the public, providing comprehensive, proactive support for caregivers, and improving access to home nursing services.
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Affiliation(s)
- Julie A Van Orne
- Director of Nursing Research and Innovation, Cook Children's Medical Center, 801 7(th) Avenue, Fort Worth, TX 76104, USA.
| | - Paula Clutter
- Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA.
| | - Nina Fredland
- Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA.
| | - Rebecca Schultz
- Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA.
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Broden EG, Boyden JY, Keller S, James R, Mooney-Doyle K. Who, What, Where, and How? The State of Family Science in Pediatric Palliative Care. J Pain Symptom Manage 2024:S0885-3924(24)00844-3. [PMID: 38992396 DOI: 10.1016/j.jpainsymman.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
CONTEXT Families are vital providers and recipients of pediatric palliative care (PPC) services. Understanding the scope and nature of evidence at the intersection of family science and PPC research is necessary to develop family-focused interventions that enhance child and family health. OBJECTIVES Explore and describe the family-level impact of pediatric serious illness. METHODS We conducted a librarian-assisted scoping review using Arskey and O'Malley's approach. We searched PubMed, Scopus, CINAHL, and EMBASE databases for empirical publications from 2016 to 2021 that focused on families navigating serious pediatric illness published in English. Two reviewers assessed eligibility, with discrepancies resolved by a third. We used Covidence and REDCap for data management and extraction. RESULTS We screened 10,983 abstracts; 309 abstracts were included in full text screening. The final group of 52 citations was analyzed by the entire team. Most research was conducted in Western Europe and North America. The perspectives of parents of children with cancer were most frequently described; voices of seriously ill youth and their siblings were less often presented. Most of the research was descriptive qualitative, followed by descriptive quantitative. Few studies were mixed methods, inferential, or interpretive. Studies most often described parent, youth, and family experience with illness and less often explored family processes and relationships. Irrespective of the approach (i.e., qualitative, quantitative), few studies focused on families as the analytic unit or used family-level analysis techniques. Study participants were usually from local dominant populations and less often from historically marginalized communities. CONCLUSION The robust, descriptive, and individual-level evidence describing family impact of serious pediatric illness provides a solid foundation for future research priorities. Stronger integration of family techniques and diverse family voices in pediatric palliative care research can clarify family processes, illuminate structural barriers, and inform interventions that are responsive to family needs. These steps will enhance the education, policy, and clinical provision of PPC to all who would benefit, thereby advancing health equity for children living with serious illness and their families.
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Affiliation(s)
- Elizabeth G Broden
- Yale National Clinician Scholars Program (E.G.B.), Yale University, New Haven, CT; School of Public Health (E.G.B.), Yale University, New Haven, CT.
| | - Jackelyn Y Boyden
- Department of Family and Community Health (J.Y.B.), School of Nursing, University of Pennsylvania, Philadelphia, PA; Division of General Pediatrics (J.Y.B.), Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan Keller
- Research Library (S.K.M.), Children's National Hospital, Washington, DC
| | - Richard James
- Nemours Children's Health (R.J.M.), Wilmington, DE; Fontan Outcomes Network
| | - Kim Mooney-Doyle
- Department of Family and Community Health (K.M-D.), School of Nursing, University of Maryland, Baltimore, MD
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Harlow AB, Ledbetter L, Brandon DH. Parental presence, participation, and engagement in paediatric hospital care: A conceptual delineation. J Adv Nurs 2024; 80:2758-2771. [PMID: 38037504 DOI: 10.1111/jan.15996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
AIM To delineate between the concepts of parental presence, participation, and engagement in paediatric hospital care. DESIGN The concepts' uses in the literature were analysed to determine attributes, influences, and relationships. METHODS Delineations of each concept are established and conceptual definitions are proposed following Morses' methods. DATA SOURCES MEDLINE (PubMed); CINAHL, PsycINFO, Sociology Source Ultimate (EBSCOhost); Embase, Scopus (Elsevier); Google Scholar. Search dates October 2021, February 2023. RESULTS Multinational publications dated 1991-2023 revealed these concepts represent a range of parental behaviours, beliefs, and actions, which are not always perceptible to nurses, but which are important in family-integrated care delivery. Parental presence is the state of a parent being physically and/or emotionally with their child. Parental participation reflects parents' performing caregiving activities with or without nurses. Parental engagement is a parents' state of emotional involvement in their child's health and the ways they act on their child's behalf. CONCLUSION These concepts' manifestations are important to parental role attainment but may be inadequately understood and considered by healthcare providers. IMPLICATIONS Nurses have influence over parents' parental presence, participation, and engagement in their child's care but need support from healthcare institutions to ensure equitable family-integrated care delivery. IMPACT Problem: Lack of clear definition among these concepts results in incomplete and at times inequitable family-integrated care delivery. FINDINGS Parental presence is an antecedent to parental participation, and parental presence and participation are elements of parental engagement. The concepts interact to influence one another. IMPACT Hospitalized children, their families, nurses, and researchers will benefit through a better understanding of the concepts' attributes, interactions, and implications for enhanced family-integrated care delivery.
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Affiliation(s)
| | - Leila Ledbetter
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Debra H Brandon
- Duke University School of Nursing, Durham, North Carolina, USA
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Widyaratne A, Bally JMG. Utilization of the Keeping Hope Possible Toolkit with parents of children with life limiting and life threatening illnesses during the COVID-19 pandemic: Exploring pediatric nurses and allied healthcare provider opinions. J Pediatr Nurs 2024; 77:e177-e186. [PMID: 38627171 DOI: 10.1016/j.pedn.2024.04.008] [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: 02/02/2023] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND For families with children diagnosed with complex illnesses, the COVID-19 pandemic added many challenges. In order to mitigate inevitable disruptions in pediatric care settings, caregivers may need added supports and resources. The Keeping Hope Possible (KHP) Toolkit is a self-administered intervention intended to enhance caregiving experiences of parents with a child with multiple needs. However, little is known about effectively disseminating the Toolkit. PURPOSE AND METHODS A qualitative, thematic analysis was conducted to explore the opinions and perceptions of pediatric nurses and allied healthcare providers (HCPs) in relation to the dissemination and use of the KHP Toolkit for use by families with complex medical needs. Structured interview data were analyzed from a sample of seven pediatric HCPs working in various care settings in one Canadian province. FINDINGS Five themes were developed including: Recognising Importance of the KHP Toolkit; Needing Support and Direction; Implementation and Use of the KHP Toolkit; Realizing Important Considerations for Success; and, Emphasizing Connection through Isolated Times. DISCUSSION Participants recognized the importance of the KHP Toolkit for parents and extended family in a variety of settings to encourage self-care, daily structure, and connectedness. Thus, pediatric nurses' awareness and openness to the initial dissemination of the Toolkit is essential, and a subsequent interprofessional team approach will ensure consistent reminders and support for families. APPLICATION TO PRACTICE Careful assessment of family readiness for learning about and using the KHP Toolkit is essential, along with an interprofessional approach to consistent inquiry and support at each family encounter.
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Affiliation(s)
- Amaya Widyaratne
- College of Arts & Science, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK S7N 5A5, Canada.
| | - Jill M G Bally
- College of Nursing, University of Saskatchewan, 104 Clinic Drive, Saskatoon, SK S7N 2Z4, Canada
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Woodgate RL, Gonzalez M, Ripat JD, Edwards M, Rempel G. Exploring fathers' experiences of caring for a child with complex care needs through ethnography and arts-based methodologies. BMC Pediatr 2024; 24:93. [PMID: 38308237 PMCID: PMC10835869 DOI: 10.1186/s12887-024-04567-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Although the number of children living with complex care needs (CCN) is increasing worldwide, there is limited data on the experience of fathers caring for children with CCN. This paper reports on findings specific to fathers' experiences of caring for their child with CCN and highlights recommendations provided for parents of children with CCN, service providers, and policymakers. The findings emerged from a larger study designed to examine how Canadian families of children with CCN participate in society. METHODS We used the qualitative research approach of ethnography and arts-based methodologies (ecomaps and photovoice) as well as purposive and snowball sampling techniques. Four parents were engaged as advisors and twenty-nine fathers participated in interviews (all were married or in a relationship; age range of 28 to 55 years). In line with an ethnographic approach, data analysis involved several iterative steps including comparing data from the first, second, and third set of interviews and refining themes. RESULTS One overarching theme, striving to be there for the child with CCN, was identified. Five supporting themes further exemplified how fathers strived to be there for their child: 1) contributing to the parental team through various roles; 2) building accessibility through adaptation; 3) engaging in activities with the child; 4) expressing admiration and pride in their children; and 5) meaning making. Recommendations for parents included making and nurturing connections and asking for help while recommendations for healthcare and social service providers included communicating authentically with families and listening to parents. Fathers also indicated that leadership and funding for programs of families of children with CCN should be priorities for policymakers. CONCLUSIONS In addition to documenting fathers' active involvement in their child's care and development, our findings provide new insights into how fathers make participation in everyday life accessible and inclusive for their children. Study findings also point to 1) priority areas for policymakers (e.g., accessible physical environments); 2) factors that are critical for fostering collaborative care teams with fathers; and 3) the need for complex care teams in the adult health care system. Implications for those providing psychosocial support for these families are noted as well as knowledge gaps worthy of future exploration such as the role of diversity or intersectionality in fathering children with CCN.
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Affiliation(s)
- Roberta L Woodgate
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada.
| | - Miriam Gonzalez
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Jacquie D Ripat
- College of Rehabilitation Sciences, Department of Occupational Therapy, Rady Faculty of Health Sciences, University of Manitoba, R215-771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada
| | - Marie Edwards
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Gina Rempel
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, CE-208 Children's Hospital, Health Sciences Centre, Max Rady College of Medicine, University of Manitoba, 840 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
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Hirt E, Wright A, Kehring A, Wang Y, Toraño V, Boles J. "Fitting the Pieces Together": The Experiences of Caregivers of Children With Medical Complexity. Hosp Pediatr 2023; 13:1056-1066. [PMID: 37916264 DOI: 10.1542/hpeds.2022-007112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Families of children with medical complexity manage a multitude of care responsibilities that must be carefully coordinated alongside typical family roles and activities. Currently, little is known about this experience from the perspectives of caregivers; therefore, the purpose of this study was to explore the experience of caregiving for a child with medical complexity while identifying unmet medical and psychosocial needs. METHODS Nineteen caregivers were recruited from the pediatric complex care clinic at an academic medical center in the United States. Each participant completed an in-depth, narrative interview that was audio-recorded and transcribed; transcripts were analyzed using an inductive coding approach. RESULTS Participants described their caregiving experiences along 4 themes: (1) the many responsibilities of caregiving, (2) insufficient respite care and skilled support, (3) financial limitations and costs of care, and (4) challenges with mental health and wellbeing. Participants identified unmet needs in 6 dimensions: (1) transition stress, (2) communication across teams, (3) learning to be an advocate, (4) purposefully inclusive environments, (5) finding connections and community, and (6) the challenges of coronavirus disease 2019. CONCLUSIONS Caregivers of children with medical complexity identify a host of experiences and unmet needs that challenge the physical, emotional, and psychosocial wellbeing of themselves and their families. With more attention to the holistic experience of caregiving for this population, providers and teams can better anticipate needs and provide services and programs that enhance caregiver and family wellbeing simultaneously.
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Affiliation(s)
- Elise Hirt
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Alyssa Wright
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Allysa Kehring
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yinuo Wang
- Vanderbilt University, Nashville, Tennessee
| | | | - Jessika Boles
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University, Nashville, Tennessee
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Nogueira AJ, Ribeiro MT. A psychological experience assessment protocol of parent caregivers in paediatric palliative care. Ann Med 2023; 55:2268093. [PMID: 38010855 PMCID: PMC10836293 DOI: 10.1080/07853890.2023.2268093] [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: 07/19/2023] [Accepted: 10/02/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Paediatric Palliative Care (PPC) has undergone rapid growth in Portugal, where there are over 7800 children with life-limiting conditions. This is a complex experience for families due to the ongoing threat and vulnerability caused by the emergence of an illness, and therefore several studies have tended to focus on the adaptation of parent caregivers. The aim of the present study is to present a psychological experience assessment protocol of parents in PPC. Methods: It consists of a socio-demographic and clinical questionnaire and a semi-structured interview based on an incomplete narrative deriving from the Unwanted Guest Metaphor. Results: On the basis of the latter, 10 dimensions of the experience in the parental subsystem were explored through parents' own perspective, namely: confrontation with the diagnosis; representation of the illness; emotional impact; day-to-day challenges; family impact; resources and social support; coping strategies; posttraumatic growth; representation of the sick child; and future perspectives. Discussion: The protocol can be used in person or remotely and its application enables the identification of specific needs and the establishment of psychotherapeutic goals and strategies for each family, thus enhancing their well-being and resilience, from an eco-systemic perspective. Conclusions: The protocol is presented in detail and its importance in the context of research and systemic intervention in PPC is discussed.
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Affiliation(s)
- Alexandra Jóni Nogueira
- CICPSI, Faculty of Psychology, University of Lisbon, Alameda da Universidade, Lisboa, Portugal
| | - Maria Teresa Ribeiro
- CICPSI, Faculty of Psychology, University of Lisbon, Alameda da Universidade, Lisboa, Portugal
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Bense JE, Stiggelbout AM, Lankester AC, de Pagter APJ. Long-term parental distress after pediatric hematopoietic stem cell transplantation for nonmalignant diseases. Pediatr Blood Cancer 2023; 70:e30638. [PMID: 37638835 DOI: 10.1002/pbc.30638] [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: 03/15/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Survival rates have continued to increase for pediatric hematopoietic stem cell transplantation (HSCT) for nonmalignant diseases. Despite the crucial role of caregivers in this high-intensity treatment, knowledge about long-term parental impact is lacking. PROCEDURE This cross-sectional study assessed parental distress and everyday problems in parents of patients 2 years and older after pediatric HSCT for a nonmalignant disease using Distress Thermometer for Parents (DT-P), and compared outcomes to matched Dutch parents of healthy children and Dutch parents of children with a chronic condition (CC). RESULTS Median follow-up was 5.3 years (interquartile range [IQR]: 2.9-8.6). Underlying diseases were inborn errors of immunity (N = 30), hemoglobinopathies (N = 13), and bone marrow failure (N = 27). Mothers of pediatric HSCT recipients (N = 70) reported comparable overall distress levels to mothers of healthy children, but experienced more distress related to parenting problems, specifically managing their child's emotions, discussing disease consequences, and fostering independence. Fathers of HSCT recipients (N = 45) reported higher overall distress levels and had more emotional distress compared to fathers of healthy children. CONCLUSIONS Overall, parental distress and everyday problems of parents of HSCT recipients are comparable to those of parents of children with CC. However, there is ongoing parental burden, both emotional and in parenting, long-term after HSCT compared to parents of healthy children, and the type of burden differs between mothers and fathers. These results indicate that individualized parental supportive care should not remain restricted to the acute hospitalization phase, but also be actively offered during long-term follow-up after pediatric HSCT.
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Affiliation(s)
- Joëll E Bense
- Department of Pediatrics, Division of Stem Cell Transplantation, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Leiden, The Netherlands
| | - Arjan C Lankester
- Department of Pediatrics, Division of Stem Cell Transplantation, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne P J de Pagter
- Department of Pediatrics, Division of Stem Cell Transplantation, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
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Smith NDW, Boone DM, Schimmel-Bristow A, Rawlins J, Ellingham L, Sobalvarro S, Faith MA. The mediating role of caregiver hope in relations among caregivers' coping and emotional socialization beliefs in pediatric oncology. J Psychosoc Oncol 2023; 42:271-285. [PMID: 37589450 DOI: 10.1080/07347332.2023.2241855] [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: 08/18/2023]
Abstract
The purpose of this study is to identify links between caregiver hope, caregiver coping behaviors, and caregivers' coaching versus dismissing emotion socialization (ES) beliefs in a pediatric cancer sample. Self-report measures. Caregivers (N = 183, 80.20% mothers; 58.5% white; 32.2% Hispanic) of youth undergoing cancer treatment (51.10% hematological malignancy, 15.30% brain or spinal [CNS] tumor, and 25.14% non-CNS solid tumor) for at least six weeks. We used a series of mediation models to examine links between caregivers' coping behaviors, hope, and ES beliefs. Caregivers' hope significantly mediated a positive relation between caregivers' coping and their emotion coaching beliefs, as well as an inverse relation between caregivers' maladaptive coping and their emotion dismissing beliefs. Enhancing caregivers' hope or adaptive coping may support caregivers' beliefs during the pediatric cancer experience. Our findings support future research to evaluate whether enhancing caregivers' hope or adaptive coping may help support evidence-based interventions that target ES beliefs and behaviors.
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Affiliation(s)
- Nicholas David W Smith
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Health System, Tampa, Florida, USA
| | - Dianna M Boone
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Allison Schimmel-Bristow
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Jonathan Rawlins
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Lauren Ellingham
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Sarah Sobalvarro
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Melissa A Faith
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
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Nogueira AJ, Ribeiro MT. "The Key Is to Value Every Little Achievement": A Qualitative Study of the Psychological Experience of Parent Caregivers in Paediatric Palliative Care. Clin Pract 2023; 13:670-683. [PMID: 37366931 DOI: 10.3390/clinpract13030062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
In Europe, Portugal has been identified as the country with the most rapid evolution of paediatric palliative care provision, which is a highly complex experience for families. The present descriptive-exploratory study seeks to contribute to the understanding of the psychological experience of life-limiting conditions in parent caregivers. A total of 14 families completed a sociodemographic and clinical data sheet and answered a structured online interview based on an incomplete narrative resulting from the Unwanted Guest Metaphor. A thematic analysis of the various narratives was performed through an inductive-deductive process. The results provide a holistic view of 10 essential dimensions in the parental psychological experience and contribute to the design of intervention methodologies in an eco-systemic approach. The importance of clear communication with health professionals, an awareness of the unpredictability of the disease, the desire for more self-care, the difficulty in understanding their children's needs and the threat implicit in everyday life are some of the main findings. This research emphasizes the importance of having opportunities of emotional expression and psychoeducation about anxiety' management, enhancing the perception of positive characteristics in children with palliative needs and creating time for the couple. The study has some limitations, such as the small sample size, and suggests that further research should explore the father's experience.
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Fathers' Experiences of Caring for a Child with a Chronic Illness: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020197. [PMID: 36832326 PMCID: PMC9955404 DOI: 10.3390/children10020197] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
The prevalence of children living with chronic health conditions is increasing worldwide and can disrupt family roles, relationships, function, and parental involvement in family caregiving. The purpose of this systematic review was to explore fathers' experiences and involvement in caring for a child with a chronic condition. Systematic searches using seven databases were conducted. Study criteria included (1) peer-reviewed original research in English, Spanish, French, or Portuguese, (2) children less than 19 years of age with a chronic condition, (3) fathers (biological or guardian) as direct informants, and (4) outcomes addressing fathers' experience, perceptions, and/or involvement in the child's care. Data were synthesized from ten articles reflecting eight separate studies that utilized quantitative designs. Three areas of focus were identified: Family Functioning, Father's Psychological Health, and Need for Support. Data suggested increased involvement from the father in caring for their child with a chronic condition was associated with improved family functioning, increased anxiety and distress, decreased self-esteem, and increased need for support. This review revealed a paucity of data regarding fathers' experiences and involvement when caring for a child with a chronic condition, with that available primarily from developed countries. Rigorous empirical studies are needed to deepen understanding of how fathers are involved in the care of their child with a chronic condition.
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DiFazio RL, Miller PJ, Geyer D, Shore BJ, Snyder BD, Vessey JA. Parental caregivers' perception of their transition from hospital to home in children with cerebral palsy who have undergone orthopedic surgery. J Pediatr Nurs 2023; 69:47-55. [PMID: 36640526 DOI: 10.1016/j.pedn.2022.12.023] [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: 10/02/2022] [Revised: 11/29/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Evaluate parental perception of the quality of discharge teaching, readiness for discharge, and the impact of these on post discharge coping difficulty and resource utilization in children with cerebral palsy (CP) following surgery. DESIGN AND METHODS Prospective cohort study conducted from September 2017-March 2021 at a pediatric academic medical center. Demographics were collected pre-operatively. Parents completed the Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS) within four hours of discharge. Four weeks post-discharge, parents completed the Post-discharge Coping Difficulty Scale (PDCDS). Utilization of healthcare resources were extracted from the electronic health record for 90 days post-operatively. Associations among demographics, RHDS, QDTS, PDCDS and resource utilization were assessed using general linear models; PDCDS's open-ended questions were analyzed using directed content analysis. RESULTS 114 parental caregivers participated. Post discharge coping was significantly associated with additional resource utilization: length of stay (p = 0.046), readmissions (p = 0.001), emergency department visits (p = 0.001), clinic calls (p = 0.001) and unplanned clinic visits (p = 0.006). PDCDS was negatively correlated with the QDTS Quality of Teaching Delivered subscale (r = -0.32; p = 0.004) and three of five RHDS subscales: 1) Child's Personal Status (r = -0.24; p = 0.02); 2) Knowledge (r = -0.30; p = 0.005); and 3) Coping Ability (r = -0.39; p < 0.001). Four themes explicated parental coping difficulties. CONCLUSION Parents experiencing coping difficulties were more likely to have difficulty managing their child's care needs at home and required additional health care resources. PRACTICE IMPLICATIONS Recognizing that parents' readiness for discharge may not reflect their coping abilities post-discharge requiring nurses to coordinate pre- and post-discharge education and support services.
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Affiliation(s)
- Rachel L DiFazio
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA 02115, United States of America.
| | - Patricia J Miller
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, United States of America
| | - David Geyer
- Boston College, Connell School of Nursing, Chestnut Hill, MA, United States of America.
| | - Benjamin J Shore
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA 02115, United States of America
| | - Brian D Snyder
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA 02115, United States of America
| | - Judith A Vessey
- Medical, Surgical, and Behavioral Health Programs, Boston Children's Hospital, Boston, MA 02115, United States of America
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Gallegos C, Aldridge MD, Connor K, Zuba L. Parenting a child with a chronic illness during a pandemic. J Pediatr Nurs 2022; 66:64-69. [PMID: 35640486 PMCID: PMC9145970 DOI: 10.1016/j.pedn.2022.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nearly 20% of children in the United States experience one or more chronic health conditions. Parents of a child with a special healthcare need (CSHCN) experience increased stress caring for a child with chronic illness. PURPOSE The purpose of this descriptive study is to describe stress in parents of a child with chronic illness during the COVID-19 pandemic. METHODS Parents of CSHCN (n = 34) were asked to fill out the Pediatric Inventory for Parents (PIP) and answer two questions related to caring for their child during the COVID-19 pandemic. CONCLUSIONS The means of the PIP-F (M = 146.6, SD = 20.5) and PIP-D (M = 141.9, SD = 23.9) were significantly higher than in previous studies. There is statistically significant positive correlation between parent stress and variables of age of the child and the length of time since diagnosis. In response to the questions about the impact of COVID, nearly all parents reported COVID increased their stress and reported their stress was related to isolation, lack of resources, and concern for the mental health of other children in the household. PRACTICE IMPLICATIONS COVID-19 likely exacerbated feelings of stress for parents of children with chronic health conditions. Although unprecedented, COVID-19 shed light on the existing fragility and high stress of parents of CSHCN. Pediatric nurses not only care for children, but must be advocates for the mental health of their patient's parents.
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Affiliation(s)
- Cara Gallegos
- School of Nursing, Boise State University, United States of America.
| | - Michael D Aldridge
- School of Nursing, University of Northern Colorado, United States of America
| | - Kelley Connor
- School of Nursing, Boise State University, United States of America
| | - Lauren Zuba
- School of Nursing, Boise State University, United States of America
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Spurr S, Bally J, Burles M, Mcharo K. A investigation into hope, self-efficacy, distress and uncertainty in parents who have a child with a life-threatening or life-limiting illness. J Pediatr Nurs 2022; 66:e9-e15. [PMID: 35842378 DOI: 10.1016/j.pedn.2022.07.002] [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: 01/21/2022] [Revised: 06/14/2022] [Accepted: 07/02/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine the experiences of parents who are caring for a child with a life-threatening or life-limiting illness (LTI/LLI) including levels of uncertainty, distress, hope, and self-efficacy to determine if there are significant variations with respect to demographic characteristics. DESIGN AND METHODS Data for this analysis are derived from a quasi-experimental evaluation of a support intervention with a purposeful sample of parental caregivers from a western Canadian province. Participants completed a demographic survey and four quantitative measures at baseline and following use of the support intervention. RESULTS Many parents had high scores of hope and self-efficacy, with highest levels of hope amongst parents who could stay at home with their children, and higher self-efficacy expressed by parents without financial concerns. Increased levels of uncertainty and distress were found amongst parents without other children living in the home, and those with financial concerns, respectively. CONCLUSIONS This exploratory analysis found that many parents experienced clinically significant distress along with uncertainty. The results determined that caring for children in the home other than the ill child significantly decreased uncertainty. High levels of parental hope and self-efficacy were frequently identified, with variations reflecting differences in social roles and stressors. The results contribute to an increased understanding of the value of support resources including parental leave and financial support. PRACTICE IMPLICATIONS Pediatric nurses may consider adopting an approach to caring for families with children in treatment for LLIs/LTIs that gives high priority to promoting hope and self-efficacy while ensuring access to support resources.
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Affiliation(s)
- Shelley Spurr
- University of Saskatchewan, College of Nursing, 104 Clinic Place, Saskatoon, Saskatchewan, Canada.
| | - Jill Bally
- University of Saskatchewan, College of Nursing, 104 Clinic Place, Saskatoon, Saskatchewan, Canada.
| | - Meridith Burles
- University of Saskatchewan, College of Nursing, 104 Clinic Place, Saskatoon, Saskatchewan, Canada.
| | - Kasha Mcharo
- University of Saskatchewan, College of Nursing, 104 Clinic Place, Saskatoon, Saskatchewan, Canada.
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