Making the transition from hospital to home: caring for the newly diagnosed child with cancer

Parents' experiences on handling paediatric anticancer drugs at home after an educational intervention

BACKGROUND

The shift of treatment of paediatric cancer patients to include more care at home puts a lot of pressure on health care professionals (HCPs) to prepare and train parents on safe and correct drug handling at home. Parents must take in and understand the information presented to them while coping with their own fear related to their child's cancer diagnosis. In Sweden, parents are expected to handle and manipulate oral anticancer drugs (OADs) in the home setting. There is however a lack of a standardized method to inform and educate parents on how to handle OADs in a correct way at home.

AIM

To describe parents' experiences of handling OADs at home after participating in an educational intervention.

METHOD

Educational intervention in the present study aimed to improve parents' knowledge in key concepts that is, handling OADs at home by using information presented in different forms. Fifteen parents to 12 children with cancer were recruited from a paediatric oncology ward in Sweden to participate in an interview. The interviews were transcribed verbatim and subjected to qualitative content analysis.

RESULTS

Parents' experiences are presented in categories: Relieved stress, Awareness of own exposure, Facilitated my everyday life, Parents need continued support individually. The educational intervention resulted in both positive and negative feelings, increased awareness of drug exposure and correct drug handling at home. Practical training and information presented in different ways facilitated the process of drug handling. To handle the drug correctly at home parents requested to be trained and informed in the beginning of their child's oral drug treatment. In addition, parents requested to be individually approached by HCP to get answers to questions and concerns.

CONCLUSIONS

This educational intervention study shows promising results for the method used by HCPs to inform and educate parents on complicated topics such as handling OADs at home.

Reducing pain in children with cancer at home: a feasibility study of the KLIK pain monitor app

PURPOSE

This study assessed adherence to, feasibility of, and barriers and facilitators of implementation of an app developed to monitor and follow-up with pain in children with cancer at home.

METHODS

Children (8-18 years) receiving cancer treatment (all diagnoses) or their parents (of children aged 0-7 years) used the KLIK Pain Monitor app for 3 weeks. Pain was assessed twice daily using an 11-point numeric rating scale (NRS-11) (ranging from 0 to 10). Healthcare professionals (HCP's) from the hospital's Pediatric Pain Service were instructed to follow-up with clinically significant pain scores (≥ 4) within 120 min (scores 4-6) or 30 min (scores 7-10). Adherence, feasibility, and implementation outcomes were assessed using questionnaires, app log data, and interviews.

RESULTS

Twenty-seven children (M age = 7.3 years, 51.8% male) and six HCP's participated. Sixty-three percent (N = 17) of families used the app on a daily basis during three weeks, and 18.5% (N = 5) reported pain scores twice daily during that time (family adherence). Twelve out of 27 children (44.4%) reported a clinically significant pain score at least once. In 70% (14/20) of clinically significant pain scores, HCP's followed-up with families within the set timeframe (HCP adherence). Outcomes reveal feasibility for the majority of app functions (i.e., positive evaluation by ≥ 70% families/HCP's), and non-feasible aspects could be resolved. Identified barriers and facilitators were used to improve future implementation efforts.

CONCLUSION

Use of the KLIK Pain Monitor app seems feasible. Future research will determine its effectiveness in reducing pain in children with cancer at home.

Pain at home during childhood cancer treatment: Severity, prevalence, analgesic use, and interference with daily life

BACKGROUND

Pain is a common symptom in childhood cancer. Since children spend more time at home, families are increasingly responsible for pain management. This study aimed at assessing pain at home.

PROCEDURE

In this longitudinal observational study (April 2016-January 2017), pain severity and prevalence, analgesic use, and pain interference with daily life (Brief Pain Inventory Short Form) were assessed for 4 consecutive days around the time of multiple chemotherapy appointments. Descriptive statistics (frequencies and percentages) were used to report pain severity (with clinically significant pain defined as: score ≥ 4 on "worst pain" or "average pain in the last 24 h"), pain prevalence, and analgesic use. Mixed models were estimated to assess whether patient characteristics were associated with pain severity, and whether pain severity was associated with interference with daily life.

RESULTS

Seventy-three children (50.7% male) participated (1-18 years). A majority (N = 57, 78%) experienced clinically significant pain at least once, and 30% reported clinically significant pain at least half the time. In 33.6% of scores ≥ 4, no medication was used. We found an association between pain severity and interference with daily life: the higher the pain, the bigger the interference (estimated regression coefficient = 1.01 [95% CI 0.98-1.13]).

CONCLUSIONS

The majority of children experienced clinically significant pain at home, and families frequently indicated no medication use. A stronger focus on education and coaching of families seems essential, as well as routine screening for pain in the home setting.

Grandparents’ Experiences of Childhood Cancer, Part 1

In this study, the authors examined the experiences of grandparents who have had, or have, a grandchild with childhood cancer. Sixteen grandparents were interviewed using unstructured interviews, and the data were analyzed according to hermeneutic–phenomenological tradition, as guided by the philosophical hermeneutics of Hans-Georg Gadamer. Interpretive findings indicate that grandparents suffer and worry in many complex ways that include a doubled worry for their own children as well as their grandchildren. According to the grandparents in this study, this worry was, at times, silenced in efforts to protect the parents of the grandchild from the burden of concern for the grandparent. Other interpretations include the nature of having one’s universe shaken, of having lives put on hold, and a sense of helplessness. The grandparents in this study offer advice to other grandparents as well as to the health care system regarding what kinds of things might have been more helpful to them as one level of the family system, who, like other subsystems of the family, are also profoundly affected by the event of childhood cancer.

Education given to parents of children newly diagnosed with acute lymphoblastic leukemia: a narrative review

Over the past 30 years, diagnosis and treatment of childhood cancers has developed significantly due to medical research and advancements in technology. As a result, prognosis has improved, and approximately 80% of children diagnosed with cancer survive into adulthood. Care has also shifted from a sole inpatient setting to include outpatient treatment where possible, and both these trends have resulted in a shift in the focus of research to the psychosocial and psychological effects of treatment on children and their families. Increasingly, parents are taking on the role of providing "nursing" care for their children, for example, managing medications and emergency situations as well as everyday treatment needs. This article critically reviews the current literature surrounding the approaches and methods used by nursing staff to educate families to perform this care within the context of a planned first discharge from hospital. Twenty-two relevant articles were identified covering different aspects of education and discharge planning, including the following: facilitation of education and discharge planning, collaboration between professional disciplines and family, responsibilities and contractual agreements, timing and approach, care planning, and the information needs of families. Only 4 articles discussed what the family felt they needed to know and be prepared for prior to discharge. This review indicates that further research is required to establish the needs of parents and caregivers with regard to education prior to their child's first discharge from hospital in the pediatric hematology and oncology setting.

The cost of childhood cancer from the family's perspective: a critical review

The costs incurred by the families of children with cancer remain under researched. The objectives were to systematically review the literature and identify research and clinical implications. Thirteen studies were critically appraised using the Pediatric Quality Appraisal Questionnaire (PQAQ) [Ungar and Santos. Value Health 2003; 6:584-594]. Existing research indicates that families incur significant variable costs throughout cancer treatment. However, problems with the published studies related to various PQAQ domains (e.g., time horizon, sensitivity analysis) rendered the magnitude of families' childhood cancer costs somewhat uncertain. Strategies for enhancing the quality of childhood cancer cost of illness research are presented. Implications for clinical practice are discussed.

Experiences of Parents With Caring for Their Child After a Cancer Diagnosis

Children and adolescents with cancer are increasingly treated and cared for at home; hospital stays are reduced to a minimum. Taking care of a sick child at home has an impact on the entire family: the sick child, the siblings, and the parents. This qualitative study examines the experiences of parents taking their child home for the first time after the diagnosis. Parents of 10 children newly diagnosed with cancer were interviewed twice around the time of the first discharge; data were analyzed using content analysis methodology. Findings illustrated parents’ preparation of and experiences around their child’s first discharge, the huge amount of new and changed tasks parents have to fulfill at home when caring for their child with cancer, and consequences for the parents. By providing individualized information and instruction, by having parents anticipate potential problems and solutions, and by describing available community support and integrating district nurses as well as other parents with the same experiences more frequently, health care professionals in the hospital can optimize discharge planning for these parents.

The care of my child with cancer: a new instrument to measure caregiving demand in parents of children with cancer

The growing societal trend toward delivering more and more illness-related care in the home, driven both by family preferences and by mandates from third-party reimbursers, places additional responsibilities for increasingly complex caregiving on parents of children with serious illness. This article reports on the development and initial field test of The Care of My Child with Cancer, a caregiving demand instrument specific to the childhood cancer population. The instrument demonstrated strong internal consistency and test-retest reliability, and exploratory factor analysis provided initial evidence for the instrument's construct validity. The instrument will now be applied in a collaborative program of nursing research to further investigate caregiving demand and ultimately to develop nursing interventions to maximize medical and quality of life outcomes for children with cancer and their families.