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Kasimovskaya N, Geraskina N, Fomina E, Ivleva S, Krivetskaya M, Ulianova N, Zhosan M. Russian nurses' readiness for transcultural care of palliative patients. BMC Palliat Care 2023; 22:87. [PMID: 37407991 DOI: 10.1186/s12904-023-01198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Palliative care involves an approach aimed at improving the quality of life of patients and their families, who are forced to cope with the problems associated with life-threatening diseases. This definition includes a growing group of patients around the world. It requires an extension of the definition of patients in need of palliative care in countries such as Russia and a significant improvement in the work of nursing personnel with these patients. This study aims to determine the level of preparedness of nursing personnel for specialized care (transcultural care) and the quality of care provided to palliative patients. The presented findings of the study demonstrate the relevance of developing transcultural competence, which enables significant improvement in the quality of life of palliative patients. The analysis of medical workers' assessment of the level of specific training and their intercultural preparedness was conducted based on hospices (Moscow). A survey was conducted among 113 medical workers of the middle level of education aged between 28 and 56 (average of 44.2 years) and experience in palliative care ranged from 3 to 18 years (average of 9.5 years). The Intercultural Readiness Check (IRC) test, widely used to assess nursing staff worldwide, was used for the survey to determine the level of readiness for transcultural care. A strong correlation was found between a number of the test scales and measures of participants' age and experience. The presented material demonstrates the realization of an interdisciplinary approach to the issues of specific training of nursing personnel in the field of "transcultural care" in providing palliative care to incurable patients.
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Affiliation(s)
- Nataliya Kasimovskaya
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Natalia Geraskina
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
| | - Elena Fomina
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Svetlana Ivleva
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Maria Krivetskaya
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Nina Ulianova
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Marina Zhosan
- Department of Nursing Management and Social Work, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Rico-Mena P, Güeita-Rodríguez J, Martino-Alba R, Chocarro-Gonzalez L, Sanz-Esteban I, Palacios-Ceña D. Understanding pediatric palliative care within interdisciplinary palliative programs: a qualitative study. BMC Palliat Care 2023; 22:80. [PMID: 37355579 DOI: 10.1186/s12904-023-01194-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/07/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE To describe the process of delivery of pediatric palliative care from the perspective of a pediatric interdisciplinary team and the children's parents. METHODS A qualitative descriptive case study was conducted. Purposeful sampling took place within a specialized pediatric palliative care Unit in Madrid (Spain), located at the Niño Jesus Hospital. The study participants included a specialized pediatric palliative care team from Madrid's pediatric palliative care program, other professional teams involved in interdisciplinary care and parents of children under pediatric palliative care. Data were collected via semi-structured interviews, focus groups and researchers' field notes. A thematic analysis was performed. RESULTS This study included 28 participants (20 women, 8 men), of whom 18 were professionals who belonged to the pediatric palliative care interdisciplinary team, 4 professionals were from other units that collaborated with the pediatric palliative care, and 6 were parents (5 women, 1 man). The mean age of the pediatric palliative care members was 38.2 years (SD ± 7.9), that of the collaborating professionals was 40.5 (SD ± 6.8), and that of the parents was 44.2 (SD ± 5.4). Two main themes emerged: a) Pediatric palliative care has a distinct identity, associated with life. It represents the provision of special care in highly complex children, in the context of the home, far from the hospital environment; b) The team is key: its interdisciplinary organization provides a more comprehensive view of the child and their family, fosters communication among professionals, and improves coordination with other services involved in the care of children. The mindset shift experienced by ID-PPC professionals towards a palliative approach makes them more sensitive to the needs of their patients and leads them to develop specific skills in areas such as communication, decision-making, and adaptability that were identified as differentiating aspects of pediatric palliative care. CONCLUSIONS Describing pediatric palliative care from the professional and parental perspective helps to establish realistic and comprehensive goals for the care of children and their parents. The findings of this study may help with the establishment of a pediatric palliative care team, as a necessary organizational change in a health care system that cares for children with complex and life-threatening conditions. Promoting training in pediatric palliative care, prioritizing more horizontal organizations, providing tools and spaces for coordination and communication between professionals from different services, together with the creation of a position of case coordinator in the care process of children could enhance the understanding of pediatric palliative care services.
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Affiliation(s)
- Patricia Rico-Mena
- Department of Physiotherapy, Chiropody and Dance, Physical Therapy and Health Sciences Research Group, Universidad Europea de Madrid, C. Tajo, S/N, 28670 Villaviciosa de Odón, Madrid, Spain
- International Doctorate School, Rey Juan Carlos University, Madrid, Spain
| | - Javier Güeita-Rodríguez
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Humanities and Qualitative Research in Health Science Research Group, Universidad Rey Juan Carlos, Madrid, Spain.
| | - Ricardo Martino-Alba
- Pediatric Palliative Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Ismael Sanz-Esteban
- Department of Physiotherapy, Chiropody and Dance, Physical Therapy and Health Sciences Research Group, Universidad Europea de Madrid, C. Tajo, S/N, 28670 Villaviciosa de Odón, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Humanities and Qualitative Research in Health Science Research Group, Universidad Rey Juan Carlos, Madrid, Spain
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Bernier Carney KM, Goodrich G, Lao A, Tan Z, Kiza AH, Cong X, Hinderer KA. Palliative care referral criteria and application in pediatric illness care: A scoping review. Palliat Med 2023; 37:692-706. [PMID: 36971413 DOI: 10.1177/02692163231163258] [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] [Indexed: 05/30/2023]
Abstract
BACKGROUND Specialty pediatric palliative care services can help to address unmet care needs for children with complex and serious illness. Current guidelines support the identification of unmet palliative care needs; however, it is unknown how these guidelines or other clinical characteristics influence pediatric palliative care referral in research and practice. AIM To evaluate the identification and application of palliative care referral criteria in pediatric illness care and research. DESIGN A scoping review with a content analysis approach to summarize results. DATA SOURCES Five electronic databases (PubMed, CINAHL, PsycINFO, SCOPUS, and Academic Search Premier) were used to identify peer-reviewed literature published in English between January 2010 and September 2021. RESULTS We included 37 articles focused on the referral of pediatric patients to palliative care teams. The identified categories of referral criteria were: disease-related; symptom-related; treatment communication; psychosocial, emotional, and spiritual support; acute care needs; end-of-life care needs; care management needs; and self-referrals for pediatric palliative care services. We identified two validated instruments to facilitate palliative care referral and seven articles which described population-specific interventions to improve palliative care access. Nineteen articles implemented a retrospective health record review approach that consistently identified palliative care needs with varying rates of service use. CONCLUSIONS The literature demonstrates inconsistent methods for identifying and referring children and adolescents with unmet palliative care needs. Prospective cohort studies and clinical trials would inform more consistent pediatric palliative care referral practices. More research is needed on palliative care referral and outcomes in community-focused pediatrics.
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Affiliation(s)
| | - George Goodrich
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Amberly Lao
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Zewen Tan
- School of Medicine, University of Connecticut, Farmington, CT, USA
| | | | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, USA
- School of Nursing, Yale University, Orange, CT, USA
| | - Katherine A Hinderer
- School of Nursing, University of Connecticut, Storrs, CT, USA
- School of Medicine, University of Connecticut, Farmington, CT, USA
- Institute for Nursing Research and Evidence-Based Practice, Connecticut Children's, Hartford, CT, USA
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Vasli P, Karami M, AsadiParvar-Masouleh H. Pediatric palliative care for children with cancer: a concept analysis using Rodgers' evolutionary approach. World J Pediatr 2022; 18:791-803. [PMID: 36100798 DOI: 10.1007/s12519-022-00600-x] [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: 05/02/2022] [Accepted: 07/24/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Providing access to pediatric palliative care (PPC) for children living with a serious illness, such as cancer, is of critical importance, although this specialized intervention, as a novel concept, still seems vague and complicated. The present study analyzed the concept of PPC for children with cancer. METHODS Rodgers' evolutionary method was employed for the concept analysis. Articles on PPC, particularly those for children suffering from cancer, published between 2010 and 2021 were searched in valid academic research databases. The inclusion criteria for the full-text articles were based on the characteristics, antecedents, and consequences of PPC for children with cancer. RESULTS In total, 19 relevant articles were selected and then reviewed and analyzed after applying the inclusion criteria and the final sampling. The analysis of the concept of PPC for children affected with cancer revealed four characteristics, including "PPC as holistic and integrated care", "PPC as patient- and family-centered care", "PPC as early-start continuous care", and "PPC as interdisciplinary and team-based care". Some effective factors could also act as antecedents for this concept, i.e., health care providers' training and expertise as well as human resources and financing. Moreover, improved quality of life, symptom reduction, and coordination between patient care and family support were among the PPC consequences for such children. CONCLUSIONS The study results demonstrated that delivering PPC to children with cancer demanded a comprehensive view of its various dimensions. Furthermore, numerous factors need to be delineated for its accurate and complete implementation.
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Affiliation(s)
- Parvaneh Vasli
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali Asr Ave., Ayatollah Hashemi Rafsanjani Cross Road, Tehran, Iran.
| | - Maryam Karami
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Riiser K, Holmen H, Winger A, Steindal SA, Castor C, Kvarme LG, Lee A, Lorentsen VB, Misvaer N, Früh EA. Stories of paediatric palliative care: a qualitative study exploring health care professionals' understanding of the concept. BMC Palliat Care 2022; 21:187. [PMID: 36273144 PMCID: PMC9587603 DOI: 10.1186/s12904-022-01077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background By sharing patient stories, health care professionals (HCPs) may communicate their attitudes, values and beliefs about caring and treatment. Previous qualitative research has shown that HCPs usually associate paediatric palliative care (PPC) with death or dying and that they find the concept challenging to understand and difficult to implement. Attending to HCPs’ stories may provide a richer account of their understanding of PPC. Thus, the aim of this study was to explore PPC stories narrated by HCPs to gain increased insight into their understanding of what PPC entails. Methods This qualitative study collected data from four focus group interviews with 21 HCPs from different units in two Norwegian hospitals. Stories told by the HCPs to illustrate their comprehension of PPC were analysed following thematic analysis procedures. Results Four themes were identified illustrating what PPC meant to the participants: creating spaces for normality, providing tailored support for the family, careful preparations for saying goodbye and experiencing dilemmas and distress. The stories centred on family care, particularly relating to dramatic or affective situations when the death of a child was imminent. Conclusion The stories reflect how the HCPs view PPC as a specific field of health care that requires particular professional sensitivity, including good communication, collaboration and planning. Thus, the HCPs in this study demonstrated knowledge about the core qualities needed to succeed in PPC. However, similar to previous research, the stories illustrate that how HCPs speak about PPC is strongly associated with end-of-life care, and by that the HCPs do not capture the breadth of the PPC concept. The findings highlight the importance of increasing knowledge about the meaning and content of PPC among HCPs in order to maintain quality of life for all children with life-limiting or life-threatening conditions throughout their illness trajectory.
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Affiliation(s)
- Kirsti Riiser
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway.
| | - Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggt. 15b, NO-0456, Oslo, Norway
| | - Charlotte Castor
- Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 00, Lund, Box 157, Sweden
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Anja Lee
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, NO-0424, Ullevål, Nydalen, Oslo, PO Box 4950, Norway
| | - Vibeke Bruun Lorentsen
- Department of Nursing, Faculty of Health Studies, VID Specialized University, NO-0319, Vinderen, Oslo, PO Box 184, Norway
| | - Nina Misvaer
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Elena Albertini Früh
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
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Benini F, Papadatou D, Bernadá M, Craig F, De Zen L, Downing J, Drake R, Friedrichsdorf S, Garros D, Giacomelli L, Lacerda A, Lazzarin P, Marceglia S, Marston J, Muckaden MA, Papa S, Parravicini E, Pellegatta F, Wolfe J. International Standards for Pediatric Palliative Care: From IMPaCCT to GO-PPaCS. J Pain Symptom Manage 2022; 63:e529-e543. [PMID: 35031506 DOI: 10.1016/j.jpainsymman.2021.12.031] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Since the publication of the IMPaCCT project in 2007, much effort has been made to develop new approaches to pediatric palliative care (PPC). Fifteen years later, it is time to redefine the standards in PPC. OBJECTIVES An international group of experts in PPC has revised the standards in PPC through the GO-PPaCS project (Global Overview - PPC Standards). The goal was to update the PPC standards considering the specificity of different settings, resources, and emerging challenges. The present document is intended to reach all people directly or indirectly involved in PPC. METHODS A literature review in MEDLINE was conducted to expand on the fundamental points and current standards on PPC and to cover an international setting. The literature search (updated on the 15th of April 2021) was carried out using different combinations of keywords and focusing on papers published in English over the past 5 years (2016-2020), but older articles were considered when relevant. The consensus on the fundamental points, standards of care and paper contents was reached by open discussion. RESULTS Fundamental points were defined regarding the definition of PPC, eligibility criteria and the magnitude of the need for PPC, while standards were redefined for the following six areas: 1) clinical, developmental, psychological, social, ethical and spiritual needs; 2) end-of-life care; 3) care models and settings of care; 4) PPC in humanitarian emergencies; 5) care tools; and 6) education and training for healthcare providers. CONCLUSION The present document, developed with the contribution of an international group of experts from different countries, experiences and models of care, provides fundamental points and standards for a wider implementation of PPC worldwide.
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Affiliation(s)
- Franca Benini
- Paediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy.
| | - Danai Papadatou
- Professor of Clinical Psychology, Department of Mental Health and Behavioral Studies, Faculty of Nursing, National and Kapodistrian University of Athens, Greece
| | - Mercedes Bernadá
- Associated Professor of Pediatrics, School of Medicine, Universidad de la República, Pereira Rossell Hospital Center, Pediatric Palliative Care Team Director, Montevideo, Uruguay
| | - Finella Craig
- Consultant in Paediatric Palliative Medicine at the Louis Dundas Centre, Great Ormond Street Hospital for Children, London, UK
| | - Lucia De Zen
- Pediatric Palliative Care and Pain Service, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Julia Downing
- International Children's Palliative Care Network (ICPCN), Uganda/UK
| | - Ross Drake
- Pediatric Palliative Care and Pain Services, Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Stefan Friedrichsdorf
- Professor in Pediatrics, Medical Director, Center of Pediatric Pain, Palliative and Integrative Medicine at UCSF Benioff Children's Hospitals in Oakland and San Francisco, California, USA
| | - Daniel Garros
- Department of Pediatrics, Division of Critical Care, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital PICU, Edmonton, Alberta, Canada
| | | | - Ana Lacerda
- Department of Pediatrics, Portuguese Institute of Oncology, Lisbon Centre, Lisbon, Portugal
| | - Pierina Lazzarin
- Paediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Joan Marston
- Sunflower Children's Hospice, Bloemfontein, South Africa
| | | | | | | | | | - Joanne Wolfe
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute and Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
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7
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Pacurari N, De Clercq E, Dragomir M, Colita A, Wangmo T, Elger BS. Challenges of paediatric palliative care in Romania: a focus groups study. BMC Palliat Care 2021; 20:178. [PMID: 34794399 PMCID: PMC8598931 DOI: 10.1186/s12904-021-00871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The availability of palliative care facilities for children vary considerably among the European member states. In Romania, a country where health expenditure is among the lowest in Europe, palliative care has been mainly provided by charitable organizations. Despite the high number of children needing palliative care, there is scant literature and research available on paediatric palliative care in Romania. The study explores the viewpoints of various paediatric oncology providers with regard to paediatric palliative care provision in Romania. METHODS Four mixed focus groups were conducted at four university-affiliated paediatric oncology centres located in three distinct Romanian regions (Bucuresti-llfov, Nord-Est and Nord-Vest). The focus groups were analyzed using thematic coding. RESULTS For many healthcare professionals, emotional burden inherent to the profession; unhealthy work-life balance and understaffing were among the biggest barriers to the successful integration of pediatric palliative care. The lack of staff was attributed to a shortage of financial resources, and to the persisting cultural stigma surrounding palliative care and oncology. Also political turmoil was identified as an important obstacle to palliative care implementation. CONCLUSION Significant barriers persist limiting the broader implementation of pediatric palliative care in Romania. In order to render palliative care in pediatric oncology more sustainable, more attention should be paid to the mental health care of healthcare professionals working in this field, to the development of mobile palliative care services and to the emigration of skilled medical staff.
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Affiliation(s)
- Nadia Pacurari
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, CH, Switzerland
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, CH, Switzerland.
| | - Monica Dragomir
- Department of Pediatric Oncology, The Institute of Oncology, Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania
| | - Anca Colita
- Department of Pediatric Hemato-Oncology & Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, CH, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, CH, Switzerland
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Sugalski AJ, Lo T, Beauchemin M, Grimes AC, Robinson PD, Walsh AM, Santesso N, Dang H, Fisher BT, Wrightson AR, Yu LC, Sung L, Dupuis LL. Facilitators and barriers to clinical practice guideline-consistent supportive care at pediatric oncology institutions: a Children's Oncology Group study. Implement Sci Commun 2021; 2:106. [PMID: 34530933 PMCID: PMC8447588 DOI: 10.1186/s43058-021-00200-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/25/2021] [Indexed: 11/27/2022] Open
Abstract
Background Clinical practice guideline (CPG)-consistent care improves patient outcomes, but CPG implementation is poor. Little is known about CPG implementation in pediatric oncology. This study aimed to understand supportive care CPG implementation facilitators and barriers at pediatric oncology National Cancer Institute (NCI) Community Oncology Research Program (NCORP) institutions. Methods Healthcare professionals at 26 pediatric, Children's Oncology Group-member, NCORP institutions were invited to participate in face-to-face focus groups. Serial focus groups were held until saturation of ideas was reached. Supportive care CPG implementation facilitators and barriers were solicited using nominal group technique (NGT), and implementation of specific supportive care CPG recommendations was discussed. Notes from each focus group were analyzed using a directed content analysis. The top five themes arising from an analysis of NGT items were identified, first from each focus group and then across all focus groups. Results Saturation of ideas was reached after seven focus groups involving 35 participants from 18 institutions. The top five facilitators of CPG implementation identified across all focus groups were organizational factors including charging teams with CPG implementation, individual factors including willingness to standardize care, user needs and values including mentorship, system factors including implementation structure, and implementation strategies including a basis in science. The top five barriers of CPG implementation identified were organizational factors including tolerance for inconsistencies, individual factors including lack of trust, system factors including administrative hurdles, user needs and values including lack of inclusivity, and professional including knowledge gaps. Conclusions Healthcare professionals at pediatric NCORP institutions believe that organizational factors are the most important determinants of supportive care CPG implementation. They believe that CPG-consistent supportive care is most likely to be delivered in organizations that prioritize evidence-based care, provide structure and resources to implement CPGs, and eliminate implementation barriers. Trial registration ClinicalTrials.gov Identifier: NCT02847130. Date of registration: July 28, 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00200-2.
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Affiliation(s)
- Aaron J Sugalski
- University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Tammy Lo
- Department of Research and Evaluation, Kaiser Permanente, Pasadena, USA
| | | | - Allison C Grimes
- University of Texas Health Science Center at San Antonio, San Antonio, USA
| | | | - Alexandra M Walsh
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, USA.,University of Arizona, Phoenix, USA
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Ha Dang
- Children's Oncology Group, Monrovia, USA.,Department of Population and Public Health Sciences, University of Southern California, Los Angeles, USA
| | - Brian T Fisher
- Pediatrics and Epidemiology, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Andrea Rothfus Wrightson
- Clinical Research Nurse Coordinator, Nemours Center for Cancer and Blood Disorders, Wilmington, USA
| | - Lolie C Yu
- LSUHSC/Children's Hospital, New Orleans, USA
| | - Lillian Sung
- Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - L Lee Dupuis
- Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. .,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
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9
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Song IG, Kwon SY, Chang YJ, Kim MS, Jeong SH, Hahn SM, Han KT, Park SJ, Choi JY. Paediatric palliative screening scale as a useful tool for clinicians' assessment of palliative care needs of pediatric patients: a retrospective cohort study. BMC Palliat Care 2021; 20:73. [PMID: 34030666 PMCID: PMC8146205 DOI: 10.1186/s12904-021-00765-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background Although the importance of palliative care in pediatric patients has been emphasized, many health care providers have difficulty determining when patients should be referred to the palliative care team. The Paediatric Palliative Screening Scale (PaPaS) was developed as a tool for screening pediatric patients for palliative care needs. The study aimed to evaluate the PaPaS as a reliable tool for primary care clinicians unfamiliar with palliative care. Methods This was a retrospective cohort study of patients referred to the pediatric palliative care teams in two tertiary hospitals in the Republic of Korea between July 2018 and October 2019. Results The primary clinical and pediatric palliative care teams assessed the PaPaS scores of 109 patients, and both teams reported a good agreement for the sum of the PaPaS score. Furthermore, the PaPaS scores correlated with those obtained using the Lansky performance scale. Although the mean PaPaS score was higher in the pediatric palliative care team, the scores were higher than the cut-off score for referral in both groups. Conclusion The PaPaS can be a useful tool for primary care clinicians to assess the palliative care needs of patients and their families.
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Affiliation(s)
- In Gyu Song
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Republic of Korea.,National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Seung Yeon Kwon
- Palliative Care Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Yoon Jung Chang
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Min Sun Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Sung Hoon Jeong
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.,Department of Public Health, Graduate school, Yonsei University, Seoul, Republic of Korea
| | - Seung Min Hahn
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.,Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Kyu Tae Han
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - So-Jung Park
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jin Young Choi
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
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Pennarola B, MacDonell-Yilmaz RE, Sprinz P, Renaud T. Impact of a pediatric palliative care team on resident education in end of life care. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1871578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Brian Pennarola
- Department of Pediatrics, Division of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Philippa Sprinz
- Division of Pediatric Hematology/Oncology, Hasbro Children’s Hospital/Brown University, Providence, RI, USA
| | - Thomas Renaud
- Division of Pediatric Hematology/Oncology, Hasbro Children’s Hospital/Brown University, Providence, RI, USA
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11
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Zhang M, Li X. Focuses and trends of the studies on pediatric palliative care:A bibliometric analysis from 2004 to 2018. Int J Nurs Sci 2021; 8:5-14. [PMID: 33575439 PMCID: PMC7859508 DOI: 10.1016/j.ijnss.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/10/2020] [Accepted: 11/26/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To investigate the focuses and trends of the studies on pediatric palliative care (PPC) and provide directions for future research. METHODS Relevant papers about PPC published from 2004 to 2018 were analyzed using bibliometric analysis methods, including co-word analysis, biclustering analysis, and strategic diagram analysis. The included papers were divided into three groups based on the publication time, including 2004-2008, 2009-2013, and 2014-2018. RESULTS A total of 1132 papers were published between 2004 and 2018, and there were 293 papers published between 2004 and 2008, 396 between 2009 and 2013, and 443 between 2014 and 2018. There were 42 high-frequency MeSH terms/MeSH subheadings in papers published between 2004 and 2018, including 12 between 2004 and 2008, 13 between 2009 and 2013, and 17 between 2014 and 2018. CONCLUSION Studies on PPC were making progress, with the increasing number, expanding scope, and uneven global distribution. Integration palliative care into pediatrics, cancer treatments in pediatric oncology, education methods on PPC, and establishment of professional teams were the major themes during 2004-2008, then the themes changed into establishing interventions to enhance the quality of life of the patients and parents, building professional-family relationship, and investigating attitude of health personnel in PPC during 2009-2013 and subsequently turned into communication skills, end-of-life decision making, and guidelines making on PPC during 2014-2018. Underdeveloped and protential themes including effective approaches to deal with the ethical dilemmas, training programs on communication skills, family support and guideline making are worth studying in the future.
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Affiliation(s)
- Miao Zhang
- School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, Liaoning, China
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12
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Palliative Care Knowledge and Characteristics in Caregivers of Chronically Ill Children. J Hosp Palliat Nurs 2020; 22:456-464. [DOI: 10.1097/njh.0000000000000685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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13
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Correa VC, Lugo-Agudelo LH, Aguirre-Acevedo DC, Contreras JAP, Borrero AMP, Patiño-Lugo DF, Valencia DAC. Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview. Health Res Policy Syst 2020; 18:74. [PMID: 32600417 PMCID: PMC7322919 DOI: 10.1186/s12961-020-00588-8] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 06/11/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction Clinical practice guidelines (CPGs) are designed to improve the quality of care and reduce unjustified individual variation in clinical practice. Knowledge of the barriers and facilitators that influence the implementation of the CPG recommendations is the first step in creating strategies to improve health outcomes. The present systematic meta-review sought to explore the barriers and facilitators for the implementation of CPGs. Methods A search was conducted in the PubMed, Embase, Cochrane, Health System Evidence and International Guideline Library (G-I-N) databases. Systematic reviews of qualitative, quantitative or mixed-methods studies that identified barriers or facilitators for the implementation of CPGs were included. The selection of the title and abstract, the evaluation of the full text, extraction of the data and the quality assessment were carried out by two independent reviewers. To summarise the evidence, we grouped the barriers and facilitators according to the following contexts: political and social, health organisational system, guidelines, health professionals and patients. Results Overall, 25 systematic reviews were selected. The relevant barriers in the social-political context were the absence of a leader, difficulties with teamwork and a lack of agreement with colleagues. Relevant barriers in the health system were a lack of time, financial problems and a lack of specialised personnel. Barriers of the CPGs included a lack of clarity and a lack of credibility in the evidence. Regarding the health professional, a lack of knowledge about the CPG and confidence in oneself were relevant. Regarding patients, a negative attitude towards implementation, a lack of knowledge about the CPG and sociocultural beliefs played a role. Some of the most frequent facilitators were consistent leadership, commitment of the members of the team, administrative support of the institution, existence of multidisciplinary teams, application of technology to improve the practice and education regarding the guidelines. Conclusions The barriers and facilitators described in this review are factors that influence the implementation of evidence in clinical practice. Knowledge of these factors should contribute to the development of a theoretical basis for the creation of CPG implementation strategies to improve professional practice and health outcomes for patients.
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Affiliation(s)
- Verónica Ciro Correa
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| | - Luz Helena Lugo-Agudelo
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| | - Daniel Camilo Aguirre-Acevedo
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| | - Jesús Alberto Plata Contreras
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| | - Ana María Posada Borrero
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
| | - Daniel F Patiño-Lugo
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia.
| | - Dolly Andrea Castaño Valencia
- Facultad de Medicina, Universidad de Antioquia, Grupo de Investigación Rehabilitación en Salud, Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia
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Garten L, Globisch M, von der Hude K, Jäkel K, Knochel K, Krones T, Nicin T, Offermann F, Schindler M, Schneider U, Schubert B, Strahleck T. Palliative Care and Grief Counseling in Peri- and Neonatology: Recommendations From the German PaluTiN Group. Front Pediatr 2020; 8:67. [PMID: 32181234 PMCID: PMC7058113 DOI: 10.3389/fped.2020.00067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/11/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Lars Garten
- Department of Neonatology, Palliative Neonatology Team, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marcel Globisch
- Department for Content and Development, German Children's Hospice Association, Olpe, Germany
| | - Kerstin von der Hude
- Department of Neonatology, Palliative Neonatology Team, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karin Jäkel
- Association of Premature and At-Risk Born Children, Regional group of Rhineland-Palatinate, Mainz, Germany
| | - Kathrin Knochel
- Center for Pediatric Palliative Care, University Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tanja Krones
- University Hospital Zürich/Institute of Biomedical Ethics and History of Medicine, University of Zürich, Zurich, Switzerland
| | - Tatjana Nicin
- Department of Obstetrics, Klinikum Hanau, Hanau, Germany
| | - Franziska Offermann
- Federal Association of Orphaned Parents and Mourning Siblings in Germany, Leipzig, Germany
| | - Monika Schindler
- Department of Neonatology and Paediatric Intensive Care, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Uwe Schneider
- Department of Obstetrics, Universitätsklinikum Jena, Jena, Germany
| | - Beatrix Schubert
- Roman-Catholic Diocese of Rottenburg-Stuttgart, Department Pastoral Care in Health Care, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Thomas Strahleck
- Department of Neonatology and Neonatal Intensive Care, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
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15
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Marcus KL, Santos G, Ciapponi A, Comandé D, Bilodeau M, Wolfe J, Dussel V. Impact of Specialized Pediatric Palliative Care: A Systematic Review. J Pain Symptom Manage 2020; 59:339-364.e10. [PMID: 31404638 PMCID: PMC6989377 DOI: 10.1016/j.jpainsymman.2019.08.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/22/2022]
Abstract
CONTEXT Specialized pediatric palliative care (SPPC) is increasingly involved in the care of seriously ill children, yet the evidence on its impact has not been comprehensively reviewed. OBJECTIVE The objective of this study was to assess the effects of providing SPPC to seriously ill children on patient-, caregiver-, and systems-level outcomes. METHODS We performed a Systematic Review following Cochrane methods. DATA SOURCES Medline, Embase, PsycINFO, Global Health, The Cochrane Central Register of Controlled Trials, LILACS, and Web of Science were searched from January 1996 to June 2018. STUDY SELECTION/DATA EXTRACTION We included randomized controlled, cohort, case-control, and before-after studies in which exposure to SPPC services was the intervention of interest. All outcomes reported in these studies were included. Two investigators independently selected articles, extracted data, and assessed risk of bias of included studies using standardized criteria. RESULTS Twenty-four studies were included in qualitative synthesis: one nonrandomized controlled trial, 16 cohort studies, and seven before-after studies. Evidence certainty was low. Twenty-one studies had one or more area with high risk of bias, most commonly selection bias, low group comparability, risk for confounding, and inadequate statistical reporting. Studies analyzed 46 domains, operationalized as 136 distinct outcomes. SPPC was associated with better child quality of life scores in all four studies that assessed this outcome. No other outcome showed this consistency. CONCLUSION Receiving SPPC was associated with better child quality of life. However, the paucity and low certainty of the evidence precluded any firm recommendations about SPPC practice. Larger collaborative networks and greater consensus regarding SPPC research standards are needed.
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Affiliation(s)
- Katherine L Marcus
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gisella Santos
- Center for Research and Implementation in Palliative Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Cochrane Center, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Daniel Comandé
- Cochrane Center, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Madeline Bilodeau
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joanne Wolfe
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Veronica Dussel
- Center for Research and Implementation in Palliative Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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16
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Cheng BT, Wangmo T. Palliative care utilization in hospitalized children with cancer. Pediatr Blood Cancer 2020; 67:e28013. [PMID: 31612605 DOI: 10.1002/pbc.28013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is growing evidence that palliative care (PC) is associated with increased quality of life in children with cancer. Despite increasing recommendations in support of PC to improve pediatric oncology care, little is known about its patterns of use. METHODS We analyzed the 2005-2011 National Inpatient Sample, a representative, cross-sectional sample of US hospital admissions. Our study cohort comprised 10 960 hospitalizations of children with cancer and high in-hospital mortality risk. Survey-weighted regression models were constructed to determine associations of person- and hospital-level characteristics with PC involvement and healthcare costs. RESULTS Overall, 4.4% of hospitalizations included PC involvement. In regression models invoking stepwise variable selection, a shorter length of stay (PC vs no PC; mean: 23.9 vs 32.6 days), solid cancer (solid vs hematologic vs brain cancer; PC use: 7.4% vs 2.8% vs 5.5%), and older age (PC vs no PC; mean: 10.2 vs 8.9 years) were associated with PC use. PC utilization was also associated with lower overall and daily hospital costs. CONCLUSIONS One in 20 pediatric inpatients with cancer and high mortality risk receives PC, with differential utilization by socio-economic groups. These results have significant implications for public health resource allocation and the delivery of pediatric PC as high-value care. Future research should focus on the development of new tools to help physicians assess when PC is appropriate for their patients.
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Affiliation(s)
- Brian T Cheng
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tenzin Wangmo
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
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17
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Rost M, De Clercq E, Rakic M, Wangmo T, Elger B. Barriers to Palliative Care in Pediatric Oncology in Switzerland: A Focus Group Study. J Pediatr Oncol Nurs 2019; 37:35-45. [DOI: 10.1177/1043454219871082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: For children with cancer, early integration of pediatric palliative care in conjunction with curative treatments is recommended. In Switzerland, pediatric palliative care is mostly provided by an interdisciplinary primary oncology team that is mainly composed of nurses. However, only a small fraction of children receive pediatric palliative care and only a minority of them in a timely manner. The main aim was to identify barriers to the provision of pediatric palliative care in Swiss pediatric oncology. Method: This qualitative study consisted of five focus groups. In total, 29 pediatric oncology providers participated (13 nurses, 11 physicians, 4 psycho-oncologists, 1 social worker). Data were analyzed employing applied thematic analysis. Results: Analysis revealed eleven barriers: lack of financial resources, lack of prejob education regarding pediatric palliative care, lack of awareness in politics and policy making, absence of a well-established nationwide bridging care system, insufficient psychosocial and professional supervision for staff, understaffing, inadequate infrastructure of hospitals, asymmetry of factual and emotional knowledge between parents and providers, cultural aspects, irrational parental hopes, and “the unspoken.” Discussion: Awareness should be raised for pediatric palliative care (in particular in demarcation from palliative care in adults) among politics and policy makers which could lead to increased financial resources that, in turn, could be used to improve bridging care, hospital’s infrastructure, and team support. More flexibility for care determining factors is needed, for example, with respect to convening team meetings, short-termed staffing, and reimbursement at the interface between inpatient and outpatient services.
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Sasazuki M, Sakai Y, Kira R, Toda N, Ichimiya Y, Akamine S, Torio M, Ishizaki Y, Sanefuji M, Narama M, Itai K, Hara T, Takada H, Kizawa Y, Ohga S. Decision-making dilemmas of paediatricians: a qualitative study in Japan. BMJ Open 2019; 9:e026579. [PMID: 31431444 PMCID: PMC6707677 DOI: 10.1136/bmjopen-2018-026579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care. DESIGN We conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis. PARTICIPANTS Participants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data. RESULTS We performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians' convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence). CONCLUSIONS This is the first qualitative study to demonstrate the framework of paediatricians' decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.
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Affiliation(s)
- Momoko Sasazuki
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health and Welfare, Seinan Jogakuin University, Kitakyushu, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Naoko Toda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Akamine
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michiko Torio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshito Ishizaki
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Sanefuji
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miho Narama
- Department of Nursing, Kyoto Tachibana University, Kyoto, Japan
| | - Koichiro Itai
- Department of Bio/Medical Ethics, Interdisciplinary Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toshiro Hara
- President, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Hidetoshi Takada
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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De Clercq E, Rost M, Rakic M, Ansari M, Brazzola P, Wangmo T, Elger BS. The conceptual understanding of pediatric palliative care: a Swiss healthcare perspective. BMC Palliat Care 2019; 18:55. [PMID: 31296209 PMCID: PMC6625075 DOI: 10.1186/s12904-019-0438-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background Health care providers’ perception of pediatric palliative care might negatively influence timely implementation. The aim of the study was to examine understanding of and attitudes towards pediatric palliative care from the perspective of health care providers working in pediatric oncology in Switzerland to promote the timely implementation of pediatric palliative care. Methods Five mixed focus groups were conducted with 29 health care providers (oncologists, nurses, psychologists, and social workers) at five Swiss pediatric oncology group centers. The focus group interviews were analyzed using thematic coding. Results Most participants associated pediatric palliative care with non-curative treatment. They regularly reported difficulties in addressing palliative care services to families due to the strong stigma surrounding this term. They also thought that the notion of palliative care is very much linked to a policy context, and difficult to reconcile with children’s everyday life. To overcome these obstacles many participants used synonyms such as comfort or supportive care. A few providers insisted on the need of using palliative care and reported the importance of positive “word of mouth”. Conclusions The use of synonyms might be a pragmatic approach to overcome initial barriers to the implementation of palliative care in pediatrics. However, this tactic might ultimately prove to be ineffective as these terms might acquire the same negative connotations as palliative care. Positive word-of-mouth by satisfied families and healthcare providers might be a more sustainable way to advocate for pediatric palliative care than replacing it with a euphemistic term.
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Affiliation(s)
- Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Basel, Switzerland.
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Basel, Switzerland
| | - Milenko Rakic
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Basel, Switzerland
| | - Marc Ansari
- Division of General Pediatrics Pediatric Oncohematology Unit, Hopitaux Universitaires de Geneve Hopital des enfants, Rue Willy Donzé 6, 1205, Geneva, Switzerland
| | - Pierluigi Brazzola
- Ospedale Regionale di Bellinzona e Valli, Pediatria Bellinzona, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Basel, Switzerland
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20
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Cheng BT, Rost M, De Clercq E, Arnold L, Elger BS, Wangmo T. Palliative care initiation in pediatric oncology patients: A systematic review. Cancer Med 2018; 8:3-12. [PMID: 30525302 PMCID: PMC6346252 DOI: 10.1002/cam4.1907] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/06/2018] [Accepted: 11/08/2018] [Indexed: 02/06/2023] Open
Abstract
Palliative care (PC) aims to improve quality of life for patients and their families. The World Health Organization and American Academy of Pediatrics recommend that PC starts at diagnosis for children with cancer. This systematic review describes studies that reported PC timing in the pediatric oncology population. The following databases were searched: PubMed, Web of Science, CINAHL, and PsycInfo databases. Studies that reported time of PC initiation were independently screened and reviewed by 2 researchers. Studies describing pilot initiatives, published prior to 1998, not written in English, or providing no empirical time information on PC were excluded. Extracted data included sample characteristics and timing of PC discussion and initiation. Of 1120 identified citations, 16 articles met the inclusion criteria and comprised the study cohort. Overall, 54.5% of pediatric oncology patients received any palliative service prior to death. Data revealed PC discussion does not occur until late in the illness trajectory, and PC does not begin until close to time of death. Despite efforts to spur earlier initiation, many pediatric oncology patients do not receive any palliative care service, and those who do, predominantly receive it near the time of death. Delays occur both at first PC discussion and at PC initiation. Efforts for early PC integration must recognize the complex determinants of PC utilization across the illness timeline. This systematic review examines the timing of palliative care initiation in pediatric oncology patients to assess the state of palliative care integration. Many pediatric oncology patients do not receive any palliative service, and those who do, typically receive it late in the illness trajectory.
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Affiliation(s)
- Brian T Cheng
- Department of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Supporting Parent Caregivers of Children with Life-Limiting Illness. CHILDREN-BASEL 2018; 5:children5070085. [PMID: 29949926 PMCID: PMC6069074 DOI: 10.3390/children5070085] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/20/2018] [Indexed: 11/17/2022]
Abstract
The well-being of parents is essential to the well-being of children with life-limiting illness. Parents are vulnerable to a range of negative financial, physical, and psychosocial issues due to caregiving tasks and other stressors related to the illness of their child. Pediatric palliative care practitioners provide good care to children by supporting their parents in decision-making and difficult conversations, by managing pain and other symptoms in the ill child, and by addressing parent and family needs for care coordination, respite, bereavement, and social and emotional support. No matter the design or setting of a pediatric palliative care team, practitioners can seek to provide for parent needs by referral or intervention by the care team.
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Rost M, Acheson E, Kühne T, Ansari M, Pacurari N, Brazzola P, Niggli F, Elger BS, Wangmo T. Palliative care in Swiss pediatric oncology settings: a retrospective analysis of medical records. Support Care Cancer 2018; 26:2707-2715. [PMID: 29478188 DOI: 10.1007/s00520-018-4100-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE This study examined the provision of palliative care and related decision-making in Swiss pediatric oncology settings. The aim was to determine if and when children who died from cancer received palliative care, whether there were differences by cancer diagnosis, and inclusion of children in decision-making regarding palliative care. METHODS Using a standardized data extraction form, a retrospective review of medical records of deceased pediatric patients was conducted. The form captured information on demographics, diagnosis, relapse(s), treatments, decision-making during palliative care, and circumstances surrounding a child's death. RESULTS For 170 patients, there was information on whether the child received palliative care. Among those, 38 cases (22%) did not receive palliative care. For 16 patients, palliative care began at diagnosis. The mean duration of palliative care was 145 days (Mdn = 89.5, SD = 183.4). Decision to begin palliative care was discussed solely with parent(s) in 60.9% of the cases. In 39.1%, the child was involved. These children were 13.6 years of age (SD = 4.6), whereas those not included were 7.16 years old (SD = 3.9). Leukemia patients were less likely to receive palliative care than the overall sample, and patients with CNS neoplasms received palliative care for a longer time than other patients. CONCLUSIONS There are still high numbers of late or non-referrals, and even children older than 12 years were not involved in decision-making regarding palliative care. These results do not align with international organizational guidelines which recommend that palliative care should begin at diagnosis.
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Affiliation(s)
- Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, -4056, Basel, CH, Switzerland.
| | - Elaine Acheson
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, -4056, Basel, CH, Switzerland
| | - Thomas Kühne
- Pediatric Oncology and Hematology, University of Basel Children's Hospital UKBB Basel, Basel, Switzerland
| | - Marc Ansari
- Department of Pediatric, Oncology and Hematology Unit, Geneva University Hospital, Geneva, Switzerland
| | - Nadia Pacurari
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, -4056, Basel, CH, Switzerland
| | - Pierluigi Brazzola
- Ospedale Regionale di Bellinzona e Valli, Pediatria, Bellinzona, Switzerland
| | - Felix Niggli
- Depatment of Pediatric Oncology, University Children's Hospital, Zurich, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, -4056, Basel, CH, Switzerland.,Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, -4056, Basel, CH, Switzerland
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