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Sampath R, Seshadri S, Phan T, Allen R, Duberstein PR, Saeed F. Uncovering Patient and Caregiver Goals for Goal-Concordant Care in Kidney Therapy Decisions. Am J Hosp Palliat Care 2024; 41:1350-1357. [PMID: 38196280 PMCID: PMC11231053 DOI: 10.1177/10499091241227242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
CONTEXT In kidney therapy (KT) decisions, goal-concordant decision-making is recognized to be important, yet alignment with patients' goals during dialysis initiation is not always achieved. OBJECTIVES To explore older patients' and caregivers' hopes, goals, and fears related to KT and communication of these elements with members of their health care team. METHODS The study included patients aged ≥75 years with an estimated glomerular filtration rate ≤25 mL/min/1.73 m2 and their caregivers enrolled in a palliative care intervention for KT decision-making. Patients and caregivers were asked open-ended questions about their hopes, goals, and fears related to KT decisions. A survey assessed if patients shared their goals with members of their health care team. Qualitative data underwent content analysis, supplemented by demographic descriptive statistics. RESULTS The mean age of patients (n = 26) was 82.7 (±5.7) years, and caregivers (n = 15) had a mean age of 66.4 (±13.7) years. Among the participants, 13 patients and 11 caregivers were women, and 20 patients and 12 caregivers were White. Four themes emerged: (1) Maintaining things as good as they are by avoiding dialysis-related burdens; (2) seeking longevity while avoiding dialysis; (3) avoiding pain, symptoms, and body disfigurement; and (4) deferring decision-making. Patients rarely had shared their goals with the key members of their health care team. CONCLUSION Patients and caregivers prioritize maintaining quality of life, deferring decision-making regarding dialysis, and avoiding dialysis-related burdens. These goals are often unshared with their family and health care teams. Given our aging population, urgent action is needed to educate clinicians to actively explore and engage with patient goals in KT decision-making.
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Affiliation(s)
- Ramya Sampath
- Department of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Sandhya Seshadri
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Tramanh Phan
- Departments of Medicine and Public Health, Divisions of Nephrology and Palliative Care, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Fahad Saeed
- Departments of Medicine and Public Health, Divisions of Nephrology and Palliative Care, University of Rochester Medical Center, Rochester, NY, USA
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Calza S, Da Rin Della Mora R, Todeschini A, Petralia P, Scelsi S. A qualitative study of pediatric nurses' perception of factors affecting negotiation of care in a Pediatric Stem Cell Transplant Unit. Minerva Pediatr (Torino) 2024; 76:517-525. [PMID: 33438856 DOI: 10.23736/s2724-5276.20.06165-4] [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: 07/09/2024]
Abstract
BACKGROUND The adoption of a "family centered care" (FCC) philosophy is essential for the care process and its negotiation. A better understanding of nurses' perception of factors that affect the process of negotiation could allow us to better address future interventions and to improve FCC. The purpose of our study was to investigate pediatric nurses' perception of factors that affect the process of negotiation of care with stem cell transplantation pediatric patients and their parents. METHODS A qualitative research design with in-depth interviews was chosen. Sixteen interviews (16 nurses) were audio recorded and transcribed verbatim. Two researchers conducted independently a thematic analysis of the verbatim transcripts of the interviews. RESULTS Four themes emerged from the data as factors that affect the process of negotiation: 1) communication; 2) personal factors; 3) specificity; and 4) organization. CONCLUSIONS These themes represent interesting points for future improvement interventions. Negotiation in the stem cell transplant setting would deserve further research, with special focus on children' and parents' perception of factors affecting this important aspect. Furthermore, in the future, negotiation guidelines could be validated and implemented effectively and an already validated tool could be used to document the negotiation process in the stem cell transplant setting.
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Malaval CI, Cabanillas Stanchi KM, Werle D, Thiel S, Gansel M, Lang P, Handgretinger R, Svaldi J, Döring M. Application of the National Comprehensive Cancer Network-distress thermometer in pediatric patients during autologous and allogeneic hematopoietic stem cell transplantation and relationship to blood parameters of the stress axis. J Cancer Res Clin Oncol 2023; 149:15899-15909. [PMID: 37676266 PMCID: PMC10620269 DOI: 10.1007/s00432-023-05300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Hematopoietic stem cell transplantations (HSCT) are extremely stressful procedures for pediatric patients. The activation of the hypothalamic pituitary adrenocortical axis (HPA) can influence the immune system negatively and therefore the overall outcome. The distress thermometer (DT) is an easy to use tool for the self-assessment of perceived distress. METHODS In this prospective study, a DT with an attached problem list was used in 40 pediatric patients undergoing HSCT and in one parent of each patient. The patients were aged 10-18 years. The patients' cortisol, thyroid stimulating hormone, free triiodothyronine and thyroxine levels were measured regularly during the in-patient stay. RESULTS After admission to the hospital, the stress levels of the pediatric patients and their parents increased and reached their maximum on the day of HSCT. The overall stress values of the parents were higher than those of their children. There was a significant difference in the parents' stress levels on the day of HSCT, as compared to their stress levels on other days. The mean cortisol values of the pediatric patients also increased after admission, reaching significant elevated levels above the upper normal limit 1 week after HSCT and on discharge day. Although the pediatric patients experienced mainly exhaustion, especially on the day of transplantation, their parents mainly felt worry and anxiety. Interestingly, the rate of worry among children increased in the post-transplant period and reached its maximum on the day of discharge. CONCLUSIONS In summary, a significantly increased stress level is shown for both the patients and their parents. This is reflected for the patients both in the DT scores and in the increased cortisol values. For the parents, the focus is primarily on worry and anxiety, for the patients primarily on exhaustion and worry.
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Affiliation(s)
- Carmen Isolde Malaval
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Karin Melanie Cabanillas Stanchi
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Dustin Werle
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Stefanie Thiel
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Melanie Gansel
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Peter Lang
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Rupert Handgretinger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Jennifer Svaldi
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Michaela Döring
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
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Levine DR, Epperly R, Collins G, Talleur AC, Mandrell B, Pritchard M, Sarvode Mothi S, Li C, Lu Z, Baker JN. Integration of Palliative Care in Hematopoietic Cell Transplant: Pediatric Patient and Parent Needs and Attitudes. J Pain Symptom Manage 2023; 66:248-257. [PMID: 37302531 DOI: 10.1016/j.jpainsymman.2023.06.005] [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: 05/01/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
CONTEXT Early integration of palliative care (PC) in hematopoietic cell transplantation (HCT) has demonstrated benefits, yet barriers remain, including perceived lack of patient/caregiver receptivity despite no data on attitudes toward PC and limited patient/caregiver reported outcomes in pediatric HCT. OBJECTIVES This study aimed to evaluate perceived symptom burden and patient/parent attitudes toward early PC integration in pediatric HCT. METHODS Following IRB approval, consent/assent, eligible participants were surveyed at St. Jude Children's Research Hospital including English-speaking patients aged 10-17, 1-month to 1-year from HCT, and their parents/primary-caregivers, as well as parent/primary-caregivers of living HCT recipients RESULTS Eighty one participants, within one year of HCT, at St. Jude Children's Research Hospital were enrolled including: 36 parents of patients CONCLUSION Our findings suggest that patient/family receptivity should not be a barrier to early PC in pediatric HCT; obtaining patient reported outcomes is a priority in the setting of high symptom burden; and robust quality-of-life directed care with early PC integration is both indicated and acceptable to patients/caregivers.
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Affiliation(s)
- Deena R Levine
- Division of Quality-of-life and Palliative Care, Department of Oncology (D.R.L., G.C., J.N.B.), St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Rebecca Epperly
- Department of Bone Marrow Transplantation and Cellular Therapy (R.E., A.C.T.), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Griffin Collins
- Division of Quality-of-life and Palliative Care, Department of Oncology (D.R.L., G.C., J.N.B.), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Aimee C Talleur
- Department of Bone Marrow Transplantation and Cellular Therapy (R.E., A.C.T.), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Belinda Mandrell
- Division of Nursing Research, Department of Pediatric Medicine (B.M., M.P.), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michele Pritchard
- Division of Nursing Research, Department of Pediatric Medicine (B.M., M.P.), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Suraj Sarvode Mothi
- Department of Biostatistics (S.S.M., C.L., Z.L.), St. Jude Children's Research Hospital, Memphis, TN
| | - Chen Li
- Department of Biostatistics (S.S.M., C.L., Z.L.), St. Jude Children's Research Hospital, Memphis, TN
| | - Zhaohua Lu
- Department of Biostatistics (S.S.M., C.L., Z.L.), St. Jude Children's Research Hospital, Memphis, TN
| | - Justin N Baker
- Division of Quality-of-life and Palliative Care, Department of Oncology (D.R.L., G.C., J.N.B.), St. Jude Children's Research Hospital, Memphis, TN, USA
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Feudtner C, Beight LJ, Boyden JY, Hill DL, Hinds PS, Johnston EE, Friebert SE, Bogetz JF, Kang TI, Hall M, Nye RT, Wolfe J. Goals of Care Among Parents of Children Receiving Palliative Care. JAMA Pediatr 2023; 177:800-807. [PMID: 37306979 PMCID: PMC10262061 DOI: 10.1001/jamapediatrics.2023.1602] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/15/2023] [Indexed: 06/13/2023]
Abstract
Importance While knowing the goals of care (GOCs) for children receiving pediatric palliative care (PPC) are crucial for guiding the care they receive, how parents prioritize these goals and how their priorities may change over time is not known. Objective To determine parental prioritization of GOCs and patterns of change over time for parents of children receiving palliative care. Design, Setting, and Participants A Pediatric Palliative Care Research Network's Shared Data and Research cohort study with data collected at 0, 2, 6, 12, 18, and 24 months in hospital, outpatient, or home settings from April 10, 2017, to February 15, 2022, at 7 PPC programs based at children's hospitals across the US. Participants included parents of patients, birth to 30 years of age, who received PPC services. Exposures Analyses were adjusted for demographic characteristics, number of complex chronic conditions, and time enrolled in PPC. Main Outcomes Parents' importance scores, as measured using a discrete choice experiment, of 5 preselected GOCs: seeking quality of life (QOL), health, comfort, disease modification, or life extension. Importance scores for the 5 GOCs summed to 100. Results A total of 680 parents of 603 patients reported on GOCs. Median patient age was 4.4 (IQR, 0.8-13.2) years and 320 patients were male (53.1%). At baseline, parents scored QOL as the most important goal (mean score, 31.5 [SD, 8.4]), followed by health (26.3 [SD, 7.5]), comfort (22.4 [SD, 11.7]), disease modification (10.9 [SD, 9.2]), and life extension (8.9 [SD, 9.9]). Importantly, parents varied substantially in their baseline scores for each goal (IQRs more than 9.4), but across patients in different complex chronic conditions categories, the mean scores varied only slightly (means differ 8.7 or less). For each additional study month since PPC initiation, QOL was scored higher by 0.06 (95% CI, 0.04-0.08) and comfort scored higher by 0.3 (95% CI, 0-0.06), while the importance score for life extension decreased by 0.07 (95% CI, 0.04-0.09) and disease modification by 0.02 (95% CI, 0-0.04); health scores did not significantly differ from PPC initiation. Conclusions and Relevance Parents of children receiving PPC placed the highest value on QOL, but with considerable individual-level variation and substantial change over time. These findings emphasize the importance of reassessing GOCs with parents to guide appropriate clinical intervention.
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Affiliation(s)
- Chris Feudtner
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Leah J. Beight
- Doctor of Medicine Program, Georgetown University School of Medicine, Washington, DC
| | - Jackelyn Y. Boyden
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia
| | - Douglas L. Hill
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pamela S. Hinds
- Children’s National Hospital, Department of Nursing Science, Professional Practice & Quality, Department of Pediatrics, the George Washington University, Washington, DC
| | - Emily E. Johnston
- Department of Pediatrics, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham
| | - Sarah E. Friebert
- Department of Pediatrics, Division of Palliative Care, Akron Children’s Hospital and Rebecca D. Considine Research Institute, Akron, Ohio
| | - Jori F. Bogetz
- Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle
| | - Tammy I. Kang
- Department of Pediatrics, Section of Palliative Care, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Russell T. Nye
- Justin Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute and Department of Pediatrics Boston Children’s Hospital, Boston, Massachusetts
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Tang Y, Hua Y, Huang X, Cao Y, Sun X. Psychological Burden of Patients with Head and Neck Cancer Undergoing Radiotherapy and Their Family Caregivers: A Cross-Sectional Survey. J Multidiscip Healthc 2023; 16:927-935. [PMID: 37051506 PMCID: PMC10083181 DOI: 10.2147/jmdh.s398064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/22/2023] [Indexed: 04/07/2023] Open
Abstract
Background The consequences of Head and neck cancer (HNC) affect both the person who receives the diagnosis and their family caregivers (FCs). Objective To investigate the psychological status of patients and their FCs, and the burden of the FCs during radiotherapy. Methods This cross-sectional study was conducted with a questionnaire survey by convenience sampling method. Patients with HNC and their caregivers (both N = 85) from the radiotherapy department of our hospital were recruited between March 2021 and March 2022. The Hospital Anxiety and Depression Scale (HADS), the Chinese version of the Connor and Davidson Resilience Scale (CD-RISC), and the Zarit Burden Interview (ZBI) were used to assess the symptoms of anxiety and depression, psychological resilience, and the impact of care work, emotions and social lives of participants. Pearson's correlation analysis and a Mann-Whitney test were used to analyse the association between the HADS and the CD-RISC scores of the patients. Results About half of the patients (56.47%) and the caregivers (62.35%) have had anxiety. The average HADS-Anxiety scores, HADS-Depression scores, and CD-RISC scores of the patients with HNC were 7.4±1.9, 6.4±2.2, and 56.8±12.6. The "Strength" and "Resilience" scores of the patients were inversely related to their HADS anxiety scores (p < 0.05). The "Resilience" and "optimism" scores of them were inversely related to HADS depression scores (p < 0.05). The average ZBI score of the caregivers was 23.8±10.1; HADS anxiety scores and HADS depression scores of the caregivers were positively associated with total ZBI scores and individual burden scores (p < 0.05). Conclusion More than half of patients with HNC undergoing radiotherapy have anxiety, and about a third have depression. The anxiety and depression status of the FCs of patients with HNC undergoing radiotherapy is related to caregiver burden, deserving the attention of clinical medical staff.
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Affiliation(s)
- Yuanyuan Tang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Yuchen Hua
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Xiaoping Huang
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Yuandong Cao
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Xinchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
- Correspondence: Xinchen Sun, Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, People’s Republic of China, Tel +86 25 68305696, Email
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Papasarantopoulou A, Polikandrioti M, Dousis E, Evagelou E, Zartaloudi A, Dafogianni C, Misouridou E, Pavlatou N, Mintzaridis K, Koutelekos I. Anxiety and Depression in Parents of Children Undergoing Hematopoietic Stem Cell Transplant (HSCT). ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:31-46. [PMID: 37581779 DOI: 10.1007/978-3-031-31986-0_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) is a well-established therapy tool for several malignant and non-malignant diseases. Parents of children undergoing HSCT experience physiological distress for various reasons such as intensive caregiving, potential complications, and medically intensive process. The purpose of this study was to explore anxiety/depression in parents of children who underwent HSCT and the associated self-reported characteristics. METHOD AND MATERIAL In the present study were enrolled 100 parents of children who underwent HSCT. Data were collected by the completion of the "Hospital Anxiety and Depression Scale (HADs)," which also included parents' characteristics. The statistical significance level was p < 0.05. RESULTS Of the 100 participants, 81% and 64% of parents experienced anxiety and depression, respectively, based on HADs scores. A statistically significant association was observed between parental anxiety and gender (p = 0.017), frequency of visiting the hospitalized child (p = 0.023), whether they desired family members to remain in hospital (p = 0.033), as well as with the need for participation in daily care (p = 0.023), for help based on personal needs (p = 0.026), for scheduled meetings with parents having same problems (p = 0.006), for contact with hospital after discharge (p = 0.035), and for written information (p = 0.044). In terms of depression, a statistically significant association was observed with difficulties during the hospital stay (p = 0.034), whether they desired other family members to remain in hospital (p = 0.009), as well as with the need for opportunities or time for questions (p = 0.004), for scheduled meetings with parents having the same problems (p = 0.026), and for contact with hospital after discharge (p = 0.038). CONCLUSION Anxiety and depression were associated with possibility of family members to remain in the hospital as well as with the need for scheduled meetings with parents having the same problems and for contact after hospital discharge. Based on the findings presented, it is suggested that understanding parents' needs and perceptions is fundamental to the development of appropriate interventions that address their worries.
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Affiliation(s)
| | | | - Evangelos Dousis
- Department of Nursing, University of West Attica, Athens, Greece
| | - Eleni Evagelou
- Department of Nursing, University of West Attica, Athens, Greece
| | | | | | | | - Niki Pavlatou
- Department of Nursing, University of West Attica, Athens, Greece
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Addressing Common Pain Syndromes in Pediatric Stem Cell Transplant: A Review. CHILDREN 2022; 9:children9020139. [PMID: 35204860 PMCID: PMC8870628 DOI: 10.3390/children9020139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/08/2022] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Abstract
Assessment and management of pain for pediatric patients receiving stem cell transplants can be challenging for a health care team. Diagnostic evaluation and interventions vary between institutions and individual provider practices. In this review, we investigate and describe approaches to pain management for the most common sources of pain in pediatric patients undergoing stem cell transplants. Mucositis pain, abdominal pain, and hemorrhagic cystitis emerged as the most frequent sources of acute pain in children during conditioning and transplantation periods. Furthermore, psychosocial distress and psychological pain or distress constitute significant components of the total pain experienced by children undergoing stem cell transplantation. We will expand upon appropriate usage and escalation of opioids, as well as complementary interventions and timely initiation of interventions, in order to help control pain in these clinical syndromes.
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Collins GS, Beaman H, Ho AM, Hermiston ML, Cohen HJ, Dzeng EW. Perceptions of specialty palliative care and its role in pediatric stem cell transplant: A multidisciplinary qualitative study. Pediatr Blood Cancer 2022; 69:e29424. [PMID: 34705322 DOI: 10.1002/pbc.29424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Consultation of specialty palliative care remains uncommon in pediatric stem cell transplant (SCT) despite growing evidence that early integration of palliative care improves outcomes in patients with advanced cancers or undergoing SCT. Little is known about how multidisciplinary pediatric SCT teams perceive palliative care and its role in SCT. PROCEDURE We conducted semistructured interviews of members of a multi-disciplinary SCT team to understand their perceptions of palliative care, how specialty palliative care is integrated into SCT, and to identify barriers to increased integration. Eligible participants included physicians, nurses, inpatient nurse practitioners, social workers, and child life specialists. Data were analyzed using thematic analysis. RESULTS Four major themes were identified. First, SCT team members held a favorable perception of the palliative care team. Second, participants desired increased palliative care integration in SCT. Third, participants believed that the palliative care team had insufficient resources to care for the large number of SCT patients, which led to the SCT team limiting palliative care consultation. And, finally, the lack of a standardized palliative care consultation process prevented greater integration of palliative care in SCT. CONCLUSIONS SCT team members held a favorable perception of palliative care and saw a role for greater palliative care integration throughout the SCT course. We identified modifiable barriers to greater palliative care integration. SCT teams who desire greater palliative care integration may adapt and implement an existing model of palliative care integration in order to improve standardization and increase integration of specialty palliative care in SCT.
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Affiliation(s)
- Griffin S Collins
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Hannah Beaman
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Alvin M Ho
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michelle L Hermiston
- Division of Pediatric Allergy, Immunology, and Bone Marrow Transplant, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Harvey J Cohen
- Division of Pediatric Hematology and Oncology, Stanford University, Palo Alto, California, USA
| | - Elizabeth W Dzeng
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,Cicely Saunders Institute, King's College London, London, UK
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Koch A, Kozhumam AS, Seeler E, Docherty SL, Brandon D. Multiple Roles of Parental Caregivers of Children with Complex Life-Threatening Conditions: A Qualitative Descriptive Analysis. J Pediatr Nurs 2021; 61:67-74. [PMID: 33780717 PMCID: PMC8464614 DOI: 10.1016/j.pedn.2021.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Children born with Complex Life-Threatening Conditions (CLTCs) often require complex and specialized services. Parents of children with CLTCs balance the role of caregiver with other responsibilities of employment, education, relationships, and self-care. The purpose of this paper is to describe the challenges for parents serving as caregivers of children with CLTCs and their intersection with health care provider expectations through utilization and adaptation of the role theory framework. DESIGN/METHODS We employed a qualitative descriptive design, secondary analysis of a longitudinal study on parent and provider decision making for children with CLTC. There were 218 interviews from sixty-one parents of 35 infants with prematurity, bone marrow transplant, and/or complex cardiac disease, followed for one year unless death occurred. Content analysis and thematic generation were performed capturing the various parental roles embedded within provider expectations of informal parental caregiving. RESULTS Results showed that parents of children with CLTCs serve multidimensional roles, including that of informal nurse and care coordinator, while maintaining additional personal roles as parent and family provider. Parents experienced challenges as caregivers that were shaped by perceived expectations of health care providers as well as lack of support, often leading to role strain, conflict, overload, and sometimes exit. CONCLUSIONS Parents of children with CLTCs experience both common and unique challenges inn balancing multiple roles as an informal caregiver. Despite utilizing positive coping mechanisms, their status as parent caregiver carries significant risk for role strain and overload. We recommend the implementation of strategies for increasing parental support and family-centered care.
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Affiliation(s)
- Amie Koch
- Duke University School of Nursing, Family Nurse Practitioner Transitions Lifecare, Nurse Practitioner Lincoln Community Health Clinic, NC, United States of America.
| | - Arthi S Kozhumam
- Duke University, Global Health Institute, NC, United States of America
| | - Erika Seeler
- Duke University, School of Nursing, NC, United States of America
| | | | - Debra Brandon
- Duke University, School of Nursing, NC, United States of America
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