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Sousa FP, Roldão MG, Rebotim AM, Figueira AR, Barbosa J, Fradique E, Santos Curado MA. The Neonatal Palliative Care Attitude Scale: Psychometric properties for Portuguese neonatal nurses. Palliat Support Care 2024; 22:571-576. [PMID: 35818713 DOI: 10.1017/s1478951522000797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This study is aimed to perform the translation and cultural adaptation of the Neonatal Palliative Care Attitude Scale (NiPCAS) and evaluation of its psychometric properties with Portuguese neonatal nurses. METHODS The research started with a scoping review that allowed the identification of the NiPCAS. It was a methodological study with a quantitative approach. The semantic equivalence of the items was adjusted with the participation of 20 neonatal nurse experts. They performed facial and quantitative content validation. Psychometric validation of the NiPCAS was performed on a nonprobability nurses sample (n = 283) in 13 level 3 neonatal units between July 2021 and February 2022. Confirmatory factor analysis using the polychoric correlation matrix was performed to estimate factor validity using the "lavaan" package for R statistical software. Internal consistency was estimated using Cronbach's alpha coefficient, and item sensitivity was assessed using the asymmetry and kurtosis coefficients. Empirical indices were considered: chi-square over degrees of freedom; comparative fit index; normed fit index; Tucker-Lewis index, and root mean square error of approximation; average extracted variance and composite reliability were used to assess convergent validity. RESULTS Asymmetry and kurtosis were <|3| and <|7|, respectively, suggesting psychometric sensitivity. The convergent validity of the factors was: F1, FCF1 = 0.90 and for F2, FCF2 = 0.80, and a lower value for F3, FCF3 = 0.40. According to the squared correlation criterion average variance extracted (AVE) between the factors, there was no discriminant validity for F1 and F2, but there was discriminant validity for F1, F3, F2, and F3. SIGNIFICANCE OF RESULTS This instrument has implications for providing end-of-life care to newborns and their families. The use of this instrument reveals several barriers and facilitating elements inherent in the organization and culture of the facility and nursing education.
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Affiliation(s)
- Fátima Pacheco Sousa
- Neonatal Intensive Care Unit, North Lisbon University Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Maria Graça Roldão
- Neonatal Intensive Care Unit, North Lisbon University Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Ana Marisa Rebotim
- Neonatal Intensive Care Unit, North Lisbon University Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
| | - Ana Rita Figueira
- Neonatal Intensive Care Unit, North Lisbon University Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
| | - Joana Barbosa
- Neonatal Intensive Care Unit, North Lisbon University Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
| | - Emília Fradique
- Neonatal Intensive Care Unit, North Lisbon University Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
| | - Maria Alice Santos Curado
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
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Lykke C, Ekholm O, Olsen M, Sjøgren P. Paediatric end-of-life care - symptoms and problems: parent assessment. BMJ Support Palliat Care 2023; 13:e327-e333. [PMID: 33707300 DOI: 10.1136/bmjspcare-2021-002891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Symptoms and problems (S&P) are under-reported in children in end-of-life care.To target future interventions, the primary aim was to examine S&P in children in end-of-life care. METHODS All parents, who lost a child under the age of 18 years due to life-limiting diagnoses in the period 2012-2014 in Denmark, were invited to complete a self-administered questionnaire in 2017. In all, 152 (38%) children were represented by 136 mothers and 57 fathers. In the present study, parents' assessments of S&P during the last month of life were restricted to children aged 3-18 years. Data were analyses by means of descriptive statistics. RESULTS Children ≥3 years at the time of death were represented by 71 parents (48 mothers and 23 fathers) representing 56 out of the 152 children. Physical fatigue (93%), sleepiness (90%), poor appetite (87%), pain (84%) and nausea (84%) were the five most frequent symptoms reported by the parents. In all, 65% of the parents reported that satisfactory pain relief was obtained and 64% of the parents reported that the healthcare services to a large extent reacted quickly, when the child and/or family needed help. However, 46% of the parents experienced 'mess-ups' or sloppy services in the primary ward and 27% experienced that the children suffered from fear of death. CONCLUSION According to the parents, children with life-limiting diagnosis are highly symptomatic and have substantial problems during end-of-life care. Our findings indicate that systematic screening of S&P in children should be considered.
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Affiliation(s)
- Camilla Lykke
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology and Palliative Care, Nordsjællands Hospital, Hillerod, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Marianne Olsen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
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Correia ME, Melo T, Nobre J. Grieving Experiences of Parents with Children in End-of-Life Care—A Qualitative Review Protocol. NURSING REPORTS 2022; 12:426-430. [PMID: 35894031 PMCID: PMC9326657 DOI: 10.3390/nursrep12030041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Parents that accompany their children in end-of-life care until death go through a devastating, complex and vulnerable situation, which is experienced in a unique way and with individual needs, given the specificity of the palliative care setting in which it occurs. This qualitative review aims to identify and synthesize the best evidence available on the grieving experiences of parents with children in end-of-life care in a palliative care setting. This qualitative review protocol is according to the review method proposed by the Joanna Briggs Institute. The results will enable us to identify how parents of children in end-of-life care in a palliative care setting experience their grieving process. This review will broaden the horizon of understanding of the specificities of the grieving experience of parents who have accompanied their children in end-of-life care until their death in a palliative care setting and promote research in this context. The results of the review will also allow the construction of an “end-of-life grieving script”, with the aim of identifying one’s individuality in the grieving process. This protocol is registered at Open Science Framework.
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Affiliation(s)
- Maria Eduarda Correia
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1990-096 Lisboa, Portugal
- Health School, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal;
- Correspondence:
| | - Tânia Melo
- Paediatric Hospital of the Centro Hospitalar e Universitário de Coimbra, 3000-602 Coimbra, Portugal;
- Nursing School of Coimbra, 3000-232 Coimbra, Portugal
| | - Joana Nobre
- Health School, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal;
- VALORIZA—Research Centre for Endogenous Resource Valorization, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal
- Nursing Research Unit for South and Islands (NURSE’IN), 2914-503 Setubal, Portugal
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Winger A, Früh EA, Holmen H, Kvarme LG, Lee A, Lorentsen VB, Misvær N, Riiser K, Steindal SA. Making room for life and death at the same time - a qualitative study of health and social care professionals' understanding and use of the concept of paediatric palliative care. BMC Palliat Care 2022; 21:50. [PMID: 35410275 PMCID: PMC9004044 DOI: 10.1186/s12904-022-00933-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept of pediatric palliative care (PPC) is applied differently within the healthcare system and among healthcare professionals (HCPs). To our knowledge, no studies have investigated how multidisciplinary HCPs understand the concept of PPC and the aim of this study was to explore the concept of PPC from the view of HCP in a paediatric setting. METHODS We employed an explorative and descriptive design and conducted four focus groups with a total of 21 HCPs working in hospitals with children in palliative care. The data were analysed using qualitative content analysis. RESULTS The data analysis of the concept of pediatric palliative care resulted in two themes. The first theme "A frightening concept that evokes negative emotions," contains categories to explore the meaning, named "An unfamiliar and not meaningful concept, "A concept still associated with death and dying" and "Healthcare professionals' responsibility for introducing and using the concept and, to obtain a common meaning." The second theme was named "A broad and complementary concept," containing the categories "Total care for the child and the family," "Making room for life and death at the same time" and "The meaning of alleviation and palliative care." CONCLUSIONS The included HCPs reflected differently around PPC but most of them highlighted quality of life, total care for the child and the child's family and interdisciplinary collaboration as core elements. Attention to and knowledge among HCPs might change the perception about PPC from a frightening concept to one that is accepted by all parties, implemented in practice and used as intended. However, our study reveals that there is still some work to do before PPC is understood and accepted by all those involved.
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Affiliation(s)
- Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway.
| | - Elena Albertini Früh
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Anja Lee
- Oslo University Hospital, Oslo, Norway
| | | | - Nina Misvær
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Kirsti Riiser
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Simen A Steindal
- VID Specialized University, Oslo, Norway.,Lovisenberg Diaconal University College, Oslo, Norway
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Grunauer M, Mikesell C, Bustamante G, Cobo G, Sánchez S, Román AM, Icaza-Freire AP, Gavilanes AWD, Wang NE. Pain Assessment and Management in Pediatric Intensive Care Units Around the World, an International, Multicenter Study. Front Pediatr 2021; 9:746489. [PMID: 34778135 PMCID: PMC8581242 DOI: 10.3389/fped.2021.746489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/04/2021] [Indexed: 12/11/2022] Open
Abstract
The adequate assessment and management of pain remains a challenging task in the Pediatric Intensive Care Unit (PICU). Our goal is to describe how pain is assessed and managed in PICUs around the world and to examine how human and material resources impact achievement of this goal. An international multicenter cross-sectional observational study was designed with the participation of 34 PICUs located in urban, suburban, and rural areas of 18 countries. We evaluated how PICUs around the world assessed and managed pain according to the Initiative for Pediatric Palliative Care recommendations, and how human and material resources impacted achievement of this goal. Data was collected for this study from 2016 to 2018 using questionnaires completed by medical doctors and nurses. In this paper, we focus on the indicators related to how pain is managed and assessed. The average achievement of the goal of pain relief across all centers was 72.2% (SD: 21.1). We found a statistically significant trend of more effective pain management scores, routine assessment, proper documentation, and involvement of pain management experts by increasing country income. While there are efforts being made worldwide to improve the knowledge in pain assessment and management, there is a lack of resources to do so appropriately in low-middle-income countries. There is a mismatch between the existing guidelines and policies, which are mainly designed in high income countries, and the resources available in lower resourced environments.
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Affiliation(s)
- Michelle Grunauer
- School of Medicine, Universidad San Francisco de Quito USFQ, Quito, Ecuador
- Pediatric Intensive Care Unit, Hospital de los Valles, Quito, Ecuador
| | - Caley Mikesell
- School of Medicine, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | | | - Gissela Cobo
- School of Medicine, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Sebastián Sánchez
- School of Medicine, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Ana María Román
- School of Medicine, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | | | | | - Nancy Ewen Wang
- Emergency Medicine, Stanford University School of Medicine, Stanford, CA, United States
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Horton DB, Salas J, Wec A, Kohlheim M, Kapadia P, Beukelman T, Boneparth A, Haverkamp K, Mannion ML, Moorthy LN, Ringold S, Rosenthal M. Making Decisions About Stopping Medicines for Well-Controlled Juvenile Idiopathic Arthritis: A Mixed-Methods Study of Patients and Caregivers. Arthritis Care Res (Hoboken) 2021; 73:374-385. [PMID: 31880862 PMCID: PMC7319899 DOI: 10.1002/acr.24129] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Improved treatments for juvenile idiopathic arthritis (JIA) have increased remission rates. We conducted this study to investigate how patients and caregivers make decisions about stopping medications when JIA is inactive. METHODS We performed a mixed-methods study of caregivers and patients affected by JIA, recruited through social media and flyers, and selected by purposive sampling. Participants discussed their experiences with JIA, medications, and decision-making through recorded telephone interviews. Of 44 interviewees, 20 were patients (50% ages <18 years), and 24 were caregivers (50% caring for children ages ≤10 years). We evaluated characteristics associated with high levels of reported concerns about JIA or medicines using Fisher's exact testing. RESULTS Decisions about stopping medicines were informed by competing risks between disease activity and treatment. Participants who expressed more concerns about JIA were more likely to report disease-related complications (P = 0.002) and more motivated to continue treatment. However, participants expressing more concern about medicines were more likely to report treatment-related complications (P = 0.04) and felt more compelled to stop treatment. Additionally, participants considered how JIA or treatments facilitated or interfered with their sense of normalcy and safety, expressed feelings of guilt and regret about previous or potential adverse events, and reflected on uncertainty and unpredictability of future harms. Decision-making was also informed by trust in rheumatologists and other information sources (e.g., family and online support groups). CONCLUSION When deciding whether to stop medicines whenever JIA is inactive, patients and caregivers weigh competing risks between disease activity and treatment. Based on our results, we suggest specific approaches for clinicians to perform shared decision-making regarding stopping medicines for JIA.
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Affiliation(s)
- Daniel B. Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Jomaira Salas
- Department of Sociology, Rutgers University, New Brunswick, NJ, USA
| | | | - Melanie Kohlheim
- Pediatric Rheumatology Care and Outcomes Improvement Network, Cincinnati, OH, USA
| | - Pooja Kapadia
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | | | | | - Ky Haverkamp
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - L. Nandini Moorthy
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Marsha Rosenthal
- Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
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Dunbar H, Carter B. Experiencing place identity and place belongingness at a children's hospice: Parents' perspectives. J Child Health Care 2021; 25:161-171. [PMID: 32216572 DOI: 10.1177/1367493520915134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children's hospices are key players in the provision of palliative care services for families with children with life-limiting conditions (LLCs). However, evidence suggests that some of the negative terminology/language which surrounds the notions of palliative and hospice care may contribute to the lack of uptake of hospice services by families. This article reports two elements of place bonding: parents' experiences of place identity and place belongingness at a children's hospice in a region in England. Underpinned by a constructivist grounded theory methodology, focus groups were undertaken with 24 parents of children with LLCs accessing a children's hospice. Despite initial reservations associated with the identity of the hospice, parents described how and why their view changed and therefore consequently how they were able to experience the hospice differently. This article demonstrates how parents' views of the identity of the hospice change and how the hospice becomes a place where parents experience a sense of belongingness.
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Affiliation(s)
- Helena Dunbar
- Leicester School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
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Krikheli L, Erickson S, Carey LB, Carey-Sargeant CL, Mathisen BA. Speech-Language Pathologists in Pediatric Palliative Care: An International Study of Perceptions and Experiences. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:150-168. [PMID: 33352058 DOI: 10.1044/2020_ajslp-20-00090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The purpose of this study is to gather qualitative data regarding the experiences and perceptions of speech-language pathologists (SLPs) practicing in pediatric palliative care (PPC) and investigate their approaches for working with patients, families, and the multidisciplinary team. Method Ten participants from Australia, Canada, and the United States were recruited from a previous survey study. In-depth interviews were conducted via videoconferencing. Two coders used NVivo software to record and organize the data into themes. Interrater reliability of the coding was established with a third coder. The COnsolidated criteria for REporting Qualitative research 32-item checklist has been used for reporting the research. Results Interrater coding reliability (using weighted kappa) was .81, indicating "almost perfect" agreement on the selection of themes from the code frame. Emerging themes included clinical interventions, unique SLP skills in PPC, multidisciplinary team relationships, workforce issues, education and training, governance, medicolegal considerations, bioethical issues, and holistic care. Additional subthemes are also noted. In the absence of research evidence and practice recommendations, SLPs rely on client perspectives and clinical experience to guide their professional practice in PPC. Conclusions Qualitative survey analysis of the perceptions and experiences of SLP clinicians from three postindustrial countries identified nine major themes regarding PPC. Results expand on limited literature to date in the area of PPC. Future research using larger samples is needed to provide clinicians with best practice recommendations for working with patients, families, and the broader care team.
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Affiliation(s)
- Lillian Krikheli
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Shane Erickson
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Lindsay B Carey
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Christa L Carey-Sargeant
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- School of Audiology and Speech Pathology, University of Melbourne, Victoria, Australia
| | - Bernice A Mathisen
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Speech Pathology, School of Health and Human Sciences, Southern Cross University, East Lismore, New South Wales, Australia
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Radford C, Marshall J, Herbert A, Irving H, Weir K. Risk Feeding: An Australian Pediatric Palliative Care Perspective. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-19-00032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
This article explores the challenges of risk feeding from an Australian Paediatric Palliative Care perspective. There is currently limited evidence to guide risk feeding in pediatric clinical practice. Therefore, this article uses evidence from the adult palliative and end-of-life care context (extrapolating to pediatric application), in addition to the authors' clinical experience in supporting children and their families with risk feeding. Recommendations for the clinical management of pediatric risk feeding are discussed, including the suggested focus for families and the interprofessional team along the different phases of the palliative care continuum.
Conclusion
There is currently limited information to guide decision making regarding risk feeding in pediatrics. Overall, in the absence of evidence-based practice guidelines, it is the authors' recommendation that a risk feeding plan is developed in consultation and collaboration with the family, treating physician, and interprofessional team. Further research is required to support guidance for clinicians working in this area.
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Affiliation(s)
- Claire Radford
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Jeanne Marshall
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Anthony Herbert
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Helen Irving
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kelly Weir
- Gold Coast Hospital and Health Service, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Krikheli L, Carey LB, Mathisen BA, Erickson S, Carey-Sargeant CL. Speech-language pathologists in paediatric palliative care: a Delphi study protocol. BMJ Support Palliat Care 2018; 10:e43. [DOI: 10.1136/bmjspcare-2018-001667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/12/2018] [Accepted: 10/24/2018] [Indexed: 11/04/2022]
Abstract
BackgroundGiven the dearth of literature and no clinical practice guidelines written for speech-language pathologists (SLPs) working in paediatric palliative care (PPC), a need has been identified to explore the scope of clinical practice and strategies used by SLPs.ObjectiveThis study aims to undertake an international investigation into the role and scope of practice of SLPs working in PPC to develop consensus-driven ‘Recommendations for Speech-Language Pathologists in Paediatric Palliative Care Teams’ (ReSP3CT).MethodsA modified Delphi process will be used to synthesise consensus-based statements from SLPs in six different countries about their role and practice working in PPC. Initially, preliminary survey data will be collected from SLPs to obtain demographic and caseload information. Respondents will then be invited to participate in an in-depth interview to explore common and unique themes that emerge from the online survey. Participants from the interview will then ‘opt-in’ to become Delphi panel members and receive questionnaires comprising statements for agreement over multiple rounds. Statements will be based on common themes that arise from the literature review, survey and interview data. The Delphi process for each statement will stop if statements achieve ≥ 70 % agreement and an IQR of ≤ 1 (maximum of five rounds).ConclusionThis is the first study to investigate the role and practice of SLPs in PPC across internationally accepted scope of practice areas. The study will use existing frameworks for statistical analysis and a mixed-methods approach to aid in the synthesis of statements/recommendations for international consensus.
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Baenziger PH, Moody K. Palliative Care for Children with Central Nervous System Malignancies. Bioengineering (Basel) 2018; 5:bioengineering5040085. [PMID: 30322131 PMCID: PMC6315897 DOI: 10.3390/bioengineering5040085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023] Open
Abstract
Children with central nervous system (CNS) malignancies often suffer from high symptom burden and risk of death. Pediatric palliative care is a medical specialty, provided by an interdisciplinary team, which focuses on enhancing quality of life and minimizing suffering for children with life-threatening or life-limiting disease, and their families. Primary palliative care skills, which include basic symptom management, facilitation of goals-of-care discussions, and transition to hospice, can and should be developed by all providers of neuro-oncology care. This chapter will review the fundamentals of providing primary pediatric palliative care.
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Affiliation(s)
- Peter H Baenziger
- Peyton Manning Children's Hospital, Ascension St. Vincent, 2001 West 86th Street, Indianapolis, IN 46260, USA.
| | - Karen Moody
- MD Anderson Cancer Center, University of Texas, 1515 Holcomb Blvd., Unit 87, Houston, TX 77030, USA.
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Krikheli L, Mathisen BA, Carey LB. Speech-language pathology in paediatric palliative care: A scoping review of role and practice. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:541-553. [PMID: 28665209 DOI: 10.1080/17549507.2017.1337225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/17/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Attempts have been made within the literature to clarify the role and scope of speech-language pathologists (SLPs) within paediatric palliative care (PPC). As SLP literature regarding adult/geriatric populations is gaining traction, it is fitting to investigate the role of SLPs in the management of infants and children in end-of-life care. METHOD Arksey and O'Malley's ( 2005 ) scoping review method was utilised for searching multiple databases. Two database searches were undertaken. The first located literature in which SLP PPC intervention is specifically addressed. The second search utilised internationally recognised SLP scope of practice areas. Manual searching of reference lists was also utilised. RESULT Themes identified included management of communication, feeding, upper-airway and oral health as well as the role of SLPs within a multidisciplinary PPC team. CONCLUSION There is acknowledgement that SLPs have a role in PPC. However, there is little information identifying SLP involvement in the diagnosis and management of swallowing, cognition/communication, oral hygiene and upper airway issues. The available literature predominantly relies on limited adult palliative care research and does not address age-specific management approaches across the paediatric life-stage. Given an absence of SLP PPC guidelines, further research is warranted to explicitly define SLP scope of practice within this population.
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Affiliation(s)
- Lillian Krikheli
- a Palliative Care Unit, School of Psychology and Public Health , La Trobe University , Melbourne , Australia
- b Cabrini Health , Victoria , Australia , and
| | - Bernice A Mathisen
- c Department of Community and Allied Health , La Trobe Rural Health School, La Trobe University , Bendigo , Australia
| | - Lindsay B Carey
- a Palliative Care Unit, School of Psychology and Public Health , La Trobe University , Melbourne , Australia
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13
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Thomas R, Phillips M, Hamilton RJ. Pain Management in the Pediatric Palliative Care Population. J Nurs Scholarsh 2018; 50:375-382. [PMID: 29729653 DOI: 10.1111/jnu.12389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this integrative review was to identify, review, synthesize, and analyze the current literature related to pain management in the pediatric palliative care population from infancy through adolescence. METHODS The literature was searched for the terms palliative, pediatric, and pain in PubMed, PsycINFO, Cumulative Index to Nursing and Allied HeALTH LITERATUre (CINAHL) Complete, and Google Scholar. The search was limited to papers in English that had been published from January 1, 2005, to December 31, 2016. RESULTS These searches resulted in 918 articles, of which 29 met inclusion criteria. These 29 articles were reviewed and reported. Four broad themes emerged: patient and family experience, pain assessment, pharmacological pain management, and nonpharmaceutical interventions. CONCLUSIONS Gaps in current research have been identified, such as investigating pediatric pain scales for the palliative care population and new complementary and alternative medical therapy and other interventions. More research is needed to bring innovative pain management interventions to the attention of pediatric caregivers. CLINICAL RELEVANCE A better understanding of current research on pain in the pediatric palliative care population can improve patient care and lead to better research in this specialty field.
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Affiliation(s)
- Rene Thomas
- Doctoral Student, Rush University College of Nursing, Chicago, IL, USA
| | - Marcia Phillips
- Assistant Professor, Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, IL, USA
| | - Rebekah J Hamilton
- Professor, Department of Women, Children, and Family Nursing, Rush University College of Nursing, Chicago, IL, USA
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Abstract
OBJECTIVES Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process. METHODS A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed. RESULTS Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child's condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people's actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention. Significance of results A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular emotional and practical implications for parents. Greater understanding of this stage can improve clinician's support for parents as they care for their child.
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Bösch A, Wager J, Zernikow B, Thalemann R, Frenzel H, Krude H, Reindl T. Life-Limiting Conditions at a University Pediatric Tertiary Care Center: A Cross-Sectional Study. J Palliat Med 2018; 21:169-176. [PMID: 29297749 DOI: 10.1089/jpm.2017.0020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increasing number of children with life-threatening and life-limiting conditions requires an individualized approach and additional supportive care in hospitals. However, these patients' characteristics and their prevalence in a pediatric tertiary hospital setting have not been systematically analyzed. OBJECTIVE This study aimed to determine the proportion of hospitalized children who are receiving care for life-threatening diseases with feasible curative treatments and for life-limiting diseases (LLDs) with inevitable premature death as opposed to care for acute or chronic diseases; additionally, it sought to compare patient characteristics, clinical features, and symptoms within these subgroups. DESIGN/SETTING/SUBJECTS A cross-sectional survey of 208 patients was conducted at a large tertiary pediatric care center through standardized interviews with the responsible medical teams. Patient subgroups were defined as those with acute, chronic, life-threatening, or LLDs. RESULTS The comparisons of patient subgroups showed distinct differences and revealed that nearly half of all inpatients suffer from life-threatening (20%) or LLDs (27%), with a high proportion of rare diseases (82%). They experienced a high burden of symptoms in all parameters of clinical features, including high demand for medications and nursing care. CONCLUSION A substantial proportion of pediatric inpatients suffered from life-threatening or LLDs, as well as rare diseases, indicating a high burden of symptoms and a high need for additional care. The results suggest a substantial need to implement pediatric palliative care structures in tertiary care centers for patients in critical and terminal conditions.
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Affiliation(s)
- Annemarie Bösch
- 1 Charité Universitätsmedizin Berlin Campus Virchow-Klinikum , Clinic for Paediatrics, Department of Oncology/Haematology, Berlin, Germany
| | - Julia Wager
- 2 Paediatric Palliative Care Centre, Children's and Adolescent's Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University , Faculty of Health, School of Medicine, Germany
| | - Boris Zernikow
- 2 Paediatric Palliative Care Centre, Children's and Adolescent's Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University , Faculty of Health, School of Medicine, Germany
| | - Ralf Thalemann
- 3 Charité Universitätsmedizin Berlin Campus Virchow-Klinikum , Clinic for Paediatrics, Center for Chronically Sick Children, Berlin, Germany
| | - Heidi Frenzel
- 4 HealthTwiSt and Franz-Volhard Clinic , Charité Universitätsmedizin, Berlin, Germany
| | - Heiko Krude
- 5 Charité Universitätsmedizin Berlin Campus Virchow-Klinikum , Institute of Experimental Pediatric Endocrinology, Berlin, Germany
| | - Tobias Reindl
- 1 Charité Universitätsmedizin Berlin Campus Virchow-Klinikum , Clinic for Paediatrics, Department of Oncology/Haematology, Berlin, Germany
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16
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Abstract
INTRODUCTION There is increased awareness of paediatric palliative care in Malaysia, but no local published data on home care services. We aimed to describe the paediatric experience at Hospis Malaysia, a community-based palliative care provider in Malaysia. METHODS We conducted a retrospective case note review of patients aged up to 21 years who were referred to Hospis Malaysia from 2009 to 2013. RESULTS A total of 137 patients (92 male, 45 female) with a median age of 140 (3-250) months were included in this study. The majority (71.5%) had malignancies. At referral, 62 patients were still in hospital and 17 died prior to discharge. A total of 108 patients received home visits. At the first home visit, 89.8% of patients had at least one physical symptom. Pain was the most common (52.5%) symptom. Patients had various supportive devices: 39 were on feeding tubes, ten had tracheostomies, five were on bilevel positive airway pressure and ten had urinary catheters. 66 families discussed the preferred location of care at end-of-life. Among those who died, 78.9% died at home, as they preferred (p < 0.001). Regression analysis showed no statistically significant association between a home death and age, diagnosis and number of home visits. Bereavement follow-up occurred for 93.3% of families. CONCLUSION Community care referrals tend to occur late, with 25.5% of patients dying within two weeks of referral. At referral, patients often had untreated physical symptoms. The majority of families preferred and had a home death.
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Affiliation(s)
- Lee Ai Chong
- Department of Paediatrics, Hospis Malaysia, Kuala Lumpur, Malaysia
| | - Farah Khalid
- Department of Paediatrics, University Putra Malaysia, Selangor, Malaysia
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Wiegand DL, MacMillan J, dos Santos MR, Bousso RS. Palliative and End-of-Life Ethical Dilemmas in the Intensive Care Unit. AACN Adv Crit Care 2016; 26:142-50. [PMID: 25898882 DOI: 10.1097/nci.0000000000000085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Critical care nurses and advanced practice registered nurses frequently face bioethical dilemmas in clinical practice that are related to palliative and end-of-life care. Many of these dilemmas are associated with decisions made concerning continuing, limiting, or withdrawing life-sustaining treatments. The purpose of this article is to describe common ethical challenges through case study presentations and discuss approaches that critical care nurses and advanced practice registered nurses in collaboration with the interdisciplinary team can use to address these challenges. Resources that may be helpful in managing ethical dilemmas are identified.
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Affiliation(s)
- Debra L Wiegand
- Debra L. Wiegand is Associate Professor, University of Maryland School of Nursing, 655 West Lombard Street, Office 404P, Baltimore, MD 21201 . Julia MacMillan is Palliative Care Coordinator and Co-Chair Danbury Hospital Ethics Committee, Chair Nursing Ethics Committee, Danbury Hospital, Western Ct. Health Network, Danbury Hospital, Danbury, Connecticut. Maiara Rogrigues dos Santos is Doctoral Student, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil. Regina Szylit Bousso is Associate Professor, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
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Coombes LH, Wiseman T, Lucas G, Sangha A, Murtagh FE. Health-related quality-of-life outcome measures in paediatric palliative care: A systematic review of psychometric properties and feasibility of use. Palliat Med 2016; 30:935-949. [PMID: 27247087 PMCID: PMC5117129 DOI: 10.1177/0269216316649155] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The number of children worldwide requiring palliative care services is increasing due to advances in medical care and technology. The use of outcome measures is important to improve the quality and effectiveness of care. AIM To systematically identify health-related quality-of-life outcome measures that could be used in paediatric palliative care and examine their feasibility of use and psychometric properties. DESIGN A systematic literature review and analysis of psychometric properties. DATA SOURCES PsychInfo, Medline and EMBASE were searched from 1 January 1990 to 10 December 2014. Hand searches of the reference list of included studies and relevant reviews were also performed. RESULTS From 3460 articles, 125 papers were selected for full-text assessment. A total of 41 articles met the eligibility criteria and examined the psychometric properties of 22 health-related quality-of-life measures. Evidence was limited as at least half of the information on psychometric properties per instrument was missing. Measurement error was not analysed in any of the included articles and responsiveness was only analysed in one study. The methodological quality of included studies varied greatly. CONCLUSION There is currently no 'ideal' outcome assessment measure for use in paediatric palliative care. The domains of generic health-related quality-of-life measures are not relevant to all children receiving palliative care and some domains within disease-specific measures are only relevant for that specific population. Potential solutions include adapting an existing measure or developing more individualized patient-centred outcome and experience measures. Either way, it is important to continue work on outcome measurement in this field.
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Affiliation(s)
- Lucy H Coombes
- Caroline Menez Research Team, Oak Centre for Children and Young People, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Theresa Wiseman
- Applied Health Research Team, The Royal Marsden NHS Foundation Trust, London, UK.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Grace Lucas
- Applied Health Research Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Amrit Sangha
- Applied Health Research Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Fliss Em Murtagh
- Department of Palliative Care, Policy & Rehabilitation, Faculty of Life Sciences and Medicine, Cicely Saunders Institute, King's College London, London, UK
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Lindley LC. Multiple Complex Chronic Conditions and Pediatric Hospice Utilization among California Medicaid Beneficiaries, 2007-2010. J Palliat Med 2016; 20:241-246. [PMID: 27797636 DOI: 10.1089/jpm.2016.0227] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Over 42,000 children die each year in the United States, including many with multiple complex chronic conditions (MCCCs), but little is known about whether the presence of MCCCs influences families to utilize pediatric hospice care. OBJECTIVE The study objective was to examine the relationship between MCCCs and pediatric hospice utilization among Medicaid beneficiaries. METHODS A retrospective, longitudinal cohort design was conducted with 2007-2010 California Medicaid data to examine the relationship between MCCCs (i.e., two or more MCCCs) and pediatric hospice utilization (i.e., hospice enrollment, hospice length of stay). Multivariate logistic regression with year fixed effects examined the effect of MCCCs on hospice enrollment, and negative binomial model with year fixed effects explored the relationship between MCCCs and hospice length of stay. RESULTS More than 10% of children enrolled in hospice care with an average length of stay of approximately three days. In the study sample, 48.6% of the children had MCCCs. MCCCs were not significantly related to hospice enrollment. However, children with MCCCs (incidence rate ratios = 4.25, p < 0.01) were associated with an increase in the number of days in hospice care. CONCLUSIONS This study demonstrated that children with MCCCs have limited hospice care utilization at end of life. Future research is needed to explore barriers to hospice care for children with MCCCs.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing, University of Tennessee , Knoxville, Knoxville, Tennessee
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20
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Currie ER, Christian BJ, Hinds PS, Perna SJ, Robinson C, Day S, Meneses K. Parent Perspectives of Neonatal Intensive Care at the End-of-Life. J Pediatr Nurs 2016; 31:478-89. [PMID: 27261370 DOI: 10.1016/j.pedn.2016.03.023] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 03/23/2016] [Accepted: 03/31/2016] [Indexed: 11/17/2022]
Abstract
This descriptive qualitative study explored parent experiences related to their infant's neonatal intensive care unit (NICU) hospitalization, end-of-life care, and palliative care consultation. "Life and death in the NICU environment" emerged as the primary theme with the following categories: ups and downs of parenting in the NICU, decision-making challenges in the NICU, and parent support. Parents encountered challenges with areas for improvement for end-of-life and palliative care in the NICU. Further research is necessary to understand barriers with integrating palliative care and curative care in the NICU, and how NICU care affects bereavement and coping outcomes after infant death.
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Affiliation(s)
- Erin R Currie
- University of Alabama at Birmingham School of Nursing, Birmingham, AL.
| | | | - Pamela S Hinds
- Nursing Research and Quality Outcomes, Children's National Health System, Washington, DC.
| | - Samuel J Perna
- University of Alabama at Birmingham School of Medicine, Birmingham, AL.
| | - Cheryl Robinson
- University of Alabama at Birmingham School of Nursing, Birmingham, AL.
| | - Sara Day
- St. Jude Children's Research Hospital, Memphis, TN.
| | - Karen Meneses
- University of Alabama at Birmingham School of Nursing, Birmingham, AL.
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21
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Latha SM, Scott JX, Kumar S, Kumar SM, Subramanian L, Rajendran A. Parent's Perspectives on the End-of-life Care of their Child with Cancer: Indian Perspective. Indian J Palliat Care 2016; 22:317-25. [PMID: 27559262 PMCID: PMC4973494 DOI: 10.4103/0973-1075.185047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context: Parents report that end-of-life decisions are the most difficult treatment-related decisions that they face during their child cancer experience. Research from the parent's perspective of the quality of end-of-life care of their cancer children is scarce, particularly in developing countries like India. Aims: This study aimed to identify the symptoms (medical/social/emotional) that most concerned parents at the end-of-life care of their cancer child and to identify the strategies parents found to be helpful during this period. Settings and Design: We wanted to conduct this to focus on the parents perspectives on their cancer child's end-of-life care and to address the issues that could contribute to the comfort of the families witnessing their child's suffering. Materials and Methods: The study was conducted at Sri Ramachandra University, Chennai, a Tertiary Care Pediatric Hemato Oncology Unit. Parents who lost their child to cancer, treated in our institution were interviewed with a validated prepared questionnaire. Statistical analysis was performed using SAS statistical software package. Results: Toward death, dullness (30%), irritability (30%), and withdrawn from surroundings (10%) were the most common symptoms encountered. About 30% of the children had fear to be alone. About 50% of the children had the fear of death. Pain, fatigue, loss of appetite were the main distressful symptoms that these children suffered from parents’ perspective. Though the parents accepted that the child was treated for these symptoms, the symptom relief was seldom successful. Conclusion: The conclusion of the study was that at the end of their child's life, parents value obtaining adequate information and communication, being physically present with the child, preferred adequate pain management, social support, and empathic relationships by the health staff members.
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Affiliation(s)
- Sneha Magatha Latha
- Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Julius Xavier Scott
- Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Satish Kumar
- Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Suresh M Kumar
- Department of Clinical Psychology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Lalitha Subramanian
- Department of Clinical Psychology, Karthikeyan Child Development Unit, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Aruna Rajendran
- Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
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Goldhagen J, Fafard M, Komatz K, Eason T, Livingood WC. Community-based pediatric palliative care for health related quality of life, hospital utilization and costs lessons learned from a pilot study. BMC Palliat Care 2016; 15:73. [PMID: 27487770 PMCID: PMC4971636 DOI: 10.1186/s12904-016-0138-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/22/2016] [Indexed: 11/12/2022] Open
Abstract
Background Children with chronic complex-medical conditions comprise a small minority of children who require substantial healthcare with major implications for hospital utilization and costs in pediatrics. Community-Based Pediatric Palliative Care (CBPPC) provides a holistic approach to patient care that can improve their quality of life and lead to reduced costs of hospital care. This study's purpose was to analyze and report unpublished evaluation study results from 2007 that demonstrate the potential for CBPPC on Health Related Quality of Life (HRQoL) and hospital utilization and costs in light of the increasing national focus on the care of children with complex-medical conditions, including the Affordable Care Act's emphasis on patient-centered outcomes. Methods A multi-method research design used primary data collected from caregivers to determine the Program's potential impact on HRQoL, and administrative data to assess the Program's potential impact on hospital utilization and costs. Caregivers (n=53) of children enrolled in the Northeast Florida CBPPC program (Community PedsCare) through the years 2002-2007 were recruited for the Health Related Quality of Life (HRQoL) study. Children (n=48) enrolled in the Program through years 2000-2006 were included in the utilization and cost study. Results HRQoL was generally high, and hospital charges per child declined by $1203 for total hospital services (p=.34) and $1047 for diagnostic charges per quarter (p=0.13). Hospital length of stay decreased from 2.92 days per quarter to 1.22 days per quarter (p<.05). Conclusion The decrease in hospital utilization and costs and the high HRQoL results indicate that CBPPC has the potential to influence important outcomes for the quality of care available for children with complex-medical conditions and their caregivers. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0138-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, Department of Pediatrics, UF College of Medicine - Jacksonville, 841 Prudential Drive, Suite 1330 m, Jacksonville, FL, 32207, USA
| | - Mark Fafard
- Baptist Health Research Institute, Baptist Health System, 836 Prudential Drive, Pavilion 6th Floor, Jacksonville, FL, 32207, USA.
| | - Kelly Komatz
- Division of Community and Societal Pediatrics, Department of Pediatrics, UF College of Medicine - Jacksonville, 841 Prudential Drive, Suite 1330 m, Jacksonville, FL, 32207, USA
| | - Terry Eason
- Community PedsCare, Community Hospice of Northeast Florida, 4266 Sunbeam Rd., Jacksonville, FL, 32257, USA
| | - William C Livingood
- Center for Health Equity and Quality Research, UF College of Medicine-Jacksonville, 580 W. 8th St., Tower II, Room 6015, Jacksonville, FL, 32209, USA
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Lindley LC, Mack JW, Bruce DJ. Clusters of Multiple Complex Chronic Conditions: A Latent Class Analysis of Children at End of Life. J Pain Symptom Manage 2016; 51:868-74. [PMID: 26747723 PMCID: PMC4875829 DOI: 10.1016/j.jpainsymman.2015.12.310] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 12/04/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Children at end of life often experience multiple complex chronic conditions with more than 50% of children reportedly having two or more conditions. These complex chronic conditions are unlikely to occur in an entirely uniform manner in children at end of life. Previous work has not fully accounted for patterns of multiple conditions when evaluating care among these children. OBJECTIVES The objective of the study was to understand the clusters of complex chronic conditions present among children in the last year of life. METHODS Participants were 1423 pediatric decedents from the 2007 to 2008 California Medicaid data. A latent class analysis was used to identify clusters of children with multiple complex chronic conditions (neurological, cardiovascular, respiratory, renal, gastrointestinal, hematologic, metabolic, congenital, cancer). Multinomial logistic regression analysis was used to examine the relationship between demographic characteristics and class membership. RESULTS Four latent classes were yielded: medically fragile (31%); neurological (32%); cancer (25%); and cardiovascular (12%). Three classes were characterized by a 100% likelihood of having a complex chronic condition coupled with a low or moderate likelihood of having the other eight conditions. The four classes exhibited unique demographic profiles. CONCLUSION This analysis presented a novel way of understanding patterns of multiple complex chronic conditions among children that may inform tailored and targeted end-of-life care for different clusters.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing, University of Tennessee-Knoxville, Knoxville, Tennessee, USA.
| | - Jennifer W Mack
- Department of Pediatric Oncology and the Division of Population Sciences' Center for Outcomes and Policy Research Harvard Medical School, Boston, Massachusetts, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Pediatric Hematology/Oncology, Children's Hospital, Boston, Massachusetts, USA
| | - Donald J Bruce
- Center for Business & Economic Research, University of Tennessee, Knoxville, Tennessee, USA; Department of Economics, University of Tennessee, Knoxville, Tennessee, USA
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Abstract
OBJECTIVE Health professionals in PICUs support both child and parents when a child's death is imminent. Parents long to stay connected to their dying child but the high-tech environment and treatment implications make it difficult to stay physically close. This study explores in what sense physical aspects of end-of-life care in the PICU influence the parent-child relationship. DESIGN Retrospective, qualitative interview study. SETTING Level 3 PICU in Erasmus Medical Center in the Netherlands. PARTICIPANTS Thirty-six parents of 20 children who had died in this unit 5 years previously. MEASUREMENTS AND MAIN RESULTS Parents vividly remembered the damage done to the child's physical appearance, an inevitable consequence of medical treatment. They felt frustrated and hurt when they could not hold their child. Yet they felt comforted if facilitated to be physically close to the dying child, like lying with the child in one bed, holding the child in the hour of death, and washing the child after death. CONCLUSIONS End-of-life treatment in the PICU presents both a barrier and an opportunity for parents to stay physically connected to their child. Parents' experiences suggest that aspects of physicality in medical settings deserve more attention. Better understanding of the significance of bodily aspects-other than pain and symptom management-improves end-of-life support and should be part of the humane approach to families.
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Wiegand DL, MacMillan J, dos Santos MR, Bousso RS. Palliative and End-of-Life Ethical Dilemmas in the Intensive Care Unit. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Critical care nurses and advanced practice registered nurses frequently face bioethical dilemmas in clinical practice that are related to palliative and end-of-life care. Many of these dilemmas are associated with decisions made concerning continuing, limiting, or withdrawing life-sustaining treatments. The purpose of this article is to describe common ethical challenges through case study presentations and discuss approaches that critical care nurses and advanced practice registered nurses in collaboration with the interdisciplinary team can use to address these challenges. Resources that may be helpful in managing ethical dilemmas are identified.
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Affiliation(s)
- Debra L. Wiegand
- Debra L. Wiegand is Associate Professor, University of Maryland School of Nursing, 655 West Lombard Street, Office 404P, Baltimore, MD 21201
| | - Julia MacMillan
- Julia MacMillan is Palliative Care Coordinator and Co-Chair Danbury Hospital Ethics Committee, Chair Nursing Ethics Committee, Danbury Hospital, Western Ct. Health Network, Danbury Hospital, Danbury, Connecticut
| | - Maiara Rogrigues dos Santos
- Maiara Rogrigues dos Santos is Doctoral Student, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
| | - Regina Szylit Bousso
- Regina Szylit Bousso is Associate Professor, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
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Abstract
One of the many difficult moments for families of children with life-limiting illnesses is to make the decision to access pediatric hospice care. Although determinants that influence families' decisions to access pediatric hospice care have been recently identified, the relationship between these determinants and access to pediatric hospice care have not been explicated or grounded in accepted healthcare theories or models. Using the Andersen Behavioral Healthcare Utilization Model, this article presents a conceptual model describing the determinants of hospice access. Predisposing (demographic; social support; and knowledge, beliefs, and values), enabling (family and community resources) and need (perceived and evaluated needs) factors were identified through the use of hospice literature. The relationships among these factors are described and implications of the model for future study and practice are discussed.
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Beecham E, Candy B, Howard R, McCulloch R, Laddie J, Rees H, Vickerstaff V, Bluebond‐Langner M, Jones L. Pharmacological interventions for pain in children and adolescents with life-limiting conditions. Cochrane Database Syst Rev 2015; 2015:CD010750. [PMID: 25768935 PMCID: PMC6481584 DOI: 10.1002/14651858.cd010750.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pain is one of the most common symptoms in children and young people (CYP) with life-limiting conditions (LLCs) which include a wide range of diagnoses including cancer. The current literature indicates that pain is not well managed, however the evidence base to guide clinicians is limited. There is a clear need for evidence from a systematic review to inform prescribing. OBJECTIVES To evaluate the evidence on the effectiveness of different pharmacological interventions used for pain in CYP with LLCs. SEARCH METHODS The following electronic databases were searched up to December 2014: CENTRAL (in the Cochrane Library), MEDLINE, EMBASE, PsycINFO and CINAHL. In addition, we searched conference proceedings and reference lists of included studies. For completeness, we also contacted experts in the field. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-randomised studies and other studies that included a clearly defined comparator group were included. The studies investigated pharmacological treatments for pain associated with LLCs in CYP. The treatment included those specifically developed to treat pain and those that acted as an adjuvant, where the treatment was not primarily developed to treat pain but has pain relieving properties. The LLC was identified by its inclusion in the Richard Hain Directory of LLCs. DATA COLLECTION AND ANALYSIS Citations were screened by five review authors. Data were extracted by one review author and checked by a second. Two review authors assessed the risk of bias of included studies. A sufficient number of studies using homogeneous outcomes was not identified so a meta-analysis was not possible. MAIN RESULTS We identified 24,704 citations from our database search. Nine trials with 379 participants fulfilled our inclusion criteria. Participants had cerebral palsy (CP) in five of the studies and osteogenesis imperfecta (OI) in the other four. Participants across the trials ranged in age from 2 to 19 years. All studies, apart from one cross-over trial, were parallel designed RCTs. Three of the trials on CP evaluated intrathecal baclofen (ITB) and two botulinum toxin A (BoNT-A). All of the OI trials evaluated the use of bisphosphonates (two alendronate and one pamidronate). No trials were identified that evaluated a commonly used analgesic in this patient group. Pain was a secondary outcome in five of the eight identified studies. Overall the quality of the trials was mixed. Only one study involved over 100 participants.For the two ITB studies for pain in CP, in the same study population but assessed at different time points in their disease, both found an effect on pain favouring the intervention compared to the control group (standard care or placebo) (mean difference (MD) 4.20, 95% confidence interval (CI) 2.15 to 6.25; MD 26.60, 95% CI 2.61 to 50.59, respectively). In these studies most of the adverse events related to the procedure or device for administration rather than the drug, such as swelling at the pump site. In one trial there were also eight serious adverse effects; these included difficulty swallowing and an epileptic seizure. The trial did not state if these occurred in the intervention group. At follow-up in both BoNT-A trials there was no evidence of a difference in pain between the trial arms among CP participants. The adverse events in the BoNT-A trials mostly involved those who received the intervention drug and involved seizures. Gastrointestinal problems were the most frequent adverse event in those who received alendronate. The trial investigating pamidronate found no evidence of a difference in pain compared to the control group. No adverse events were reported in this trial. AUTHORS' CONCLUSIONS Published, controlled evidence on the pharmacological interventions for pain in CYP with LLCs is limited. The evidence that is currently available evaluated pain largely as a secondary outcome and the drugs used were all adjuvants and not always commonly used in general paediatric palliative care for pain. Based on current data this systematic review is unable to determine the effects of pharmacological interventions for pain for CYP with LLCs. Future trials with larger populations should examine the effects of the drugs commonly used as analgesics; with the rising prevalence of many LLCs this becomes more necessary.
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Affiliation(s)
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
| | - Richard Howard
- Great Ormond Street HospitalAnaesthesia and Pain ManagementGreat Ormond StreetLondonUKWC1N 3JH
| | - Renée McCulloch
- Great Ormond Street HospitalLouis Dundas Centre for Children's Palliative Care, Palliative Care TeamLondonUK
| | - Jo Laddie
- Evelina London Children's HospitalDepartment of Paediatric Palliative MedicineLondonUK
| | - Henrietta Rees
- UCL Institute of Child HealthLouis Dundas Centre for Children's Palliative CareLondonUK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
| | | | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
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Van Doren BA, Roy D, Noone JM, Blanchette CM, Arthur ST. Cachexia & debility diagnoses in hospitalized children and adolescents with complex chronic conditions: evidence from the Kids' Inpatient Database. Drugs Context 2015; 4:dic-4-212277. [PMID: 25767549 PMCID: PMC4353190 DOI: 10.7573/dic.212277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 02/17/2015] [Indexed: 12/22/2022] Open
Abstract
Objective: To characterize the frequency, cost, and hospital-reported outcomes of cachexia and debility in children and adolescents with complex chronic conditions (CCCs). Methods: We identified children and adolescents (aged ≤20 years) with CCCs, cachexia, and debility in the Kids’ Inpatient Database [Healthcare Cost and Utilization Project, Agency for Healthcare Research & Quality]. We then compared the characteristics of patients and hospitalizations, including cost and duration of stay, for CCCs with and without cachexia and/or debility. We examined factors that predict risk of inpatient mortality in children and adolescents with CCCs using a logistic regression model. We examined factors that impact duration of stay and cost in children and adolescents with CCCs using negative binomial regression models. All costs are reported in US dollars in 2014 using Consumer Price Index inflation adjustment. Results: We estimated the incidence of hospitalization of cachexia in children and adolescents with CCCs at 1,395 discharges during the sample period, which ranged from 277 discharges in 2003 to 473 discharges in 2012. We estimated the incidence of hospitalization due to debility in children and adolescents with CCCs at 421 discharges during the sample period, which ranged from 39 discharges in 2003 to 217 discharges in 2012. Cachexia was associated with a 60% increase in the risk of inpatient mortality, whereas debility was associated with a 40% decrease in the risk of mortality. Cachexia and debility increased duration of stay in hospital (17% and 39% longer stays, respectively). Median cost of hospitalization was $15,441.59 and $23,796.16 for children and adolescents with cachexia and debility, respectively. Conclusions: Incidence of hospitalization for cachexia in children and adolescents with CCCs is less than that for adults but the frequency of cachexia diagnoses increased over time. Estimates of the incidence of hospitalization with debility in children and adolescents with CCCs have not been reported, but our study demonstrates that the frequency of these discharges is also increasing.
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Affiliation(s)
| | - Debosree Roy
- University of North Carolina at Charlotte, NC, USA
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Nakawesi J, Kasirye I, Kavuma D, Muziru B, Businge A, Naluwooza J, Kabunga G, Karamagi Y, Akankwasa E, Odiit M, Mukasa B. Palliative care needs of HIV exposed and infected children admitted to the inpatient paediatric unit in Uganda. Ecancermedicalscience 2014; 8:489. [PMID: 25624870 PMCID: PMC4303617 DOI: 10.3332/ecancer.2014.489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Indexed: 11/23/2022] Open
Abstract
Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-limiting conditions and also for their families. It is a response to the suffering and unique needs of such children. Globally there is limited documented data available on the palliative care needs of children with HIV. A retrospective review of data of all the HIV exposed and positive children who were admitted to the ward from January to December 2012 was done to document their palliative care needs. A total of 243 children were admitted to the ward during the stated period. Of these, 139 (57.2%) were female and 104 (42.8%) were male. Among them 131 (54%) were aged five years and below whereas 112 (46%) were above five years. Some of the identified palliative care needs documented included physical needs: pneumonia 46 (19%), severe acute malnutrition 38 (16%), mild and moderate acute malnutrition 23 (9.6%), and respiratory tract infections 22 (9.3%). Social needs: poor social support 21 (41%), financial instability 16 (31%), and child neglect 4 (8%). Psychological needs: antiretroviral treatment (ART) counselling 127 (36%), HIV counselling and testing for the child and family 63 (18%), adherence support 53 (15%), and others 11 (3%). Spiritual needs: discontinuing ART because of belief in spiritual healing 18 (81%), loss of hope because of severe ill health 1 (5%), and others 3 (14%). These results emphasise the need for palliative care in children with HIV even in the era of ART. The needs identified are in keeping with studies done elsewhere and are similar to the palliative care needs of children with other life-limiting illnesses such as cancer.
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Affiliation(s)
| | - Ivy Kasirye
- Mildmay Uganda, PO Box 24985, Kampala, Uganda
| | | | | | | | | | | | | | | | - Mary Odiit
- Mildmay Uganda, PO Box 24985, Kampala, Uganda
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Valadares MTM, Mota JAC, de Oliveira BM. Palliative care in pediatric hematological oncology patients: experience of a tertiary hospital. Rev Bras Hematol Hemoter 2014; 36:403-8. [PMID: 25453649 PMCID: PMC4318475 DOI: 10.1016/j.bjhh.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/25/2014] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the approach to palliative care for hematological oncology patients in the pediatric ward of a tertiary hospital. Methods This was a retrospective, descriptive study of 29 hematological oncology patients who died between 2009 and 2011. Data regarding the approach and prevalence of pain, prevalence of other symptoms, multidisciplinary team participation, communication between staff and family and limited invasive therapy were collected from the medical records. Results Twenty-seven (93.1%) patients displayed disease progression unresponsive to curative treatment. The median age at death was ten years old. Pain was the most prevalent symptom with all patients who reported pain receiving analgesic medications. The majority took weak (55.2%) and/or strong (65.5%) opioids. The patients were followed by pediatricians and a pediatric hematologist/oncologist. Participation of other professionals was also documented: 86.2% were followed by social services and 69% by psychologists, among others. There were explicit descriptions of limitation of invasive therapy in the medical records of 26 patients who died with disease progression. All these decisions were shared with the families. Conclusion Although the hospital where this study was conducted does not have a specialized team in pediatric palliative care, it meets all the requirements for developing a specific program. The importance of approaching pain and other prevalent symptoms in children with cancer involving a comprehensive multidisciplinary team is evident. Discussions were had with most of the families on limiting invasive therapy, but no record of a well-defined and coordinated treatment plan for palliative care was found.
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Understanding parental behavior in pediatric palliative care: Attachment theory as a paradigm. Palliat Support Care 2014; 13:1559-68. [PMID: 24524227 DOI: 10.1017/s147895151300134x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this conceptual paper was to present important constructs in attachment theory as they apply to parent and caregiver behavior in pediatric palliative care. Clarification of these constructs is provided with specific reference to their clinical application as well as their reflection in current empirical literature. Social attachment theory is proposed as a developmentally contextual model for the study of parenting in pediatric palliative and end-of-life care. METHOD A comprehensive search was conducted of pertinent literatures. These included classic as well as recent theory and research in attachment theory in addition to the empirical literatures on parent and family experience in pediatric palliative care, serious illness, and beyond to parental bereavement. Other relevant literature was examined with respect to the phenomena of concern. RESULTS The empirical literature in pediatric palliative care supports the use of central concepts in attachment theory as foundational for further inquiry. This is evidenced in the emphasis on the importance of parental protection of the child, as well as executive activities such as decision making and other prominent parental operations, parental psychological resolution of the child's diagnosis and illness as well as coping and meaning making, and the core significance of parental relationships with providers who provide secure-base and safe-haven functions. SIGNIFICANCE OF RESULTS The promise for developing integrated, conceptually based interventions from construction through implementation is of urgent importance to children and families receiving pediatric palliative care services. Focusing on key parental behaviors and processes within the context of a well-studied and contextually appropriate model will inform this task efficiently. The attachment paradigm meets these criteria and has promise in allowing us to move forward in developing well-defined, inclusive, and conceptually grounded protocols for child and family psychosocial research, practice, and education in this specialty.
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Gaab EM, Owens GR, MacLeod RD. Siblings Caring for and about Pediatric Palliative Care Patients. J Palliat Med 2014; 17:62-7. [DOI: 10.1089/jpm.2013.0117] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Erin M. Gaab
- Health Sciences Research Institute, University of California, Merced, California
| | - Glynn R. Owens
- Department of Psychology, University of Auckland, Auckland, New Zealand
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Liu SM, Lin HR, Lu FL, Lee TY. Taiwanese parents' experience of making a "do not resuscitate" decision for their child in pediatric intensive care unit. Asian Nurs Res (Korean Soc Nurs Sci) 2013; 8:29-35. [PMID: 25030490 DOI: 10.1016/j.anr.2013.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 09/19/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The purpose of this project was to explore the parental experience of making a "do not resuscitate" (DNR) decision for their child who is or was cared for in a pediatric intensive care unit in Taiwan. METHODS A descriptive qualitative study was conducted following parental signing of a standard hospital DNR form on behalf of their critically ill child. Sixteen Taiwanese parents of 11 children aged 1 month to 18 years were interviewed. Interviews were recorded, transcribed, analyzed and sorted into themes by the sole interviewer plus other researchers. RESULTS Three major themes were identified: (a) "convincing points to sign", (b) "feelings immediately after signing", and (c) "post-signing relief or regret". Feelings following signing the DNR form were mixed and included "frustration", "guilt", and "conflicting hope". Parents adjusted their attitudes to thoughts such as "I have done my best," and "the child's life is beyond my control." Some parents whose child had died before the time of the interview expressed among other things "regret not having enough time to be with and talk to my child". CONCLUSION Open family visiting hours plus staff sensitivity and communication skills training are needed. To help parents with this difficult signing process, nurses and other professionals in the pediatric intensive care unit need education on initiating the conversation, guiding the parents in expressing their fears, and providing continuing support to parents and children throughout the child's end of life process.
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Affiliation(s)
- Shu-Mei Liu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Frank L Lu
- Division of Pediatric Pulmonology and Critical Care Medicine, Department of Pediatrics, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan
| | - Tzu-Ying Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Williams-Reade J, Lamson AL, Knight SM, White MB, Ballard SM, Desai PPP. Paediatric palliative care: a review of needs, obstacles and the future. J Nurs Manag 2013; 23:4-14. [PMID: 23944156 DOI: 10.1111/jonm.12095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2013] [Indexed: 01/16/2023]
Abstract
AIM This literature review offers a response to the current paediatric palliative care literature that will punctuate the need for a framework (i.e. the three world view) that can serve as an evaluative lens for nurse managers who are in the planning or evaluative stages of paediatric palliative care programmes. BACKGROUND The complexities in providing paediatric palliative care extend beyond clinical practices to operational policies and financial barriers that exist in the continuum of services for patients. EVALUATION This article offers a review of the literature and a framework in order to view best clinical practices, operational/policy standards and financial feasibility when considering the development and sustainability of paediatric palliative care programmes. KEY ASPECTS Fifty-four articles were selected as representative of the current state of the literature as it pertains to the three world view (i.e. clinical, operational and financial factors) involved in providing paediatric palliative care. CONCLUSION In developing efficient paediatric palliative care services, clinical, operational and financial resources and barriers need to be identified and addressed. IMPLICATIONS FOR NURSING MANAGEMENT Nursing management plays a crucial role in addressing the clinical, operational and financial needs and concerns that are grounded in paediatric palliative care literature.
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Rapoport A, Shaheed J, Newman C, Rugg M, Steele R. Parental perceptions of forgoing artificial nutrition and hydration during end-of-life care. Pediatrics 2013; 131:861-9. [PMID: 23569099 DOI: 10.1542/peds.2012-1916] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Forgoing artificial nutrition and hydration (FANH) in children at the end of life (EOL) is a medically, legally, and ethically acceptable practice under specific circumstances. However, most of the evidence on FANH involves dying adults. There is a paucity of pediatric evidence to guide health care providers' and parents' decision-making around this practice. Objectives were (1) to explore the experiences of bereaved parents when a decision had been made to FANH during EOL care for their child and (2) to describe the perceived quality of death in these children, as reported by their parents. METHODS This was a qualitative study using in-depth interviews with parents whose children died after a decision to FANH. Parental perceptions about the experience and their child's quality of death were explored. Interviews were audiotaped and transcribed, then data were analyzed by using interpretive description methodology. RESULTS All parents were satisfied with their decision to FANH and believed that their child's death was generally peaceful and comfortable. The child's perceived poor quality of life was central to the decision to FANH, with feeding intolerance often contributing to this perception. Despite overall satisfaction, all parents had doubts and questions about the decision and benefited from ongoing assurances from the clinical team. CONCLUSIONS FANH in children at the EOL is an acceptable form of palliation for some parents and may contribute to a death that is perceived to be peaceful and comfortable. In situations in which FANH may be a reasonable possibility, physicians should be prepared to introduce the option.
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Affiliation(s)
- Adam Rapoport
- Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, ON, Canada.
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Lindley LC, Mark BA, Daniel Lee SY, Domino M, Song MK, Jacobson Vann J. Factors associated with the provision of hospice care for children. J Pain Symptom Manage 2013; 45:701-11. [PMID: 22921174 PMCID: PMC4019999 DOI: 10.1016/j.jpainsymman.2012.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 03/13/2012] [Accepted: 03/22/2012] [Indexed: 11/19/2022]
Abstract
CONTEXT Children at the end of life often lack access to hospice care at home or in a dedicated facility. The factors that may influence whether or not hospices provide pediatric care are relatively unknown. OBJECTIVES The purpose of this study was to understand the institutional and resource factors associated with provision of pediatric hospice care. METHODS This study used a retrospective, longitudinal design. The main data source was the 2002 to 2008 California State Hospice Utilization Data Files. The sample size was 311 hospices or 1368 hospice observations over seven years. Drawing on institutional and resource dependence theory, this study used generalized estimating equations to examine the institutional and resource factors associated with provision of pediatric hospice care. Interaction terms were included to assess the moderating effect of resource factors on the relationship between institutional factors and provision of care. RESULTS Membership in professional groups increased the probability (19%) of offering hospice services for children. Small- (-22%) and medium-sized (-11%) hospices were less likely to provide care for children. The probability of providing pediatric hospice care diminished (-23%) when competition increased in the prior year. Additionally, small size attenuated the accreditation-provision relationship and medium size magnified the membership-provision relationship. CONCLUSION Professional membership may promote conformity to industry standards of pediatric care and remove the unknowns of providing hospice care for children. Hospices, especially medium-sized hospices, interested in developing or expanding care for children may benefit by identifying a pediatric champion to join a professional group.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, TN 37996, USA.
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Abstract
Advancing pediatric palliative care is desperately needed to support the physical, emotional, cultural, spiritual, and psychosocial needs of children and families who live with life-threatening illnesses. Although educational resources and standards of practice related to this topic have been developed, dissemination and implementation of programs have been slow to progress. The purpose of this case study is to present the lived experiences of an adolescent with leukemia and his family to illustrate how health care providers may benefit from receiving enhanced palliative and end-of-life care education.
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Kumar SP. Reporting of pediatric palliative care: a systematic review and quantitative analysis of research publications in palliative care journals. Indian J Palliat Care 2012; 17:202-9. [PMID: 22347775 PMCID: PMC3276817 DOI: 10.4103/0973-1075.92337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
CONTEXT Pediatric palliative care clinical practice depends upon an evidence-based decision-making process which in turn is based upon current research evidence. AIMS This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting characteristics of articles on pediatric palliative care. SETTINGS AND DESIGN This was a systematic review of palliative care journals. MATERIALS AND METHODS Twelve palliative care journals were searched for articles with "paediatric" or "children" in titles of the articles published from 2006 to 2010. The reporting rates of all journals were compared. The selected articles were categorized into practice, education, research, and administration, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original articles' category was further classified according to study designs. STATISTICAL ANALYSIS USED Descriptive analysis using frequencies and percentiles was done using SPSS for Windows, version 11.5. RESULTS The overall reporting rate among all journals was 2.66% (97/3634), and Journal of Hospice and Palliative Nursing (JHPN) had the highest reporting rate of 12.5% (1/8), followed by Journal of Social Work in End-of-Life and Palliative Care (JSWELPC) with a rate of 7.5% (5/66), and Journal of Palliative Care (JPC) with a rate of 5.33% (11/206). CONCLUSIONS The overall reporting rate for pediatric palliative care articles in palliative care journals was very low and there were no randomized clinical trials and systematic reviews found. The study findings indicate a lack of adequate evidence base for pediatric palliative care.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Eden LM, Callister LC. Parent Involvement in End-of-Life Care and Decision Making in the Newborn Intensive Care Unit: An Integrative Review. J Perinat Educ 2012; 19:29-39. [PMID: 21197127 DOI: 10.1624/105812410x481546] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Survival rates for very preterm and critically ill infants are increasing, raising complex ethical issues for health-care providers and parents who face the challenge of making end-of-life decisions for newborns. The purpose of this integrative literature review was to evaluate parental involvement in end-of-life care and decision making for their infant in the newborn intensive care unit. Findings revealed that establishing good relationships and clear communication between health-care providers and parents builds trust and eases stress placed on parents making decisions about the care of their infant. Palliative care programs provide support for parents and facilitate their decision making. Parents can be educated about how to communicate with health-care providers. Educating nurses on how to provide end-of-life care may also help improve support for parents during this difficult time. Additional research is recommended to examine parents' needs during and after end-of-life care decisions for their newborn.
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Affiliation(s)
- Lacey M Eden
- LACEY M. EDEN is a staff nurse in the Intermountain Healthcare Urban South Newborn Intensive Care Unit in Provo, Utah, and a recent graduate as a family nurse practitioner. LYNN CLARK CALLISTER is a professor of maternal/newborn nursing at Brigham Young University College of Nursing in Provo, Utah, and a fellow in the American Academy of Nursing. She serves on the March of Dimes Bioethics Council and the March of Dimes National Nurses Advisory Council
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Sheetz MJ, Bowman MAS. Parents' perceptions of a pediatric palliative program. Am J Hosp Palliat Care 2012; 30:291-6. [PMID: 22696532 DOI: 10.1177/1049909112449376] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reports of family satisfaction with pediatric palliative care have been limited. This knowledge is critical for both program development and furthering understanding of needs. The purpose of this study was to assess parents' perceptions about whether a pediatric palliative care program was providing key elements of pediatric palliative care as described in the literature and to assess parental satisfaction with services. Data were collected from 65 parents, using a tool developed for the project, whose children died while receiving services from Rainbow Kids Palliative Care, a program of Primary Children's Medical Center, and the Department of Pediatrics, University of Utah, Salt Lake City, Utah. Respondents reported that the Rainbow Kids team had provided emotional support, helped with decision making and communication, and that their children's symptoms were managed. Furthermore, parent respondents expressed high levels of satisfaction with services from the Rainbow Kids team.
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Affiliation(s)
- M Joan Sheetz
- Rainbow Kids Palliative Care Program, Primary Children's Medical Center, Salt Lake City, UT, USA
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Hill K, Coyne I. Palliative care nursing for children in the UK and Ireland. ACTA ACUST UNITED AC 2012; 21:276-81. [DOI: 10.12968/bjon.2012.21.5.276] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
- Shivani S Tripathi
- Pediatric Critical Care Medicine, Holtz Children's Hospital/Jackson Memorial Medical Center, USA.
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Saad R, Huijer HAS, Noureddine S, Muwakkit S, Saab R, Abboud MR. Bereaved parental evaluation of the quality of a palliative care program in Lebanon. Pediatr Blood Cancer 2011; 57:310-6. [PMID: 21394892 DOI: 10.1002/pbc.23082] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 01/20/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Palliative care (PC) is important in Pediatric Oncology as more than 20% of children with cancer still die despite modern treatment. As a significant number of children reside in countries with limited resources; more research in PC is needed there. This study aimed at evaluating the quality of care provided to children with cancer at the Children's Cancer Center of Lebanon (CCCL) during their last month of life as perceived by the bereaved parents. PROCEDURE Between 2002 and 2007, 76 children with cancer treated at CCCL succumbed to their disease. Twenty-nine of the bereaved parents were interviewed at home about the symptoms and suffering experienced by their children during the last month of life, communication with the healthcare team, quality of care delivered, and recommendations for improving care. RESULTS Fatigue, anorexia, and pain were the most prevalent symptoms and edema was the most distressing. The overall communication with the healthcare team and the overall quality of care delivered was rated as "very good" to "excellent" by 86.2% and 93.1% of the participants, respectively. Parents suggested improving the organization of care, the communication, and the availability of human and material resources. CONCLUSIONS This study is the first conducted in Lebanon to evaluate the quality of pediatric palliative care (PPC). The parents' experiences in our country were similar to those described in other countries, religions, and cultures. Significant strengths and weaknesses in the management of the dying children, from the parents' perspective, were uncovered and recommendations for improving practice were made.
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Affiliation(s)
- Rima Saad
- Children's Cancer Center of Lebanon, American University of Beirut Medical Center, Beirut, Lebanon.
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Abstract
Pediatric surgeons can play an important role in offering procedures that may improve the quality of life for terminally ill children. As with all palliative interventions, surgical therapies should be evaluated in the context of explicitly defined treatment goals while weighing the risks and benefits of procedures in the context of a shortened life span. It is essential that pediatric surgeons become active members in the multidisciplinary team that provides palliative care.
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Affiliation(s)
- Julia Shelton
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2730, USA
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Lindley LC. Health Care Reform and Concurrent Curative Care for Terminally Ill Children: A Policy Analysis. J Hosp Palliat Nurs 2011; 13:81-88. [PMID: 22822304 PMCID: PMC3401095 DOI: 10.1097/njh.0b013e318202e308] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Within the Patient Protection and Affordable Care Act of 2010 or health care reform, is a relatively small provision about concurrent curative care that significantly affects terminally ill children. Effective on March 23, 2010, terminally ill children, who are enrolled in a Medicaid or state Children's Health Insurance Plans (CHIP) hospice benefit, may concurrently receive curative care related to their terminal health condition. The purpose of this article was to conduct a policy analysis of the concurrent curative care legislation by examining the intended goals of the policy to improve access to care and enhance quality of end of life care for terminally ill children. In addition, the policy analysis explored the political feasibility of implementing concurrent curative care at the state-level. Based on this policy analysis, the federal policy of concurrent curative care for children would generally achieve its intended goals. However, important policy omissions focus attention on the need for further federal end of life care legislation for children. These findings have implications nurses.
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Affiliation(s)
- Lisa C Lindley
- University of North Carolina - Chapel Hill, School of Nursing
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O’Brien I, Duffy A. The developing role of children’s nurses in community palliative care. ACTA ACUST UNITED AC 2010; 19:977-81. [DOI: 10.12968/bjon.2010.19.15.77694] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lindley LC, Mark BA. Children with special health care needs: Impact of health care expenditures on family financial burden. JOURNAL OF CHILD AND FAMILY STUDIES 2010; 19:79-89. [PMID: 20495615 PMCID: PMC2872488 DOI: 10.1007/s10826-009-9286-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We investigated the relationship between health care expenditures for Special Health Care Needs (SHCN) children and family perception of financial burden. Using 2005/2006 National Survey of Children with Special Health Care Needs data, a multivariate logistic regression model was used to estimate the relationship between the SHCN child's health care expenditure and perceived financial burden, while controlling for family and child characteristics. Our analysis suggests that health care expenditures for a SHCN child of $250 and more are associated with family perception of financial burden. In addition, families with lower socioeconomic status also perceived financial burden at lower level of expenditures. Members of the health care team who treat children with SHCN have an important role in understanding and assessing family financial burden as part of the care delivery to the child and the family. Our study reinforces the need to treat the whole family as the unit of care, especially when caring for children with special health care needs.
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Affiliation(s)
- Lisa C. Lindley
- School of Nursing, University of North Carolina – Chapel Hill, Carrington Hall, CB 7460, Chapel Hill, NC 27599-7460
| | - Barbara A. Mark
- School of Nursing, University of North Carolina – Chapel Hill, Carrington Hall, CB 7460, Chapel Hill, NC 27599-7460
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