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Hirata M, Kobayashi K. Experiences with the end-of-life decision-making process in children with cancer, their parents, and healthcare professionals: A systematic review and meta-ethnography. J Pediatr Nurs 2022; 69:e45-e64. [PMID: 36586777 DOI: 10.1016/j.pedn.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Decision-making during the end-of-life (EOL) phase for children with cancer is extremely difficult for parents. We synthesized the qualitative experiences of children with cancer, parents, and healthcare professionals (HCPs), and their social interactions during the EOL decision-making process in the pediatric oncology setting. METHODS Meta-ethnography was used to conduct a systematic review and meta-synthesis. We searched four online databases to identify original studies published in English and Japanese and examined 21 relevant studies. Two Japanese reviewers discussed the differences/relationships and included studies that synthesized the translated qualitative findings. A conceptual model of social interactions was created. RESULTS We identified four themes regarding children's, parents', and HCPs' experiences: hope and confrontation with the child's death, guidance and support during uncertainty, awareness of being protected and having hope, and mutual unspoken integration of values. CONCLUSIONS These themes evince the experiences of children, parents, and HCPs during the EOL decision-making process and suggests a complex three-way social interaction model. While considering such distinctive social interactions during a child's EOL, this study revealed the sharing of prudent information and psychosocial support by HCPs. The findings indicate that hope and uncertainty are key elements for effectively understanding the experiences of children and parents and that EOL decision-making should not be rushed but should be supported by leaving room for uncertainty and acknowledging parents' emotional needs and fostering new hope. Further research into how hope can be further supported in situations that are rife with uncertainty is needed.
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Affiliation(s)
- Mika Hirata
- Department of Nursing, School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama 343-8540, Japan.
| | - Kyoko Kobayashi
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
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2
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Pearson H H, Bryan G, Kayum C, Gibson F, Darlington AS. Parent values and preferences underpinning treatment decision-making in poor-prognosis childhood cancer: a scoping review. BMC Pediatr 2022; 22:595. [PMID: 36229792 PMCID: PMC9563461 DOI: 10.1186/s12887-022-03635-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Parents of children who are diagnosed with a poor-prognosis cancer want to be involved in making treatment-related decisions for their child. They often make repeated decisions depending on their child’s response to treatment and can experience decisional regret as a consequence. Understanding parent values and preferences when making treatment-related decisions may help enhance discussions with healthcare professionals and identify additional ways of providing support to this parent population. Objectives To explore parent values and preferences underpinning treatment decision-making for children receiving cancer-directed therapy for a poor prognosis cancer. Methods A scoping review of research literature and systematic reviews from qualitative, quantitative, and mixed methods studies was conducted following Joanna Briggs Institute methodology. Articles which included parents of a child who received cancer-directed therapy for a poor-prognosis childhood cancer, under the age of eighteen years were considered. Four electronic databases were searched (CINAHL, Medline, PsychINFO, Web of Science Core Collections). Reference and citation lists of all included full-text articles were also searched. Summative content analysis was used to synthesise findings and develop themes. Results Twelve articles were included. Parent decision-making was affected by underpinning factors: hope for a cure, fear of their child dying and uncertainty. Influencing factors: opinions of others, child’s wishes, and faith and religion had the potential to inform decision-making processes. Parents valued having enough time, being a good parent and being involved in decision-making. Preferences within these values varied resulting in the potential for conflict and ‘trade-offs’ in making decisions. Conclusions Parent decision-making in poor-prognosis childhood cancer is complex and extends beyond values and preferences. Underpinning factors and values are consistent through the decision-making process with influencing factors and preferences varying between parents. Preferences can conflict when parents want to continue cancer-directed therapy whilst maintaining their child’s quality of life or can change depending on a parents’ cognitive state as they realise cure might be unlikely.
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Affiliation(s)
- Helen Pearson H
- School of Health Sciences, University of Southampton, Southampton, UK. .,The Oak Centre for Children and Young People, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, Surrey, UK.
| | - Gemma Bryan
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Catherine Kayum
- Member of the Parent and Carer Group, Patient Public Involvement, London, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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3
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Noyes M, Herbert A, Moloney S, Irving H, Bradford N. Location of end-of-life care of children with cancer: A systematic review of parent experiences. Pediatr Blood Cancer 2022; 69:e29621. [PMID: 35293690 DOI: 10.1002/pbc.29621] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To synthesize existing qualitative research exploring the experiences of parents caring for children with cancer during the end-of-life phase, and the factors that influence parental decision-making when choosing the location of end-of-life care and death for their child. RESULTS This review included 15 studies of 460 parents of 333 children and adolescents who died from progressive cancer. Where reported, the majority (58%) of children died at home or in a hospital (39%), with only a small fraction dying in a hospice. Factors impacting decision-making for the location of care included the quality of communication and the quality of care available. Themes related to choosing home for end-of-life care and death included honoring the child's wishes, the familiarity of home, and parents' desire to be their child's primary carer. Preference for the location of death in the hospital included trust in hospital staff, practical logistics, and the safety of the hospital environment.
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Affiliation(s)
- Michelle Noyes
- Oncology Services, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Anthony Herbert
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Queensland Paediatric Palliative Care Haematology and Oncology Network, Oncology Services Group, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Susan Moloney
- Oncology Services, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Helen Irving
- Queensland Paediatric Palliative Care Haematology and Oncology Network, Oncology Services Group, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Natalie Bradford
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Queensland Paediatric Palliative Care Haematology and Oncology Network, Oncology Services Group, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcome Centre, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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4
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Rost M, Mihailov E. In the name of the family? Against parents' refusal to disclose prognostic information to children. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:421-432. [PMID: 33847853 PMCID: PMC8349339 DOI: 10.1007/s11019-021-10017-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2021] [Indexed: 06/12/2023]
Abstract
Parents frequently attempt to shield their children from distressing prognostic information. Pediatric oncology providers sometimes follow parental request for non-disclosure of prognostic information to children, invoking what we call the stability of the family argument. They believe that if they inform the child about terminal prognosis despite parental wishes, cohesion and family structure will be severely hampered. In this paper, we argue against parental request for non-disclosure. Firstly, we present the stability of the family argument in more detail. We, then, set out the (conceptual, legal, systemic) entitativity of the family and the kind of value the stability of the family argument assumes, before we set on to critically evaluate the argument. Our analysis shows that disclosure of prognostic information to children does not necessarily destabilize the family to a greater extent than non-disclosure. In fact, a systemic perspective suggests that mediated disclosure is more likely to result in a (long-term) stability of the family than non-disclosure. It is in the interest of the family to resist the initial aversive reaction to delivering bad news. In the final part, we draw a set of recommendations on how to facilitate decision-making in face of parental request for non-disclosure.
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Affiliation(s)
- Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland.
| | - Emilian Mihailov
- Institute for Biomedical Ethics, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
- Research Centre in Applied Ethics, Faculty of Philosophy, University of Bucharest, Bucharest, Romania
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5
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Yi J, Kim MA, Parsons BG, Wu YP. Why did I get cancer? Perceptions of childhood cancer survivors in Korea. SOCIAL WORK IN HEALTH CARE 2018; 57:300-314. [PMID: 29436970 PMCID: PMC5927584 DOI: 10.1080/00981389.2018.1436113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study explored whether and how childhood cancer survivors in Korea ask and resolve the question of what may have caused their cancer. Thirty-one childhood cancer survivors participated in in-depth interviews about their self-questioning process in this regard. The findings indicate that Korean childhood cancer survivors pondered this question alone due to the stigma attached to cancer in the family and society. Their answers included internal factors (doing "bad things," having unhealthy eating habits, engaging in magical thinking, having a stress-prone personality, or having a biological susceptibility) or external factors (stressors, random events, the environment, or medical conditions). How they perceived the cause of cancer had an impact on aspects of their current lives. Psychosocial care standards or guidelines are needed in regard to the provision of a safe environment in which Korean cancer survivors and their parents can share their perceptions and process their thoughts.
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Affiliation(s)
- Jaehee Yi
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Min Ah Kim
- Department of Social Welfare, Myongji University, Seoul, Republic of Korea
| | | | - Yelena P. Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
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6
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Day E, Jones L, Langner R, Stirling LC, Hough R, Bluebond-Langner M. "We just follow the patients' lead": Healthcare professional perspectives on the involvement of teenagers with cancer in decision making. Pediatr Blood Cancer 2018; 65. [PMID: 29218835 DOI: 10.1002/pbc.26898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 11/08/2022]
Abstract
PURPOSE We report on an in-depth interview and participant observation study that uses data from multiple sources to determine how the involvement of teenagers with leukaemia is understood and enacted in healthcare. In this article, we investigate healthcare professionals' (HCP) views of teenagers' involvement in decisions about their care and treatment for leukaemia. METHODS We conducted participant observation at 98 multi-disciplinary meetings and 95 open-ended, semi-structured interviews and informal conversations with clinical teenage cancer teams at one UK tertiary referral centre. Data were collected over a 9-month period, audio-recorded, transcribed verbatim and analysed using principles of grounded theory. RESULTS HCP revealed principles relating to the involvement of teenagers with leukaemia in decision making: (1) do the 'right thing', (2) act on the care and treatment preferences of the teenager and (3) openly disclose information about the teenagers' condition. These principles were prioritised and utilised uniquely in each situation, reliant on three mediating factors: (1) family communication styles, (2) stage of illness and (3) nature of the disease. CONCLUSIONS Specialist haematology teams are aware of the individual, and shifting and situational preferences of teenagers. They follow the lead which teenagers give them with regard to these preferences. If actual practice with regard to the involvement of teenagers is found to be wanting, this study refutes that this should be ascribed to insensitivity on the part of HCP about teenagers informational and decisional role preferences.
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Affiliation(s)
- Emma Day
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, United Kingdom
| | - Richard Langner
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
| | - L Caroline Stirling
- Camden, Islington ELiPSe and UCLH & HCA Palliative Care Service, CNWL, London, United Kingdom
| | - Rachael Hough
- Adolescent Haematology, University College London Hospital, London, United Kingdom
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Institute of Child Health, UCL, London, United Kingdom
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7
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Nagoya Y, Miyashita M, Shiwaku H. Pediatric Cancer Patients' Important End-of-Life Issues, Including Quality of Life: A Survey of Pediatric Oncologists and Nurses in Japan. J Palliat Med 2017; 20:487-493. [DOI: 10.1089/jpm.2016.0242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Yuko Nagoya
- Department of Child Health Nursing, Tohoku University School of Medicine, Miyagi, Japan
- Miyagi Children's Hospital, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, Miyagi, Japan
| | - Hitoshi Shiwaku
- Department of Child Health Nursing, Tohoku University School of Medicine, Miyagi, Japan
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8
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Hudson BF, Oostendorp LJM, Candy B, Vickerstaff V, Jones L, Lakhanpaul M, Bluebond-Langner M, Stone P. The under reporting of recruitment strategies in research with children with life-threatening illnesses: A systematic review. Palliat Med 2017; 31:419-436. [PMID: 27609607 PMCID: PMC5405809 DOI: 10.1177/0269216316663856] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Researchers report difficulties in conducting research with children and young people with life-limiting conditions or life-threatening illnesses and their families. Recruitment is challenged by barriers including ethical, logistical and clinical considerations. AIM To explore how children and young people (aged 0-25 years) with life-limiting conditions or life-threatening illnesses and their families were identified, invited and consented to research published in the last 5 years. DESIGN Systematic review. DATA SOURCES MEDLINE, PsycINFO, Web of Science, Sciences Citation Index and SCOPUS were searched for original English language research published between 2009 and 2014, recruiting children and young people with life-limiting conditions or life-threatening illness and their families. RESULTS A total of 215 studies - 152 qualitative, 54 quantitative and 9 mixed methods - were included. Limited recruitment information but a range of strategies and difficulties were provided. The proportion of eligible participants from those screened could not be calculated in 80% of studies. Recruitment rates could not be calculated in 77%. A total of 31% of studies recruited less than 50% of eligible participants. Reasons given for non-invitation included missing clinical or contact data, or clinician judgements of participant unsuitability. Reasons for non-participation included lack of interest and participants' perceptions of potential burdens. CONCLUSION All stages of recruitment were under reported. Transparency in reporting of participant identification, invitation and consent is needed to enable researchers to understand research implications, bias risk and to whom results apply. Research is needed to explore why consenting participants decide to take part or not and their experiences of research recruitment.
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Affiliation(s)
- Briony F Hudson
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Linda JM Oostendorp
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
| | - Paddy Stone
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
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9
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Resilience and Psychosocial Function Among Mainland Chinese Parents of Children With Cancer: A Cross-sectional Survey. Cancer Nurs 2017; 38:466-74. [PMID: 25629894 DOI: 10.1097/ncc.0000000000000220] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Resilience is commonly used to refer to the capacity to resist negative psychological reactions when encountering aversive circumstances. However, clinicians generally define resilience as a lack of psychological distress or an adoption of positive attitude in response to a potentially traumatic event. Although resilience was initially considered to be a psychological variable, it has gradually become seen as a psychosocial indicator now used in clinical settings in the Western world but is still a relatively new topic in most Eastern countries. In this study, we aimed to extend our understandings of the psychological responses of a group of mainland Chinese parents upon being informed that their children were diagnosed with cancer, using resilience as a major indicator. OBJECTIVE The aim of this study was to evaluate the level of resilience among mainland Chinese parents in response to knowing that their children were diagnosed with cancer and to examine the relationships between resilience and other psychosocial outcomes. METHODS A descriptive and a cross-sectional survey design was used and involved a sample of 125 parents who visited a specialist cancer hospital in southeast China between September 2013 and February 2014. RESULTS The participants reported lower level of resilience as compared with a control population in the Chinese community (P < .01). Resilience was negatively correlated with uncertainty in illness (P < .01) and depression (P < .01) and was positively correlated with social support (P < .01) and all other positive coping strategies subscales (P < .01). Parents from the high- resilience group reported better psychosocial functions than did those from the low-resilience group (P < .01). In addition, 6 influencing factors were identified and entered into the multiple linear regression equation of psychological resilience, which predicts 38.3% (adjusted R) of total variation in psychological resilience. CONCLUSION A high level of resilience in parents of children diagnosed with cancer is associated with better psychosocial function in response to the traumatic event. IMPLICATIONS FOR CLINICAL PRACTICE Additional attention should be given to those Mainland Chinese parents who demonstrated a low level of resilience in response to their child's diagnosis. This is particularly important because of the long and stressful process for cancer treatment. Clinicians should also provide targeted interventions to those parents to promote their psychological resilience.
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10
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Verberne LM, Kars MC, Schouten-van Meeteren AYN, Bosman DK, Colenbrander DA, Grootenhuis MA, van Delden JJM. Aims and tasks in parental caregiving for children receiving palliative care at home: a qualitative study. Eur J Pediatr 2017; 176:343-354. [PMID: 28078429 PMCID: PMC5321698 DOI: 10.1007/s00431-016-2842-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/06/2016] [Accepted: 12/23/2016] [Indexed: 11/18/2022]
Abstract
UNLABELLED In paediatric palliative care (PPC), parents are confronted with increasing caregiving demands. More children are cared for at home, and the need for PPC of children is lengthened due to technical and medical improvements. Therefore, a clear understanding of the content of parental caregiving in PPC becomes increasingly important. The objective is to gain insight into parental caregiving based on the lived experience of parents with a child with a life-limiting disease. An interpretative qualitative study using thematic analysis was performed. Single or repeated interviews were undertaken with 42 parents of 24 children with a malignant or non-malignant disease, receiving PPC. Based on their ambition to be a 'good parent', parents caring for a child with a life-limiting disease strived for three aims: controlled symptoms and controlled disease, a life worth living for their ill child and family balance. These aims resulted in four tasks that parents performed: providing basic and complex care, organising good quality care and treatment, making sound decisions while managing risks and organising a good family life. CONCLUSION Parents need early explanation from professionals about balancing between their aims and the related tasks to get a grip on their situation and to prevent becoming overburdened. What is Known: • In paediatric palliative care, parents are confronted with increasing caregiving demands. • Parenting is often approached from the perspective of stress. What is New: • Parents strive for three aims: controlled symptoms and controlled disease, a life worth living for their child and family balance. • Parents perform four tasks: providing basic and complex care, organising good quality care, making decisions while managing risks and organising a good family life. • Professionals need insight into the parents' aims and tasks from the parental perspective to strengthen parents' resilience.
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Affiliation(s)
- Lisa M. Verberne
- 0000000090126352grid.7692.aDepartment of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Marijke C. Kars
- 0000000090126352grid.7692.aDepartment of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Antoinette Y. N. Schouten-van Meeteren
- 0000000404654431grid.5650.6Department of Pediatric Oncology, Emma Children’s Hospital, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Diederik K. Bosman
- 0000000404654431grid.5650.6Department of Pediatrics, Emma Children’s Hospital, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Derk A. Colenbrander
- 0000000404654431grid.5650.6Department of Pediatrics, Emma Children’s Hospital, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Martha A. Grootenhuis
- 0000000404654431grid.5650.6Psychosocial Department, Emma Children’s Hospital, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Princess Máxima Center for Pediatric Oncology, Lundlaan 6, 3584 AE Utrecht, The Netherlands
| | - Johannes J. M. van Delden
- 0000000090126352grid.7692.aDepartment of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
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11
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Day E, Jones L, Langner R, Bluebond-Langner M. Current understanding of decision-making in adolescents with cancer: A narrative systematic review. Palliat Med 2016; 30:920-934. [PMID: 27160700 PMCID: PMC5117127 DOI: 10.1177/0269216316648072] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Policy guidance and bioethical literature urge the involvement of adolescents in decisions about their healthcare. It is uncertain how roles and expectations of adolescents, parents and healthcare professionals influence decision-making and to what extent this is considered in guidance. AIMS To identify recent empirical research on decision-making regarding care and treatment in adolescent cancer: (1) to synthesise evidence to define the role of adolescents, parents and healthcare professionals in the decision-making process and (2) to identify gaps in research. DESIGN A narrative systematic review of qualitative, quantitative and mixed-methods research. We adopted a textual approach to synthesis, using a theoretical framework of interactionism to interpret findings. DATA SOURCES The databases MEDLINE, PsycINFO, SCOPUS, EMBASE and CINHAL were searched from 2001 through May 2015 for publications on decision-making for adolescents (13-19 years) with cancer. RESULTS Twenty-eight articles were identified. Adolescents and parents initially find it difficult to participate in decision-making due to a lack of options in the face of protocol-driven care. Parent and adolescent preferences for information and response to loss of control vary between individuals and over time. No studies indicate parental or adolescent preference for a high degree of independence in decision-making. CONCLUSION Striving to make parents and adolescents fully informed or urge them towards more independence than they prefer may add to distress and confusion. This may interfere with their ability to participate in their preferred way in decisions about care and treatment. Future research should include analysis of on-ground interactions among parents, adolescents and clinicians across the trajectory.
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Affiliation(s)
- Emma Day
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London (UCL), London, UK
| | - Louise Jones
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | - Richard Langner
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London (UCL), London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London (UCL), London, UK
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12
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Sisk BA, Bluebond-Langner M, Wiener L, Mack J, Wolfe J. Prognostic Disclosures to Children: A Historical Perspective. Pediatrics 2016; 138:peds.2016-1278. [PMID: 27561728 PMCID: PMC5005028 DOI: 10.1542/peds.2016-1278] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/24/2022] Open
Abstract
Prognostic disclosure to children has perpetually challenged clinicians and parents. In this article, we review the historical literature on prognostic disclosure to children in the United States using cancer as an illness model. Before 1948, there was virtually no literature focused on prognostic disclosure to children. As articles began to be published in the 1950s and 1960s, many clinicians and researchers initially recommended a "protective" approach to disclosure, where children were shielded from the harms of bad news. We identified 4 main arguments in the literature at this time supporting this "protective" approach. By the late 1960s, however, a growing number of clinicians and researchers were recommending a more "open" approach, where children were included in discussions of diagnosis, which at the time was often synonymous with a terminal prognosis. Four different arguments in the literature were used at this time supporting this "open" approach. Then, by the late 1980s, the recommended approach to prognostic disclosure in pediatrics shifted largely from "never tell" to "always tell." In recent years, however, there has been a growing appreciation for the complexity of prognostic disclosure in pediatrics. Current understanding of pediatric disclosure does not lead to simple "black-and-white" recommendations for disclosure practices. As with most difficult questions, we are left to balance competing factors on a case-by-case basis. We highlight 4 categories of current considerations related to prognostic disclosure in pediatrics, and we offer several approaches to prognostic disclosure for clinicians who care for these young patients and their families.
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Affiliation(s)
- Bryan A. Sisk
- Department of Pediatrics, St Louis Children’s Hospital, St. Louis, Missouri
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children’s Palliative Care, Institute of Child Health, University College London, London, England
| | - Lori Wiener
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, Maryland
| | - Jennifer Mack
- Departments of Pediatric Oncology and Division of Population Sciences, and,Division of Pediatric Hematology/Oncology, and
| | - Joanne Wolfe
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; and,Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
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13
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Abstract
Over the past two decades, paediatric palliative care has emerged as both a primary approach and as its own medical subspecialty, the overall aim of which is to ease suffering for children with life-threatening illness and their families through a concurrent model of care. However, most discussions have been focused on the transition to palliative care when no realistic hope for cure exists. We believe that, because the course of cancer is so unpredictable, this idea is misleading. Indeed, palliative care is increasingly being recognized as being about not just how to cope with the process of dying, but also about how to engage in living when faced with a life-threatening illness. This article will examine our current understanding of several areas of palliative care, with the ultimate message that palliative care is simply a novel term for the total care of a child and family, an approach that should be applied consistently and concurrently regardless of disease status. By improving familiarity with palliative care and building relationships with palliative care specialists, the paediatric oncology clinician will ensure that the best care possible for children and families is provided, regardless of outcome.
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Affiliation(s)
- Elisha Waldman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA 02215, USA
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Wolfe, Associate Editor J. Parents of Children with Serious Illness Are More Resilient than Credited. J Palliat Med 2012; 15:258-9. [DOI: 10.1089/jpm.2012.9607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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