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Liu CY, Zhang S, Wang F, Ni ZH. Hope experiences in parents of children with cancer: A qualitative meta-synthesis. Eur J Oncol Nurs 2024; 70:102583. [PMID: 38631124 DOI: 10.1016/j.ejon.2024.102583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To synthesise qualitative research on the parental hope experiences for children with cancer and identify the levels of parental hope experiences and psychosocial adjustment during cancer events. METHODS Five electronic databases (Cochrane Library, PubMed, Embase, Web of Science, and CINAHL) and three Chinese databases (CNKI, Wanfang, and VIP) were used to retrieve qualitative studies on the hope experiences of parents of children with cancer from inception to February 2023. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to assess the methodological quality of the included studies. Data were synthesised using a thematic analysis. RESULTS Four analytical themes were identified: the process and way hope exists, sources of hope, positive effects of hope, and obstacles to hope maintenance. CONCLUSIONS Maintaining hope is crucial for parents who are caring for their children with cancer. There are different sources of hope, and targeted interventions can enhance the experience of hope for parents of children with cancer. Families, healthcare providers, and society should pay more attention to the parents of children with cancer and provide them with psychological, social, and financial support to improve their level of hope and quality of care.
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Affiliation(s)
- Chun-Yan Liu
- Department of Nursing, Children's Hospital of Soochow University, No. 92 Zhong Nan Street, Soochow, Jiangsu Province, China; School of Nursing, Medical College of Soochow University, No. 1 Shi Zi Road, Soochow, Jiangsu Province, China
| | - Shuo Zhang
- Department of Nursing, Children's Hospital of Soochow University, No. 92 Zhong Nan Street, Soochow, Jiangsu Province, China; School of Nursing, Medical College of Soochow University, No. 1 Shi Zi Road, Soochow, Jiangsu Province, China
| | - Fang Wang
- Department of Nursing, Children's Hospital of Soochow University, No. 92 Zhong Nan Street, Soochow, Jiangsu Province, China; School of Nursing, Medical College of Soochow University, No. 1 Shi Zi Road, Soochow, Jiangsu Province, China
| | - Zhi-Hong Ni
- Department of Nursing, Children's Hospital of Soochow University, No. 92 Zhong Nan Street, Soochow, Jiangsu Province, China.
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Fisher RS, Dattilo TM, DeLone AM, Basile NL, Kenney AE, Hill KN, Chang HF, Gerhardt CA, Mullins LL. The study of psychosocial outcomes of parents bereaved by pediatric illness: a scoping review of methodology and sample composition. J Pediatr Psychol 2024; 49:207-223. [PMID: 38423530 DOI: 10.1093/jpepsy/jsae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Parents of children who died of a medical condition experience a range of psychosocial outcomes. The current scoping review aims to summarize the outcomes assessed, methodology, and sample characteristics of recent psychosocial research conducted with this population. METHODS Included studies were limited to peer-reviewed, psychosocial outcomes research published between August 2011 and August 2022, written in English, and including caregiver study participants of children who died of a medical condition. Data sources were scholarly journal articles from 9 electronic databases, including Scopus, Web of Science, Academic Search Primer, ProQuest Research Library, PubMed, Embase, PsycINFO, Psychology & Behavioral Sciences Collection, and Health Source: Nursing/Academic Edition. The Mixed Methods Appraisal Tool-2018 evaluated methodological quality. RESULTS The study sample included 106 studies, most of which were either qualitative (60%) or quantitative (29%). Mixed-methods studies (8%) and randomized clinical trials (2%) were also identified. Study quality was variable, but most studies met all quality criteria (73%). Studies primarily represented cancer populations (58%), White participants (71%), and mothers (66%). Risk-based psychosocial outcomes (e.g., grief) were more commonly assessed than resilience-based outcomes. CONCLUSIONS The current scoping review revealed that recent research assessing the psychosocial outcomes of bereaved parents is limited in the representation of diverse populations, primarily qualitative, of broadly strong methodological quality, and oriented to psychosocial risk. To enhance the state of the science and inform evidence-based psychosocial services, future research should consider varied methodologies to comprehensively assess processes of risk and resilience with demographically and medically diverse populations.
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Affiliation(s)
- Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Alexandra M DeLone
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Ansley E Kenney
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Kylie N Hill
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hui-Fen Chang
- William E. Brock Memorial Library, Oklahoma State University, Stillwater, OK, United States
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, United States
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3
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Mahoney AF, Handberg C. New medicine for neuromuscular diseases: An evolving paradox for patient and family hopes and expectations. Nurs Inq 2022; 30:e12527. [PMID: 36115015 DOI: 10.1111/nin.12527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Recent developments in novel therapies for neuromuscular diseases offer parents new perspectives on their affected children's future. This article examines how the emergence of new therapies impacts the lives of parents of children with Duchenne muscular dystrophy or spinal muscular atrophy type 2, two genetic neuromuscular disorders characterized by progressive muscle degeneration. Aiming for a first-person perspective, fieldwork was conducted utilizing participant observation, semistructured interviews, and several internet sources. Six families with a total of 12 persons, all living in Denmark, were included in the interviews. Two types of parents were identified who were at opposite ends in dealing with the new therapies-the cure optimists and the cure pragmatists. Different hopes resulted in different narratives for their children's futures. The article raises questions about how and when children with chronic diseases should be involved in their parent's hopes for a cure and highlights the dilemmas facing health professionals working in the field of children with chronic diseases for which the prospects of a cure are improving. We conclude that health professionals must find a way to carefully balance guidance and information about experimental medicines, including the fact that experimental medicine sometimes fails, does not work as well as hoped for, or does not become available, with sustaining parental hopes for their children's future.
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Affiliation(s)
- Annette F. Mahoney
- National Rehabilitation Centre for Neuromuscular Diseases Aarhus Denmark
| | - Charlotte Handberg
- National Rehabilitation Centre for Neuromuscular Diseases Aarhus Denmark
- Department of Public Health Aarhus University Aarhus Denmark
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Spurr S, Bally J, Burles M, Mcharo K. A investigation into hope, self-efficacy, distress and uncertainty in parents who have a child with a life-threatening or life-limiting illness. J Pediatr Nurs 2022; 66:e9-e15. [PMID: 35842378 DOI: 10.1016/j.pedn.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/14/2022] [Accepted: 07/02/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine the experiences of parents who are caring for a child with a life-threatening or life-limiting illness (LTI/LLI) including levels of uncertainty, distress, hope, and self-efficacy to determine if there are significant variations with respect to demographic characteristics. DESIGN AND METHODS Data for this analysis are derived from a quasi-experimental evaluation of a support intervention with a purposeful sample of parental caregivers from a western Canadian province. Participants completed a demographic survey and four quantitative measures at baseline and following use of the support intervention. RESULTS Many parents had high scores of hope and self-efficacy, with highest levels of hope amongst parents who could stay at home with their children, and higher self-efficacy expressed by parents without financial concerns. Increased levels of uncertainty and distress were found amongst parents without other children living in the home, and those with financial concerns, respectively. CONCLUSIONS This exploratory analysis found that many parents experienced clinically significant distress along with uncertainty. The results determined that caring for children in the home other than the ill child significantly decreased uncertainty. High levels of parental hope and self-efficacy were frequently identified, with variations reflecting differences in social roles and stressors. The results contribute to an increased understanding of the value of support resources including parental leave and financial support. PRACTICE IMPLICATIONS Pediatric nurses may consider adopting an approach to caring for families with children in treatment for LLIs/LTIs that gives high priority to promoting hope and self-efficacy while ensuring access to support resources.
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Affiliation(s)
- Shelley Spurr
- University of Saskatchewan, College of Nursing, 104 Clinic Place, Saskatoon, Saskatchewan, Canada.
| | - Jill Bally
- University of Saskatchewan, College of Nursing, 104 Clinic Place, Saskatoon, Saskatchewan, Canada.
| | - Meridith Burles
- University of Saskatchewan, College of Nursing, 104 Clinic Place, Saskatoon, Saskatchewan, Canada.
| | - Kasha Mcharo
- University of Saskatchewan, College of Nursing, 104 Clinic Place, Saskatoon, Saskatchewan, Canada.
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Job MK, Schumacher P, Müller G, Kreyer C. The social and spiritual dimensions of parental experiences on end-of-life care of their child with cancer: A narrative review. Palliat Support Care 2022; 21:1-12. [PMID: 35048846 DOI: 10.1017/s1478951521001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Having a child with cancer is a burdensome experience for parents. Nurses need to better understand beliefs, hopes, and values of parents to holistically support them, which may have an impact on grief and depression. Thus, the aim of this paper was to highlight the social and spiritual dimensions of parental experiences on end-of-life care of their child with cancer. METHOD A narrative literature review was conducted by systematically searching databases (CINAHL Complete, Academic Search Elite, MEDLINE) for relevant literature. The contents of included studies were critically appraised regarding their methodological quality. RESULTS Eleven studies were included. In terms of the social dimension, three categories emerged that are important for parents: Being a Parent, Being in Relationship with the Child, and Being in Relationship with Health Professionals. Parents tried to maintain normality and joy for their child, but also kept control over the situation. They wanted to protect their child from suffering but also felt the need to talk to them about dying. Parents had ambivalent experiences with helpful but also burdensome staff. The spiritual dimension comprised two main categories, Hope and Faith and a Unique Bond. Hope was found to be an important source of strength, while Faith was only mentioned by some parents. For parents the emotional connection with their child constituted a source of meaning as well as a foundation, on which they based their decisions on. SIGNIFICANCE OF RESULTS A therapeutic relationship and a supportive environment can be established by healthcare professionals by noticing, encouraging the unique bond between parents and their children, as well as by reflecting and addressing the parents' challenging situation.
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Affiliation(s)
- Maria Katharina Job
- Hospital of St. John of God in Vienna, Johannes-von-Gott Platz 1, A-1020 Vienna, Austria
| | - Petra Schumacher
- Fachhochschule Krems - University of Applied Sciences Krems, Department of Health Sciences, Institute of Nursing Science, Am Campus Krems, A-3500 Krems, Austria
| | - Gerhard Müller
- UMIT - Private University for Health Sciences, Medical Informatics and Technology, Department of Nursing Science and Gerontology, Institute of Nursing Science, Eduard Wallnoefer-Zentrum 1, A-6060 Hall in Tyrol, Austria
| | - Christiane Kreyer
- UMIT - Private University for Health Sciences, Medical Informatics and Technology, Department of Nursing Science and Gerontology, Institute of Nursing Science, Eduard Wallnoefer-Zentrum 1, A-6060 Hall in Tyrol, Austria
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Vig PS, Lim JY, Lee RWL, Huang H, Tan XH, Lim WQ, Lim MBXY, Lee ASI, Chiam M, Lim C, Baral VR, Krishna LKR. Parental bereavement - impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review. BMC Palliat Care 2021; 20:136. [PMID: 34481491 PMCID: PMC8418708 DOI: 10.1186/s12904-021-00831-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Losing a child tragically impacts the well-being and functioning of parents. With these effects extending beyond emotional, physical morbidity and compromising self-perceptions, appropriate, longitudinal, timely and personalised support is key to effective care of bereaved parents. However, in the absence of a comprehensive understanding of parental bereavement, effective support of bereaved parents remains suboptimal. To address this gap, we scrutinise prevailing data on the effects of a child's death, aged 0-12 years, through the lens of the Ring Theory of Personhood (RToP). METHODS To study prevailing accounts of bereaved parents following the death of a child, we adopt Krishna's Systematic Evidence Based Approach (SEBA) to structure our Systematic Scoping Review (SSR in SEBA). RESULTS Three thousand seventy-four abstracts were reviewed, 160 full text articles were evaluated, and 111 articles were included and analysed using thematic and content analysis. Four themes/categories were identified relating to the four rings of the RToP. Findings reveal that static concepts of protective and risk factors for grief are misplaced and that the support of healthcare professionals is key to assisting bereaved parents. CONCLUSION In the absence of consistent support of bereaved parents, this study highlights the need for effective training of healthcare professionals, beginning with an appreciation that every aspect of an individual parent's personhood is impacted by the loss of their child. Acknowledging grief as a complex, evolving and personalised process subjected to parental characteristics, settings, context and available support, this SSR in SEBA calls attention to effective nurturing of the relationship between parents and healthcare professionals, and suggests use of the RToP to assess and direct personalised, timely, specific support of parents in evolving conditions. We believe the findings of this review also call for further studies to support healthcare professionals as they journey with bereaved parents.
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Affiliation(s)
- Prachi Simran Vig
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Jia Yin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Randal Wei Liang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Huixin Huang
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Road, Block 3 Level 1, Singapore, 169608 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Vijayendra Ranjan Baral
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Division of Neonatal and Developmental Medicine, Singapore General Hospital, Outram Road, Block 5 Level 4, Singapore, 169608 Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228 Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
- Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA UK
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Hjorth E, Lövgren M, Kreicbergs U, Sejersen T, Asaba E. "Suddenly we have hope that there is a future": two families' narratives when a child with spinal muscular atrophy receives a new drug. Int J Qual Stud Health Well-being 2021; 16:1904722. [PMID: 33789523 PMCID: PMC8216061 DOI: 10.1080/17482631.2021.1904722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Purpose: This study aims to explore negotiations of hope in everyday life for families where a child with spinal muscular atrophy (SMA) has received a new drug treatment.Methods: A narrative design was used, drawing on interviews and participant observations in two families with children with SMA, types 1-2, to situate family experiences of hope in everyday life. Narrative analysis was used on the data.Results: Results are presented as stories, with details about situations and contexts, to illustrate how hope was used by families to reconstruct their own family narratives.Conclusions: Hope was negotiated and struggled with in different ways by different family members, but contributed to each person's own way of dealing with the disease and outlook for the future.
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Affiliation(s)
- Elin Hjorth
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,The Department of Women's and Children's Health, Paediatric Oncology and Haematology, Childhood Cancer Research Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Sejersen
- The Department of Women's and Children's Health, Paediatric Neurology, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Eric Asaba
- Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.,Research, Education, Development, and Innovation Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden.,Occupational Therapy & Occupational Science Research Group, Department of Health Sciences, Lund University, Lund, Sweden
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Darlington A, Randall D, Leppard L, Koh M. Palliative and end of life care for a child: Understanding parents' coping strategies. Acta Paediatr 2021; 110:673-681. [PMID: 32564398 DOI: 10.1111/apa.15429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022]
Abstract
AIM Understanding of coping strategies that parents use before the death of their child is crucial and will enable us to best provide support. The current study aimed to explore parents' coping strategies, and map these onto an existing theoretical framework. METHODS Bereaved parents and parents of a child with a life-limiting/threatening condition were interviewed to investigate coping strategies, recruited through Intensive Care Units (2 Neonatal, 2 Paediatric, 1 Paediatric Cardiac) and a children's hospice. Analysis focused on coping strategies and mapping these onto the framework. RESULTS 24 parents of 20 children were interviewed and identified. Parents use a variety of coping strategies (n = 25) such as humour, staying positive, advocating and staying strong for others, expressing emotions and preparing, while also living life to the full, supported by others. The themes were successfully mapped onto the theoretical framework, which focuses on the constructs of approach and avoidance, as well as coping for self and others. CONCLUSION The findings have provided a detailed account of the breadth and depth of coping strategies parents use, including those classed as avoidance. The strategies were successfully mapped onto the theoretical framework. Future research should investigate changes over times, and associations to negative long-term outcomes.
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Affiliation(s)
| | - Duncan Randall
- School of Health Sciences University of Southampton Southampton UK
| | - Lisa Leppard
- Neonatal Intensive Care Unit University Hospital Southampton Southampton UK
| | - Michelle Koh
- University Hospital SouthamptonNaomi House Hospice Southampton UK
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Abstract
BACKGROUND Hope is negatively associated with parental psychosocial distress and psychological maladjustment as well as an important aspect of emotional well-being and coping for adults with cancer and their caregivers. Yet, little is known about hope experiences of parents of children with cancer. OBJECTIVE The aim of this study was to comprehensively describe hope experiences in parents of children with cancer using a systematic mixed-studies review. INTERVENTION/METHODS Psych INFO, PubMed, Academic Search Premier, and CINAHL databases were used to retrieve articles published in English between January 2005 and October 2019. Using the systematic mixed-studies review convergent design, qualitative and quantitative data were collected and extracted followed by qualitative synthesis. Seventeen articles met the inclusion criteria. Exclusion criteria were systematic reviews, nonresearch articles, case reports, and abstracts. RESULTS Hope is a fundamental source of strength and inner guidance for parents. Findings suggest that hope is negatively correlated with parental psychological distress symptoms and coping dysfunctions. Religiosity, spirituality, and adequate provider-parent communication may strengthen hope in parents. CONCLUSION Parental hope may help minimize psychological distress and maladjustment after a child's cancer diagnosis. Open communication channels between providers and parents are critical in preserving hope. An understanding of religiosity, spirituality, optimism, and sociodemographic variables may inform parental psychosocial interventions. IMPLICATIONS FOR PRACTICE Early identification of parents with psychological distress is critical as they may struggle more in the absence of hope. Targeted psychosocial interventions may help parents of children with cancer cope better. Ongoing assessments of spiritual needs may be important in sustaining hope.
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Saad R, Kurdahi LB, Yazbick-Dumit N, Irani C, Muwakkit S. Paediatric oncology providers' perspectives on early integration of paediatric palliative care. Int J Palliat Nurs 2020; 26:100-109. [PMID: 32275476 DOI: 10.12968/ijpn.2020.26.3.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Healthcare providers' perceptions of palliative care in children with cancer influence care management, specifically that of its early integration. Thus, it is crucial to understand the perspectives of the providers on early integration of palliative care so that measures to create informed care decisions are based on reconciling their views. AIMS To explore the perceptions of paediatric oncology providers at the Children's Cancer Institute (CCI) in Lebanon regarding the integration of early paediatric palliative care (PPC) in the management of children with cancer. METHODS A qualitative descriptive research design with focus groups was used in a leading paediatric oncology setting. FINDINGS The thematic analysis yielded four themes: (1) healthcare providers understood palliative care as pain relief and psychological support mainly at the end of life; (2) the timing of integrating PPC is linked to end of life, advanced disease or treatment failure; (3) interdisciplinary collaboration is important for addressing patients' and families' needs effectively; and (4) communication with the child and family is one of the most difficult aspects of integrating PPC. CONCLUSION This study demonstrated the perceptions of healthcare providers about early palliative care in paediatric oncology in Lebanon. It also highlighted the importance of interdisciplinary collaboration and effective communication with the child and family for better management of PPC.
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Affiliation(s)
- Rima Saad
- Clinical Nurse Specialist, Children's Cancer Institute, American University of Beirut Medical Center, Lebanon
| | | | - Nuhad Yazbick-Dumit
- Associate Professor, Hariri School of Nursing, American University of Beirut, Lebanon
| | - Christelle Irani
- Registered Nurse, Children's Cancer Institute, American University of Beirut Medical Center, Lebanon
| | - Samar Muwakkit
- Professor, Children's Cancer Institute, American University of Beirut Medical Center, Lebanon
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11
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Mitchell S, Bennett K, Morris A, Slowther AM, Coad J, Dale J. Achieving beneficial outcomes for children with life-limiting and life-threatening conditions receiving palliative care and their families: A realist review. Palliat Med 2020; 34:387-402. [PMID: 31431129 PMCID: PMC7074600 DOI: 10.1177/0269216319870647] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Palliative care for children and young people is a growing global health concern with significant resource implications. Improved understanding of how palliative care provides benefits is necessary as the number of children with life-limiting and life-threatening conditions rises. AIM The aim is to investigate beneficial outcomes in palliative care from the perspective of children and families and the contexts and hidden mechanisms through which these outcomes can be achieved. DESIGN This is a systematic realist review following the RAMESES standards. A protocol has been published in PROSPERO (registration no: CRD42018090646). DATA SOURCES An iterative literature search was conducted over 2 years (2015-2017). Empirical research and systematic reviews about the experiences of children and families in relation to palliative care were included. RESULTS Sixty papers were included. Narrative synthesis and realist analysis led to the proposal of context-mechanism-outcome configurations in four conceptual areas: (1) family adaptation, (2) the child's situation, (3) relationships with healthcare professionals and (4) access to palliative care services. The presence of two interdependent contexts, the 'expert' child and family and established relationships with healthcare professionals, triggers mechanisms, including advocacy and affirmation in decision-making, which lead to important outcomes including an ability to place the emphasis of care on lessening suffering. Important child and family outcomes underpin the delivery of palliative care. CONCLUSION Palliative care is a complex, multifactorial intervention. This review provides in-depth understanding into important contexts in which child and family outcomes can be achieved so that they benefit from palliative care and should inform future service development and practice.
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Affiliation(s)
- Sarah Mitchell
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Karina Bennett
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Morris
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jane Coad
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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Szabat M. Parental experience of hope in pediatric palliative care: Critical reflections on an exemplar of parents of a child with trisomy 18. Nurs Inq 2020; 27:e12341. [PMID: 31899851 DOI: 10.1111/nin.12341] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 12/01/2022]
Abstract
The purpose of this study is to analyze the experience of hope that appears in a parent's blog presenting everyday life while caring for a child with Trisomy 18 (Edwards syndrome). The author, Rebekah Peterson, began her blog on 17 March 2011 and continues to post information on her son Aaron's care. The analysis of hope in the blog is carried out using a mixed methodology: initial and focused coding using Charmaz's constructed grounded theory and elements of Colaizzi's method. Each aspect of hope is coded through the blog author's statements, from which three main aspects of hope emerge: hope for the longest possible presence of Aaron with his family, hope for control over situations, pain, and symptoms, and existential facets of hope. These various aspects reveal to what extent the experience of hope is unique. Additionally, analyzing the experience of parental hope uncovers the additional problem of inappropriate communication by health care professionals (HCPs) in intensive care units, particularly when discussing the termination of causal treatment. The problem may be solved through proper education for HCPs and serious consideration of parental involvement in order to properly elaborate guidelines on this issue. The three main aspects of parental hope discussed in this paper might expand knowledge on the issue, helping HCPs to better understand the parents' experience of care and to help sustain parental hope in pediatric palliative care.
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Affiliation(s)
- Marta Szabat
- Department of Philosophy and Bioethics, Medical College, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
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13
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Falkenburg JL, van Dijk M, Tibboel D, Ganzevoort RR. The fragile spirituality of parents whose children died in the pediatric intensive care unit. J Health Care Chaplain 2019; 26:117-130. [PMID: 31583971 DOI: 10.1080/08854726.2019.1670538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Spiritual care is recognized as a relevant dimension of health care. In the context of pediatric palliative end-of-life care, spirituality entails more than adhering to a spiritual worldview or religion. Interviews with parents whose critically ill child died in the pediatric intensive care unit revealed features of a spirituality that is fragmentary and full of contradictions. This type of spirituality, which we refer to as fragile, speaks of parents' connectedness with the deceased child and the hope of some kind of reuniting after one's own death. Acknowledging that fragments of spirituality can be part of parents' experiences in their child's end-of-life stage can be a meaningful contribution to compassionate care.
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Affiliation(s)
- Jeannette L Falkenburg
- Intensive Care Unit and Department of Pediatric Surgery (JLF, DT, MvD), Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Monique van Dijk
- Intensive Care Unit and Department of Pediatric Surgery (JLF, DT, MvD), Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dick Tibboel
- Intensive Care Unit and Department of Pediatric Surgery (JLF, DT, MvD), Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - R Ruard Ganzevoort
- Faculty of Religion and Theology (RRG), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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14
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Robert R, Stavinoha P, Jones BL, Robinson J, Larson K, Hicklen R, Smith B, Perko K, Koch K, Findley S, Weaver MS. Spiritual assessment and spiritual care offerings as a standard of care in pediatric oncology: A recommendation informed by a systematic review of the literature. Pediatr Blood Cancer 2019; 66:e27764. [PMID: 31033210 DOI: 10.1002/pbc.27764] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 12/22/2022]
Abstract
Children with cancer and their families experience shifts in spiritual wellness from diagnosis through treatment and survivorship or bereavement. An interdisciplinary team conducted a systematic review of quantitative and qualitative research on spiritual assessments, interventions, and outcomes in childhood cancer following PRISMA guidelines using a PROSPERO registered protocol. Thirty-nine well-designed studies were included in the final analysis. The findings from this systematic review indicate the need for early spiritual assessment with offering of continued support for the spiritual functioning of children with cancer and their families as a standard of care.
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Affiliation(s)
- Rhonda Robert
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pete Stavinoha
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Barbara L Jones
- Steve Hicks School of Social Work and Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Jacob Robinson
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Kara Larson
- Division of Spiritual Ministry and Chaplaincy, Children's Hospital Medical Center, Omaha, Nebraska
| | - Rachel Hicklen
- The Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Blake Smith
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
| | - Kathleen Perko
- Bridges Palliative Care Program, Doernbecher, Children's Hospital, Oregon Health and Science University, Portland, Oregon
| | - Kendra Koch
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
| | - Stephen Findley
- Department of Spiritual Care and Education, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
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15
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Parental coping in the context of having a child who is facing death: A theoretical framework. Palliat Support Care 2017; 16:432-441. [DOI: 10.1017/s1478951517000463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACTObjective:While improvements in healthcare have resulted in children with complex and life-threatening conditions living longer, a proportion of them still die. The death of a child puts parents at increased risk for anxiety, depression, and complicated grief. Increasing our understanding of the coping strategies that parents use under such extreme circumstances will enable us to best provide support to families, before and after a child's death. Our aim herein was to develop a theoretical framework of parental coping.Method:Evidence from the literature was employed to develop a theoretical framework to describe parental coping in the context of having a child with a life-limiting illness who is declining and facing eventual death.Results:The reasoning and argument consists of three guiding elements: (1) the importance of approach as well as avoidance (as coping strategies) in the context of managing the extreme emotions; (2) the importance of the social aspect of coping within a family, whereby parents cope for others as well as for themselves; and (3) the importance of a flexible and balanced coping profile, with parents using different coping strategies simultaneously. Central to the proposed framework is that effective coping, in terms of adjustment, is achieved by balancing coping strategies: accessing different coping strategies simultaneously or in parallel with a specific focus on (1) approach and avoidance and (2) coping aimed at self and others.Significance of results:Understanding of parental coping strategies is essential for health professionals in order to support parents effectively.
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Krafft AM, Martin-Krumm C, Fenouillet F. Adaptation, Further Elaboration, and Validation of a Scale to Measure Hope as Perceived by People: Discriminant Value and Predictive Utility Vis-à-Vis Dispositional Hope. Assessment 2017; 26:1594-1609. [DOI: 10.1177/1073191117700724] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Against the background of different psychological conceptualizations of hope, this article elaborates and validates a measure to assess hope as perceived by the general public adapting it from the hope and optimism subscale of the World Health Organization Quality of Life Spirituality, Religion and Personal Beliefs Questionnaire. The results presented here are part of a yearly Internet-based cross-sectional survey in Germany and Switzerland called Hope-Barometer, from which 4 samples of 3 different years with about 17,500 participants have been used. Following the results of exploratory and confirmatory factor analyses as well as convergent validity, discriminant value, and predictive utility, our findings suggest that the six items of the resulting Perceived Hope Scale exhibits robust psychometric properties, and that perceived hope is distinct and broader than dispositional hope, in which it relates not only to cognitive but also to spiritual, religious, and altruistic dimensions.
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Affiliation(s)
- Andreas M. Krafft
- University of St. Gallen, St. Gallen, Switzerland
- swissfuture, Lucerne, Switzerland
| | - Charles Martin-Krumm
- Université de Lorraine, Metz, France
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
- IFEPS Angers Les Ponts de Cé, Les Ponts-de-Cé, France
- CREAD - EA 3875 - ESPE de Bretagne - UBO
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van der Geest IM, van den Heuvel-Eibrink MM, Zwaan CM, Pieters R, Passchier J, Darlington ASE. Participation in a clinical trial for a child with cancer is burdensome for a minority of children. Acta Paediatr 2016; 105:1100-4. [PMID: 26991953 DOI: 10.1111/apa.13405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/02/2016] [Accepted: 03/11/2016] [Indexed: 11/27/2022]
Abstract
AIM This study explored how parents who had lost a child to cancer felt about them taking part in a clinical trial. METHODS A retrospective questionnaire was sent to parents who had lost a child to cancer. They were asked whether their child took part in a clinical trial during their palliative phase, their motives for their child's participation, how they perceived their child's burden and whether they would, hypothetically speaking, enrol again. RESULTS The 24 parents of 16 deceased children who had participated in a clinical trial explained their motives for their child's participation. The most common answers, with multiple responses, were treatment for future patients (n = 16), hope for a cure (n = 9) and prolonging their child's life (n = 6). Eight parents said that participating was not burdensome for their child and four said it was very burdensome, with others answering in between. None of the parents would decline participation if they would be in the same situation again. CONCLUSION Performing clinical trials, even in a vulnerable population, such as children with cancer at the end of life, may not always lead to increased burden. None of the parents would in future, given the same circumstances, decline participation in a clinical trial.
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Affiliation(s)
- Ivana M.M. van der Geest
- Department of Paediatric Oncology/Haematology; Erasmus MC-Sophia Children's Hospital; Rotterdam Netherlands
- Princess Maxima Centre for Paediatric Oncology; Utrecht Netherlands
| | | | - C. Michel Zwaan
- Department of Paediatric Oncology/Haematology; Erasmus MC-Sophia Children's Hospital; Rotterdam Netherlands
| | - Rob Pieters
- Princess Maxima Centre for Paediatric Oncology; Utrecht Netherlands
| | - Jan Passchier
- Department of Clinical Psychology; VU University Amsterdam; Amsterdam Netherlands
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