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Rajendran P, Jarasiunaite-Fedosejeva G, İsbir GG, Shorey S. Healthy siblings' perspectives about paediatric palliative care: A qualitative systematic review and meta-synthesis. Palliat Med 2024; 38:25-41. [PMID: 38087809 DOI: 10.1177/02692163231217597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Siblings of children requiring palliative care are often forgotten and overlooked, as the focus tends to be on the ill child and their parents. Limited knowledge of non-bereaved siblings' perspectives makes it challenging to provide appropriate support for them. A review of existing literature is thus needed to better understand the experiences of these siblings and to identify research gaps that may require further examination. AIM To consolidate the available qualitative evidence on the perspectives of non-bereaved healthy siblings regarding paediatric palliative care. DESIGN A qualitative systematic review using a meta-synthesis approach was conducted. DATA SOURCES Six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until October 2022. The search included qualitative and mixed-method studies that reported the perceptions and associations of siblings of patients receiving paediatric palliative care. Data were synthesised using thematic analysis. RESULTS Eleven studies were included. The overarching theme of the review would be 'A walking shadow: Living in the darkness shaped by the dying sibling', and three key themes and nine subthemes were identified from the included articles: (1) Changing family dynamics; (2) Impact on school and socialisation and (3) Psychological impact and coping. CONCLUSION Siblings demonstrated negative psychological impacts and were affected by changing family structure and relationships. However, socialisation with society, and varied coping skills such as cognitive coping and using distraction techniques, were significant for siblings to go through this journey and even led to some positive outcomes for them.
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Affiliation(s)
- Priyadharshni Rajendran
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Gözde Gökçe İsbir
- Midwifery Department, School of Health, Mersin University, Mersin, Turkey
| | - Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Weaver MS, Nasir A, Lord BT, Starin A, Linebarger JS. Supporting the Family After the Death of a Child or Adolescent. Pediatrics 2023; 152:e2023064426. [PMID: 38009001 DOI: 10.1542/peds.2023-064426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/28/2023] Open
Abstract
Whether death occurs in the context of a chronic illness or as the sudden loss of a previously healthy infant, child, or adolescent, the death of a child is a highly stressful and traumatic event. Psychosocial support for families after the death of a child embodies core medical values of professional fidelity, compassion, respect for human dignity, and promotion of the best interests of a grieving family. The pediatrician has an important role in supporting the family unit after the death of a child through a family-centered, culturally humble, trauma-informed approach. This clinical report aims to provide the pediatrician with a review of the current evidence on grief, bereavement, and mourning after the loss of a child and with practical guidance to support family caregivers, siblings, and the child's community. Pediatricians have an important role in helping siblings and helping families understand sibling needs during grief. Ways for pediatricians to support family members with cultural sensitivity are suggested and other helpful resources in the community are described.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
- National Center for Ethics in Health Care, Veterans Health Affairs, Washington, District of Columbia
| | - Arwa Nasir
- Department of Pediatrics, University of Nebraska, Omaha, Nebraska
| | - Blyth T Lord
- Courageous Parents Network, Newton, Massachusetts
| | - Amy Starin
- National Association of Social Workers, Washington, District of Columbia
| | - Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
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Huth K, Frankel H, Cook S, Samuels RC. Caring for a Child with Chronic Illness: Effect on Families and Siblings. Pediatr Rev 2023; 44:393-402. [PMID: 37391635 DOI: 10.1542/pir.2022-005649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Affiliation(s)
- Kathleen Huth
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Hilary Frankel
- Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY
| | - Stacey Cook
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Ronald C Samuels
- Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY
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Perceived Psychological Impact on Children and Parents of Experiencing COVID-19 Infection in One or More Family Members. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091370. [PMID: 36138679 PMCID: PMC9498072 DOI: 10.3390/children9091370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022]
Abstract
SARS-CoV-2 infection may impair behavior and mental health; we explored the psychological impact on parents and children who experienced COVID-19 within their families. A cross-sectional web-based survey was conducted on families attending the COVID-19 Follow-up Clinic at the Department for Women’s and Children’s Health, Padua (Italy). From April 2020 to August 2021, 75 surveys were collected from 66 families (97 parents and 129 children); almost 70% of participants had COVID-19, mostly asymptomatic/mildly symptomatic, and the median time from infection to survey compilation was 164.7 days (SD 56). Most parents (>87%) reported positive relationships with family members either before, during, or after COVID-19. More than one-third of children and adolescents were unable to adapt to isolation. Among 31 pre-school children with a median age of 3 (SD 1.7), a change of one or more functions was reported for 74.2% of cases irrespective of COVID-19 status, particularly a change in circadian rhythm (25%), in relationship with parents (42.8%), and poor emotional control (36%). Among 74 children with a median age of 10.9 years (SD 2.7), 8.1% had a score indicating a disease; however, significant impairment in attention was reported for 16.7%, along with anxiety/depression and problems with conduct in 5.6% and 6.5% of cases, respectively.
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Home-Based Care for Children with Serious Illness: Ecological Framework and Research Implications. CHILDREN 2022; 9:children9081115. [PMID: 35892618 PMCID: PMC9330186 DOI: 10.3390/children9081115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022]
Abstract
Care for U.S. children living with serious illness and their families at home is a complex and patchwork system. Improving home-based care for children and families requires a comprehensive, multilevel approach that accounts for and examines relationships across home environments, communities, and social contexts in which children and families live and receive care. We propose a multilevel conceptual framework, guided by Bronfenbrenner’s ecological model, that conceptualizes the complex system of home-based care into five levels. Levels 1 and 2 contain patient and family characteristics. Level 3 contains factors that influence family health, well-being, and experience with care in the home. Level 4 includes the community, including community groups, schools, and providers. Level 5 includes the broader regional system of care that impacts the care of children and families across communities. Finally, care coordination and care disparities transcend levels, impacting care at each level. A multilevel ecological framework of home-based care for children with serious illness and families can be used in future multilevel research to describe and test hypotheses about aspects of this system of care, as well as to inform interventions across levels to improve patient and family outcomes.
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Affiliation(s)
- Douglas L Hill
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Chris Feudtner
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Jaaniste T, Chin WLA, Tan SC, Cuganesan A, Coombs S, Heaton M, Cowan S, Potter D, Aouad P, Smith PL, Trethewie S. Parent and Well-Sibling Communication in Families With a Child Who Has a Life-Limiting Condition: Quantitative Survey Data. J Pediatr Psychol 2022; 47:606-616. [PMID: 35552431 DOI: 10.1093/jpepsy/jsab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Living with a child with a life-limiting condition (LLC), for which there is no hope of cure and premature death is expected, places much stress on a family unit. Familial communication has the potential to serve as a buffer when children are faced with stressful situations. The overall aim of the study was to learn more about illness-related communication between parents and well-siblings, giving particular consideration to the amount of illness-related communication, and sibling satisfaction with familial communication. METHODS Participants included 48 well-siblings (aged 6-21 years) of children with LLCs and their parents. Parents and well-siblings independently completed validated measures of familial communication and sibling functioning. Parents also provided demographic information and completed a questionnaire assessing amount of illness-related information provided to well-siblings. RESULTS Parents reported that 47.8% of well-siblings never or rarely initiated conversations about their sibling's illness. Moreover, 52.2% of well-siblings never or rarely spoke about death. Amount of illness-related communication between parents and well-siblings was most strongly predicted by parental resilience and well-sibling age. Parents engaged in significantly more illness-related communication with girls than boys (t(44)=-2.28, p = .028). Well-siblings (p < .01) and parents (p < .05) rated satisfaction with familial communication significantly higher than published norms. The only significant predictor of well-sibling satisfaction with familial communication was greater familial cohesion. Family communication variables were not significantly correlated with measures of sibling functioning (all p's>.05). CONCLUSIONS This study provides new information regarding parent and well-sibling communication in families who have a child with a LLC.
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Affiliation(s)
- Tiina Jaaniste
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Wei Ling Audrey Chin
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Sarah Caellainn Tan
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Anjali Cuganesan
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Sandra Coombs
- Department of Palliative Care, Sydney Children's Hospital, Australia
| | - Maria Heaton
- Department of Palliative Care, Sydney Children's Hospital, Australia
| | - Sue Cowan
- Department of Palliative Care, Sydney Children's Hospital, Australia
- Bear Cottage, Australia
| | - Denise Potter
- Department of Palliative Care, Children's Hospital at Westmead, Australia
| | - Phillip Aouad
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | | | - Susan Trethewie
- Department of Palliative Care, Sydney Children's Hospital, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
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Feudtner C, Nye RT, Boyden JY, Schwartz KE, Korn ER, Dewitt AG, Waldman AT, Schwartz LA, Shen YA, Manocchia M, Xiao R, Lord BT, Hill DL. Association Between Children With Life-Threatening Conditions and Their Parents' and Siblings' Mental and Physical Health. JAMA Netw Open 2021; 4:e2137250. [PMID: 34928360 PMCID: PMC8689391 DOI: 10.1001/jamanetworkopen.2021.37250] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Despite concerns regarding the potential deleterious physical and mental health outcomes among family members of a child with a life-threatening condition (LTC), few studies have examined empirical measures of health outcomes among these family members. OBJECTIVES To examine whether mothers, fathers, sisters, and brothers of children with 1 of 4 types of pediatric LTCs have higher rates of health care encounters, diagnoses, and prescriptions compared with families of children without these conditions. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included US families with commercial insurance coverage from a single carrier. Children who had 1 of 4 LTCs (substantial prematurity, critical congenital heart disease, cancer, or a condition resulting in severe neurologic impairment) were identified by a diagnosis in their insurance claim data between July 1, 2015, and June 30, 2016. Each case child and their family was matched with up to 4 control children and their families based on the age of the case and control children. Data were analyzed between August 2020 and March 2021. EXPOSURES Having a child or sibling with substantial prematurity, critical congenital heart disease, cancer, or a condition resulting in severe and progressive neurologic impairment. MAIN OUTCOMES Rates of occurrence of health care encounters, physical and mental health diagnoses, and physical and mental health medication prescriptions, identified from insurance claims data, were compared between case and control families using a multivariable negative binomial regression model. The statistical analysis adjusted for observed differences between case and control families and accounted for clustering at the family level. RESULTS The study included 25 528 children (6909 case children [27.1%] and 18 619 control children [72.9%]; median age, 6.0 years [IQR, 1-13 years]; 13 294 [52.1%] male), 43 357 parents (11 586 case parents [26.7%] and 31 771 control parents [73.3%]; mean [SD] age, 40.4 [8.1] years; 22 318 [51.5%] female), and 25 706 siblings (7664 case siblings [29.8%] and 18 042 control siblings [70.2%]; mean [SD] age, 12.1 [6.5] years; 13 114 [51.0%] male). Overall, case mothers had higher rates of the composite outcome of health care encounters, diagnoses, and prescriptions compared with control mothers (incident rate ratio [IRR], 1.61; 95% CI, 1.54-1.68), as did case fathers compared with control fathers (IRR, 1.55; 95% CI, 1.46-1.64). Sisters of children with LTCs had higher rates of the composite outcome compared with sisters of children without LTCs (IRR, 1.68; 95% CI, 1.55-1.82), as did brothers of children with LTCs compared with brothers of children without LTCs (IRR, 1.70; 95% CI, 1.56-1.85). CONCLUSIONS AND RELEVANCE In this cohort study, mothers, fathers, sisters, and brothers who had a child or sibling with 1 of 4 types of LTCs had higher rates of health care encounters, diagnoses, and medication prescriptions compared with families who did not have a child with that condition. The findings suggest that family members of children with LTCs may experience poorer mental and physical health outcomes. Interventions for parents and siblings of children with LTCs that aim to safeguard their mental and physical well-being appear to be warranted.
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Affiliation(s)
- Chris Feudtner
- Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of General Pediatrics, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Russell T. Nye
- Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jackelyn Y. Boyden
- Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katherine E. Schwartz
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Emilie R. Korn
- Division of General Pediatrics, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Aaron G. Dewitt
- Division of Cardiology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Amy T. Waldman
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Lisa A. Schwartz
- Division of Oncology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Michael Manocchia
- Cigna, Bloomfield, Connecticut
- Department of Sociology, University of North Florida, Jacksonville
| | - Rui Xiao
- Division of General Pediatrics, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Douglas L. Hill
- Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract
OBJECTIVE/METHODS Pediatric Palliative Care (PPC) is a multidisciplinary medical subspecialty focused on the care of children with serious illnesses and terminal diagnoses. Providers impact the care of children from the perinatal stage through adolescence/young adulthood and help patients and families face diagnoses such as complex chronic disease and malignancy. This article describes these unique populations and distinct areas of current PPC research. RESULTS Unique aspects of PPC include a high level of prognostic uncertainty, symptom burden, pediatric, and surrogate advance care planning, hope in the face of prognostic challenges, care of children at end of life, concurrent care, staff support, sibling support, and bereavement. CONCLUSION PPC's evolution from an extension of hospice into a continuum of support for families and staff caring for children with serious illnesses is exemplified in both qualitative and quantitative research. The literature proves the value that PPC can provide to families, hospitals, and communities. PPC is evolving from a supportive service into a uniquely beneficial, collaborative, educational, and interdisciplinary specialty that improves outcomes for all involved.Plain Language Summary (PLS)Pediatric Palliative Care (PPC) is a service provided to all children with serious illness as a way of addressing suffering. Populations served by PPC range from those not yet born to patients preparing for adulthood. The serious illnesses they face range from chronic disease to cancer. Over the last 20 years research has explored the unique aspects of the pediatric experience of serious illness, including prognostic uncertainty, concurrent care, symptom management, advance care planning, hope, family experience of illness, care at the end of life, staff support, and bereavement.As the number of patients who would benefit from PPC services rapidly expands nationally and worldwide, PPC teams provide education and skills training for their colleagues in primary and subspecialty fields. Hospitals benefit from PPC through improved patient experience, family-centered care, and staff support. Communities are served by PPC that occurs in and out of the hospital.Research in PPC provides guidance for challenging questions in care and has resulted in an increasingly robust body of work. PPC providers have skills of advanced communication training, hope in the face of uncertainty, targeted and personalized symptom management, and a diverse understanding of quality of life. These skills help support decision-making and establish strong connections between providers and families.The field of PPC has a distinct skillset to support families who face serious illness. This article helps medical and psychosocial providers visualize how PPC is evolving from what has often been explained to families as an added layer of support into a uniquely beneficial, collaborative, and interdisciplinary service.
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Affiliation(s)
- Benjamin Moresco
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Dominic Moore
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Akard TF, Davis K, Hills T, Lense M, Kim D, Webber R, Dietrich MS, Gilmer MJ. Songwriting intervention for cognitively-impaired children with life-limiting conditions: Study protocol. Contemp Clin Trials Commun 2021; 22:100765. [PMID: 33981908 PMCID: PMC8085894 DOI: 10.1016/j.conctc.2021.100765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
Investigations evaluating the effectiveness of music-based interventions as a complementary approach to symptom management and health promotion for cognitively-impaired children with life-limiting conditions and their families are needed to minimize the physical and psychological burdens on individuals and their caregivers. Songwriting is one music-based strategy for a remote family-centered complementary approach to improve outcomes for cognitively-impaired children with life-limiting conditions, their parents, and families. The overall purpose of this study is to test the feasibility and preliminary efficacy of a songwriting intervention for cognitively-impaired children (ages 5-17 years) who are receiving palliative or complex care and their parents. Specific aims are to: (1) determine the feasibility of songwriting for cognitively-impaired children with life-limiting conditions and their parents, and (2) examine preliminary efficacy of songwriting for child psychological distress and physical symptoms, parent psychological distress, and family environment. The protocol for this 1-group pre-and post-intervention clinical trial (N = 25) is described.
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Affiliation(s)
| | - Kelly Davis
- Vanderbilt University, Nashville, TN, USA
- Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Tracy Hills
- Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Miriam Lense
- Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dana Kim
- Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Rylie Webber
- Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | | | - Mary Jo Gilmer
- Vanderbilt University, Nashville, TN, USA
- Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Transforming a Face-to-Face Legacy Intervention to a Web-Based Legacy Intervention for Children With Advanced Cancer. J Hosp Palliat Nurs 2021; 22:49-60. [PMID: 31804281 DOI: 10.1097/njh.0000000000000614] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research is needed to examine new and innovative web-based intervention delivery methods that are feasible, cost-effective, and acceptable to children and their families to increase access to palliative care services in the home and community. Our previous work included the development of a legacy intervention using face-to-face digital storytelling for children with cancer that showed feasibility and strong promise to improve child outcomes. However, face-to-face intervention delivery techniques limited our recruitment, thus decreasing sample size and potential access to broader populations. Here we present the systematic steps of the development of a web-based legacy intervention for children (7-17 years of age) with relapsed or refractory cancer and their parent caregivers. Counts and frequencies for parent (n = 81) reports on satisfaction surveys are presented and parent suggestions for future work. Results suggest the web-based legacy intervention is feasible and acceptable, with parent-perceived beneficial outcomes for the child, parent, and family. Results provide a foundation for web-based intervention development in palliative care and the implementation of a theoretically grounded intervention to reduce suffering of seriously ill children and their family members, thereby advancing the science of symptom management in vulnerable palliative care populations.
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Kontos N, Gretzema J. Sibling Grief #394. J Palliat Med 2020; 23:985-986. [DOI: 10.1089/jpm.2020.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Natalie Kontos
- Fast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin) and Associate Editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts is available at PCNOW with contact information, and how to
| | - Jennifer Gretzema
- Fast Facts and Concepts are edited by Sean Marks, MD (Medical College of Wisconsin) and Associate Editor Drew A. Rosielle, MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact's content. The full set of Fast Facts is available at PCNOW with contact information, and how to
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Feudtner C, Rosenberg AR, Boss RD, Wiener L, Lyon ME, Hinds PS, Bluebond-Langner M, Wolfe J. Challenges and Priorities for Pediatric Palliative Care Research in the U.S. and Similar Practice Settings: Report From a Pediatric Palliative Care Research Network Workshop. J Pain Symptom Manage 2019; 58:909-917.e3. [PMID: 31445136 PMCID: PMC8499153 DOI: 10.1016/j.jpainsymman.2019.08.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022]
Abstract
CONTEXT To dramatically advance the evidence base for pediatric palliative care (PPC) interventions, practices, and programs in the U.S. and similar practice settings, the field needs to better understand the challenges and opportunities for rigorous scholarship. OBJECTIVES The Pediatric Palliative Care Research Network conducted a workshop to clarify challenges and identify key priorities. METHODS The workshop focused on PPC research topics and methods, including outcomes measurement, qualitative inquiry, analyses of big data, prospective collection of research data, case series and cohort studies, and intervention trials, with synthesizing summary and follow-up discussions. All attendees reviewed and approved the final report. RESULTS Five common challenges were identified: patient diversity and small population size; interdependencies and dynamic interactions between child, family members, and disease processes over time; outcomes and measurement; workforce and infrastructure limitations; and presumed burden of PPC research on participants. Seven priorities emerged: bolster training and development of PPC investigators; develop core resources; advance symptom measurement (and measurements of other exposures and outcomes); improve symptom management and quality of life interventions; improve communication, elicitation of goals of care, and decision making; understand family impact and facilitate or improve family adaptation and coping; and analyze and improve systems of care, policy, and education. CONCLUSION These challenges and priorities identify key research areas that can guide individual investigators and research funders to advance the field.
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Affiliation(s)
- Chris Feudtner
- The Ingerman Center for Pediatric Palliative Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
| | - Abby R Rosenberg
- Palliative Care and Resilience Program, Seattle Children's Research Institute, Seattle, Washington, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins School of Medicine and Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Lori Wiener
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Maureen E Lyon
- Center for Translational Research, Children's National Health System, Washington, District of Columbia, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Pamela S Hinds
- Children's National Health System, Department of Nursing Science, Professional Practice & Quality, and the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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14
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Weiner JA, Woodley LK. An integrative review of sibling responses to childhood cancer. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 31:109-119. [PMID: 30548360 DOI: 10.1111/jcap.12219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Abstract
TOPIC Siblings of children with cancer experience extraordinary responses and changes to their lives over the course of their family's cancer journey. PURPOSE The purpose of this paper is to conduct an integrative literature review to synthesize and analyze relevant findings related to the siblings' experiences of childhood cancer. SOURCES USED CINAHL, PubMed, Embase, MEDLINE, and PsycINFO were searched using the key terms: "sibling*" AND "pediatric*" AND "cancer" AND "experienc*" OR "experience*." Inclusion criteria for this review were research studies focused on sibling responses to having a brother or sister with cancer, published in English between January 1, 2012 and December 31, 2017. CONCLUSIONS Siblings of children with cancer experience many changes to their emotions, relationships, family and home life, school life, and extracurricular activities. They have specific needs and desires including the need for information. Whereas they undergo many changes during the cancer journey, siblings often demonstrate resilience and personal growth and find ways to problem-solve and cope.
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Affiliation(s)
- Jamie A Weiner
- University of North Carolina at Chapel Hill School of Nursing, Undergraduate Division, Chapel Hill, North Carolina
| | - Lisa K Woodley
- University of North Carolina at Chapel Hill School of Nursing, Undergraduate Division, Chapel Hill, North Carolina
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15
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Vo OK, McNeill A, Vogt KS. The psychosocial impact of 22q11 deletion syndrome on patients and families: A systematic review. Am J Med Genet A 2018; 176:2215-2225. [PMID: 29575505 PMCID: PMC6221171 DOI: 10.1002/ajmg.a.38673] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/07/2018] [Accepted: 02/25/2018] [Indexed: 12/16/2022]
Abstract
The 22q11 deletion syndrome (22q11DS) is one of the most common genomic disorders in humans, affecting around 1:2,000 to 1: 4,000 people. 22q11DS affects multiple body systems and is associated with multiple physical problems. Given the high rate of physical morbidity associated with the 22q11DS, it was hypothesized that it would exert a high psychosocial impact on patients and their relatives. To investigate this, a systematic review of the literature and narrative synthesis was performed. Three major themes emerged. First, the complex and conflicting emotions experienced by family members resulting from the diagnosis. Second, the pervasive educational and health‐care challenges associated with the diagnosis and third that people affect by 22q11DS strived for individualism. The results of this review help to inform clinical management of families with 22q11DS.
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Affiliation(s)
- Oanh Kieu Vo
- Sheffield Institute of Translational Neuroscience, The University of Sheffield, Sheffield, United Kingdom
| | - Alisdair McNeill
- Sheffield Institute of Translational Neuroscience, The University of Sheffield, Sheffield, United Kingdom.,Sheffield Clinical Genetics Service, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, United Kingdom
| | - Katharina Sophie Vogt
- Sheffield Institute of Translational Neuroscience, The University of Sheffield, Sheffield, United Kingdom
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16
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Mooney-Doyle K, Deatrick JA, Ulrich CM, Meghani SH, Feudtner C. Parenting in Childhood Life-Threatening Illness: A Mixed-Methods Study. J Palliat Med 2017; 21:208-215. [PMID: 28972873 DOI: 10.1089/jpm.2017.0054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Parenting children with life-threatening illness (LTI) and their healthy siblings requires parents to consider their various needs. OBJECTIVE AND METHODS We conducted a concurrent, cross-sectional mixed-methods study to describe challenges parents face prioritizing tasks and goals for each child with qualitative data, compare parents' tasks and goals for children with LTI and healthy siblings with quantitative data, and describe parenting in terms of the process of prioritizing tasks and goals for all children in the family. RESULTS Participants included 31 parents of children with LTI who have healthy siblings and were admitted to a children's hospital. Qualitative interviews revealed how parents managed children's needs and their perceptions of the toll it takes. Quantitative data revealed that parents prioritized "making sure my child feels loved" highest for ill and healthy children. Other goals for healthy siblings focused on maintaining emotional connection and regularity within the family and for ill children focused on illness management. Mixed-methods analysis revealed that parents engaged in a process decision making and traded-off competing demands by considering needs which ultimately transformed the meaning of parenting. DISCUSSION Future research can further examine trade-offs and associated effects, how to support parent problem-solving and decision-making around trade-offs, and how to best offer social services alongside illness-directed care.
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Affiliation(s)
- Kim Mooney-Doyle
- 1 Department of Family and Community Health, School of Nursing, University of Maryland , Baltimore, Maryland
| | - Janet A Deatrick
- 2 Department of Family and Community Health, School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Connie M Ulrich
- 3 Department of Biobehavioral Health Sciences, School of Nursing, Center for Medical Ethics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Salimah H Meghani
- 4 Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Chris Feudtner
- 5 Department of General Pediatrics and Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
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