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Riguzzi M, Thaqi Q, Peng-Keller S, Lorch A, Blum D, Naef R. Adoption of evidence-based end-of-life and bereavement support to families in cancer care: A contextual analysis study with health professionals. J Clin Nurs 2024; 33:3599-3614. [PMID: 38291546 DOI: 10.1111/jocn.17033] [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: 05/24/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
AIMS To investigate the level of adoption of evidence-based family engagement and support during end-of-life cancer care and subsequent bereavement and its contextual facilitators and barriers from health professionals' perspectives, and to explore differences between professional groups. DESIGN Contextual analysis using an online cross-sectional survey. METHODS This study was conducted in four Swiss hospitals and three home care oncology and palliative care services. Non-parametric testing was used to investigate the level of adoption and differences between nurses, physicians, occupational- and physiotherapists and psychosocial professionals (chaplains, onco-psychologists and social workers). The STROBE checklist for cross-sectional studies was followed. RESULTS The majority of the 111 participating health professionals were nurses. Adoption was statistically significantly higher during end-of-life care than bereavement, with nurses and physicians reporting higher levels than the other professional groups. Guidance on end-of-life family care was available in about half of the cases, in contrast to a quarter for bereavement care. Self-perceived knowledge, skills and attitudes were moderate to high, with nurses and physicians reporting higher levels than others, except for general skills in working with families. Organisational structures were experienced as rather supportive, with the psychosocial group appraising the organisational context as significantly less conducive to fully implementing end-of-life and bereavement care than others, particularly during the end-of-life phase. CONCLUSION Evidence-based family engagement and support were better adopted during end-of-life care than bereavement. Overall, nurses and physicians felt better enabled to care for families compared to other professional groups. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION https://osf.io/j4kfh. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Implementation and quality improvement efforts should focus particularly on the bereavement phase and be tailored to professional groups. IMPACT The findings show that evidence-based family engagement and support practices during end-of-life were rather well adopted in contrast to subsequent bereavement care, with nurses and physicians better enabled than other professionals to provide care. A better understanding of health professionals' contributions and roles in family care is important to build interprofessional capacity for evidence-based end-of-life and bereavement support. REPORTING METHOD The STROBE checklist for reports of cross-sectional studies was followed (von Elm et al., 2007).
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Zurich, Switzerland
| | - Anja Lorch
- Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Palliative Care, City Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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Garcia-Quintero X, Pedraza EC, Cuervo-Suarez MI, Correa I, Baker JN, McNeil MJ. Implementation of a hospital-based end-of-life and bereavement care program in a latin American middle-income country. A source of light and compassion in the midst of cloudy times. BMC Palliat Care 2024; 23:190. [PMID: 39075481 PMCID: PMC11285602 DOI: 10.1186/s12904-024-01522-3] [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: 02/04/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The death of a child is one of the most devastating events a family can face, resulting in significant physical and psychosocial morbidity. Bereavement support programs have been developed in high-income contexts to address this need. However, little is known about implementing bereavement programs in low-and middle-income countries (LMICs). Here, we describe the implementation of a bereavement program for parents whose children died due to cancer or other catastrophic illnesses. METHODS We conducted a retrospective analysis to describe the implementation of a hospital-based End of Life (EoL) care and bereavement program. This program was developed in several stages, including an assessment of bereaved families, development program guidelines, staff training, piloting of the program, refinement, and standardization. The program was developed between 2019 and 2021 in a nonprofit, teaching hospital and referral center for southwestern Colombia. RESULTS Several tools were developed as key components of the bereavement program: a virtual bereavement course; guidance for EoL and bereavement communication and care, memory making, and follow-up calls; a condolence letter template, and group support workshops. A total of 956 healthcare professionals were trained, 258 follow-up calls to bereaved parents were made, 150 individual psychological follow-ups to parents with complicated grief occurred, 79 condolence letters were sent, and 10 support group workshops were carried out. Challenges were identified and overcome, such as limited resources and staff, and cultural perceptions of death. In 2021, this program received an award by the hospital as the Best Strategy to Humanize Healthcare. CONCLUSIONS This study highlights the feasibility of developing and implementing EoL and bereavement care programs for parents and families within hospitals in LMICs. Lack of resources, staff, and training are some of the identified challenges to implementation. Utilizing methodological tools allows us to identify facilitator factors and deliverable outcomes of our EoL and bereavement program. This model provides a valuable framework for resource-limited settings.
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Affiliation(s)
- Ximena Garcia-Quintero
- Department of Global Medicine, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, 38105, USA.
| | - Eddy Carolina Pedraza
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Lucerne, 6005, Switzerland
| | - María Isabel Cuervo-Suarez
- Pediatric Palliative Care, Maternal and Child Department, Fundación Valle de Lili, Avenida Simon Bolivar, Cra. 98 # 18-49, Cali, 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, 760032, Colombia
| | - Isabel Correa
- Pediatric Palliative Care, Maternal and Child Department, Fundación Valle de Lili, Avenida Simon Bolivar, Cra. 98 # 18-49, Cali, 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, 760032, Colombia
| | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care, Stanford Medicine Children's Health, Palo Alto, CA, 94304, USA
| | - Michael J McNeil
- Department of Global Medicine, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, 38105, USA
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, USA
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Riguzzi M, Thaqi Q, Lorch A, Blum D, Peng-Keller S, Naef R. Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses. Eur J Oncol Nurs 2024; 70:102555. [PMID: 38626610 DOI: 10.1016/j.ejon.2024.102555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/09/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE In end-of-life cancer care, 10-20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology. METHODS 81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression. RESULTS Service specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers. CONCLUSIONS While several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland.
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Haematology Clinic, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Centre for Palliative Care, City Hospital Zurich, Tièchestrasse 99, 8037 Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Kirchgasse 9, 8001 Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
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Abstract
In this narrative medicine essay, a pediatric oncologist grapples with the emotions of loss and guilt while attending the memorial service of her 8-year-old patient.
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Affiliation(s)
- Mallory R Taylor
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
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Staniland L, Too C, Butshiire L, Skinner S, Breen LJ. Best Practice in Telephone Bereavement Support: A Thematic Analysis of Bereavement Support Providers' Perspectives. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231199876. [PMID: 37694375 DOI: 10.1177/00302228231199876] [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: 09/12/2023]
Abstract
Telephone bereavement support is recommended in bereavement care policy and practice; however, little is known about what constitutes best practice. To explore how best practice in telephone bereavement support is conceptualized by those who provide the service, 26 healthcare professionals working in Australian hospitals, hospices, and other palliative care settings were interviewed. Thematic analysis was used to construct seven themes: A Valuable Service with Limited Resources, The First Call, The Dance of Rapport, A Space to Share, Identifying and Responding to Risk, Maintaining Contact, and Training and Development Needs. Participants viewed telephone bereavement support as an effective and accessible tool in supporting individuals' processing of and adaptation to loss; however, concerns remain regarding the quality and consistency of care provided. Greater resourcing of bereavement care is required, and telephone bereavement care providers' perspectives offer a foundation to ensure the service is evidence-based, pragmatic, and supported by quality training.
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Affiliation(s)
- Lexy Staniland
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Charmaine Too
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Laura Butshiire
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Shelly Skinner
- Lionheart Camp for Kids, Perth, WA, Australia
- Perth Children's Hospital, Perth, WA, Australia
| | - Lauren J Breen
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Adeyemi OJ, Bouillon-Minois JB, Siman N, Cuthel AM, Goldfeld KS, Grudzen CR. Knowledge and Attitudes Toward Hospice and Palliative Care: Instrument Validation Among Emergency Providers. Am J Hosp Palliat Care 2023; 40:280-290. [PMID: 35549544 DOI: 10.1177/10499091221098664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Emergency providers can engage in goals of care discussions and hospice and palliative care referrals. Little is known about their knowledge and attitudes, which may influence these care practices. Objective: This study aims to re-validate the knowledge and attitude towards hospice and palliative care (KAHP) scale and assess the scale's latent constructs among emergency providers. Methods: The scale consists of ten items measured on a five-point Likert scale. Five of the ten items were reverse scored. Content validation was performed by ten experts in Hospice and Palliative Medicine and Emergency Medicine. Baseline surveys of emergency physicians, advance practice providers, and nurses conducted in the context of a pragmatic, randomized control trial were used for the item analysis and the exploratory and confirmatory factor analyses. Results: The KAHP scale is a ten-item scale scored from 10 to 50. Based on the synthesis of content validation results and the item analysis, all ten items were retained. The item and scale Content Validity Index were each .91. The reliability of the scale was .64 and the exploratory factor analysis identified three underlying constructs defined as self-rated knowledge, support for hospice and palliative care practice, and views on provider-patient communication. The presence of good model fit indices supported the structural integrity of the constructs. Conclusion: We present a validated instrument that is suitable for assessing knowledge and attitude variations toward interventions designed to improve hospice and palliative care practice among emergency providers.
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Affiliation(s)
- Oluwaseun J Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
| | - Jean-Baptiste Bouillon-Minois
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
- Emergency Department55174, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nina Siman
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
| | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
| | - Keith S Goldfeld
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, 12296New York University Grossman School of Medicine, New York, NY, USA
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, 12296New York University Grossman School of Medicine, New York, NY, USA
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Townes A, Gaul Z, Henny KD. Sexual health discussion practices and HIV clinical care provided by primary care providers in the Southeast United States, K-BAP Study (2017-2018). Fam Pract 2023; 40:39-46. [PMID: 35899789 PMCID: PMC11299194 DOI: 10.1093/fampra/cmac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Research underscores the importance of providers having routine discussions with patients about their sexual health. We examined the occurrences and association of routine sexual health discussion practices and human immunodeficiency virus (HIV) clinical care among primary care providers (PCPs) in areas with high HIV prevalence. METHODS We analysed data collected between April and August 2017 from an online survey that assessed PCPs knowledge, behaviours, attitudes, and practices of HIV-related care in 6 Southeast US jurisdictions (Atlanta, Baltimore, Baton Rouge, District of Columbia, Miami, and New Orleans). RESULTS Among PCPs, we found that 39.2% routinely obtained sexual health histories, 78.5% offered HIV testing, and 16.0% ever prescribed preexposure prophylaxis (PrEP). Based on adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), the proportion of PCPs who routinely obtained sexual histories was higher among female PCPs (aPR = 1.47, 95% CI 1.04, 2.08), PCPs who had a patient population that was >50% men who have sex with men (MSM) (aPR = 1.94, 95% CI 1.72, 2.18), offered HIV testing (aPR = 3.60, 95% CI 2.23, 5.79), and ever prescribed PrEP (aPR = 1.43, 95% CI 1.06, 1.93). CONCLUSION Improving patient-provider discussions are needed to reduce HIV-related service barriers for disproportionately affected populations. PRACTICE IMPLICATIONS Routine discussions can reduce barriers to important HIV prevention and care services and help reduce disparities among patients living in highly prevalent HIV locations.
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Affiliation(s)
- Ashley Townes
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Zaneta Gaul
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Social & Scientific Systems, Silver Spring, MD, United States
| | - Kirk D. Henny
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Challenges in Preloss Care to Parents Facing Their Child's End-of-Life: A Qualitative Study From the Clinicians Perspective. Acad Pediatr 2022; 22:910-917. [PMID: 34455098 DOI: 10.1016/j.acap.2021.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/13/2021] [Accepted: 08/21/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Bereavement care for parents predominantly focuses on care after child loss. However, Health Care Professionals (HCPs) feel responsible for supporting parents who are grieving losses in their child's end-of-life. Preloss care is tailored to the parents' needs, thus highly varying. To better understand the nature of preloss care, this study aims to gain insight into the challenges HCPs encounter while providing care for parents during their child's end-of-life. METHODS Exploratory qualitative research using semistructured interviews with physicians and nurses working in neonatology and pediatrics in 3 university pediatric hospitals and 1 child home care service. A multidisciplinary team thematically analyzed the data. RESULTS Twenty-two HCPs participated in this study. From the HCPs' inner perspective, three dyadic dimensions in preloss care delivery were identified that create tension in HCPs: sustaining hope versus realistic prospects, obtaining emotional closeness versus emotional distance, and exploring emotions versus containing emotions. Throughout preloss care delivery, HCPs weighed which strategies to use based on their perception of parental needs, the situation, and their own competencies. HCPs remained with lingering uncertainties on whether the preloss care they provide constituted optimal care. CONCLUSIONS As a result of the experienced tension, HCPs are at risk for prolonged distress and possibly even compassion fatigue. In order to maintain a positive emotional balance in HCPs, education should focus on adapting positive coping strategies and provide hands-on training. Furthermore, on an institutional level a safe environment should be fostered and well-being could be enhanced through learning by sharing as a team.
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Bereavement care provision and its associated factors among nurses in cancer care settings: a cross-sectional study. Support Care Cancer 2022; 30:7625-7633. [PMID: 35676344 DOI: 10.1007/s00520-022-07180-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The goals of this study were to (1) investigate bereavement care provision in practical settings, (2) examine the difference in care by nurses' affiliation (general hospital, hospice, or homecare setting), and (3) identify institutional and personal barriers associated with bereavement care provision. METHODS A cross-sectional survey was conducted using an online questionnaire. Nurses (n = 309) who had an experience of cancer patient care before death at least once in a previous year were included in the analysis. Kruskal-Wallis test and Mann-Whitney test were conducted to compare bereavement care provision by nurses' affiliation, and hierarchical logistic regression analysis was conducted to investigate the correlation between bereavement care provision and its associated factors. RESULTS Less than 30% of nurses reported providing bereavement care in structured settings such as home visits, counseling at a hospital, or phone calls. The differences in bereavement care provision by nurses' affiliation were significant, and the nurses working in a hospital were less likely to provide bereavement care than those working in a hospice or homecare setting. Working in a palliative care setting (OR = 2.35, 95%CI 1.09-5.07, p < 0.05) and greater confidence (OR = 2.18, 95%CI 1.07-4.42, p < 0.05) and knowledge regarding bereavement care (OR = 12.46, 95%CI 5.69-27.29, p < 0.001) were significantly associated factors of bereavement care provision. CONCLUSION This study indicated a lack of bereavement care provision, especially in general hospitals. Improving nurses' confidence and knowledge may encourage them to provide bereavement care provision.
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Linebarger JS, Johnson V, Boss RD, Linebarger JS, Collura CA, Humphrey LM, Miller EG, Williams CSP, Rholl E, Ajayi T, Lord B, McCarty CL. Guidance for Pediatric End-of-Life Care. Pediatrics 2022; 149:186860. [PMID: 35490287 DOI: 10.1542/peds.2022-057011] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The final hours, days, and weeks in the life of a child or adolescent with serious illness are stressful for families, pediatricians, and other pediatric caregivers. This clinical report reviews essential elements of pediatric care for these patients and their families, establishing end-of-life care goals, anticipatory counseling about the dying process (expected signs or symptoms, code status, desired location of death), and engagement with palliative and hospice resources. This report also outlines postmortem tasks for the pediatric team, including staff debriefing and bereavement.
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Affiliation(s)
- Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
| | - Victoria Johnson
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Berman Institute of Bioethics, Baltimore, Maryland
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van Kempen MM, Kochen EM, Kars MC. Insight into the content of and experiences with follow-up conversations with bereaved parents in paediatrics: A systematic review. Acta Paediatr 2022; 111:716-732. [PMID: 34995378 PMCID: PMC9304260 DOI: 10.1111/apa.16248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Abstract
Aim A follow‐up conversation with bereaved parents is a relatively well‐established intervention in paediatric clinical practice. Yet, the content and value of these conversations remain unclear. This review aims to provide insight into the content of follow‐up conversations between bereaved parents and regular healthcare professionals (HCPs) in paediatrics and how parents and HCPs experience these conversations. Methods Systematic literature review using the methods PALETTE and PRISMA. The search was conducted in PubMed and CINAHL on 3 February 2021. The results were extracted and integrated using thematic analysis. Results Ten articles were included. This review revealed that follow‐up conversations are built around three key elements: (1) gaining information, (2) receiving emotional support and (3) facilitating parents to provide feedback. In addition, this review showed that the vast majority of parents and HCPs experienced follow‐up conversations as meaningful and beneficial for several reasons. Conclusion An understanding of what parents and HCPs value in follow‐up conversations aids HCPs in conducting follow‐up conversations and improves care for bereaved parents by enhancing the HCPs' understanding of parental needs.
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Affiliation(s)
- Merel M. van Kempen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Eline M. Kochen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Marijke C. Kars
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
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Naito R, Kasai T. Bereavement of a child as a risk of heart failure. Eur J Heart Fail 2021; 24:190-191. [PMID: 34816534 DOI: 10.1002/ejhf.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ryo Naito
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
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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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Emotional and cognitive barriers of bereavement care among clinical staff in hospice palliative care. Palliat Support Care 2021; 18:676-682. [PMID: 32295666 DOI: 10.1017/s147895152000022x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Bereavement care is one of the major components of hospice palliative care. Previous studies revealed the barriers to the success of the system, including lack of time or support from mental health professionals. Few studies have explored the intrapersonal barriers to bereavement care by clinical staff. The aims of the study were to explore (1) the emotional and cognitive barriers of bereavement care by hospice palliative care staff and (2) the demographic and work characteristics related to these emotional and cognitive barriers. METHOD The participants were clinical staff (n = 301) who were working in hospice palliative care units, including hospice wards, home care, and hospital-based palliative care teams. Their professional backgrounds included physicians (n = 12), nurses (n = 172), social workers (n = 59), psychologists (n = 34), spiritual care specialists (n = 15), and others (n = 9). A cross-sectional design was used and a standardized questionnaire including emotional and cognitive barriers was developed. Information on demographic and work characteristics was also collected. Content validity index, an exploratory factor analysis, and multiple regression analysis were conducted. RESULTS One emotional barrier, "negative emotional reactions" (13 items, Cronbach's α = 0.92), and three cognitive barriers, "lack of ability" (7 items, Cronbach's α = 0.85), "belief in avoidance" (5 items, Cronbach's α = 0.86), and "outcome expectancy" (4 items, Cronbach's α = 0.85) were identified. Clinical staff who had higher working stress, lower self-rated ability for bereavement care, and higher negative impact from major life loss tended to have higher emotional and cognitive barriers. SIGNIFICANCE OF RESULTS Clinical staff should be aware of intrapersonal barriers to bereavement care. Educational programs should be developed to improve the ability to engage in bereavement care.
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Fan SY, Lin WC. An educational bereavement program to decrease clinical staff's barriers and improve self-efficacy of providing bereavement care. Support Care Cancer 2021; 30:835-841. [PMID: 34390399 DOI: 10.1007/s00520-021-06497-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Clinicians face personal barriers that impede the provision of bereavement care and require education in hospice care. This study aims to investigate the effects of an educational bereavement program on emotional and cognitive barriers, self-efficacy, and professional quality of life among clinicians in hospice care. METHODS A pretest-posttest design was implemented. A total of 194 clinicians with working experience in hospice care were recruited. The participants underwent a 12-h workshop. The content included lectures, role-play, and group discussion. Emotional and cognitive barriers, self-efficacy, and professional quality of life were measured before and after the program and at 3-month follow-up. RESULTS After the educational program, negative emotional barriers (F (2, 386) = 17.07, p < 0.001), lack of ability (F (2, 386) = 20.11, p < 0.001), belief in avoidance (F (2, 386) = 7.10, p = 0.001), outcome expectancy (F (2, 386) = 11.32, p < 0.001), and burnout (F (2, 386) = 5.59, p = 0.005) decreased significantly. Self-efficacy (F (2, 386) = 5.37, p = 0.006) and compassion satisfaction (F (2, 386) = 127.99, p < 0.001) increased significantly. CONCLUSION The educational program addressed personal barriers to bereavement care. Role-play and group discussion about emotional and cognitive barriers can reduce barriers and improve self-efficacy in clinicians in hospice care.
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Affiliation(s)
- Sheng-Yu Fan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan City, 701, Taiwan.
| | - Wei-Chun Lin
- Department of Hematology and Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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Kim JY, Park BK. The Most Important Aspects for a Good Death: Perspectives from Parents of Children with Cancer. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211028580. [PMID: 34218697 PMCID: PMC8261844 DOI: 10.1177/00469580211028580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A good death is an important concept in pediatric palliative care. To improve the
quality of pediatric palliative care, it is imperative to identify which domain
is most important for a good death among children with cancer and their parents.
This study aimed to (1) assess the essential domains for a good death from the
perspectives of parents whose children have cancer using the Good Death
Inventory (GDI) and (2) examine which characteristics are associated with the
perception of a good death. An anonymous cross-sectional questionnaire was
administered to 109 parents of children with cancer. Data were collected using a
validated Korean version of the GDI. Descriptive statistics,
t-test, and ANOVA were used to identify the preferred GDI
domains. Multiple linear regression analysis was performed to identify factors
associated with the GDI scores. The most essential domains for a good death
included “maintaining hope and pleasure” and “being respected as an individual.”
The factors most strongly associated with the perception of a good death were
end-of-life plan discussion with parents or others and parental agreement with
establishing a living will. Encouraging families to discuss end-of-life care and
establish a living will in advance can improve the quality of death among
children with cancer.
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Affiliation(s)
- Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Bu Kyung Park
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
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Kochen EM, Boelen PA, Teunissen SCCM, Jenken F, de Jonge RR, Grootenhuis MA, Kars MC. Health Care Professionals' Experiences With Preloss Care in Pediatrics: Goals, Strategies, Obstacles, and Facilitators. J Pain Symptom Manage 2021; 62:107-116. [PMID: 33186732 DOI: 10.1016/j.jpainsymman.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Although parents experience grief when confronted with their child's deterioration and imminent death, most bereavement care is focused on supporting parents after child loss. Insight into intentions and strategies of the health care professionals (HCPs) in preloss care during the end of life is still lacking. OBJECTIVES To create a starting point for improvement of preloss care, this study explores HCPs' experiences with providing support aimed at parental feelings of grief during the child's end of life. METHODS Exploratory qualitative research using individual semistructured interviews with clinicians in pediatrics and neonatology in hospital and homecare settings. Data were thematically analyzed by a multidisciplinary team. RESULTS Nineteen HCPs participated. HCPs tried to ensure that parents could reflect on the care received as concordant to their preferences and were not hindered in their bereavement as a consequence of their professional actions. Strategies included maximizing parental presence, enabling parental involvement in decision making, and ensuring a dignified death. While using these strategies, HCPs faced several difficulties: uncertainty about the illness course, unpredictability of parental grief responses, and being affected themselves by the child's imminent death. It helped HCPs to develop a bond with parents, find comfort with colleagues, and making joint decisions with colleagues. CONCLUSION HCPs strive to improve parental coping after the child's death, yet apply strategies that positively influence parental preparedness and well-being during the end of life as well. Individual HCPs are left with many uncertainties. A more robust approach based on theory, evidence, and training is needed to improve preloss care in pediatrics.
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Affiliation(s)
- Eline M Kochen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floor Jenken
- Department Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roos R de Jonge
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Department of Psycho-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Leveraging Grief: Involving Bereaved Parents in Pediatric Palliative Oncology Program Planning and Development. CHILDREN-BASEL 2021; 8:children8060472. [PMID: 34205109 PMCID: PMC8226717 DOI: 10.3390/children8060472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022]
Abstract
As pediatric palliative care (PPC) became a recognized medical specialty, our developing clinical PPC team longitudinally partnered with bereaved parents to understand the care that their children received as they transitioned towards end of life. Families developed Eight Priorities, shared within, to improve care for children with a poor chance of survival based on their experience of losing a child to cancer. In this paper, we delineate the top eight PPC needs from a parent perspective to offer multi-layered, individually tailored resources for patients and families. One of these Eight Priorities noted that bereavement care for the remaining family members is vital for healing after the death of a child to promote meaning making and resilience in bereaved families. Here, we outline the creation of a bereaved parent-designed bereavement support program as one example of how we have partnered with parents to fulfill their Eight Priorities for quality care.
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Henny KD, Duke CC, Sutton MY. Uptake of online HIV-related continuing medical education training among primary care providers in Southeast United States, 2017-2018. AIDS Care 2020; 33:1515-1524. [PMID: 32985225 PMCID: PMC7997808 DOI: 10.1080/09540121.2020.1822986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Primary care providers play a vital role for HIV prevention and care in high burden areas of the Southeast United States. Studies reveal that only a third of these providers had previous HIV-related training. We evaluated the effects of targeted online continuing medical education training on HIV-related knowledge, attitudes and practices among providers in the Southeast. During April 2017–February 2018, we administered baseline and six-month follow-up surveys to assess changes attributed to online training among a representative sample of providers from six Southeast locations. Data were analyzed using logistic regression analysis (p < 0.05). Baseline and follow-up surveys were completed by 349 participants (61.2% female, 64.6% white, 69.6% physicians, and 27.5% aged 40 years or less); 18% (n = 63) of whom visited online training websites sent following the baseline survey. Comparing baseline versus follow-up responses, providers who completed online training were half as likely to identify “patients’ age” (30% vs. 15%) and “patients’ race” (3% vs. 1.4%) as barriers to discussing sex with clients; survey responses by participants who declined training remained unchanged. Based on baseline versus follow-up responses, providers who visited online training websites were more likely to become familiar with preexposure prophylaxis (PrEP) (38% vs. 58%); participants who declined training remained unchanged at 45%. No impact on clinical practices such as PrEP prescriptions was identified. Targeted online training can enhance HIV readiness and should be explored for providers in the Southeast, particularly for enhancing PrEP service delivery.
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Affiliation(s)
- Kirk D Henny
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Madeline Y Sutton
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, GA, USA
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Giorgali S. Bereaved parents' needs regarding hospital based bereavement care after the death of a child to cancer. DEATH STUDIES 2020; 46:1472-1480. [PMID: 32972331 DOI: 10.1080/07481187.2020.1824202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this study was to investigate the needs of bereaved parents in Greece (N = 56) regarding the provision of hospital based bereavement services after the death of their child to cancer. The participants did not receive formal or informal hospital based bereavement services. The majority of the parents (84%) stated that, given the opportunity, they would attend a bereavement program. Continuity of care in bereavement from the health care team, availability, individualized care, interdisciplinary approach and contact with other bereaved parents were described as key elements for the provision of bereavement services.
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Meaningful Messages From Grief Workshop Participants: A Constructivist Grounded Theory Study. J Hosp Palliat Nurs 2020; 22:180-187. [PMID: 32168087 DOI: 10.1097/njh.0000000000000641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although there is an increased need for delivery of bereavement care, many health care providers in acute care hospital settings feel inadequately prepared to deliver quality grief support, have lack of time, and have inexperience in provision of bereavement care. As a result, although families would like health care providers to offer bereavement support, they are inadequately trained and susceptible to burnout, resulting in families not having their needs met. The purpose of this qualitative study was to uncover the social process occurring in a bereavement education workshop titled "How to Care, What to Say" offered to health care providers. The goal of the workshop was to improve delivery of care for the dying and their family by providing holistic care to the family before, during, and after the death of a loved one. Past grief workshop participants who cared for the bereaved were interviewed, and data were analyzed and synthesized using constructivist grounded theory. Individual interviews and focus group data revealed participants' perceptions, learnings, and potential integration of the workshop into practice. The overarching theory of providing bereavement care that emerged from the data is "a relational process of understanding knowledge, self-awareness, moral responsibilities, and advancing grief competencies of providing holistic grief support."
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22
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Kochen EM, Jenken F, Boelen PA, Deben LMA, Fahner JC, van den Hoogen A, Teunissen SCCM, Geleijns K, Kars MC. When a child dies: a systematic review of well-defined parent-focused bereavement interventions and their alignment with grief- and loss theories. BMC Palliat Care 2020; 19:28. [PMID: 32164668 PMCID: PMC7068872 DOI: 10.1186/s12904-020-0529-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/19/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The availability of interventions for bereaved parents have increased. However, most are practice based. To enhance the implementation of bereavement care for parents, an overview of interventions which are replicable and evidence-based are needed. The aim of this review is to provide an overview of well-defined bereavement interventions, focused on the parents, and delivered by regular health care professionals. Also, we explore the alignment between the interventions identified and the concepts contained in theories on grief in order to determine their theoretical evidence base. METHOD A systematic review was conducted using the methods PALETTE and PRISMA. The search was conducted in MEDLINE, Embase, and CINAHL. We included articles containing well-defined, replicable, paediatric bereavement interventions, focused on the parent, and performed by regular health care professionals. We excluded interventions on pathological grief, or interventions performed by healthcare professionals specialised in bereavement care. Quality appraisal was evaluated using the risk of bias, adapted risk of bias, or COREQ. In order to facilitate the evaluation of any theoretical foundation, a synthesis of ten theories about grief and loss was developed showing five key concepts: anticipatory grief, working models or plans, appraisal processes, coping, and continuing bonds. RESULTS Twenty-one articles were included, describing fifteen interventions. Five overarching components of intervention were identified covering the content of all interventions. These were: the acknowledgement of parenthood and the child's life; establishing keepsakes; follow-up contact; education and information, and; remembrance activities. The studies reported mainly on how to conduct, and experiences with, the interventions, but not on their effectiveness. Since most interventions lacked empirical evidence, they were evaluated against the key theoretical concepts which showed that all the components of intervention had a theoretical base. CONCLUSIONS In the absence of empirical evidence supporting the effectiveness of most interventions, their alignment with theoretical components shows support for most interventions on a conceptual level. Parents should be presented with a range of interventions, covered by a variety of theoretical components, and aimed at supporting different needs. Bereavement interventions should focus more on the continuous process of the transition parents experience in readjusting to a new reality. TRIAL REGISTRATION This systematic review was registered in Prospero (registration number: CRD42019119241).
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Affiliation(s)
- Eline M Kochen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Floor Jenken
- Department Woman and Baby, Wilhelmina Childrens Hospital, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of clinical psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands
| | - Laura M A Deben
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Jurrianne C Fahner
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department Woman and Baby, Wilhelmina Childrens Hospital, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Karin Geleijns
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
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Henny KD, Duke CC, Buchacz K, Brooks JT, Samandari T, Sutton MY. HIV prescriptions on the frontlines: Primary care providers' use of antiretrovirals for prevention in the Southeast United States, 2017. Prev Med 2020; 130:105875. [PMID: 31678174 PMCID: PMC6930335 DOI: 10.1016/j.ypmed.2019.105875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/22/2019] [Accepted: 10/19/2019] [Indexed: 01/11/2023]
Abstract
HIV disproportionately affects persons in Southeast United States. Primary care providers (PCPs) are vital for HIV prevention. Data are limited about their prescribing of antiretrovirals (ARVs) for prevention, including non-occupational post-exposure prophylaxis (nPEP), pre-exposure prophylaxis (PrEP), and antiretroviral therapy (ART). We examined these practices to assess gaps. During April-August 2017, we conducted an online survey of PCPs in Atlanta, Baltimore, Baton Rouge, Miami, New Orleans, and Washington, DC to assess HIV-related knowledge, attitudes and practices. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were used to estimate correlates of nPEP, PrEP and ART prescribing practices. Adjusting for MSA and specialty, the weighted sample (n = 820, 29.6% adjusted response rate) comprised 60.2% white and 59.4% females. PCPs reported ever prescribing nPEP (31.0%), PrEP (18.1%), and ART (27.2%). Prescribing nPEP was associated with nPEP familiarity (aPR = 2.63, 95% CI 1.59, 4.35) and prescribing PrEP (aPR = 3.57, 95% CI 2.78, 4.55). Prescribing PrEP was associated with PrEP familiarity (aPR = 4.35, 95% CI 2.63, 7.14), prescribing nPEP (aPR = 5.00, 95% CI 2.00, 12.50), and providing care for persons with HIV (aPR = 1.56, 95% CI 1.06, 2.27). Prescribing ART was associated with nPEP familiarity (aPR = 1.89, 95% CI 1.27, 2.78) and practicing in outpatient public practice versus hospital-based facilities (aPR = 2.14 95% CI 1.51, 3.04), and inversely associated with collaborations involving specialists (aPR = 0.60, 95% CI 0.42, 0.86). A minority of PCPs surveyed from the Southeast report ever prescribing ARVs for prevention. Future efforts should include enhancing HIV care coordination and developing strategies to increase use of biomedical tools.
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Affiliation(s)
- Kirk D Henny
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
| | | | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - John T Brooks
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Taraz Samandari
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Madeline Y Sutton
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, GA, United States of America
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Henny KD, Duke CC, Geter A, Gaul Z, Frazier C, Peterson J, Buchacz K, Sutton MY. HIV-Related Training and Correlates of Knowledge, HIV Screening and Prescribing of nPEP and PrEP Among Primary Care Providers in Southeast United States, 2017. AIDS Behav 2019; 23:2926-2935. [PMID: 31172333 PMCID: PMC6803031 DOI: 10.1007/s10461-019-02545-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Southeast accounted for most HIV diagnoses (52%) in the United States in 2015. Primary care providers (PCPs) play a vital role in HIV prevention for at-risk persons and treatment of persons living with HIV. We studied HIV-related training, knowledge, and clinical practices among PCPs in the Southeast to address knowledge gaps to inform HIV prevention strategies. Between April and August 2017, we conducted an on-line survey of a representative sample of PCPs in six Southeast jurisdictions with high rates of HIV diagnoses (Atlanta; Baltimore; Baton Rouge; District of Columbia; Miami; New Orleans). We defined HIV-related training as self-reported completion of any certified HIV/STD course or continuing education in past 24 months (prior to survey completion). We assessed associations between training and HIV testing practices, familiarity with nonoccupational post-exposure prophylaxis (nPEP) and pre-exposure prophylaxis (PrEP), and ever prescribing nPEP or PrEP. There were 820 participants after fielding 4595 surveys (29.6% adjusted response rate). In weighted analyses, 36.3% reported HIV-related training. Using adjusted prevalence ratio (aPR) and confidence intervals (CI), we found that PCPs with HIV-related training (compared to those with no training) were more likely to be familiar with nPEP (aPR = 1.32, 95% CI 1.05, 1.67) and PrEP (aPR = 1.67, 95% CI 1.19, 2.38); and to have ever prescribed PrEP to patients (aPR = 1.75, 95% CI 1.10, 2.78). Increased HIV-related trainings among PCPs in high HIV prevalence Southeast jurisdictions may be warranted. Strengthening nPEP and PrEP familiarity among PCPs in Southeast may advance national HIV prevention goals.
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Affiliation(s)
- Kirk D Henny
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-45, Atlanta, GA, 30329, USA.
| | | | - Angelica Geter
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-45, Atlanta, GA, 30329, USA
| | - Zaneta Gaul
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-45, Atlanta, GA, 30329, USA
- ICF, Atlanta, GA, USA
| | | | | | - Kate Buchacz
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-45, Atlanta, GA, 30329, USA
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-45, Atlanta, GA, 30329, USA
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Weaver MS, Lichtenthal WG, Larson K, Wiener L. How I approach expressing condolences and longitudinal remembering to a family after the death of a child. Pediatr Blood Cancer 2019; 66:e27489. [PMID: 30318860 PMCID: PMC6726425 DOI: 10.1002/pbc.27489] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 11/06/2022]
Abstract
Bereaved families fear their child being forgotten by those who knew their loved child, including their child's oncology team. Thoughtfully timed, family-centric condolences shared by pediatric oncology team members have the potential to extend our compassion and kindness toward a family during the darkness of grief. Well-intended medical teams sometimes feel "at a loss" in terms of what to say to a grieving family and how or when to say it. This paper provides a tangible overview of written or verbal condolence communication in a format that can be personalized to the provider and the patient's family.
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Affiliation(s)
- Meaghann S. Weaver
- Division of Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Wendy G. Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kara Larson
- Division of Spiritual Ministry and Chaplaincy, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Cheng BT, Rost M, De Clercq E, Arnold L, Elger BS, Wangmo T. Palliative care initiation in pediatric oncology patients: A systematic review. Cancer Med 2018; 8:3-12. [PMID: 30525302 PMCID: PMC6346252 DOI: 10.1002/cam4.1907] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/06/2018] [Accepted: 11/08/2018] [Indexed: 02/06/2023] Open
Abstract
Palliative care (PC) aims to improve quality of life for patients and their families. The World Health Organization and American Academy of Pediatrics recommend that PC starts at diagnosis for children with cancer. This systematic review describes studies that reported PC timing in the pediatric oncology population. The following databases were searched: PubMed, Web of Science, CINAHL, and PsycInfo databases. Studies that reported time of PC initiation were independently screened and reviewed by 2 researchers. Studies describing pilot initiatives, published prior to 1998, not written in English, or providing no empirical time information on PC were excluded. Extracted data included sample characteristics and timing of PC discussion and initiation. Of 1120 identified citations, 16 articles met the inclusion criteria and comprised the study cohort. Overall, 54.5% of pediatric oncology patients received any palliative service prior to death. Data revealed PC discussion does not occur until late in the illness trajectory, and PC does not begin until close to time of death. Despite efforts to spur earlier initiation, many pediatric oncology patients do not receive any palliative care service, and those who do, predominantly receive it near the time of death. Delays occur both at first PC discussion and at PC initiation. Efforts for early PC integration must recognize the complex determinants of PC utilization across the illness timeline. This systematic review examines the timing of palliative care initiation in pediatric oncology patients to assess the state of palliative care integration. Many pediatric oncology patients do not receive any palliative service, and those who do, typically receive it late in the illness trajectory.
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Affiliation(s)
- Brian T Cheng
- Department of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Whitford B, Nadel AL, Fish JD. Burnout in pediatric hematology/oncology-time to address the elephant by name. Pediatr Blood Cancer 2018; 65:e27244. [PMID: 29797652 DOI: 10.1002/pbc.27244] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/13/2018] [Accepted: 04/23/2018] [Indexed: 11/10/2022]
Abstract
The last decade has brought increasing recognition that the wellness of health care providers has an impact on the quality of care, patient satisfaction, and health care economics. This review will describe models of burnout, discuss the impact of burnout on medicine with a focus on pediatric hematologists/oncologists, and present interventions that may help ameliorate physician burnout.
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Affiliation(s)
- Brittney Whitford
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Cohen Children's Medical Center, New Hyde Park, New York
| | - Amy L Nadel
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Cohen Children's Medical Center, New Hyde Park, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jonathan D Fish
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Cohen Children's Medical Center, New Hyde Park, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Haines ER, Frost AC, Kane HL, Rokoske FS. Barriers to accessing palliative care for pediatric patients with cancer: A review of the literature. Cancer 2018; 124:2278-2288. [DOI: 10.1002/cncr.31265] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/23/2017] [Accepted: 12/28/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Emily R. Haines
- Department of Health Policy and Management, Gillings School of Global Public Health; The University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- End-of-Life, Hospice, and Palliative Care Program; RTI International; Research Triangle Park North Carolina
| | - A. Corey Frost
- Child and Adolescent Research and Evaluation Program; RTI International; Research Triangle Park North Carolina
| | - Heather L. Kane
- Child and Adolescent Research and Evaluation Program; RTI International; Research Triangle Park North Carolina
| | - Franziska S. Rokoske
- End-of-Life, Hospice, and Palliative Care Program; RTI International; Research Triangle Park North Carolina
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Personalized and yet standardized: An informed approach to the integration of bereavement care in pediatric oncology settings. Palliat Support Care 2018; 16:706-711. [PMID: 29386073 DOI: 10.1017/s1478951517001249] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The death of a child has been associated with adverse parental outcomes, including a heightened risk for psychological distress, poor physical health, loss of employment income, and diminished psychosocial well-being. Psychosocial standards of care for centers serving pediatric cancer patients recommend maintaining at least one meaningful contact between the healthcare team and bereaved parents to identify families at risk for negative psychosocial sequelae and to provide resources for bereavement support. This study assessed how this standard is being implemented in current healthcare and palliative care practices, as well as barriers to its implementation. METHOD Experts in the field of pediatric palliative care and oncology created a survey that was posted with review and permission on four listservs. The survey inquired about pediatric palliative and bereavement program characteristics, as well as challenges and barriers to implementation of the published standards of care.ResultThe majority of participants (N = 100) self-reported as palliative care physicians (51%), followed by oncologists (19%). Although 59% of staff reported that their center often or always deliver bereavement care after a child's death, approximately two-thirds reported having no policy for the oncology team to routinely assess bereavement needs. Inconsistent types of bereavement services and varying duration of care was common. Twenty-eight percent of participants indicated that their center has no systematic contact with bereaved families after the child's death. Among centers where contacts are made, the person who calls the bereaved parent is unknown to the family in 30% of cases. Few centers (5%) use a bereavement screening or assessment tool.Significance of resultsLack of routine assessment of bereavement needs, inconsistent duration of bereavement care, and tremendous variability in bereavement services suggest more work is needed to promote standardized, policy-driven bereavement care. The data shed light on multiple areas and opportunities for improvement.
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Pediatric Cardiology Provider Attitudes About Palliative Care: A Multicenter Survey Study. Pediatr Cardiol 2017; 38:1324-1331. [PMID: 28664445 DOI: 10.1007/s00246-017-1663-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/15/2017] [Indexed: 02/07/2023]
Abstract
While availability of palliative care consultation for children with advanced heart disease increases, little is known about cardiologist attitudes towards palliative care. We sought to describe perspectives of cardiologists regarding palliative care and to characterize their perceived competence in palliative care concepts. A cross-sectional survey of pediatric cardiologists and cardiac surgeons from 19 pediatric medical centers was performed. Overall response rate was 31% (183/589). Respondents had a median of 18 years of experience since medical school (range 2-49) and most practiced at academic centers (91%). Sixty-percent of respondents felt that palliative care consultations occur "too late" and the majority (85%) agreed that palliative care consultations are helpful. Barriers to requesting palliative care consultation were most frequently described as "referring to palliative care services too early will undermine parents' hope" (45%) and "concern that parents will think I am giving up on their child" (56%). Only 33% of cardiologists reported feeling "very" or "moderately" competent in prognosticating life expectancy while over 60% felt competent caring for children with heart disease around end of life, and nearly 80% felt competent discussing goals of care and code status. Greater perceived competence was associated with subspecialty (heart failure/intensivist vs. other) (OR 3.6, 95% CI 1.6-8.1, p = 0.003) and didactic training (OR 6.27, 95% CI 1.8-21.8, p = 0.004). These results underscore the need for further training in palliative care skills for pediatric cardiologists. Enhancing palliative care skills among cardiologists and facilitating partnership with subspecialty palliative care teams may improve overall care of children with advanced heart disease.
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