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Boyden JY, Umaretiya PJ, D'Souza L, Johnston EE. Disparities in Pediatric Palliative Care: Where Are We and Where Do We Go from Here? J Pediatr 2024; 275:114194. [PMID: 39004168 DOI: 10.1016/j.jpeds.2024.114194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/12/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Jackelyn Y Boyden
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA; Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Puja J Umaretiya
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Louise D'Souza
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Pediatric Hematology/Oncology, Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
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Schwartz-Attias I, Krulik T, Ronen T. Well-being in parents of children with cancer: illness perceptions' mediating role for hope and social support. Front Psychol 2024; 15:1206520. [PMID: 39021645 PMCID: PMC11252627 DOI: 10.3389/fpsyg.2024.1206520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/21/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Parents of children with cancer may experience enormous physical and emotional pressures. During such times, perception of the situation can be important in mediating the link between one's basic resources (mainly cognitive and social) and the well-being one attains as an emotional and cognitive response. This study aimed to explore the role of illness impact perceptions in mediating the link between hope, social support and subjective well-being in parents of children with cancer. Methods The cross-sectional study included 108 parents of children aged 7-18 diagnosed with cancer at least 6 months prior to the study. The parents completed one questionnaire comprising five instruments: perceived impact of illness, hope, social support, positive and negative affect (the emotional component of well-being) and life satisfaction (the cognitive component of well-being). Descriptive statistics and Pearson correlations were conducted for all study variables. SEM analysis was performed to examine the study's theoretical model. Results The current sample included 108 parents of children with cancer recruited from two pediatric hematology-oncology wards in two different hospitals in central Israel. Most participants were mothers (70.4%), and the mean age was 44.46. The main results indicated that hope and social support correlated negatively with perceptions of the illness' impact. Illness impact perceptions mediated the relations between hope, social support and positive emotions, which means that when the parents perceived their child's illness as less impactful on the family, they experienced higher levels of emotional well-being. Conclusion A parent with social support resources and higher levels of hope experiences higher levels of positive perceptions regarding their child's illness. Higher levels of positive perceptions allow the parent to express more positive than negative emotions, thus maintaining a more optimal level of subjective emotional well-being. The findings offer implications for healthcare teams to enhance sensitivity to parents' needs and to help parents attain more resources, positive perceptions, and well-being.
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Affiliation(s)
- Irit Schwartz-Attias
- Meir Academic Nursing School, Meir Medical Center, Clalit Health Services, Kfar Saba, Israel
| | - Tamar Krulik
- Department of Nursing, Faculty of Medical & Health Sciences, Steyer School of Health Professions, Tel Aviv University, Tel Aviv, Israel
| | - Tammie Ronen
- Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
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Boyden JY, Ersek M, Widger KA, Shea JA, Feudtner C. The Home-Based Experiences of Palliative and Hospice Care for Children and Caregivers (EXPERIENCE) Measure: Evaluation of Psychometric Properties. J Pain Symptom Manage 2024:S0885-3924(24)00838-8. [PMID: 38942094 DOI: 10.1016/j.jpainsymman.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/15/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
CONTEXT Home-based pediatric palliative and hospice care (PPHC) supports the hundreds of thousands of children with serious illness and complex care needs and their families in the home setting. Considerable variation, however, exists in the provision and quality of home-based PPHC in the U.S. Ensuring equitable, high-quality home-based PPHC for all children requires the evaluation of families' care experiences and assessment of whether these experiences are aligned with their needs and priorities. OBJECTIVES To evaluate the psychometric properties of the previously developed 23-item home-based PPHC EXPERIENCE Measure for use with families of children receiving home-based PPHC in the United States. METHODS Participants included families recruited from the Children's Hospital of Philadelphia, Courageous Parents Network, and several other hospital- and community-based PPHC programs across the U.S. who provide home-based PPHC services. Participants completed the EXPERIENCE Measure at baseline and again at retest. We evaluated the factor structure of the EXPERIENCE Measure, as well as evidence regarding score reliability and validity. RESULTS Eighty-two family participants completed the baseline and 53 completed the retest questionnaire from 15 states across the U.S. We found evidence for the score reliability and validity of a four-domain EXPERIENCE measure. CONCLUSION The EXPERIENCE Measure is a tool with evidence for reliable and valid scores to evaluate family-reported home-based PPHC experiences at the time care is being received. Future work will evaluate the usability (i.e., acceptability, feasibility, and clinical actionability) of EXPERIENCE, including the sensitivity of the instrument to change over time and its impact on real-time clinical actions.
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Affiliation(s)
- Jackelyn Y Boyden
- Department of Family and Community Health (J.Y.B.), Department of Biobehavioral Health Sciences (M.E.), School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Pediatrics (J.Y.B., C.F.), Children's Hospital of Philadelphia; Philadelphia, Pennsylvania, USA.
| | - Mary Ersek
- Department of Family and Community Health (J.Y.B.), Department of Biobehavioral Health Sciences (M.E.), School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center (M.E.), Philadelphia, Pennsylvania, USA
| | - Kimberley A Widger
- Lawrence Bloomberg Faculty of Nursing (K.A.W.), University of Toronto; Toronto, Ontario, Canada; Pediatric Advanced Care Team, Hospital for Sick Children (K.A.W.), Toronto, Ontario, Canada
| | - Judy A Shea
- Department of Medicine (J.A.S.), Department of Pediatrics (C.F.), Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Department of Pediatrics (J.Y.B., C.F.), Children's Hospital of Philadelphia; Philadelphia, Pennsylvania, USA; Department of Medicine (J.A.S.), Department of Pediatrics (C.F.), Perelman School of Medicine, University of Pennsylvania; Philadelphia, Pennsylvania, USA
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Walter JK, Feudtner C, Cetin A, DeWitt AG, Zhou M, Montoya-Williams D, Olsen R, Griffis H, Williams C, Costarino A. Parental communication satisfaction with the clinical team in the paediatric cardiac ICU. Cardiol Young 2024; 34:282-290. [PMID: 37357911 PMCID: PMC10749983 DOI: 10.1017/s1047951123001555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Understanding parents' communication preferences and how parental and child characteristics impact satisfaction with communication is vital to mitigate communication challenges in the cardiac ICU. METHODS This cross-sectional survey was conducted from January 2019 to March 2020 in a paediatric cardiac ICU with parents of patients admitted for at least two weeks. Family satisfaction with communication with the medical team was measured using the Communication Assessment Tool for Team settings. Clinical characteristics were collected via Epic, Pediatric Cardiac Critical Care Consortium local entry and Society for Thoracic Surgeons Congenital Heart Surgery Databases. Associations between communication score and parental mood, stress, perceptions of clinical care, and demographic characteristics along with patient demographic and clinical characteristics were examined. Multivariable ordinal models were conducted with characteristics significant in bivariate analysis. RESULTS In total, 93 parents of 84 patients (86% of approached) completed surveys. Parents were 63% female and 70% White. Seventy per cent of patients were <6 months old at admission, 25% had an extracardiac abnormality, and 80% had a cardiac surgery this admission. Parents of children with higher pre-surgical risk of mortality scores (OR 2.875; 95%CI 1.076-7.678), presence of surgical complications (72 [63.0, 75.0] vs. 64 [95%CI 54.6, 73] (p = 0.0247)), and greater satisfaction with care in the ICU (r = 0.93922; p < 0.0001) had significantly higher communication scores. CONCLUSION These findings can prepare providers for scenarios with higher risk for communication challenges and demonstrate the need for further investigation into interventions that reduce parental anxiety and improve communication for patients with unexpected clinical trajectories.
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Affiliation(s)
- Jennifer K Walter
- Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chris Feudtner
- Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arzu Cetin
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aaron G DeWitt
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle Zhou
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diana Montoya-Williams
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rob Olsen
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine Williams
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew Costarino
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Encina E, Waratworawan W, Kongjareon Y, Desai MM, Guadamuz TE. Sexual orientation disclosure and depression among Thai gay, bisexual, and other men who have sex with men: The roles of social support and intimate partner violence. PLoS One 2023; 18:e0294496. [PMID: 37992077 PMCID: PMC10664870 DOI: 10.1371/journal.pone.0294496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/02/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Among gay, bisexual, and other men who have sex with men (GBM), sexual orientation disclosure to social groups can act as a significant risk for depression. The primary goal of this research is to understand the association between disclosure and depression, the association of social support and intimate partner violence (IPV) experiences, depression, and disclosure. METHODS This project uses a secondary dataset of Thailand from a larger cross-sectional study distributed in the Greater Mekong Sub-Region. This study utilized web-based answers from 1468 Thai GBM respondents between the ages of 15-24 years. RESULTS Prevalence of depression was over 50%. Across the social groups of interest, those who disclosed to everyone had the lowest depression prevalence. This association was statistically significant for all groups (p<0.050) except for "Family members" (p = 0.052). There was a statistically significant association illustrated between full disclosure to social groups and increased social support. Most respondents (43.9%) had low social support, and additionally this group had the highest level of depression, compared to those with high social support. There was a statistically significant association for lowered depression outcomes and increased social support. IPV experiences that occurred within the last six months had a statistically significant relationship with depression (p = 0.002). There was a notable association between those with experiences of being a victim of IPV, alone and in conjunction with experience of being a perpetrator of IPV, which was associated with increased odds of depression. However, the type of IPV experiences an individual had did not differ based on disclosure status. DISCUSSION This study provides strengthened evidence of the impact that differences in supportive networks can have on mental health outcomes. In addition, they provided a wider consideration for how people may have different IPV experiences, either as a perpetrator, victim, or both, and how those shapes health outcomes of depression. GBM communities still face adversity and challenges that affect their long-term health outcomes, even if they do live in what is considered an accepting country.
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Affiliation(s)
- Eduardo Encina
- Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Worawalan Waratworawan
- Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Yamol Kongjareon
- Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mayur M. Desai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Thomas E. Guadamuz
- Mahidol Center for Health, Behavior and Society, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- John F. Kennedy School of Government, Harvard University, Cambridge, MA, United States of America
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Coats H, Doyon K, Isaacson MJ, Tay D, Rosa WE, Mayahara M, Kates J, Frechman E, Wright PM, Boyden JY, Broden EG, Hinds PS, James R, Keller S, Thrane SE, Mooney-Doyle K, Sullivan SS, Xu J, Tanner J, Natal M. The 2023-2026 Hospice and Palliative Nurses Association Research Agenda. J Hosp Palliat Nurs 2023; 25:55-74. [PMID: 36843048 DOI: 10.1097/njh.0000000000000935] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The Hospice and Palliative Nursing Association established the triannual research agenda to ( a ) provide focus for researchers to conduct meaningful scientific and quality improvement initiatives and inform evidence-based practice, ( b ) guide organizational funding, and ( c ) illustrate to other stakeholders the importance of nursing research foci. HPNA Research Agendas are developed to give direction for future research to continue advancing expert care in serious illness and ensure equitable delivery of hospice and palliative care.
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Cosquer M, Jousselme C. The experience of parents in Ronald McDonald houses in France. Arch Pediatr 2023; 30:219-225. [PMID: 36990937 DOI: 10.1016/j.arcped.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/21/2022] [Accepted: 02/12/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Ronald McDonald houses are located close to children's hospitals. They enable the hospitalized child to benefit from their family's presence, while helping the family to cope better with their child's hospital stay. This study aimed to describe the experience of parents staying in Ronald McDonald houses in France, identify their needs, and study the psychological impact of their child being in hospital. METHOD This cross-sectional observational epidemiological study was conducted in 2016, using anonymous self-administered questionnaires offered to parents staying in one of the nine Ronald McDonald houses in France. The questionnaire had two sections: a general section about the hospitalized child, and a 62 questions section to be completed by each parent, including a Hospital Anxiety and Depression Scale (HADS). RESULTS The participation rate was 62.9%: 71% of mothers completed the questionnaire (n = 320), and 54.7% of fathers did so (n = 246). They were the parents of 333 children (53.9% boys, 46.1% girls), under 1 year old (44.1%), hospitalized in the following three departments: intensive care (24%), pediatric oncology (23.1%), and neonatal care (20.1%). The mothers on average spent 11 h a day at their child's bedside, while the fathers spent 8 h 47 min. The parents tended to be employees or manual workers, and mostly lived together, with an average 2-h journey to hospital. They reported financial problems in 42.1% of cases, significant sleep deprivation (>90 min) in 73.2% of cases, and anxiety and depressive disorders: anxiety (59%) and depression (26%). There were some significant differences between the experiences of mothers and fathers: mothers lost out on their sleep and lost more appetite, and spent more time at their child's bedside, while the fathers encountered twice as many work-related difficulties (p<0.01). Additionally, their perception of the Ronald McDonald House was similar, as over 90% of them stated that this family accommodation allowed them to feel closer to their child and supported them in their role as parents. CONCLUSION The parents of children in hospital were 6-8 times more anxious than the general population, while clinical symptoms of depression were twice as common as in the overall population. Despite this suffering linked to their child's illness, the parents rated highly the support provided by the Ronald McDonald House in helping them cope with their child's time in hospital.
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Hatzell JT, Gioia SA, Francis LA. Unmet health care needs in children of parents with poor self-rated mental health: justification for a “think-family” approach. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2148670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jane T. Hatzell
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Sarah A. Gioia
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Lori A. Francis
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
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Wickramaratne PJ, Yangchen T, Lepow L, Patra BG, Glicksburg B, Talati A, Adekkanattu P, Ryu E, Biernacka JM, Charney A, Mann JJ, Pathak J, Olfson M, Weissman MM. Social connectedness as a determinant of mental health: A scoping review. PLoS One 2022; 17:e0275004. [PMID: 36228007 PMCID: PMC9560615 DOI: 10.1371/journal.pone.0275004] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/08/2022] [Indexed: 11/29/2022] Open
Abstract
Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.
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Affiliation(s)
- Priya J. Wickramaratne
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, United States of America
| | - Tenzin Yangchen
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, United States of America
| | - Lauren Lepow
- Departments of Psychiatry and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Braja G. Patra
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Benjamin Glicksburg
- Departments of Psychiatry and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ardesheer Talati
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, United States of America
| | - Prakash Adekkanattu
- Department of Information Technologies and Services, Weill Cornell Medicine, New York, NY, United States of America
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Joanna M. Biernacka
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Alexander Charney
- Departments of Psychiatry and Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - J. John Mann
- Division of Molecular Imaging and the Neuropathology, Departments of Psychiatry and Radiology, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Jyotishman Pathak
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Myrna M. Weissman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, United States of America
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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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11
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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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12
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Madrigal VN, Hill DL, Shults J, Feudtner C. Trust in Physicians, Anxiety and Depression, and Decision-Making Preferences among Parents of Children with Serious Illness. J Palliat Med 2022; 25:428-436. [PMID: 34516933 PMCID: PMC8968833 DOI: 10.1089/jpm.2021.0063] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To assess parental decision-making preferences when caring for a child with serious illness and to evaluate for an association between preferences and parental trust in physicians, and potential modification of this association by parental anxiety or depression. Methods: We analyzed cross-sectional data from 200 parents of 158 children in the United States who had life-threatening illnesses and whose attending physicians thought that the parents would have to make major medical decision in the next 12 to 24 months. Parents completed measures of decision-making preferences, trust in physicians, anxiety, and depression. Results: Higher reported levels of trust were associated with lower preferences for autonomous decision making (Spearman correlation = -0.24; 95% confidence interval [CI] = -0.36 to -0.01; p < 0.008). Among parents with higher levels of trust, increasing anxiety scores were associated with decreasing preference for autonomy, whereas among parents with lower levels of trust, increasing anxiety scores showed an increasing preference for autonomy (regression coefficient = -0.01; 95% CI = -0.02 to -0.001; p ≤ 0.03). Conclusions: Decreasing trust in physicians is associated with a higher preference for autonomous decision making. Parents who have higher levels of anxiety exhibit this association more strongly. Decision support for parents of children with serious illness should use strategies to respect parental decision-making preferences, address potential distrust, and provide mental health support to parents who are anxious or depressed.
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Affiliation(s)
- Vanessa N. Madrigal
- Division Critical Care Medicine, Department of Pediatrics, George Washington University, Washington, DC, USA.,Pediatric Ethics Program, Children's National Hospital, Washington, DC, USA
| | - Douglas L. Hill
- Department of Medical Ethics, Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Justine Shults
- Department of Biostatistics, Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Department of Medical Ethics, Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Address correspondence to: Chris Feudtner, MD, PhD, MPH, Department of Medical Ethics, Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, USA
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13
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Boyden JY, Hill DL, Nye RT, Bona K, Johnston EE, Hinds P, Friebert S, Kang TI, Hays R, Hall M, Wolfe J, Feudtner C. Pediatric Palliative Care Parents' Distress, Financial Difficulty, and Child Symptoms. J Pain Symptom Manage 2022; 63:271-282. [PMID: 34425212 PMCID: PMC8816828 DOI: 10.1016/j.jpainsymman.2021.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
CONTEXT Parents of patients with a serious illness experience psychological distress, which impacts parents' wellbeing and, potentially, their ability to care for their children. Parent psychological distress may be influenced by children's symptom burden and by families' financial difficulty. OBJECTIVES This study examined the associations among parent psychological distress, parent-reported patient symptoms, and financial difficulty, seeking to determine the relative association of financial difficulty and of patient symptoms to parent psychological distress. METHODS Cross-sectional study of baseline data for 601 parents of 532 pediatric palliative care patients enrolled in a prospective cohort study conducted at seven US children's hospitals. Data included self-reported parent psychological distress and parent report of child's symptoms and family financial difficulty. We used ordinary least squares multiple regressions to examine the association between psychological distress and symptom score, between psychological distress and financial difficulty, and whether the degree of financial difficulty modified the relationship between psychological distress and symptom score. RESULTS The majority of parents were moderately to severely distressed (69%) or severely distressed (17%) and experienced some degree of financial difficulty (65%). While children's symptom scores and family financial difficulty together explained more of the variance in parental psychological distress than either variable alone, parental distress was associated more strongly, and to a larger degree, with financial difficulty than with symptom scores alone. CONCLUSIONS Parent psychological distress was associated with parent-reported patient symptoms and financial difficulty. Future work should examine these relationships longitudinally, and whether interventions to improve symptom management and ameliorate financial difficulties improve parental outcomes.
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Affiliation(s)
- Jackelyn Y Boyden
- Justin Ingerman Center for Palliative Care (J.Y.B., D.L.H., R.T.N., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Douglas L Hill
- Justin Ingerman Center for Palliative Care (J.Y.B., D.L.H., R.T.N., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Russell T Nye
- Justin Ingerman Center for Palliative Care (J.Y.B., D.L.H., R.T.N., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences (K.B.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School (K.B.), Boston, Massachusetts, USA
| | - Emily E Johnston
- Department of Pediatrics (E.E.J.), Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pamela Hinds
- Children's National Hospital (P.H.), Department of Nursing Science, Professional Practice & Quality, Department of Pediatrics, The George Washington University, Washington, District of Columbia, USA
| | - Sarah Friebert
- Department of Pediatrics( S.F.), Division of Palliative Care, Akron Children's Hospital and Rebecca D. Considine Research Institute, Akron, Ohio, USA
| | - Tammy I Kang
- Department of Pediatrics (T.I.K.), Section of Palliative Care, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Ross Hays
- Department of Pediatrics (R.H.), Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, Washington, USA
| | - Matt Hall
- Children's Hospital Association (M.H.), Lenexa, Kansas, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology (J.W.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Chris Feudtner
- Justin Ingerman Center for Palliative Care (J.Y.B., D.L.H., R.T.N., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics (C.F.), Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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14
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Roeper M, Hoermann H, Salimi Dafsari R, Koestner F, Mayatepek E, Kummer S, Reinauer C, Meissner T. Anxiety, depression, and quality of life in parents of children with congenital hyperinsulinism. Eur J Pediatr 2022; 181:2779-2788. [PMID: 35507217 PMCID: PMC9192457 DOI: 10.1007/s00431-022-04486-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
This study aimed to assess mental health, family burden, and quality of life (PQoL) in parents of children with persistent congenital hyperinsulinism (CHI). Forty-eight individual CHI parents (75% female) completed self-reported questionnaires and screening tools for anxiety (GAD-7), depression (PHQ-8), PQoL (ULQIE), and family burden (FaBeL). Additional data on sociodemographics, social support, and child- and disease-related data were recorded. 29.8% of parents showed major depressive symptoms and 38.3% had a probable general anxiety disorder, including 20.8% who had both. The family burden was moderate and assessment of PQoL yielded average scores. Neurological impairment in an affected child (p = .002 and p < .001, respectively) and lower working hours (p = .001 and p = .012, respectively) were the strongest predictors of worse GAD-7 and PHQ-8 scores. Furthermore, lower working hours (p = .012) and comorbidities in the affected child (p = .007) were significantly associated with lower PQoL. Mothers had worse GAD-7 scores (p = .006) and lower PQoL (p = .035) than fathers. Indication of sleep disturbance was associated with worse PHQ-8 scores (p = .003), higher family burden (p = .039), and reduced PQoL (p = .003). A higher number of caretakers besides parents was associated with decreased family burden (p = .019), improved PQoL (p < .001), and lower scores for anxiety (p = .016) and depressive (p = .021) symptoms. Conclusion: Symptoms of depression and anxiety are alarmingly prevalent in parents of children with CHI. Psychological screening of parents should be initiated to ensure early identification of psychological strains and psychosocial support should be offered as needed. A good support network and regular work activities can improve parental mental health and well-being. What is Known: • Psychosocial strains and reduced quality of life are common in parents of chronically ill children. What is New: • In this first study evaluating mental health, family burden, and quality of life in parents of children with congenital hyperinsulinism (CHI), symptoms of depression and anxiety were alarmingly prevalent. • Parents of children with CHI should receive regular psychological screening and psychosocial support should be offered as needed. A good support network and regular work activities can improve parental mental health and well-being.
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Affiliation(s)
- Marcia Roeper
- grid.411327.20000 0001 2176 9917Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Henrike Hoermann
- grid.411327.20000 0001 2176 9917Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Roschan Salimi Dafsari
- grid.411327.20000 0001 2176 9917Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Felix Koestner
- grid.411327.20000 0001 2176 9917Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Ertan Mayatepek
- grid.411327.20000 0001 2176 9917Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Sebastian Kummer
- grid.411327.20000 0001 2176 9917Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Christina Reinauer
- grid.411327.20000 0001 2176 9917Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children's Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
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15
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Chong L, Khalid F, Abdullah A. Compassionate Healthcare for Parents of Children with Life-limiting Illnesses: A Qualitative Study. Indian J Palliat Care 2021; 28:266-271. [PMID: 36072248 PMCID: PMC9443155 DOI: 10.25259/ijpc_50_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/26/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: Premature death of a child from a serious illness is probably one of the most painful experiences for a parent. This study examined the clinical experiences of bereaved parents of children with a life-limiting illness to provide recommendations for quality care. Materials and Methods: Data were collected using semi-structured in-depth interviews with bereaved parents whose children had died at least 3 months before the interview. Parents were purposively sampled from two institutions offering end-of-life care to children with life-limiting illnesses. Data were analysed using thematic analysis. Results: Data analysis revealed three main themes: (1) Clinical communication, (2) Healthcare infrastructure and (3) Non-physical aspects of healthcare. The seven subthemes uncovered were as follows: (1) Honesty and clarity, (2) empathy, (3) interdisciplinary communication, (4) inconveniences in hospital, (5) home palliative care, (6) financial burden of illness and (7) psychosocial and spiritual support. Conclusion: Strategies to improve healthcare for children and their families are multifold. Underlying the provision of quality care is compassion; a child and family-friendly healthcare system with compassionate providers and compassionate institutional policies are vital components to achieving quality healthcare. Culturally sensitive psychosocial, emotional and spiritual support will need to be integrated as standard care.
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Affiliation(s)
- Leeai Chong
- Department of Paediatrics University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan, Malaysia,
| | - Farah Khalid
- Department of Paediatrics University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan, Malaysia,
| | - Adina Abdullah
- Department of Primary Care Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan, Malaysia,
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16
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Ivashchuk A, Guillen U, Mackley A, Locke R, Sturtz W. Parental protective factors and stress in NICU mothers and fathers. J Perinatol 2021; 41:2000-2008. [PMID: 33339983 DOI: 10.1038/s41372-020-00908-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/19/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Evaluate the effect of parental protective factors on parental stress at time of NICU admission and prior to discharge. STUDY DESIGN Parents of infants born at <35 weeks gestation were approached at a single level III NICU. Consenting parents completed a questionnaire on admission and prior to infant's discharge of demographic information and three validated instruments: (1) parental stress (PSS:NICU), (2) Parents' Assessment of Protective Factors (PAPF), and (3) health literacy (PHLAT-8). RESULTS Mean PSS:NICU Total score was 2.8 ± 0.9 (Time 1) and 2.6 ± 1.1 (Time 2). Mean PAPF scores in all subcategories were high (means >3, ±0.3-0.5) (Time 1, Time 2). There was no clinically significant association between PSS:NICU scores and PAPF or any of the other measured variables. CONCLUSION PAPF and other commonly implicated factors were not associated with perceived self-reported parental stress at time of NICU admission and prior to discharge.
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Affiliation(s)
- Alina Ivashchuk
- Pediatrics/Neontalogy, ChristianaCare, Newark, DE, USA. .,Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA.
| | | | - Amy Mackley
- Pediatrics/Neontalogy, ChristianaCare, Newark, DE, USA
| | - Robert Locke
- Pediatrics/Neontalogy, ChristianaCare, Newark, DE, USA
| | - Wendy Sturtz
- Pediatrics/Neontalogy, ChristianaCare, Newark, DE, USA
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17
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Dolan JG, Hill DL, Faerber JA, Palmer LE, Barakat LP, Feudtner C. Association of psychological distress and religious coping tendencies in parents of children recently diagnosed with cancer: A cross-sectional study. Pediatr Blood Cancer 2021; 68:e28991. [PMID: 33844421 PMCID: PMC8285076 DOI: 10.1002/pbc.28991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Parents of children with cancer exhibit high levels of psychological distress. Parents of children with serious illness report religion and spirituality are important coping resources. We sought to describe characteristics of religion, religious coping, social support, and resiliency in parents of children newly diagnosed with cancer and examine associations between psychological distress and self-reported religious coping, religiosity, resiliency, and social support. PATIENTS AND METHODS Cross-sectional observational study of 100 parents of 81 unique children recently diagnosed with cancer. Parents provided demographic information and completed measures of psychological distress, importance of religion, religious coping, resiliency, and social support. Patients' type of tumor and intensity of treatment were collected by medical record abstraction. RESULTS Compared to nationally reported data for adults, parents of children with cancer reported high scores for psychological distress but similar levels of religiosity, religious coping, and resiliency. Negative religious coping (feelings of negativity related to the divine) was associated with higher levels of psychological distress. This effect was most prominent in parents who reported the highest levels of religiosity. Positive religious coping, religiosity, and social support were not associated with levels of psychological distress. DISCUSSION Findings confirm high levels of distress for parents of children with cancer. Negative religious coping was associated with higher levels of psychological distress but positive religious coping, religiosity, and other coping factors were not found to be significantly associated with distress. Further assessment of negative religious coping to inform interventions to promote resiliency is warranted as they may impact parental decision-making and care.
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Affiliation(s)
- J. Gregory Dolan
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Douglas L. Hill
- The Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer A. Faerber
- Healthcare Analytics Unit, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura E. Palmer
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Dept of Spiritual Care, Patient and Family Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lamia P. Barakat
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Division of Oncology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Feudtner
- The Justin Michael Ingerman Center for Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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18
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Phillips BE, Theeke LA, Sarosi KM. Relationship between negative emotions and perceived support among parents of hospitalized, critically ill children. Int J Nurs Sci 2020; 8:15-21. [PMID: 33575440 PMCID: PMC7859540 DOI: 10.1016/j.ijnss.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives The purpose of this study was to describe relationships between negative emotions and perceived emotional support in parents of children admitted to the pediatric intensive care unit (PICU). Methods This cross-sectional descriptive study conducted face-to-face interviews between January 2019 and January 2020. Study variables included depression (PHQ-9 Scale), anxiety (Emotional Distress-Anxiety-Short Form 8a), anger (Emotional Distress-Anger-Short Form 5a), fear (Fear-Affect Computerized Adaptive Test), somatic fear (Fear-Somatic Arousal-Fixed Form), loneliness (Revised 20-item UCLA Loneliness Scale), and perceived emotional support (Emotional Support-Fixed Form). Results Eighty parents reported symptoms of depression 8.00(4.00, 13.75), anxiety (23.43 ± 7.80), anger (13.40 ± 5.46), fear (72.81 ± 27.26), somatic fear 9.00(6.00, 12.75), loneliness (39.35 ± 12.00), and low perceived emotional support (32.14 ± 8.06). Parents who were young, single, low-income, and with limited-post secondary education reported greater loneliness and lower perceived emotional support. Fear correlated with depression (r = 0.737, P < 0.01) and anxiety (r=0.900, P < 0.01). Inverse relationships were discovered between perceived emotional support and loneliness (r = −0.767, P < 0.01), anger (r=-0.401, P < 0.01), and depression (r = −0.334, P < 0.01). Conclusions The cluster of negative emotions identified will serve as potential targets for future interventions designed to enhance support for parents of critically ill children.
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Affiliation(s)
- Brad E. Phillips
- Corresponding author. 64 Medical Center Drive, P.O. Box 9600, Morgantown, WV, 26506-9600, United States.
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