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Daniels S, Franqui-Rios ND, Mothi SS, Gaitskill E, Cantrell K, Kaye EC. Access to legacy-oriented interventions at end of life for pediatric oncology patients: A decedent cohort review. Pediatr Blood Cancer 2024; 71:e31066. [PMID: 38757484 DOI: 10.1002/pbc.31066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/13/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Legacy-oriented interventions have the potential to offer pediatric oncology patients and families comfort at end of life and during bereavement. Certified child life specialists often provide these services, and presently little is known about whether disparities exist in the provision of legacy-oriented interventions. METHODS In this retrospective decedent cohort study, we examined demographic and clinical characteristics from a sample of 678 pediatric oncology patients who died between 2015 and 2019. Bivariate analysis assessed differences between patients who received any versus no legacy-oriented intervention. Uni- and multivariable logistic regression models assessed associations of baseline characteristics and likelihood of receiving legacy-oriented intervention. Further multivariable analysis explored joint effects of significant variables identified in the univariable analysis. RESULTS Fifty-two percent of patients received a legacy-oriented intervention. Older adolescents (≥13 years) were less likely (odds ratio [OR]: 1.73, p = .007) to receive legacy-oriented interventions than younger ones. Patients with home/hospice deaths were also less likely (OR: 19.98, p < .001) to receive interventions compared to patients who passed away at SJCRH locations. Hispanic patients (OR: 1.53, p = .038) and those in palliative care (OR: 10.51, p < .001) were more likely to receive interventions. No significant race association was noted. CONCLUSION All children and adolescents with cancer deserve quality care at end of life, including access to legacy-oriented interventions, yet nearly half of patients in this cohort did not receive these services. By identifying demographic and clinical characteristics associated with decreased odds of receiving legacy-oriented interventions, healthcare professionals can modify end-of-life care processes to improve access. Introducing legacy-oriented interventions early and increasing exposure in community spaces may enhance access to legacy-oriented interventions for pediatric oncology patients.
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Affiliation(s)
- Sarah Daniels
- Child Life Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Nelson D Franqui-Rios
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico, Puerto Rico
| | - Suraj S Mothi
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Elizabeth Gaitskill
- Child Life Program, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kathryn Cantrell
- Department of Human Development, Family Studies, and Counseling, Texas Woman's University, Denton, Texas, USA
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Keller BP, Akard TF, Boles JC. Legacy in paediatrics: A concept analysis. J Adv Nurs 2024; 80:948-957. [PMID: 37921200 DOI: 10.1111/jan.15922] [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: 06/14/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
AIM To provide an analysis of legacy and legacy-oriented interventions in paediatric healthcare. DESIGN Walker and Avant's method of concept analysis. METHODS Using Walker and Avant's method, three defining attributes of the concept were determined, followed by antecedents, consequences, and empirical referents of legacy. RESULTS In paediatrics, legacy is co-authored in relationships, has the capability to outlive the person or event it represents, and elicits the essence of a person or experience. Receiving legacy-oriented interventions are not a prerequisite for having a legacy, nor is death. CONCLUSION Engaging in purposeful, individualized legacy-oriented interventions can improve coping in paediatric patients, families, and providers. By understanding the concept of legacy, providers are better equipped to provide care honouring the unique personhood, relationships, and strengths of children and families in even the most dire circumstances. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Understanding the scope and purpose of legacy in paediatrics assists providers in improving patient- and family-centred outcomes by designing interventions that facilitate long-term coping in patients facing a loss of or significant change in health, normalcy, or life. IMPACT Legacy-oriented interventions are provided at most children's hospitals in the United States, yet no widespread consensus on foundation or scope has been determined. This concept analysis provides evidence-based guidelines for policy and practice in creating legacy for and with children, providing opportunities to improve quality of care for young patients and their families around the world. REPORTING METHOD N/A. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Briana P Keller
- Vanderbilt University Peabody College, Nashville, Tennessee, USA
| | - Terrah F Akard
- Vanderbilt University Graduate School, Nashville, Tennessee, USA
| | - Jessika C Boles
- Vanderbilt University Peabody College, Nashville, Tennessee, USA
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Xu DD, Zhang GX, Ding XB, Ma J, Suo YX, Peng YY, Zeng JL, Liu M, Hou RT, Li J, Hu F. Bereaved parents' perceptions of memory making: a qualitative meta-synthesis. BMC Palliat Care 2024; 23:24. [PMID: 38273273 PMCID: PMC10809512 DOI: 10.1186/s12904-024-01339-0] [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: 09/27/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE This study aims to investigate the experiences of parents who have experienced bereavement in their efforts to preserve memories of their deceased child. METHODS Employing a qualitative meta-synthesis approach, this study systematically sought relevant qualitative literature by conducting searches across various electronic databases, including PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Wiley, up until July 2023. RESULTS Nine studies are eligible for inclusion and included in the meta-synthesis. Three overarching categories are identified: (1) Affirming the Significance of Memory Making. (2) Best Practices in Memory Making. (3) Barriers to Effective Memory Making. CONCLUSION Bereaved parents highly value the act of creating lasting memories, emphasizing its profound significance. While forming these memories, it is imperative to offer family-centered care and honor diverse preferences and needs. It is essential to offer effective support to parents, offering them a range of choices. Furthermore, a more comprehensive examination of memory-making practices is required to better understand their influence on parents' recollections of their deceased child.
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Affiliation(s)
- Dan-Dan Xu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Guang-Xiong Zhang
- Department of Anesthesiology, Hubei Province Corps Hospital of The Chinese Armed Police Force (CAPF), Wuhan, China
| | - Xin-Bo Ding
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Ya-Xi Suo
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China
| | - Yang-Yao Peng
- Department of Neurosurgical Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ji-Li Zeng
- Department of Otorhinolaryngology, General Hospital of Central Theater Command, Wuhan, China
| | - Miao Liu
- Department of Pulmonary Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rui-Tong Hou
- Department of Pulmonary Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jin Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China.
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, PO Box 430071, No. 169 Donghu Road, Wuhan, Hubei Province, China.
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van Dokkum NH, Fagan LJ, Cullen M, Loewy JV. Assessing HeartSong as a Neonatal Music Therapy Intervention: A Qualitative Study on Personal and Professional Caregivers' Perspectives. Adv Neonatal Care 2023; 23:264-271. [PMID: 37075326 DOI: 10.1097/anc.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND The music therapy HeartSong intervention pairs newborn infant heartbeats with parents' Song of Kin. Formal evidence on professional and personal caregiver perspectives of this intervention is lacking. PURPOSE This survey study evaluates the HeartSong music therapy intervention from parent and staff perspectives. METHODS A qualitative study assessing inclusion of HeartSong for family neonatal intensive care unit (NICU) care surveyed 10 professional caregivers comprising medical and psychosocial NICU teams anonymously reflecting their impressions of the intervention. Digital survey of parents/guardians contacted through semistructured phone interviews relayed impressions of recordings: subsequent setup, Song of Kin selection, and use of HeartSong, including thoughts/feelings about it as an intervention. RESULTS Professional and personal caregivers valued the HeartSong intervention for bereavement support, family support, including parental, extended family/infant support, and to enhance bonding. Emergent themes: memory-making, connectedness/closeness, support of parent role, processing mental health needs of stressful NICU days, and subsequent plans for lifelong HeartSong use. Therapeutic experience was named as a crucial intervention aspect and participants recommended the HeartSong as a viable, accessible NICU intervention. IMPLICATIONS FOR PRACTICE AND RESEARCH HeartSong's use showed efficacy as a clinical NICU music therapy intervention for families of critically ill and extremely preterm infants, when provided by trained, specialized, board-certified music therapists. Future research focusing on HeartSong in other NICU populations might benefit infants with cardiac disease, parental stress, and anxiety attending to parent-infant bonding. Costs and time benefits related to investment are needed before implementation is considered.
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Affiliation(s)
- Nienke H van Dokkum
- The Louis Armstrong Center for Music & Medicine, Mount Sinai Hospitals, New York City, New York (Dr van Dokkum and Mss Fagan and Loewy); Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Dr van Dokkum); and Department of Neonatology, Mount Sinai West Hospital, New York City, New York (Ms Cullen)
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Scaramozzino MU, Levi G, Sapone G, Romeo Plastina U. Chest Examination 3.0 With Wireless Technology in a Clinical Case Based on Literature Review. Cureus 2023; 15:e39464. [PMID: 37378239 PMCID: PMC10292082 DOI: 10.7759/cureus.39464] [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] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Physicians use auscultation as a standard method of thoracic examination: it is simple, reliable, non-invasive, and widely accepted. Artificial intelligence (AI) is the new frontier of thoracic examination as it makes it possible to integrate all available data (clinical, instrumental, laboratory, functional), allowing for objective assessments, precise diagnoses, and even the phenotypical characterization of lung diseases. Increasing the sensitivity and specificity of examinations helps provide tailored diagnostic and therapeutic indications, which also take into account the patient's clinical history and comorbidities. Several clinical studies, mainly conducted in children, have shown a good concordance between traditional and AI-assisted auscultation in detecting fibrotic diseases. On the other hand, the use of AI for the diagnosis of obstructive pulmonary disease is still debated as it gave inconsistent results when detecting certain types of lung noises, such as wet and dry crackles. Therefore, the application of AI in clinical practice needs further investigation. In particular, the pilot case report aims to address the use of this technology in restrictive lung disease, which in this specific case is pulmonary sarcoidosis. In the case we present, data integration allowed us to make the right diagnosis, avoid invasive procedures, and reduce the costs for the national health system; we show that integrating technologies can improve the diagnosis of restrictive lung disease. Randomized controlled trials will be needed to confirm the conclusions of this preliminary work.
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Affiliation(s)
- Marco Umberto Scaramozzino
- Department of Pulmonology, La Madonnina Clinic, Reggio Calabria, ITA
- Department of Thoracic Endoscopy, Tirrenia Hospital, Reggio Calabria, ITA
| | - Guido Levi
- Department of Pulmonology, ASST Spedali Civili, Brescia, ITA
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ITA
| | - Giovanni Sapone
- Department of Cardiology, Policlinico Madonna della Consolazione, Reggio Calabria, ITA
| | - Ubaldo Romeo Plastina
- Department of Radiology, ECORAD Study of Radiology and Ultrasound, Reggio Calabria, ITA
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Schreck B, Loewy J, LaRocca RV, Harman E, Archer-Nanda E. Amplified Cardiopulmonary Recordings: Music Therapy Legacy Intervention with Adult Oncology Patients and Their Families-A Preliminary Program Evaluation. J Palliat Med 2022; 25:1409-1412. [PMID: 35475758 DOI: 10.1089/jpm.2022.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Amplified cardiopulmonary recording (ACPR) is a unique music therapy intervention implementing recorded heartbeats with meaningful music. Although its clinical application has grown, there is limited research on the acceptability and usage by bereaved families. Objective: The research objective was to understand the frequency recipients engaged with ACPR after their loved one died. Design: A survey was undertaken with relatives of 191 adult patients who had participated in ACPR. Setting/Subjects: Bereaved loved ones of adult oncology patients who received care at the Norton Cancer Institute in Louisville, Kentucky, USA. Results: Out of the 191 participants, 73% of family members responded, 49% reported listening to their recording frequently, 31% listened to the recording at least once after receiving it, and 20% reported never listening. Conclusions: ACPR appears to have moderate acceptability and usage among bereaved family members, especially when created in the context of ongoing music therapy treatment. We recommend that this process-based music therapy intervention be studied further and offered proactively.
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Affiliation(s)
- Brian Schreck
- Behavioral Oncology, Norton Cancer Institute, Louisville, Kentucky, USA.,Norton Women's and Children's Hospital, Louisville, Kentucky, USA
| | - Joanne Loewy
- The Louis Armstrong Center for Music and Medicine, Mount Sinai Beth Israel, New York, New York, USA.,Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Renato V LaRocca
- Neuro-Oncology, Norton Cancer Institute-Brownsboro, Louisville, Kentucky, USA
| | - Elizabeth Harman
- Division of Child Life and Integrative Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Goldberg JM, Rose KL, Matthews OR, Boles JC. Little time, lasting impact: Bereaved caregiver perceptions of legacy in perinatal and infant loss. J Neonatal Perinatal Med 2022; 15:617-626. [PMID: 35342052 DOI: 10.3233/npm-210897] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Legacy interventions are standard in most children's hospital, but little is known about how bereaved parents understand and describe the concept of legacy that these interventions are designed to document. The aim of this qualitative study was to understand the legacy experiences and perceptions of parents who have experienced perinatal or early infant (less than three months of age) loss. METHODS Grounded in constructionist epistemology and phenomenological qualitative traditions, ten bereaved parents completed an in-depth phenomenological interview regarding their perceptions of and experiences with the legacy of their deceased child. Interviews were transcribed verbatim and analyzed using an open, inductive coding process to illuminate the essence of participants' experiences. RESULTS Three themes were identified: 1) legacies are composed of memories and experiences that have a lasting effect on others; 2) healthcare experiences both generate and participate in infants' legacies; and 3) parents' legacy perceptions are shaped by cultural conceptions, spiritual beliefs, and grief experiences. Parents described experiences and interactions with community members and healthcare providers that honored or challenged their perceptions of their child's unique legacy. CONCLUSIONS In the context of perinatal or early infant loss, bereaved parents describe legacy as enduring, unique to each child and family, and heavily influenced by healthcare experiences and staff relationships. Parent-led, legacy-oriented interventions are needed in maternal/fetal, labor/delivery, and neonatal intensive care settings to support parent coping with loss.
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Affiliation(s)
- J M Goldberg
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Patient and Family Centered Care Department, Nashville, TN, USA
| | - K L Rose
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Patient and Family Centered Care Department, Nashville, TN, USA
| | - O R Matthews
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Patient and Family Centered Care Department, Nashville, TN, USA
| | - J C Boles
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Patient and Family Centered Care Department, Nashville, TN, USA.,Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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Collaborative Legacy Building to Alleviate Emotional Pain and Suffering in Pediatric Cancer Patients: A Case Review. CHILDREN 2022; 9:children9010033. [PMID: 35053659 PMCID: PMC8774266 DOI: 10.3390/children9010033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
Childhood cancer patients experience emotional hardship associated with their life-threatening diagnoses. Interdisciplinary team members working in pediatric cancer care can help alleviate physical pain and psychological suffering of children by facilitating collaborative legacy-building activities with patients and families. The contents of this article aim to support legacy building as a medium for emotional healing prior to the end of life. The authors use a case review to contextualize legacy-building projects and provide a comprehensive overview of methods and considerations for these initiatives.
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