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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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Safarifard R, Kiernan G, Corcoran Y, Courtney E, Mitchell J, Akard T, Lambert V. Memory-making interventions for children and their families receiving pediatric palliative or bereavement care: A systematic review protocol. HRB Open Res 2024; 7:30. [PMID: 39071733 PMCID: PMC11282391 DOI: 10.12688/hrbopenres.13891.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 07/30/2024] Open
Abstract
Background In paediatric palliative and bereavement care, providing comprehensive support that extends beyond medical treatment to address the emotional and psychosocial needs of children and their families is essential. Memory-making interventions play a critical role in capturing cherished moments and fostering emotional resilience. However, widespread consensus on the foundation and scope of memory-making interventions for children and young people remains sparse. This review aims to identify, appraise, and synthesise the evidence on memory-making interventions for children and young people with life-limiting or life-threatening conditions and their family members receiving palliative or bereavement care. Methods This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A systematic search will be undertaken from January 1, 1985, to February 27, 2024, across the following databases: PubMed, EMBASE, CINAHL (EBSCO), PsycINFO (EBSCO), Web of Science, the Cochrane Library, and Scopus. Studies across diverse research designs that examine children (0-19 years) with life-limiting or life-threatening conditions undergoing memory-making interventions with psychosocial or other outcomes will be included. Screening, data extraction, and quality appraisal will be performed by two independent reviewers, with a third reviewer resolving discrepancies. Joanna Briggs Institute guidelines for conducting mixed methods systematic reviews will be used to inform the data analysis and synthesis process. Conclusions This review will provide critical insights into the existing evidence base on memory-making interventions in paediatric palliative and bereavement care, highlighting psychosocial and other impacts, implementation factors, and evidence quality. By identifying best practices and gaps in knowledge, this evidence review may inform future research and intervention design, or adaptation, and contribute to the enhancement of healthcare for children and young people with life-limiting and life-threatening conditions and their families as well as families in bereavement. Registration This review was registered in PROSPERO, the International Prospective Register of Systematic Reviews (CRD42024521388; 18/03/2024).
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Affiliation(s)
- Razieh Safarifard
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Leinster, D09 V209, Ireland
| | - Gemma Kiernan
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Leinster, D09 V209, Ireland
| | - Yvonne Corcoran
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Leinster, D09 V209, Ireland
| | - Eileen Courtney
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Leinster, D09 V209, Ireland
| | - John Mitchell
- Head of Partnerships, Barretstown Children’s Charity, Ballymore Eustace, Kildare, W91 RDX6, Ireland
| | - Terrah Akard
- School of Nursing, Vanderbilt University, Nashville, Tennessee, TN 37240, USA
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Leinster, D09 V209, Ireland
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Bell CJ, Spruit JL, Deatrick JA, Weaver MS, Dickens DS, Hinds PS, Kavanaugh KL. Development and Validation of a Ready-to-Talk Measure for Use in Adolescents and Young Adults Living With Advanced Cancer. Cancer Nurs 2024:00002820-990000000-00255. [PMID: 38832797 DOI: 10.1097/ncc.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND In the era of evolving and emerging therapies, adolescents and young adults (AYAs) living with advanced cancer experience a high degree of uncertainty, making palliative care and end-of-life (PCEOL) discussions difficult. Clinical conversations determine values/preferences that guide shared decision-making and goals of treatment, including end-of-life care when cancer progresses. Initiating PCEOL conversations is challenging for clinicians. OBJECTIVE This study describes the development and validation of an instrument that measures AYA readiness to engage in PCEOL clinical conversations. METHODS A Ready-to-Talk Measure (R-T-M) was developed, guided by the revised conceptual model of readiness across 3 domains (awareness, acceptance, and willingness). Content experts evaluated validity, and 13 AYAs with advanced cancer participated in cognitive interviews. Acceptability (item applicability, clarity, interpretation, sensitivity, missingness) and experiences (benefit, burden) were analyzed. RESULTS The scale content validity index was ≥0.90 for each domain. Forty-two of the 55 R-T-M items were acceptable without any change. Three items were deleted. Ten items were modified, and 3 were added. Adolescents and young adults wanted more items about friends/siblings and about AYA unique qualities for clinicians to know them better. Adolescents and young adults acknowledged benefit through talking about difficult, relevant topics. CONCLUSION Ready-to-Talk Measure validity was strengthened by deleting or modifying unclear or misinterpreted items and by adding items. Next steps include psychometric analysis to determine reliability/dimensionality and stakeholder input to make the R-T-M a clinically useful tool. IMPLICATIONS FOR PRACTICE Ready-to-Talk Measure assessment of readiness to engage in PCEOL conversations while identifying unique preferences of AYAs holds promise for facilitating ongoing discussions.
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Affiliation(s)
- Cynthia J Bell
- Author Affiliations: Department of Cancer Care Services, Corewell Health, Lemmen-Holton Cancer Pavilion, Grand Rapids (Dr Bell); and Department of Pediatrics, Palliative Care, C. S. Mott Children's Hospital, Ann Arbor (Dr Spruit), Michigan; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia (Dr Deatrick); Department of Pediatric Palliative Care, Children's Nebraska, University of Nebraska Medical Center, Omaha (Dr Weaver); Department of Pediatrics, Hematology/Oncology, University of Iowa (Dr Dickens); Department of Nursing Science, Professional Practice & Quality, Children's National Hospital, and Department of Pediatrics, George Washington University, Washington, District of Columbia (Dr Hinds); and Department of Nursing Research and Evidence Based Practice, Children's Wisconsin, Milwaukee, and University of Illinois at Chicago (Dr Kavanaugh)
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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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Rolbiecki AJ, Washington KT, Bitsicas KC, Lero CM, Spinner E, Akard TF. Digital Storytelling for Bereaved Individuals in a Virtual Setting. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:951-960. [PMID: 34866480 DOI: 10.1177/00302228211051524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An emerging body literature exists highlighting the use of Digital Storytelling as an educational, and/or therapeutic intervention. Authors of this manuscript have studied Digital Storytelling as a narrative bereavement intervention designed to help individuals make meaning of adverse life events, like the death of a family member. Until recently, Digital Storytelling is typically delivered in person. The purpose of this article is to describe the steps to implementing Digital Storytelling as a bereavement intervention in a completely virtual setting, using Zoom technology. Best practices and lessons learned for the virtual delivery of Digital Storytelling are provided.
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Affiliation(s)
- Abigail J Rolbiecki
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | - Karla T Washington
- Division of Palliative Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Christine M Lero
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
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Jones MT, Albanese E, Boles JC. "They were here, and they still matter": A qualitative study of bereaved parents legacy experiences and perceptions. Palliat Med 2023; 37:1222-1231. [PMID: 37310037 PMCID: PMC10503247 DOI: 10.1177/02692163231180926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Legacy building interventions are used in pediatric healthcare settings to help families cope with difficult healthcare experiences and typically reserved for intentional use at or near the end of a child's life. However, little is known about how bereaved families perceive the concept of legacy that these practices are meant to address. Emerging research challenges the view of legacy as a standardized, handheld keepsake item but rather as a summation of qualities and experiences that affect those left behind. Therefore, more research is needed. AIM To explore the legacy perceptions and experiences of bereaved parents/caregivers in an effort to inform legacy-oriented interventions in pediatric palliative care. DESIGN In this qualitative, phenomenological study grounded in social constructionist epistemology, bereaved parent/caregivers completed a semi-structured interview about their legacy perceptions and experiences. The interviews were audio-recorded, transcribed, and analyzed using an inductive, open coding approach grounded in psychological phenomenology. SETTING/PARTICIPANTS Participants were parents/caregivers and one adult sibling of children (ages 6 months-18 years) that died between 2000 and 2018 at a children's hospital in the Southeastern United States and spoke English as their primary language. RESULTS Sixteen parents/caregivers and one adult sibling were interviewed. Participants' responses converged across three themes: (1) definitions of legacy, including traits and characteristics, impacts on others, and the child's enduring presence; (2) manifestations of legacy, such as tangible items, experiences, traditions, and rituals, and altruism; and (3) factors perceived to affect legacy experiences, including characteristics of the child's death and one's personal grief process. CONCLUSION Bereaved parents/caregivers define and experience their child's legacy in ways and manifestations that conflict with current legacy building interventions used in pediatric healthcare settings. Thus, an immediate shift from standardized legacy-oriented care to individualized assessment and intervention is needed to provide high-quality patient- and family-centered pediatric palliative care.
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Affiliation(s)
- Maile T Jones
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Patient- and Family-Centered Care Department, Nashville, TN, USA
| | - Elena Albanese
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Jessika 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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Cho E, Dietrich MS, Friedman DL, Gilmer MJ, Gerhardt CA, Given BA, Hendricks-Ferguson VL, Hinds PS, Akard TF. Effects of a Web-Based Pediatric Oncology Legacy Intervention on the Coping of Children With Cancer. Am J Hosp Palliat Care 2023; 40:34-42. [PMID: 35535490 DOI: 10.1177/10499091221100809] [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: 12/16/2022] Open
Abstract
BACKGROUND Recurrent or refractory cancer often results in substantial and extensive physical, emotional, psychosocial, and spiritual burdens for children and their families. However, the therapeutic benefits of legacy interventions in children with recurrent or refractory cancer have been examined only recently, with limited attention to specific effects on children's coping abilities. OBJECTIVE The purpose of this study was to determine the effects of a digital storytelling-legacy intervention on the adaptive coping of children with recurrent or refractory cancer. METHODS This study used a 2-arm randomized, waitlist-controlled trial design. A total of 150 children with recurrent or refractory cancer and their parents were recruited via Facebook advertisements. RESULTS The analysis sample included 92 dyads (35-intervention group, 57-control group). The legacy intervention showed small and statistically nonsignificant effects on primary-control and disengagement coping strategies among children with recurrent or refractory cancer. CONCLUSIONS Legacy interventions using readily accessible digital storytelling have the potential to enhance the adaptive coping skills among children with recurrent or refractory cancer. Further research should determine how to enhance interventions tailored to this population to optimize the benefits.
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Affiliation(s)
- Eunji Cho
- School of Nursing, 5718Vanderbilt University, Nashville, TN, USA
| | - Mary S Dietrich
- School of Nursing, 5718Vanderbilt University, Nashville, TN, USA.,School of Medicine, 5718Vanderbilt University, Nashville, TN, USA
| | - Debra L Friedman
- Division of Hematology-Oncology, Department of Pediatrics, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Mary Jo Gilmer
- School of Nursing, 5718Vanderbilt University, Nashville, TN, USA.,School of Medicine, 5718Vanderbilt University, Nashville, TN, USA
| | - Cynthia A Gerhardt
- Departments of Pediatrics and Psychology, 2647The Ohio State University, Columbus, OH, USA.,Center for Biobehavioral Health, 51711The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Barbara A Given
- College of Nursing, 3078Michigan State University, East Lansing, MI, USA
| | | | - Pamela S Hinds
- Department of Nursing Science, Professional Practice and Quality Outcomes, 8404Children's National Health System, Washington, DC, USA.,Department of Pediatrics, 8367George Washington University, Washington, DC, USA
| | - Terrah Foster Akard
- School of Nursing, 5718Vanderbilt University, Nashville, TN, USA.,School of Medicine, 5718Vanderbilt University, Nashville, TN, USA
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Dunbar JE, Jones MT, Boles JC. Hospitalized children's perceptions of legacy: 'A symbol of yourself that you leave behind'. Child Care Health Dev 2022; 49:534-543. [PMID: 36218248 DOI: 10.1111/cch.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Legacy building is a developmentally grounded, trauma-informed and family-centred psychosocial intervention designed to bolster patient and family resilience through collaborative activities and meaning making. However, little is known about the effects of these interventions, partially because of a lack of clarity regarding how children of different developmental levels understand the concept of legacy. Therefore, this study explored the ways in which hospitalized children defined the concept of legacy. METHODS Semi-structured interviews were conducted with 45 hospitalized children (ages 6 to 18 years) on the acute and critical care units of an academic children's medical centre. Interviews were audio-recorded and transcribed verbatim; transcripts were independently coded by at least two members of the research team using an inductive, line-by-line approach; and codes were categorized and assembled into four overarching themes, resulting in a developmental typology of the concept of legacy. RESULTS Participants described legacy as (1) concepts, actions or feelings motivated by the future; (2) represented through both tangible and intangible means; (3) informed by personal, educational, experiential and ideological sources; and (4) experienced as good, bad or neutral. CONCLUSIONS The findings of this study demonstrate that hospitalized children are aware of and can articulate an emerging concept of legacy - one that mirrors the progression of cognitive complexity shaped by their unique personal life and healthcare experiences. The developmental typology presented in this study can be a useful starting point for clinicians as they present and facilitate legacy building interventions throughout a child's hospital stay.
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Affiliation(s)
| | - Maile T Jones
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Jessika C Boles
- Department of Human Development and Psychology, Vanderbilt University, Nashville, TN, USA
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Lawrence A, Jones M, Boles J. Helping Children Cope with Loss: Legacy Interventions for the Grieving Classroom. CONTINUITY IN EDUCATION 2022; 3:92-100. [PMID: 38774289 PMCID: PMC11104402 DOI: 10.5334/cie.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/28/2022] [Indexed: 05/24/2024]
Abstract
Early experiences of death and loss have a significant impact on children's coping and development across the lifespan, whether the deceased was a family member, friend, or even classmate. Given the sense of community and continuity that children often garner in schools, teachers are uniquely positioned to tailor and facilitate grief supports to meet the developmental and coping needs of their students in response to loss, especially in the case of a classmate's death. Legacy building interventions, though healthcare-derived, have internationally been applied to promote self-expression and meaning making for grieving children and families; the underlying theory and practice of such interventions may render them useful even in classroom environments. Combining art-based activities with storytelling and reflection, legacy building activities may promote awareness and understanding of death in children and adolescents while encouraging adaptive grief responses. This paper describes how teachers may apply legacy building interventions to support students experiencing the death of a classmate. Two sample curricular plans are provided, one targeted towards elementary school children, the other towards middle and high school students. Although these resources appear ready for immediate implementation, it is essential that teachers adapt them - based on their unique classroom, school system, and sociocultural context - to best meet the needs of grieving students.
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Affiliation(s)
| | - Maile Jones
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, US
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