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Naz H, Apesoa-Varano EC, Romero C, Keegan T, Malogolowkin M, Callas C, Gosdin M, Alvarez E. How Do Adolescent and Young Adult Patients with Cancer Manage Their Chemotherapy-Related Symptoms at Home? J Adolesc Young Adult Oncol 2023; 12:923-928. [PMID: 37699237 PMCID: PMC10739787 DOI: 10.1089/jayao.2022.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Chemotherapy can cause many distressing side effects, potentially impacting treatment completion and quality of life in adolescent and young adult (AYA) patients with cancer. To identify ways to help mitigate chemotherapy-related symptoms, we sought to elicit barriers and facilitators to managing symptoms experienced by AYAs with cancer through interviews. Qualitative thematic analysis identified three main domains: (1) managing chemotherapy symptoms (e.g., medication, home remedies), (2) anticipating and mitigating symptoms (e.g., management of symptoms at home, anticipatory guidance), and (3) knowing when to seek care (e.g., unexpected and unusual symptoms). This study elucidated that AYAs can successfully manage symptoms at home when given the proper guidance and this could be a focus of future efforts to improve outcomes in this population. The Clinical Trial Registration number is NCT04594096.
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Affiliation(s)
- Hiba Naz
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | | | - Crystal Romero
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Theresa Keegan
- Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, California, USA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology/Oncology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Christina Callas
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Melissa Gosdin
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Elysia Alvarez
- Division of Pediatric Hematology/Oncology, University of California Davis School of Medicine, Sacramento, California, USA
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Rothmund M, Sodergren S, Rohde G, de Rojas T, Paratico G, Albini G, Mur J, Darlington AS, Majorana A, Riedl D. Updating our understanding of health-related quality of life issues in children with cancer: a systematic review of patient-reported outcome measures and qualitative studies. Qual Life Res 2023; 32:965-976. [PMID: 36152110 PMCID: PMC9510324 DOI: 10.1007/s11136-022-03259-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is a key concept in pediatric oncology. This systematic review aims to update the conceptual HRQOL model by Anthony et al. (Qual Life Res 23(3):771-789, 2014), covering physical, emotional, social and general HRQOL aspects, and to present a comprehensive overview of age- and disease-specific HRQOL issues in children with cancer. METHODS Medline, PsychINFO, the Cochrane Database for Systematic Reviews (CDSR), and the COSMIN database were searched (up to 31.12.2020) for publications using patient-reported outcome measures (PROMs) and qualitative studies in children with cancer (8-14-year) or their parents. Items and quotations were extracted and mapped onto the conceptual model for HRQOL in children with cancer mentioned above. RESULTS Of 2038 identified studies, 221 were included for data extraction. We identified 96 PROMS with 2641 items and extracted 798 quotations from 45 qualitative studies. Most items and quotations (94.8%) could be mapped onto the conceptual model. However, some adaptations were made and the model was complemented by (sub)domains for 'treatment burden', 'treatment involvement', and 'financial issues'. Physical and psychological aspects were more frequently covered than social issues. DISCUSSION This review provides a comprehensive overview of HRQOL issues for children with cancer. Our findings mostly support the HRQOL model by Anthony et al. (Qual Life Res 23(3):771-789, 2014), but some adaptations are suggested. This review may be considered a starting point for a refinement of our understanding of HRQOL in children with cancer. Further qualitative research will help to evaluate the comprehensiveness of the HRQOL model and the relevance of the issues it encompasses.
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Affiliation(s)
- Maria Rothmund
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | | | - Gudrun Rohde
- Department of Clinical Research, Faculty of Health and Sport Sciences, Kristiansand and Sorlandet Hospital, University of Agder, Kristiansand, Norway
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | | | - Gloria Paratico
- Department of Oral Medicine and Paediatric Dentistry, University of Brescia, Brescia, Italy
| | - Giorgia Albini
- Department of Oral Medicine and Paediatric Dentistry, University of Brescia, Brescia, Italy
| | - Johanna Mur
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Alessandra Majorana
- Department of Oral Medicine and Paediatric Dentistry, University of Brescia, Brescia, Italy
| | - David Riedl
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria.
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria.
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Salins N, Muckaden MA, Ghoshal A, Jadhav S. Experiences of Adolescents with Cancer Attending a Tertiary Care Cancer Centre: A Thematic Analysis. Indian J Palliat Care 2022; 28:428-433. [DOI: 10.25259/ijpc_24_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction:
Adolescents with cancer experience several psychosocial concerns. Cancer among adolescents contributes to one-fifth of cancers in India. Most of the published empirical literature on adolescents’ views about their cancer experience is from high-income countries.
Objectives:
The objectives of the study were to explore the experiences of adolescents with cancer in India.
Materials and Methods:
Twenty-eight adolescents were purposively recruited and participated in prospectively conducted qualitative interviews conducted at the Tata Memorial Hospital, Mumbai, between 2013 and 2015. Interview data were transcribed and analysed using Braun and Clarke’s reflexive thematic analysis.
Results:
Two themes and several subthemes were generated during the analysis. The transition to the new reality of illness was traumatic. It embodied fear about the unknown, disease and symptoms. The experience was isolating and disfigurement further led to peer separation. Inadequate information made the adolescents anxious and worried, and children and parents experienced moments of severe distress. The love and support received from parents, siblings and extended family facilitated positive coping. Peer support was reassuring and enabled them to have a normalising experience. Discovering their inner strength, acceptance of the situation and faith in God made them resilient and hopeful.
Conclusion:
Adolescents with cancer experience significant emotional concerns, which are often unexplored and unaddressed. An adolescent-specific communication framework and psychosocial programme contextual to the Indian setting may be developed based on the study findings.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, India,
| | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India,
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India,
| | - Sunita Jadhav
- Department of Medical Social Work, Tata Memorial Hospital, Mumbai, Maharashtra, India,
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Linder LA, Newman A, Bernier Carney KM, Wawrzynski S, Stegenga K, Chiu YS, Jung SH, Iacob E, Lewis M, Linder C, Fox K, Altizer R. Symptoms and daily experiences reported by children with cancer using a game-based app. J Pediatr Nurs 2022; 65:33-43. [PMID: 35490550 PMCID: PMC10405915 DOI: 10.1016/j.pedn.2022.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/18/2022] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Mobile health (mHealth) resources, including apps, are emerging as resources to support children in tracking symptoms and other health-related data. The purpose of this study was to describe symptoms and daily experiences reported by elementary school-age children receiving treatment for cancer using the newly developed Color Me Healthy app. DESIGN AND METHODS Participants in this descriptive study were children 6-12 years of age, who were receiving cancer treatment at a free-standing children's hospital in the Intermountain West of the United States. Children were requested to use the app for at least five days between clinical visits. Children's app-reported data were extracted from individual user accounts for analysis. Quantitative data were summarized descriptively. Qualitative data were summarized using qualitative content analysis. RESULTS Nineteen children (6-12 years; median 8 years; 7 females) completed 107 days of app use. All children reported symptoms at least once, and 14 reported at least one day with a symptom of moderate or greater severity. Daily experiences reported through the app reflected children's engagement in usual childhood experiences while also describing life with cancer, including symptoms. CONCLUSIONS Elementary school-age children are capable of self-reporting symptoms using a symptom reporting app, providing preliminary evidence for the potential benefits and clinical relevance of mHealth resources to support health outcomes within this population. PRACTICE IMPLICATIONS Clinicians should anticipate and support ongoing symptom management needs between clinical visits. Children's self-reported data can promote a person-centered approach to symptom assessment and management.
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Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
| | - Amy Newman
- College of Nursing, Marquette University, 530 N 16(th) St., Milwaukee, WI 53233, USA
| | - Katherine M Bernier Carney
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; University of Connecticut School of Nursing, 231 Glenbrook Rd., Unit 4026, Storrs, CT 06269-4026, USA
| | - Sarah Wawrzynski
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Kristin Stegenga
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Yin-Shun Chiu
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Se-Hee Jung
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Eli Iacob
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Melina Lewis
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Huntsman Cancer Hospital, 1950 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Caitlin Linder
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Kaitlyn Fox
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA; Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd, SN-ADM, Portland, OR 97239-2941, USA
| | - Roger Altizer
- Population Health Science, Entertainment Arts and Engineering, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
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Bernier Carney KM, Stegenga K, Linder LA. Informing Parents as Caregivers With a Symptom Assessment App Developed for Children With Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:264-272. [PMID: 35791850 PMCID: PMC9527534 DOI: 10.1177/27527530211073307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Mobile health technologies can assist children to communicate their symptom experiences in a developmentally appropriate format. However, few investigations have examined how mHealth resources may also assist parents in their caregiver role. The purpose of this study was to explore how a symptom assessment app designed for school-age children with cancer could further inform parents as caregivers. Methods: Nineteen parents (18 mothers; median 35 years old, range 26-48 years) of children (6-12 years of age) receiving cancer treatment participated in the feasibility/acceptability trial of a game-based symptom assessment app. Acceptability interviews with parents were completed after each child's trial with the app. We completed a secondary analysis of the parent interviews using thematic analysis to examine how the app could support parents in their caregiving role. Results: Parents perceived the app to (1) elicit the child's voice about his/her symptom experience; (2) provide a supportive and safe environment for the child to report symptoms; and (3) create an opportunity to facilitate communication between the child, parent, and clinical team. Parents expressed a willingness for their child to represent his/her experience with the app so that they could make informed decisions regarding symptom care. Discussion: Perceived benefits of the app extended to parents as they described developing further insight into their child's cancer experience. The knowledge gained allowed parents the potential to enhance symptom communication and supportive care strategies. Future research should further evaluate how mHealth tools facilitate shared symptom management between children receiving treatment for cancer and their caregivers.
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Affiliation(s)
| | - Kristin Stegenga
- Division of Hematology/Oncology, Children’s Mercy Hospital, Kansas City, MO,
USA
| | - Lauri A. Linder
- University of Utah, College of Nursing, Salt Lake City, UT, USA
- Clinical Nurse Specialist, Primary Children’s Hospital, Center for Cancer
and Blood Disorders, Salt Lake City, UT, USA
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Abstract
Purpose of this Review The purpose of this review is to describe the evolution of palliative care in paediatric oncology, the needs of children and their families in a paediatric oncology setting, palliative care referral practices in paediatric oncology, outcomes of palliative care referral in paediatric oncology and models of palliative care in paediatric oncology. Recent Findings Cancer constitutes 5.2% of the palliative care needs in children. Approximately, 90% of children with cancer lives in low and middle-income countries, constituting 84% of the global burden of childhood cancers. Children in low and middle-income countries have low cure rates and high death rates making palliative care relevant in a paediatric oncology setting. Children with cancer experience pain and physical symptoms, low mood, anxiety, and fear. They feel less resilient, experience low self-worth, and have challenges coping with the illness. The families lead very stressful lives, navigating the hospital environment, and dealing with uncertainties of the future. Palliative care referral in children with cancer improves physical symptoms, emotional support, and quality of life. It enables communication between families and health care providers. It improves end-of-life care support to children and their families and facilitates less invasive diagnostic and therapeutic interventions at the end of life. Worldwide children with cancer are infrequently referred to palliative care and referred late in the illness trajectory. Most of the children referred to palliative care receive some form of cancer-directed therapy in their last days. Children in low and low-middle income countries are less likely to access palliative care due to a lack of awareness amongst paediatric oncologists about palliative care and the reduced number of services providing palliative care. A three-tier model is proposed to provide palliative care in paediatric oncology, where most children with palliative care needs are managed by paediatric oncologists and a smaller number with complex physical and psychosocial needs are managed by paediatric palliative care specialists. There are several palliative care models in paediatric oncology practised globally. However, no one model was considered better or superior, and the choice of model depended on the need, preferences identified, and available resources. Summary Children with cancer are sparingly referred to palliative care and referred late and oncologists and haematologists gatekeep the referral process. Knowledge on palliative care referral in paediatric oncology settings might enhance collaboration between paediatric oncology and paediatric palliative care.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Sean Hughes
- Division of Health Research, Health Innovation One, Lancaster University, Sir John Fisher Drive, Lancaster, LA1 4AT UK
| | - Nancy Preston
- Division of Health Research, Health Innovation One, Lancaster University, Sir John Fisher Drive, Lancaster, LA1 4AT UK
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Cheng L, Zhao X, Ge Y, Wang Y, Kang Q. The Experiences of Chinese Children 5- to 7-year-old during cancer Treatment Reflected Through Interviews and Drawings. J Pediatr Oncol Nurs 2021; 39:88-98. [PMID: 34533397 DOI: 10.1177/10434542211041919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: For children with cancer, the experience during treatment can be challenging. There is a limited number of studies on self-reported treatment experiences of younger Chinese children with cancer using qualitative methods. Objectives: This study aimed at exploring the experience of Chinese children aged 5 to 7 years during cancer treatment reflected through interviews and drawings. Methods: This study used a descriptive qualitative design with the technique of "draw-and-tell." Participants were enrolled from the pediatric oncology inpatient department of one national children's medical center in China. They were asked to draw a picture of "your feelings in the hospital." An inductive content analysis approach was used. Results: Twelve participants were enrolled (8 male, mean age 5.7 years). Four themes were established: (1) suffering from adverse treatment effects; (2) perceiving changed relationships; (3) being thankful for others; and (4) trying out coping strategies. Conclusion: Chinese children aged 5 to 7 years expressed multiple cancer treatment impacts. They appreciated others' support and had their own way to cope with treatment demands. The authors also extended the dynamic nature of using the "draw-and-tell" methodology. Study findings highlight the importance of inviting and hearing the voice of young children during their cancer treatment, with particular consideration of the influence of disease, treatment, child development, family dynamics, and culture.
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Affiliation(s)
- Lei Cheng
- School of Nursing, 12478Fudan University, Shanghai, China
| | - Xinlei Zhao
- School of Nursing, 12478Fudan University, Shanghai, China
| | - Youhong Ge
- Pediatric Hematology and Oncology Unit, 145601Children's Hospital of Fudan University, Shanghai, China
| | - Yingwen Wang
- Pediatric Hematology and Oncology Unit, 145601Children's Hospital of Fudan University, Shanghai, China
| | - Qiongfang Kang
- Pediatric Surgical Oncology Unit, Children's Hospital of Fudan University, Shanghai, China
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Symptom and Illness Experience for English and Spanish-Speaking Children with Advanced Cancer: Child and Parent Perspective. CHILDREN-BASEL 2021; 8:children8080657. [PMID: 34438547 PMCID: PMC8392359 DOI: 10.3390/children8080657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
Understanding the symptom and illness experience of children with advanced cancer facilitates quality care; yet, obtaining this understanding is complicated by the child’s developmental level and physical and psychological health factors that affect communication. The purpose of this study was to describe the symptom and illness experience of English- and Spanish-speaking children with advanced cancer as described by the child and parent. We conducted hermeneutic phenomenological, descriptive, and interpretive interviews with eligible children and parents. The interdisciplinary research team analyzed transcripts hermeneutically until consensus on theme labels was reached. Four themes and associated subthemes were identified from the interviews of the 10 child–parent dyads: 1. symptoms disrupt life (path to diagnosis, life is disrupted), 2. isolation (lack of understanding, family separations/relationships), 3. protection, and 4. death is not for children. Children and parents readily described the impact symptoms and cancer treatment had on their lives and relationships. These findings underscore the salient aspects of daily life disrupted by cancer. With a deeper understanding of symptom burden and its interference, relationship and communication implications, and anticipatory grief, the treating team may better optimize care for children and their families living with advanced cancer.
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Davison G, Kelly MA, Conn R, Thompson A, Dornan T. How do children and adolescents experience healthcare professionals? Scoping review and interpretive synthesis. BMJ Open 2021; 11:e054368. [PMID: 34244289 PMCID: PMC8273482 DOI: 10.1136/bmjopen-2021-054368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/22/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Explore children's and adolescents' (CADs') lived experiences of healthcare professionals (HCPs). DESIGN Scoping review methodology provided a six-step framework to, first, identify and organise existing evidence. Interpretive phenomenology provided methodological principles for, second, an interpretive synthesis of the life worlds of CADs receiving healthcare, as represented by verbatim accounts of their experiences. DATA SOURCES Five key databases (Ovid Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Web of Science), from inception through to January 2019, reference lists, and opportunistically identified publications. ELIGIBILITY CRITERIA Research articles containing direct first-person quotations by CADs (aged 0-18 years inclusive) describing how they experienced HCPs. DATA EXTRACTION AND SYNTHESIS Tabulation of study characteristics, contextual information, and verbatim extraction of all 'relevant' (as defined above) direct quotations. Analysis of basic scope of the evidence base. The research team worked reflexively and collaboratively to interpret the qualitative data and construct a synthesis of children's experiences. To consolidate and elaborate the interpretation, we held two focus groups with inpatient CADs in a children's hospital. RESULTS 669 quotations from 99 studies described CADs' experiences of HCPs. Favourable experiences were of forming trusting relationships and being involved in healthcare discussions and decisions; less favourable experiences were of not relating to or being unable to trust HCPs and/or being excluded from conversations about them. HCPs fostered trusting relationships by being personable, wise, sincere and relatable. HCPs made CADs feel involved by including them in conversations, explaining medical information, and listening to CADs' wider needs and preferences. CONCLUSION These findings strengthen the case for making CADs partners in healthcare despite their youth. We propose that a criterion for high-quality child-centred healthcare should be that HCPs communicate in ways that engender trust and involvement.
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Affiliation(s)
- Gail Davison
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- Children's Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Martina Ann Kelly
- Department of Family Medicine, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Richard Conn
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- General Paediatrics Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Andrew Thompson
- General Paediatrics Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
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Bernier Carney KM, Jung SH, Iacob E, Lewis M, Linder LA. Communication of pain by school-age children with cancer using a game-based symptom assessment app: A secondary analysis. Eur J Oncol Nurs 2021; 52:101949. [PMID: 33813185 DOI: 10.1016/j.ejon.2021.101949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/18/2021] [Accepted: 03/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the self-reported pain experiences of school-age children with cancer participating in a feasibility trial of a game-based symptom assessment app. METHOD Nineteen children (median: 8 years, range 6-12 years old) receiving cancer treatment were recruited to complete five days of symptom tracking between clinical visits using a symptom assessment app. Children could report pain as a general symptom with the ability to further localize pain on an avatar. Children could also describe symptoms in response to the app's free-text questions or the app's diary. Descriptive statistics characterized reports of pain frequency, severity, bother, and location. Free-text responses were examined for pain-related statements and analyzed using content analysis. RESULTS All 19 children documented pain on at least one day of app reporting between clinical visits. Pain was most frequently recorded as of mild severity and mild bother. Participants localized pain most frequently to the head, followed by the stomach, chest, extremities, and mouth. Eleven children documented 32 qualitative statements which included rich descriptions of pain-related topics (i.e., "my port hurts a little") and location (i.e., "my vision aching"). CONCLUSIONS These results demonstrate that school-age children with cancer are willing to describe their ambulatory pain experiences on a game-based mobile app through quantitative reports and by using narrative descriptions. Additionally, these findings can potentially guide clinicians in using multiple approaches to elicit a clinically meaningful evaluation of pain in this population.
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Affiliation(s)
| | - Se-Hee Jung
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Eli Iacob
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Melina Lewis
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Lauri A Linder
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA; Primary Children's Hospital, Center for Cancer and Blood Disorders, Salt Lake City, UT, USA.
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11
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Linder LA, Newman AR, Stegenga K, Chiu YS, Wawrzynski SE, Kramer H, Weir C, Narus S, Altizer R. Feasibility and acceptability of a game-based symptom-reporting app for children with cancer: perspectives of children and parents. Support Care Cancer 2021; 29:301-310. [PMID: 32358779 PMCID: PMC7606212 DOI: 10.1007/s00520-020-05495-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children with cancer have difficulty identifying and describing the multiple symptoms they experience during hospitalization and between clinical encounters. Mobile health resources, including apps, are potential solutions to support child-centric symptom reporting. This study evaluated the feasibility and acceptability of a newly developed game-based symptom-reporting app for school-age children with cancer. PROCEDURE Nineteen school-age children (6-12 years of age) receiving treatment for cancer at a COG institution in the Intermountain West of the United States used a game-based symptom-reporting app between clinical visits. Feasibility was evaluated through a summary of actual days of app use and interaction with each of the app's features. Children and their parents participated in interviews regarding the app's acceptability. RESULTS Children used the app a median of 4 days (range 1-12) and interacted most frequently with the symptom reporting and the drawing features. Children enjoyed aspects of the app that supported their creativity and provided choices. Parents endorsed the interactive nature of the app and the value of the child providing his/her own report. Both children and parents identified additional opportunities to enhance the child's user experience. CONCLUSION Study results support the preliminary feasibility and acceptability of the app. Children's and parents' responses supported the developmental relevance of the app and its role in enhancing the child's autonomy and serving as an outlet for creativity. Future directions include optimizing the child user's experience and investigating the app's role as a resource to enhance shared decision-making for symptom management.
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Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, Salt Lake City, UT, USA.
- Center for Cancer and Blood Disorders, Primary Children's Hospital, Salt Lake City, UT, USA.
| | - Amy R Newman
- College of Nursing, Marquette University, Milwaukee, WI, USA
- Children's Hospital Wisconsin, Milwaukee, WI, USA
| | | | - Yin-Shun Chiu
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Sarah E Wawrzynski
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Pediatric Critical Care Services, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Scott Narus
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
- Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Roger Altizer
- Population Health Sciences, Entertainment Arts & Engineering, University of Utah, Salt Lake City, UT, USA
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12
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Gilljam BM, Nygren JM, Svedberg P, Arvidsson S. Impact of an Electronic Health Service on Child Participation in Pediatric Oncology Care: Quasiexperimental Study. J Med Internet Res 2020; 22:e17673. [PMID: 32720907 PMCID: PMC7420525 DOI: 10.2196/17673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023] Open
Abstract
Background For children 6-12 years old, there is a shortage of electronic Health (eHealth) services that promote their participation in health care. Therefore, a digital communication tool, called Sisom, was developed to give children a voice in their health care. Children with long-term diseases want to be more involved in their health care and have the right to receive information, be listened to, express their opinions, and participate in decision making in health care. However, the outcomes of using Sisom in practice at pediatric oncology clinics have not been investigated. Objective The aim of this study was to investigate children’s participation during appointments with pediatricians at pediatric oncology clinics, with or without the use of the eHealth service Sisom. Methods A quasiexperimental design with mixed methods was used. We analyzed 27 filmed appointments with pediatricians for 14 children (8 girls and 6 boys) aged 6-12 years (mean 8.3 years) with a cancer diagnosis. The intervention group consisted of children who used Sisom prior to their appointments with pediatricians at a pediatric oncology clinic, and the control group consisted of children who had appointments with pediatricians at 4 pediatric oncology clinics. Data from observations from the videos were quantitatively and qualitatively analyzed. The quantitative analysis included manual calculations of how many times the pediatricians spoke directly to the children, the proportion of the appointment time that the children were talking, and levels of participation by the children. For the qualitative analysis, we used directed content analysis to analyze the children’s levels of participation guided by a framework based on Shier’s model of participation. Results Pediatricians directed a greater proportion of their discussion toward the child in the intervention group (731 occasions) than in the control group (624 occasions), but the proportion of the appointment time the children talked was almost the same for both the intervention and control groups (mean 17.0 minutes vs 17.6 minutes). The levels of participation corresponded to the first three levels of Shier’s participation model: children were listened to, children were supported to express their views, and children’s views were taken into account. The results showed an increased level of participation by the children in the intervention group. Several codes that were found did not fit into any of the existing categories, and a new category was thus formed: children received information. Conclusions This study shows that the eHealth service Sisom can increase children’s participation during appointments with health care professionals. Further studies employing a randomized control design focusing on the effects of eHealth services on children’s health outcomes, perceived participation, and cost-effectiveness could make a significant contribution to guiding the implementation of eHealth services in pediatric care.
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Affiliation(s)
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Susann Arvidsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Linder LA, Hooke MC. Symptoms in Children Receiving Treatment for Cancer-Part II: Pain, Sadness, and Symptom Clusters. J Pediatr Oncol Nurs 2020; 36:262-279. [PMID: 31307323 PMCID: PMC7197222 DOI: 10.1177/1043454219849578] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Children and adolescents receiving treatment for cancer experience multiple symptoms as a consequence of their disease and its treatment that interfere with the child's quality of life. Understanding of symptom assessment in children with cancer is foundational to the work of the Children's Oncology Group Nursing Discipline, whose research aims are to address knowledge gaps including understanding illness-related distress. This article is the second of a two-part summary of current evidence addressing the assessment of symptoms frequently reported by children and adolescents receiving treatment for cancer. Studies reporting assessment of pain, sadness, and symptom clusters published between January 2008 and May 2018 were included. Forty-three publications addressed pain. Pain was highly prevalent and distressing, varied in its trajectory across a cycle of chemotherapy and across multiple cycles of treatment, and correlated with biomarkers associated with the pain response. Consequences of pain were poorer functional status and emotional health. Twenty publications addressed sadness. Sadness was the most prevalent psychosocial symptom. Its prevalence decreased over the course of treatment and over a cycle of chemotherapy. Persistent sadness was of greater severity and distress. Eight publications addressed symptom clusters. These studies identified both groups of co-occurring symptoms and groups of patients with common symptom profiles. This two-article series provides evidence for the distressing nature of symptoms among children receiving cancer treatment. Efforts to support clinicians in routine symptom assessment are needed. Additional research directed at alleviating symptoms and building resilience among the child experiencing symptoms is needed.
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Affiliation(s)
- Lauri A Linder
- 1 University of Utah College of Nursing, Salt Lake City, UT, USA
- 2 Cancer Transplant Service, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mary C Hooke
- 3 University of Minnesota School of Nursing, Minneapolis, MN, USA
- 4 Children's Minnesota, Minneapolis, MN, USA
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Lin B, Gutman T, Hanson CS, Ju A, Manera K, Butow P, Cohn RJ, Dalla‐Pozza L, Greenzang KA, Mack J, Wakefield CE, Craig JC, Tong A. Communication during childhood cancer: Systematic review of patient perspectives. Cancer 2019; 126:701-716. [DOI: 10.1002/cncr.32637] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Beryl Lin
- School of Public Health University of Sydney Sydney New South Wales Australia
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
| | - Talia Gutman
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Camilla S. Hanson
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Angela Ju
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Karine Manera
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Phyllis Butow
- Psycho‐oncology Co‐operative Research Group School of Psychology University of Sydney Sydney New South Wales Australia
| | - Richard J. Cohn
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
- Kids Cancer Centre Sydney Children's Hospital Randwick New South Wales Australia
| | - Luciano Dalla‐Pozza
- Cancer Centre for Children The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Katie A. Greenzang
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Dana‐Farber Cancer Institute Boston Massachusetts
| | - Jennifer Mack
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Dana‐Farber Cancer Institute Boston Massachusetts
| | - Claire E. Wakefield
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
- Kids Cancer Centre Sydney Children's Hospital Randwick New South Wales Australia
| | - Jonathan C. Craig
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Allison Tong
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
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Larsson I, Svedberg P, Arvidsson S, Nygren JM, Carlsson IM. Parents' experiences of an e-health intervention implemented in pediatric healthcare: a qualitative study. BMC Health Serv Res 2019; 19:800. [PMID: 31690287 PMCID: PMC6833200 DOI: 10.1186/s12913-019-4643-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/16/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The growing field of participation in healthcare has the potential to provide a number of benefits for children, patients, healthcare professionals and also the healthcare systems. According to the Convention on the Rights of the Child (UNCRC), children have the right to participate in their own healthcare and make their voice heard. Children's opportunities for understanding their conditions, sharing their views and participating in decisions regarding their care depend on healthcare professionals but also on parents' ability to communicate and include children. E-health solutions can remove barriers to children's communication with healthcare professionals. The aim of this study was to explore parents' perspectives on the outcomes of an e-health solution, Sisom, used by children during healthcare appointments. METHODS The empirical data is based on interviews with 16 parents. In the present study constructivist, grounded theory was chosen as the method. RESULTS The theory of enhancing participation, by orientating communication about healthcare towards the voice of the child instead of the parents, summarizes the process of how the outcome of Sisom for children lead to enhanced participation, by making the child the main actor and an agent in his/her own healthcare. The facilitators for achieving participation in Sisom were four interrelated outcomes; engaging, voice-guarding, raising awareness and integrity preserving. In addition to generating increased participation, it emerged that the use of Sisom also initiated a process, which was evident in all four subcategories that facilitated the child in coping with the experience of having an illness. CONCLUSIONS We conclude, that Sisom orientated communication about healthcare towards the voice of the child instead of the parents as well as including the child in the dialogue with the healthcare professional and thus increasing the child's participation and human rights.
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Affiliation(s)
- Ingrid Larsson
- School of Health and Welfare, Halmstad University, PO Box 823, S-30118 Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, PO Box 823, S-30118 Halmstad, Sweden
| | - Susann Arvidsson
- School of Health and Welfare, Halmstad University, PO Box 823, S-30118 Halmstad, Sweden
| | - Jens M. Nygren
- School of Health and Welfare, Halmstad University, PO Box 823, S-30118 Halmstad, Sweden
| | - Ing-Marie Carlsson
- School of Health and Welfare, Halmstad University, PO Box 823, S-30118 Halmstad, Sweden
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Linder LA, Bratton H, Nguyen A, Parker K, Wawrzynski SE. Symptoms and Self-Management Strategies Identified by Children With Cancer Using Draw-and-Tell Interviews. Oncol Nurs Forum 2019; 45:290-300. [PMID: 29683122 DOI: 10.1188/18.onf.290-300] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This cross-sectional study described how school-aged children with cancer represent their symptoms and associated characteristics using draw-and-tell interviews. PARTICIPANTS & SETTING 27 children aged 6-12 years receiving treatment for cancer at the Cancer Transplant Center at Primary Children's Hospital, a tertiary pediatric hospital in Salt Lake City, Utah. METHODOLOGIC APPROACH Children participated in draw-and-tell interviews while completing drawings depicting days when they felt well and days when they felt sick. Children's drawings and accompanying explanations were analyzed qualitatively. FINDINGS Children's drawings related symptoms and the strategies children used to self-manage those symptoms. Nausea, fatigue, pain, and sadness were the most frequently reported symptoms. Strategies to manage symptoms most often included physical and psychosocial care strategies. IMPLICATIONS FOR NURSING Children with cancer were able to relate detailed descriptions of their symptoms and symptom self-management strategies when presented with developmentally sensitive approaches. Healthcare providers are well positioned to integrate arts-based approaches to symptom assessment and to support children in implementing their preferred strategies to alleviate symptoms.
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Duffy EA, Dias N, Hendricks-Ferguson V, Hellsten M, Skeens-Borland M, Thornton C, Linder LA. Perspectives on Cancer Pain Assessment and Management in Children. Semin Oncol Nurs 2019; 35:261-273. [PMID: 31078340 DOI: 10.1016/j.soncn.2019.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To report evidence regarding pain assessment and management for children and adolescents receiving treatment for cancer. DATA SOURCES Published research and clinical guidelines. CONCLUSION Children and adolescents experience multiple sources of pain across the cancer continuum. They require developmentally relevant approaches when assessing and managing pain. This review suggests that consideration of the developmental stage and age of the child are essential in both pain assessment and pain management. IMPLICATIONS FOR NURSING PRACTICE Pediatric oncology nurses play a key role in developmentally appropriate pain assessment, identification of potential strategies to manage pain, and delivery of pharmacologic and nonpharmacologic therapies.
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Affiliation(s)
| | - Nancy Dias
- East Carolina University College of Nursing, Greenville, NC
| | | | - Melody Hellsten
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | | | - Cliff Thornton
- Herman & Walter Samuelson Children's Hospital of Sinai, Division of Pediatric Hematology/Oncology, Johns Hopkins School of Nursing, Baltimore, MD
| | - Lauri A Linder
- University of Utah, College of Nursing, Salt Lake City, UT; Primary Children's Hospital, Salt Lake City, UT
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Tsimicalis A, Rennick J, Le May S, Stinson J, Sarkis B, Séguin K, Siedlikowski M, Choquette A, Louli J. “Tell it as it is”: How Sisom prompts children and parents to discuss their cancer experience. Cancer Rep (Hoboken) 2019. [DOI: 10.1002/cnr2.1173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Argerie Tsimicalis
- Ingram School of Nursing, Faculty of MedicineMcGill University Montreal Quebec Canada
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Janet Rennick
- Ingram School of Nursing, Faculty of MedicineMcGill University Montreal Quebec Canada
- Montreal Children's HospitalMcGill University Health Centre Montreal Quebec Canada
| | - Sylvie Le May
- UHC Sainte‐Justine Montreal Quebec Canada
- University of Montreal Montreal Quebec Canada
| | - Jennifer Stinson
- The Hospital for Sick Children Toronto Ontario Canada
- Lawrence S Bloomberg Faculty of NursingUniversity of Toronto Toronto Ontario Canada
| | - Bianca Sarkis
- Faculty of MedicineMcGill University Montreal Quebec Canada
| | - Karine Séguin
- Faculty of ScienceMcGill University Montreal Quebec Canada
| | - Maia Siedlikowski
- Ingram School of Nursing, Faculty of MedicineMcGill University Montreal Quebec Canada
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Anne Choquette
- Montreal Children's HospitalMcGill University Health Centre Montreal Quebec Canada
| | - Julie Louli
- Ingram School of Nursing, Faculty of MedicineMcGill University Montreal Quebec Canada
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Rodgers CC, Hooke MC, Taylor OA, Koerner KM, Mitby PA, Moore IM, Scheurer ME, Hockenberry MJ, Pan W. Childhood Cancer Symptom Cluster: Leukemia and Health-Related Quality of Life. Oncol Nurs Forum 2019; 46:228-237. [PMID: 30767969 DOI: 10.1188/19.onf.228-237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the relationship of the Childhood Cancer Symptom Cluster-Leukemia (CCSC-L) with health-related quality of life (HRQOL). SAMPLE & SETTING 327 children receiving treatment for acute lymphoblastic leukemia from four pediatric oncology programs across the United States. METHODS & VARIABLES Participants completed fatigue, sleep disturbance, pain, nausea, and depression symptom questionnaires at four time points; these symptoms comprised the CCSC-L. HRQOL was measured at the start of postinduction therapy and then at the start of maintenance therapy. Relationships between the CCSC-L and HRQOL scores were examined with longitudinal parallel-process modeling. RESULTS The mean HRQOL significantly increased over time (p < 0.001). The CCSC-L had a significant negative association with HRQOL scores at the start of postinduction therapy (beta = -0.53, p < 0.005) and the start of maintenance therapy (beta = -0.33, p < 0.015). Participants with more severe symptoms in the CCSC-L over time had significantly lower HRQOL at the start of maintenance therapy (beta = -0.42, p < 0.005). IMPLICATIONS FOR NURSING Nurses are pivotal in providing management strategies to minimize symptom severity that may improve HRQOL.
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Antill Keener T. Childhood Cancer-Related Fatigue and Day-to-Day Quality of Life. J Pediatr Oncol Nurs 2018; 36:74-85. [PMID: 30556476 DOI: 10.1177/1043454218818062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Childhood cancer-related fatigue is often viewed as an inevitable symptom of cancer and cancer treatment leading to underassessment by health care providers and self-management by families in the home and hospital environment. Parents' perspectives of the influence of childhood cancer-related fatigue on their child's day-to-day life is needed to understand how parents may or may not prioritize, report, and/or manage the fatigue symptom. This qualitative study used conventional content analysis to describe parents' observations and perspectives on the influence of fatigue in their child's day-to-day quality of life (QOL). Eleven interviews were gathered from parents. The concept childhood cancer-related fatigue and domains of QOL in pediatric oncology patients were used to guide the study, construct interview questions, and conduct conventional content analysis. A synthesis of three categories and seven codes led to three major findings: (a) parents perceive their child's symptoms as co-occurring not as a discrete entity of fatigue, (b) parents accept the child's behavior as a "new normal," and (c) parents recognize fatigue as a warning sign. The study findings reveal differences in how parents observe childhood cancer-related fatigue and how they perceive the symptom influences day-to-day QOL. Findings of this study support current guidelines underscoring the importance of multidimensional fatigue care. Additionally, the findings suggest a standardized multiple symptom instrument may be helpful in assessing symptom experience.
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McLaughlin CA, Gordon K, Hoag J, Ranney L, Terwilliger NB, Ureda T, Rodgers C. Factors Affecting Adolescents' Willingness to Communicate Symptoms During Cancer Treatment: A Systematic Review from the Children's Oncology Group. J Adolesc Young Adult Oncol 2018; 8:105-113. [PMID: 30489196 DOI: 10.1089/jayao.2018.0111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The purpose of this systematic review is to (1) synthesize evidence facilitators and barriers affecting adolescent willingness to communicate symptoms to health care providers (HCPs) and (2) create practice recommendations. The PICOT (Population, Intervention, Comparison, Outcome, Time) question guiding the review was, among adolescents with cancer, what factors affect their willingness to communicate symptoms to HCPs? Three databases, PubMed, CINAHL, and PsychINFO, were searched using keywords from the PICOT question. Inclusion criteria included original research studies with samples of at least 51% adolescents aged 10-18 years who were receiving or had received cancer treatment. Studies were included that evaluated outcomes related to willingness to communicate in general as well as communication of specific treatment symptoms. Exclusion criteria included systematic reviews and publications emphasizing cancer screening, cancer prevention, survivorship, or decision making. A total of 11 studies were included in the systematic review. Two of the studies focused on symptom communication; the remaining nine studies focused on general communication or the overlap between general and symptom communication. Barriers to symptom and/or general communication included negative expectations, health-related uncertainty, ambiguousness with assessments, unfamiliarity, restriction of information, perceived negative provider characteristics/behaviors, adolescent circumstance, worry about others' perceptions, and provider approach. Facilitators to symptom and/or general communication included open communication, perceived favorable provider characteristics/behaviors, seasoned adolescent, and patient-provider rapport. Five practice recommendations were developed from the evidence that supports general and symptom communication between adolescents who are receiving or have completed cancer treatment and their HCPs.
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Affiliation(s)
- Colleen A McLaughlin
- 1 Department of Pediatrics, Division of Pediatric Blood & Marrow Transplant, Duke University Medical Center, Durham, North Carolina
| | - Kristi Gordon
- 2 Department of Hematology/Oncology & Bone Marrow Transplant, Children's Mercy Hospital, Kansas City, Missouri
| | - Jennifer Hoag
- 3 Department of Pediatrics, Division of Hematology, Oncology, Blood and Marrow Transplant, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lori Ranney
- 4 Department of Cancer and Blood Disorders Clinic, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Nancy B Terwilliger
- 2 Department of Hematology/Oncology & Bone Marrow Transplant, Children's Mercy Hospital, Kansas City, Missouri
| | - Tonya Ureda
- 5 Department of Pediatric Hematology/Oncology/Transplant, Levine Children's Hospital, Charlotte, North Carolina
| | - Cheryl Rodgers
- 6 Duke University School of Nursing, Durham, North Carolina
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Namisango E, Bristowe K, Allsop MJ, Murtagh FEM, Abas M, Higginson IJ, Downing J, Harding R. Symptoms and Concerns Among Children and Young People with Life-Limiting and Life-Threatening Conditions: A Systematic Review Highlighting Meaningful Health Outcomes. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 12:15-55. [DOI: 10.1007/s40271-018-0333-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Tsimicalis A, Rennick J, Stinson J, May SL, Louli J, Choquette A, Treherne S, Berube S, Yoon S, Ruland C. Usability Testing of an Interactive Communication Tool to Help Children Express Their Cancer Symptoms. J Pediatr Oncol Nurs 2018; 35:320-331. [PMID: 29848164 DOI: 10.1177/1043454218777728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Sisom is an interactive computer software program that allows children to rate the severity of their cancer symptoms. The study objectives were to describe the usability of Sisom in terms of ease of use, usefulness, and aesthetics and to offer suggestions for improvement. METHOD A multisite, descriptive study was conducted to describe the usability of Sisom. A purposive sample of children, ages 6 to 12 years, being treated for cancer was recruited. English- and French-speaking children completed the eight tasks in Sisom recorded using Morae software and provided input via an audiotaped interview. Data were downloaded, transcribed verbatim, and analyzed descriptively. RESULTS Thirty-four children with varying cancers participated. The majority of children liked Sisom and found Sisom easy to use, found it to be helpful in expressing their symptoms, and were satisfied with the aesthetics. Some children provided suggestions for improvement to optimize Sisom use in Canada. CONCLUSIONS Children's positive responses and desire to use Sisom again suggest that future research should be directed toward implementing and evaluating its effectiveness in a variety of settings.
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Affiliation(s)
- Argerie Tsimicalis
- 1 McGill University, Montreal, Quebec, Canada.,2 Shriners Hospitals for Children®-Canada, Montreal, Quebec, Canada
| | - Janet Rennick
- 1 McGill University, Montreal, Quebec, Canada.,3 Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jennifer Stinson
- 4 The Hospital for Sick Children, Toronto, Ontario, Canada.,5 University of Toronto, Toronto, Ontario, Canada
| | - Sylvie Le May
- 6 UHC Sainte-Justine, Montreal, Quebec, Canada.,7 University of Montreal, Montreal, Quebec, Canada
| | - Julie Louli
- 1 McGill University, Montreal, Quebec, Canada
| | - Anne Choquette
- 3 Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Sarah Berube
- 6 UHC Sainte-Justine, Montreal, Quebec, Canada.,7 University of Montreal, Montreal, Quebec, Canada
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Linder LA, Wawrzynski SE. Staff Perceptions of Symptoms, Approaches to Assessment, and Challenges to Assessment Among Children With Cancer. J Pediatr Oncol Nurs 2018; 35:332-341. [PMID: 29652214 PMCID: PMC6319255 DOI: 10.1177/1043454218767888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nurses are often the first to recognize and respond to children's symptoms. This descriptive, exploratory study characterized how pediatric oncology health care providers characterize and assess children's cancer-related symptoms. The study also explored challenges associated with symptom assessment and information perceived as helpful in planning interventions. The setting was a Children's Oncology Group-affiliated hospital in the Intermountain West of the United States. Twenty-two pediatric oncology health care providers (95% female; 68% nurses) participated in one of four focus group sessions. Sessions were facilitated by two individuals and included six open-ended questions addressing participants' perspectives of cancer-related symptoms, approaches to symptom assessment, challenges and frustrations encountered when assessing symptoms, and information needed to plan interventions. Participants identified 75 physical and psychosocial responses that included both subjectively experienced symptoms and other consequences of the cancer experience. Qualitative content analysis procedures organized other responses into categories and subcategories. Participants most frequently reported using observational approaches including physical assessment findings and observation of the child's behavior to identify symptoms. Strategies that sought the child's input such as the use of a rating scale or seeking the child's verbal description were less frequently named. Participants related discerning and interpreting the child's behaviors as a challenge to symptom assessment. They also reported attention to symptom characteristics as important to planning interventions. Future directions include building capacity to support child-centric symptom assessment. Development of reliable and valid resources for use in clinical settings may support a more child-centric approach to symptom assessment.
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Affiliation(s)
- Lauri A. Linder
- University of Utah, Salt Lake City, UT, USA
- Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Sarah E. Wawrzynski
- University of Utah, Salt Lake City, UT, USA
- Primary Children’s Hospital, Salt Lake City, UT, USA
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Tsimicalis A, Genest L, Stevens B, Ungar WJ, Barr R. The Impact of a Childhood Cancer Diagnosis on the Children and Siblings’ School Attendance, Performance, and Activities: A Qualitative Descriptive Study. J Pediatr Oncol Nurs 2017; 35:118-131. [DOI: 10.1177/1043454217741875] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Families of children with cancer are confronted with unexpected out-of-pocket expenses and productivity costs associated with the diagnosis. One productivity cost that falls on children is the impact of cancer on children’s school attendance, performance, and activities (eg, play, friendships, and socialization). Nested within the Childhood Cancer Cost Study, this qualitative descriptive study used convenience sampling to recruit and interview parents of children newly diagnosed with cancer. Content analysis techniques were used to inductively descriptive the semistructured interview data. Sixty-six parents of 65 children with cancer and of 73 siblings participated. The most commonly reported productivity loss in children with cancer was school absenteeism mainly due to cancer treatment. Children fell behind their classmates academically and lost important social time with peers. A few siblings also fell behind their peers primarily due to limited parental attention. Parents adopted various strategies to lessen the impact of the diagnosis on their children’s school attendance, performance, and activities. Providing parents with additional resources and support may optimize their children’s academic and social reintegration into school.
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Affiliation(s)
- Argerie Tsimicalis
- McGill University, Montreal, Quebec, Canada
- Shriners Hospitals for Children–Canada, Montreal, Quebec, Canada
| | | | - Bonnie Stevens
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy J. Ungar
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ronald Barr
- Pediatric Oncology Group of Ontario (POGO), Toronto, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
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Ångström-Brännström C, Lindh V, Mullaney T, Nilsson K, Wickart-Johansson G, Svärd AM, Nyholm T, Lindh J, Engvall G. Parents' Experiences and Responses to an Intervention for Psychological Preparation of Children and Families During the Child's Radiotherapy. J Pediatr Oncol Nurs 2017; 35:132-148. [PMID: 29172925 DOI: 10.1177/1043454217741876] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to evaluate parents' experiences and responses to a systematic intervention for psychological preparation of children and families during the child's radiotherapy (RT) treatment. In this case-control study at 3 pediatric RT centers, an intervention with a preparatory kit, including age-adjusted information on tablets, gift of a stuffed toy or a pair of headphones, a parent booklet, and toy models of the computed tomography and RT machines was implemented. For evaluation, a mixed methods data collection was conducted. A total of 113 parents of children undergoing RT were included-n = 59 in the baseline group and n = 54 in the intervention group. Health-related quality of life was rated low, but parents in the intervention group expressed less anxiety after the RT compared with the baseline group. They found information suitable for their young children, siblings, and friends were involved and the toy models were used for play. Parents expressed positive feelings due to close interaction with staff and each other within the family. The solutions developed within a human-centered design approach and shaped as a systematic family-centered strategy contributed to parents understanding and coping with the child's RT.
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Comparison of good days and sick days of school-age children with cancer reflected through their drawings. Qual Life Res 2017; 26:2729-2738. [PMID: 28612308 DOI: 10.1007/s11136-017-1621-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Childhood cancer disrupts children's daily life experiences. Eliciting children's perspectives regarding their life experiences during cancer treatment can be challenging. The purpose of this study was to characterize elementary school-age children's "good days" and "sick days" through their drawings. METHODS This study used draw-and-tell interviews, a developmentally sensitive arts-based technique that supports children's recall and communication of information, facilitating a deeper understanding of children's personal interpretation and meaning of a given phenomenon of interest. Children were asked to draw pictures representing both a "good day" and a "sick day." Following completion of each drawing, research team members used a semi-structured interview guide to elicit children's explanations of their pictures. Content analysis techniques were used to descriptively characterize children's drawings followed by thematic analysis to identify commonalities. RESULTS Participants were 27 children 6.33-12.83 years of age (mean 9.16 years; SD = 1.9) receiving treatment for cancer. "Good day" and "sick day" pictures were similar with regards to the presence of the child, the inclusion of other individuals, and the type of art medium used. Children's pictures characterized "good days" as being happy, outside in sunny weather, and engaged in activities. In contrast, "sick days" were characterized as feeling sad, lying down or reclining, and experiencing illness-related symptoms. CONCLUSIONS Children's drawings illustrate their capacity to provide rich personal data related to their "good days" and "sick days." Incorporating arts-based strategies in the clinical setting may provide a child-centric strategy to understand the child's perspective and direct interventions.
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The embodied spaces of children with complex care needs: Effects on the social realities and power negotiations of families. Health Place 2017; 46:6-12. [PMID: 28432912 DOI: 10.1016/j.healthplace.2017.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/23/2017] [Accepted: 04/05/2017] [Indexed: 11/21/2022]
Abstract
This paper presents research findings that advance knowledge around the power and agency families with children with complex care needs (CCN). Our conceptual framework uses concepts from geography towards situating the experiences and social realities of family carers within the 'embodied space of care'. The data originate from a longitudinal qualitative study of Canadian families with children with CCN. Findings reveal that interactions and decision-making processes relating to health and everyday life were complex and socially interconnected, and emphasize the need for provisions for family-based decision-making and enhanced social inclusion of families and the importance of the renegotiation of power.
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Woodgate RL, Sigurdson C, Demczuk L, Tennent P, Wallis B, Wener P. The meanings young people assign to living with mental illness and their experiences in managing their health and lives: a systematic review of qualitative evidence. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:276-401. [PMID: 28178021 DOI: 10.11124/jbisrir-2016003283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND It is estimated that less than 25% of young people in need of treatment for mental illness receive specialized services, and even fewer receive a diagnosis by their doctor. These findings are troubling given that living with a mental illness can have a significant impact on a young person's life, the lives of his/her family members, the young person's community and society generally. OBJECTIVE The objective of this systematic review was to synthesize the best available qualitative evidence on the meanings young people assign to living with mental illness and their experiences in managing their health and lives. INCLUSION CRITERIA The current review considered both interpretive and critical research studies that drew on the experiences of young people with mental illness. SEARCH STRATEGY The search for published studies included the following databases: MEDLINE, CINAHL, Social Sciences Full Text, PsycINFO, Social Work Abstracts, Sociological Abstracts, Embase, Social Services Abstracts, Child Development and Adolescent Studies, Scopus, Web of Science and Academic Search Complete. The search for unpublished studies included conference proceedings and ProQuest Dissertations and Theses Database. METHODOLOGICAL QUALITY Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to appraise the methodological quality of the articles. DATA EXTRACTION Qualitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-QARI. DATA SYNTHESIS JBI-QARI was used to pool findings based on their similarity of meaning and developed into four synthesized findings. RESULTS Fifty-four research papers generated 304 study findings that were aggregated into nine categories. The nine categories were further aggregated into four synthesis statements: (1) A different way of being, (2) Getting through the difficult times, (3) Yearning for acceptance and (4) Room for improvement. CONCLUSION Young people with mental illness experienced a range of feelings and thoughts that at times left them feeling uncomfortable in their body and world. Rejection by family and friends was a common fear. The changes experienced by young people required them to use a variety of strategies that were both negative and positive. The challenges young people faced in seeking and receiving care reinforce that there is a need for improvement in mental health services for youth living with mental illness.
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Affiliation(s)
- Roberta L Woodgate
- 1College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada 2Applied Health Sciences PhD Program, University of Manitoba, Winnipeg, Manitoba, Canada 3Elizabeth Dafoe Library, University of Manitoba, Winnipeg, Manitoba, Canada 4College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada 5University of Manitoba, Winnipeg, Manitoba, Canada and the Queen's Collaboration for Health Care Quality: a Joanna Briggs Institute Center of Excellence, Kingston, Ontario, Canada
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Rodgers C, Hooke MC, Ward J, Linder LA. Symptom Clusters in Children and Adolescents with Cancer. Semin Oncol Nurs 2016; 32:394-404. [DOI: 10.1016/j.soncn.2016.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Linder LA, Seitz M. Through Their Words: Sources of Bother for Hospitalized Children and Adolescents With Cancer. J Pediatr Oncol Nurs 2016; 34:51-64. [PMID: 26902500 DOI: 10.1177/1043454216631308] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An increased intensity of inpatient treatment, hospital-based routines, and separation from the familiar home environment may collectively increase the burden of the pediatric cancer experience. This study explored children and adolescents' perceived sources of bother related to hospitalization using two questions: (1) What bothered you the most about the hospital or hospital environment? and (2) What do you think could improve the hospital or hospital environment? Fifty children and adolescents (mean age 12.6 years) responded to these questions during each shift of a 3-day/3-night data collection period. Responses were analyzed using content analysis and chi-square analyses. Themes related to sources of bother included (1) "nothing/don't know," (2) "treatment and its consequences," (3) "isolation and loneliness," (4) "imposed bother," (5) "negative environment," and (6) "staff behaviors." Themes related to improving the hospital environment included (1) "nothing/don't know," (2) "normalizing activities," (3) "quality of the hospital environment," (4) "decrease burden of cancer and its treatment," and (5) "patient care issues." Participants' responses to these questions provide a foundation for actionable change to alleviate the burden associated with hospitalization.
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Affiliation(s)
- Lauri A Linder
- 1 University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Marie Seitz
- 2 University of Utah College of Nursing, Salt Lake City, UT, USA
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Tomlinson D, Zupanec S, Jones H, O’Sullivan C, Hesser T, Sung L. The lived experience of fatigue in children and adolescents with cancer: a systematic review. Support Care Cancer 2016; 24:3623-31. [DOI: 10.1007/s00520-016-3253-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/26/2016] [Indexed: 12/27/2022]
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Jibb L, Nathan P, Stevens B, Seto E, Cafazzo J, Stephens N, Yohannes L, Stinson J. Psychological and Physical Interventions for
the Management of Cancer-Related Pain in Pediatric and Young Adult Patients: An Integrative Review. Oncol Nurs Forum 2015; 42:E339-57. [DOI: 10.1188/15.onf.e339-e357] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ameringer S, Erickson JM, Macpherson CF, Stegenga K, Linder LA. Symptoms and Symptom Clusters Identified by Adolescents and Young Adults With Cancer Using a Symptom Heuristics App. Res Nurs Health 2015; 38:436-48. [PMID: 26455729 DOI: 10.1002/nur.21697] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
Adolescents and young adults (AYAs) with cancer experience multiple distressing symptoms during treatment. Because the typical approach to symptom assessment does not easily reflect the symptom experience of individuals, alternative approaches to enhancing communication between the patient and provider are needed. We developed an iPad-based application that uses a heuristic approach to explore AYAs' cancer symptom experiences. In this mixed-methods descriptive study, 72 AYAs (13-29 years old) with cancer receiving myelosuppressive chemotherapy used the Computerized Symptom Capture Tool (C-SCAT) to create images of the symptoms and symptom clusters they experienced from a list of 30 symptoms. They answered open-ended questions within the C-SCAT about the causes of their symptoms and symptom clusters. The images generated through the C-SCAT and accompanying free-text data were analyzed using descriptive, content, and visual analyses. Most participants (n = 70) reported multiple symptoms (M = 8.14). The most frequently reported symptoms were nausea (65.3%), feeling drowsy (55.6%), lack of appetite (55.6%), and lack of energy (55.6%). Forty-six grouped their symptoms into one or more clusters. The most common symptom cluster was nausea/eating problems/appetite problems. Nausea was most frequently named as the priority symptom in a cluster and as a cause of other symptoms. Although common threads were present in the symptoms experienced by AYAs, the graphic images revealed unique perspectives and a range of complexity of symptom relationships, clusters, and causes. Results highlight the need for a tailored approach to symptom management based on how the AYA with cancer perceives his or her symptom experience.
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Affiliation(s)
- Suzanne Ameringer
- Associate Professor School of Nursing, Virginia Commonwealth University, 1100 East Leigh Street Richmond, VA, 23298
| | - Jeanne M Erickson
- Assistant Professor College of Nursing, University of Wisconsin-Milwaukee Milwaukee, WI
| | | | - Kristin Stegenga
- Nurse Researcher Children's Mercy Hospital, Kansas City, Missouri
| | - Lauri A Linder
- Assistant Professor College of Nursing, University of Utah, Clinical Nurse Specialist, Primary Children's Hospital, Salt Lake City, UT
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Existential anxiety and growth: an exploration of computerized drawings and perspectives of children and adolescents with cancer. Cancer Nurs 2015; 37:146-59. [PMID: 24145247 DOI: 10.1097/ncc.0b013e31829ded29] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Until now, most existentially focused cancer research has been conducted within adult populations. Only a handful of qualitative investigations have captured the experiences of children with cancer relative to themes such as existential fear and finitude, meaning/meaninglessness, uncertainty, authenticity, and inauthenticity. OBJECTIVE This article aimed to provide a deeper understanding of the existential challenges faced by children living with cancer. METHODS An interpretive, descriptive qualitative research approach was used. Thirteen children (8-17 years) undergoing treatment for cancer participated. Children participated in individual open-ended interviews and also had the opportunity to journal their experiences in a computerized drawing tool. RESULTS The 4 main themes that emerged in relation to the existential challenges experienced by children with cancer included (1) existential worry, (2) existential vacuum, (3) existential longing, and (4) existential growth. The drawing tool within the computer diary was found to be particularly beneficial in assisting children to express the existential challenges that they had previously been unable to articulate in words. CONCLUSION Children moved between existential anxiety and existential growth within the cancer world. The expressive means of drawing pictures gave children a therapeutic space to explore and work at understanding the existential challenges experienced. IMPLICATIONS FOR PRACTICE This research provides evidence that the active engagement of children's imaginations through the use of a computer-drawing tool may have significant therapeutic value for children with cancer. As well, the findings support the importance of nurses "being there" for young patients with cancer in their time of despair.
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Khadra C, Le May S, Tremblay I, Dupuis F, Cara C, Mercier G, Vachon MF, Fiola JL. Development of the Adolescent Cancer Suffering Scale. Pain Res Manag 2015; 20:213-9. [PMID: 26252665 PMCID: PMC4532208 DOI: 10.1155/2015/645367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND While mortality due to pediatric cancer has decreased, suffering has increased due to complex and lengthy treatments. Cancer in adolescence has repercussions on personal and physical development. Although suffering can impede recovery, there is no validated scale in French or English to measure suffering in adolescents with cancer. OBJECTIVE To develop an objective scale to measure suffering in adolescents with cancer. METHODS A methodological design for instrument development was used. Following a MEDLINE search, semistructured interviews were conducted with adolescents 12 to 19 years of age who had undergone four to six weeks of cancer treatment, and with a multidisciplinary cohort of health care professionals. Adolescents with advanced terminal cancer or cognitive impairment were excluded. Enrollment proceeded from the hematology-oncology department⁄clinic in Montreal, Quebec, from December 2011 to March 2012. Content validity was assessed by five health care professionals and four adolescents with cancer. RESULTS Interviews with 19 adolescents and 16 health care professionals identified six realms of suffering: physical, psychological, spiritual, social, cognitive and global. Through iterative feedback, the Adolescent Cancer Suffering Scale (ACSS) was developed, comprising 41 questions on a four-point Likert scale and one open-ended question. Content validity was 0.98, and inter-rater agreement among professionals was 88% for relevance and 86% for clarity. Adolescents considered the scale to be representative of their suffering. CONCLUSIONS The ACSS is the first questionnaire to measure suffering in adolescents with cancer. In future research, the questionnaire should be validated extensively and interventions developed. Once validated, the ACSS will contribute to promote a holistic approach to health with appropriate intervention or referral.
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Affiliation(s)
- Christelle Khadra
- Faculty of Nursing, University of Montreal, Montreal, Quebec
- Centre hospitalier universitaire Sainte-Justine Research Center, Montreal, Quebec
| | - Sylvie Le May
- Faculty of Nursing, University of Montreal, Montreal, Quebec
- Centre hospitalier universitaire Sainte-Justine Research Center, Montreal, Quebec
| | - Isabelle Tremblay
- Department of Psychology, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec
| | - France Dupuis
- Faculty of Nursing, University of Montreal, Montreal, Quebec
- Centre hospitalier universitaire Sainte-Justine Research Center, Montreal, Quebec
| | - Chantal Cara
- Faculty of Nursing, University of Montreal, Montreal, Quebec
| | - Geneviève Mercier
- Department of Hematology/Oncology, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec
| | - Marie France Vachon
- Department of Hematology/Oncology, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec
| | - Jacinthe Lachance Fiola
- Faculty of Nursing, University of Montreal, Montreal, Quebec
- Centre hospitalier universitaire Sainte-Justine Research Center, Montreal, Quebec
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Comparison of Resilience in Adolescent Survivors of Brain Tumors and Healthy Adolescents. Cancer Nurs 2014; 37:373-81. [DOI: 10.1097/ncc.0000000000000094] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Macartney G, Stacey D, Harrison MB, VanDenKerkhof E. Symptoms, Coping, and Quality of Life in Pediatric Brain Tumor Survivors: A Qualitative Study. Oncol Nurs Forum 2014; 41:390-8. [DOI: 10.1188/14.onf.390-398] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Arslan FT, Basbakkal Z, Kantar M. Quality of life and chemotherapy-related symptoms of Turkish cancer children undergoing chemotherapy. Asian Pac J Cancer Prev 2014; 14:1761-8. [PMID: 23679270 DOI: 10.7314/apjcp.2013.14.3.1761] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This cross-sectional and descriptive study was designed to determine symptoms emerging due to chemotherapy treatment and their effects on children's quality of life. The research was carried out between February 2008 and February 2009 at the pediatric oncology clinics in four hospitals, focusing on 93 patients receiving chemotherapy. A survey form, the Pediatric Quality of Life Inventory (PedsQL 4.0) and the Memorial Symptom Assessment Scale (MSAS) were used as data collection tools. Chi-square and Student t tests were performed for data analysis. Some 51.6% of the children were aged 13-15 years old, and 51.8% were boys and 50.5% were diagnosed as having solid tumors. There were significant relations between: antimetabolite chemotherapeutics and feeling irritable and worrying (p=0.001, p=0.030); vinkoalkaloid and numbness/tingling in hands/feet (p=0.043); antracyclines and lack of energy and skin changes (p=0.021, p=0.004); and corticosteroids and lack of appetite, nausea and sadness (p=0.008, p=0.009, p=0.009). Several symptoms such as feeling sad, worrying and feeling irritable caused a significant decrease in the total domain of quality of life scores (p=0.034, p=0.012, p=0.010, respectively). Chemotherapeutic drugs can cause symptoms that can seriously affect quality of life in children.
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Affiliation(s)
- Fatma Tas Arslan
- Nursing, Faculty of Health Sciences, Selcuk University, Konya, Turkey.
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Al Omari O, Wynaden D. The psychosocial experience of adolescents with haematological malignancies in Jordan: an interpretive phenomenological analysis study. ScientificWorldJournal 2014; 2014:274036. [PMID: 24550700 PMCID: PMC3914442 DOI: 10.1155/2014/274036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/12/2013] [Indexed: 11/25/2022] Open
Abstract
The qualitative research method of interpretive phenomenological analysis was used to explore the lived experience of 14 Jordanian adolescents with haematological malignancies. They were admitted to two hospitals in Jordan and were interviewed for this study twice during the first six months after receiving their diagnosis. The results of this study revealed three themes: (1) Being in hospital, (2) The changing self, and (3) Fearing the unknown. When the participants were hospitalised due to their illness they were removed from their families and friends and prevented from engaging in their normal daily routine. Participants also reported receiving limited emotional and psychological support from health team members during hospitalisation. From the onset of cancer treatments, the bio-psychosocial side effects of the chemotherapy became one of the most distressing factors for participants affecting all aspects of their life and generated uncertainty about their future. The findings add to existing understanding of the lived experiences of cancer patients and in particular Jordanian adolescents. They provide a valuable insight for clinicians into improvements in service delivery to this group of patients.
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Affiliation(s)
- Omar Al Omari
- Children and Young People's Mental Health, Faculty of Nursing, Jerash University, P.O. Box 311, Jerash 26150, Jordan
- School of Nursing and Midwifery, Curtin Health Innovation, Research Institute, Curtin University, GPO Box U 1987, Perth, WA 6845, Australia
| | - Dianne Wynaden
- School of Nursing and Midwifery, Curtin Health Innovation, Research Institute, Curtin University, GPO Box U 1987, Perth, WA 6845, Australia
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Fenton G. Involving a young person in the development of a digital resource in nurse education. Nurse Educ Pract 2014; 14:49-54. [DOI: 10.1016/j.nepr.2013.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 04/22/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
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Barling JA, Stevens JA, Davies KM. The reality of hospitalisation: Stories from family members of their hospital experience for adolescents and young adults living with and dying from cancer. Contemp Nurse 2013:2707-2734. [PMID: 24087942 DOI: 10.5172/conu.2013.2707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract Background: Adolescents and Young Adults (AYA) with cancer are being disadvantaged within the present health care system. Some of the factors identified as leading to this disadvantage include medical issues specific to AYAs with cancer, delay in diagnosis, fragmented services, lack of access to clinical trials and psychosocial life stage issues Objective: A major study investigated the experience that accompanies the stages of diagnosis, treatment, dying and death of an AYA from the perspective of family members. This paper discusses the major theme of the reality of hospitalisation Methods: Narrative inquiry was the methodology for this study. The participants were a self-selected purposeful sample of 26 family members. Open-ended interviews were conducted to obtain a story of the experience of having an AYA family member live with and die of cancer. A meta-narrative of the family member's experience was developed by NVivo8. Results: In amongst the mass of data this study produced, a major theme to emerge was the experience 'of the reality of hospitalisation.' Within this theme issues regarding: the place of treatment; the hospital experience; not fitting in; and, confronting illness and death were revealed. Conclusion: While on the whole the cancer was treated with state of the art medicine, the experiences of the hospitalisation repeated consistently throughout this narrative reveals a failure to meet the higher order needs specific to adolelscents and young adults and their families As a result this cohort were exposed to a landscape which did not facilitate a therapeutic experience, as well as would be expected for children and older adults.
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Affiliation(s)
- Janet A Barling
- RN: Lecturer Southern Cross University, School of Health and Human Sciences. PO Box 157 Lismore, NSW ph 61 266203167
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Initial development of the Symptom Screening in Pediatrics Tool (SSPedi). Support Care Cancer 2013; 22:71-5. [PMID: 23995756 DOI: 10.1007/s00520-013-1945-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 08/12/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND We previously identified published scales for symptom assessment in pediatric cancer patients. The objectives of this study were to identify if any of these scales were suitable for use or adaptation as a self-report symptom screening tool, and if not, to begin the process of creating a new tool. METHODS A focus group of ten healthcare professionals with expertise in pediatric cancer symptom management and a patient advocate were convened. First, the group identified the optimal properties of a symptom screening tool for pediatric cancer patients. Next, the previously identified symptom assessment scales were evaluated against these properties. As none of the existing scales were adequate for symptom screening, a nominal group technique was used to identify the most important symptoms for inclusion in a new symptom screening tool. RESULTS Optimal properties of a symptom screening tool included minimal respondent burden, inclusion of 15 items or less, and inclusion of the most burdensome symptoms. None of the previously identified scales were adequate because they lacked content validity and were too long or would be too hard for children to understand. Nominal group technique identified 15 items to be included; an initial draft was developed and named the Symptom Screening in Pediatrics (SSPedi) Tool. CONCLUSIONS This study identified the lack of an appropriate symptom screening tool for use by pediatric cancer patients. A preliminary version of SSPedi was developed. Subsequent work will ensure that it is understandable by children and evaluate its psychometric properties.
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Abstract
PURPOSE OF REVIEW Researchers have focused on identifying and describing symptom experiences among children with various diseases but symptoms can have a synergistic and/or an antecedent effect that must be evaluated. This review reports the current knowledge of symptoms among various pediatric diseases and highlights symptom cluster research. RECENT FINDINGS Symptoms of depression and anxiety are the most prevalent variables studied across pediatric disease studies followed by pain, fatigue, and quality of life. Although previous pediatric symptom research provides a foundation for understanding the complexities of these symptoms, there is limited evidence on symptom cluster research in pediatrics. Pain and fatigue are the most common symptoms analyzed for correlations, and relationships among symptoms that have been evaluated in children with juvenile idiopathic arthritis, HIV, cancer, cardiac disease requiring an implantable cardioverter defibrillator, and at end of life. Pain and fatigue have been associated with sleep disturbances, anxiety, depression, anorexia, and nausea/vomiting. SUMMARY Pediatric oncology researchers are leading the way with symptom cluster studies; however, this work remains in the early stages. There is great potential to advance the state of the science with cluster analysis. Future research work should focus on evaluating symptoms and their interactions.
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Lee MY, Mu PF, Tsay SF, Chou SS, Chen YC, Wong TT. Body image of children and adolescents with cancer: a metasynthesis on qualitative research findings. Nurs Health Sci 2012; 14:381-90. [PMID: 22672500 DOI: 10.1111/j.1442-2018.2012.00695.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children and adolescents with cancer are confronted with many challenges. This review considered studies that used qualitative methods to examine the body image experience of children and adolescents with cancer. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1960 and October 2010. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Eight papers met the inclusion criteria. The derived four metasyntheses included being distanced from the body, loss of self-identity, self-protective strategies and support, and getting rid of the shackles of the body. In conclusion, children and adolescents with cancer also experience various problems associated with changes in their body image. Repeated courses of treatment lead to loss of a normal, orderly life, and might even result in changes in interpersonal interactions. In response to body image change, individuals with cancer develop self-protective, coping strategies. Children and adolescents who experience life-threatening cancer come to face body image change positively, and might hold a confident attitude toward their future.
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Affiliation(s)
- Mei-Yin Lee
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
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Kestler SA, LoBiondo-Wood G. Review of symptom experiences in children and adolescents with cancer. Cancer Nurs 2012; 35:E31-49. [PMID: 21760492 DOI: 10.1097/ncc.0b013e3182207a2a] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inadequate symptom relief in children and adolescents with cancer leads to unnecessary suffering. This review assesses research on children and adolescents with cancer that had been published from 2002 to 2010. OBJECTIVES The review identifies the symptom experiences of children and adolescents undergoing treatment and describes the progress that has been made since Docherty's 2003 systematic review of nurse researcher published studies from 1990 to 2002, which identified gaps in research on the symptoms of pediatric oncology patients. METHOD A computerized search of medical and nursing literature produced 50 published studies and 2 dissertations that addressed the symptom experiences of children and adolescents receiving treatment for cancer. RESULTS Pain from cancer-related procedures and fatigue were the most frequently identified symptoms, followed closely by nausea and vomiting. More preschool-aged subjects and nonwhite subjects need to be assessed, distinctions between age groups and gender should be explored, and instrumentation for the prereading group must be developed. CONCLUSIONS Research on symptoms experienced by children and adolescents has gained momentum within the last 10 years, and some of the gaps identified by Docherty have been addressed. Multicenter trials would increase sample sizes and decrease enrollment time. IMPLICATIONS FOR PRACTICE By synthesizing research completed from 2002 to 2010 on symptoms of children who had cancer, new ideas can be generated and shared with clinical nursing staff to improve patient care. Gaps to further direct research are also identified.
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Affiliation(s)
- Susan A Kestler
- University of Texas Health Science Center Houston, School of Nursing, Houston, TX 77030, USA.
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Mört S, Lähteenmäki PM, Matomäki J, Salmi TT, Salanterä S. Fatigue in young survivors of extracranial childhood cancer: a Finnish nationwide survey. Oncol Nurs Forum 2012; 38:E445-54. [PMID: 22037344 DOI: 10.1188/11.onf.e445-e454] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate self-reports of fatigue by young cancer survivors (aged 11-18 years), to compare young survivors' fatigue scores with the scores of a healthy control group and of the parent proxy evaluation, and to analyze whether demographic or disease-related factors are associated with young survivors' fatigue. DESIGN Cross-sectional quantitative study. SETTING An urban hospital in southwestern Finland. SAMPLE 384 survivors diagnosed with an extracranial malignancy at age 16 or younger, who have survived four or more years postdiagnosis, and who are free of cancer. General matched population controls were randomly selected from the Finnish Population Registry. METHODS Demographic data and a self-report written fatigue questionnaire. MAIN RESEARCH VARIABLES Total fatigue (TF), general fatigue (GF), sleep or rest fatigue (SF), and cognitive fatigue. FINDINGS The control populations reported significantly more issues with TF, GF, and SF than did the survivor population. In survivors, older age, the need for remedial education at school, and a sarcoma diagnosis were associated with increasing fatigue, whereas female gender, better school grades, and greater health-related quality-of-life (HRQOL) scores were associated with lower fatigue. The study variables explained 49%-65% of the variation in fatigue scores. CONCLUSIONS Although survivors and their matched controls seem to have similar fatigue, subgroups of survivors do experience excessive fatigue, which may have an impact on their HRQOL. IMPLICATIONS FOR NURSING This study increases the knowledge about fatigue levels of young survivors of extracranial malignancies and identifies the need for instruments specifically designed to assess fatigue in this population. The healthcare team should pay attention to the fatigue level of young survivors, particularly SF.
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Affiliation(s)
- Susanna Mört
- Department of Nursing Science, University of Turku, Turku, Finland.
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Tsimicalis A, De Courcy MJ, Di Monte B, Armstrong C, Bambury P, Constantin J, Dagelman B, Eves M, Jansen P, Honeyford L, Stregger D. Tele-practice guidelines for the symptom management of children undergoing cancer treatment. Pediatr Blood Cancer 2011; 57:541-8. [PMID: 21319280 DOI: 10.1002/pbc.22993] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 12/01/2010] [Indexed: 11/09/2022]
Abstract
The provision of tele-practice symptom management is often without the provision of evidence-based guidelines. Under the auspices of the Pediatric Oncology Group of Ontario, a nursing task force was established to appraise the evidence and develop guidelines. Promising new efforts to enhance symptom management through tele-practice are emerging. Seven guidelines and one documentation tool were created from evidence compiled from case reports, clinical examples, and nonexperimental studies. The symptom management guidelines contribute to the paucity of literature and may serve as a useful resource for health professionals providing telephone advice and conducting tele-practice symptom management assessments.
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Affiliation(s)
- Argerie Tsimicalis
- Center for Health Policy, Columbia University, New York City, New York 10032, USA.
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Dhamani KA, Paul P, Olson JK. Tanzanian nurses understanding and practice of spiritual care. ISRN NURSING 2011; 2011:534803. [PMID: 22007322 PMCID: PMC3169833 DOI: 10.5402/2011/534803] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 04/19/2011] [Indexed: 11/23/2022]
Abstract
Spirituality, as a basic characteristic of humans and a contributor to human health, is regarded as part of nursing practice. The purpose of this study was to examine how Tanzanian nurses understand spirituality and spiritual care. Using the qualitative method of interpretive description, fifteen registered nurses engaged in clinical practice in a Tanzanian hospital were recruited to participate in this study. In-depth interviews using open-ended questions were carried out, tape-recorded, and transcribed verbatim. Data collection and inductive analysis occurred concurrently. In this paper, key findings are grouped under the following headings: meaning of spiritual care, recognition of spiritual needs, and interventions to respond to spiritual needs. Although there were some differences, overall participants' understanding of spirituality and spiritual care was similar to what is found in the literature about nurses in other countries. The provision of spiritual care also included some unique elements that may reflect the African context.
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Affiliation(s)
- Khairunnisa Aziz Dhamani
- Tanzania Institute of Higher Education, The Aga Khan University, P.O. Box 38129, Dar es Salaam, Tanzania
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