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Fu C, Glasdam S, Stjernswärd S, Xu H. A Qualitative Systematic Review About Children's Everyday Lives when a Parent Is Seriously Ill with the Prospect of Imminent Death - Perspectives of Children and Parents. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228221149767. [PMID: 36628967 DOI: 10.1177/00302228221149767] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Parental dying is a life changing experience for children. This study explores children's strategies and (inter)actions in their everyday life when facing critically ill parents and imminent death, from the children's and parents' perspectives. A qualitative systematic review was carried out, registered in PROSPERO (CRD42022306862). A literature search and screening in six databases resulted in eighteen articles. Thematic analysis showed that children were capable of developing various strategies to cope in everyday life, even in vulnerable situations. From parents' and children's perspectives, inclusion, openness, and communication about parents' situations, taking children's age and needs into consideration, were important to face and cope with the situation. Children were life-capable, also in vulnerable and difficult situations. This calls for the necessity of developing children-led support, by acknowledging, and taking the children's experiences, and resources, as starting points to tailor adequate support for children of critically ill parents.
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Affiliation(s)
- Cong Fu
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stinne Glasdam
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sigrid Stjernswärd
- Health-promoting Complex Interventions, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Hongxuan Xu
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Marshall S, Fearnley R, Bristowe K, Harding R. 'It's not just all about the fancy words and the adults': Recommendations for practice from a qualitative interview study with children and young people with a parent with a life-limiting illness. Palliat Med 2022; 36:1263-1272. [PMID: 35766527 PMCID: PMC9446426 DOI: 10.1177/02692163221105564] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Healthcare professionals report challenges in supporting dying patients who have dependent children. These parents are often uncertain how to meet the needs of their children and require appropriate support from professionals. There is limited evidence based guidance for professionals around this issue, which is informed by the views and experiences of children themselves. AIM To develop an understanding of the perspective of children on living with parental life-limiting illness and inform recommendations for healthcare professionals. DESIGN Qualitative semi-structured interviews were conducted, with thematic analysis of the data. SETTING/PARTICIPANTS A diverse sample of 32 children aged 6-17, whose parent was living with life-limiting illness, were recruited from across the United Kingdom. RESULTS Despite the challenges of living with a parent with a life-limiting illness, the children display agency in their response. The children: feel a responsibility to look after their family; negotiate a relationship with healthcare; employ strategies to maintain some normality; and ensure that the inevitable sadness does not become overwhelming. CONCLUSIONS Five recommendations for healthcare professionals were developed from the findings. Clinicians should encourage dying parents to: (1) acknowledge the agency of children; (2) recognise children's caregiving roles; (3) engender children's trust in healthcare; (4) maintain some normality; and (5) discuss emotions with their children. Implementing these recommendations will assist parents with a life-limiting illness to provide evidence-based support to their dependent children.
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Affiliation(s)
- Steve Marshall
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Rachel Fearnley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Marshall S, Fearnley R, Bristowe K, Harding R. The perspectives of children and young people affected by parental life-limiting illness: An integrative review and thematic synthesis. Palliat Med 2021; 35:246-260. [PMID: 33213277 PMCID: PMC7897783 DOI: 10.1177/0269216320967590] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the death of a parent during childhood is relatively commonplace, the voices of children affected by parental life-limiting illness are under-represented in research evidence. Guidance for healthcare professionals is largely based upon professional opinion rather than the experience of children themselves. AIM To synthesise and appraise the literature from primary research with children about their experience of having a parent with a life-limiting illness. DESIGN Integrative review and thematic synthesis. Registered on PROSPERO (CRD42019094581). DATA SOURCES PsychINFO, Medline, Embase, Scopus and Web of Science were searched, supplemented by searches of grey literature and systematic reviews. There were no restrictions on publication date, and study quality was appraised using the Hawker checklist. Studies reporting the findings of primary research with participants under 18, whose parent has a life-limiting illness, were eligible for inclusion. RESULTS Twenty-one papers met the inclusion criteria (n = 13 qualitative; n = 8 quantitative), reporting on n = 18 studies from high-income countries. Findings reveal that throughout parental life-limiting illness, children strive for agency, but are often shielded and excluded by adults. The experience of living with a dying parent is emotionally demanding for children and involves significant caregiving responsibilities. However these children are not passive, developing strategies to cope with the situation and wanting to be involved. CONCLUSIONS The review has enabled the voices of children affected by parental life-limiting illness to be heard and will inform the development of guidance for parents and professionals.
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Affiliation(s)
- Steve Marshall
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Rachel Fearnley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
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Beernaert K, Kreicbergs U, Fürst CJ, Nyberg T, Steineck G, Bylund-Grenklo T. Distrust in the End-of-Life Care Provided to a Parent and Long-Term Negative Outcomes Among Bereaved Adolescents: A Population-Based Survey Study. J Clin Oncol 2017; 35:3136-3142. [DOI: 10.1200/jco.2017.72.9814] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Purpose Previous research shows that the death of a parent places children at risk for a number of negative outcomes. The role of trust in health care at the end of life has been acknowledged as crucial for patients and adult family members. However, the consequences of children’s distrust in the care provided to their parents remain unknown. Therefore, we investigated the negative long-term outcomes of cancer-bereaved sons’ and daughters’ distrust in the care that was provided to a dying parent. Methods We used a population-based nationwide survey to investigate self-reported distrust in the care provided and possible negative outcomes in 622 (73%) participants who had lost a parent as a result of cancer 6 to 9 years earlier, at ages 13 to 16 years. All participants were 18 years or older at the time of the survey. Results In those who reported no or little trust (ie, distrust) in the health care provided to their dying parents, we found statistically significantly higher risks of various negative outcomes at the time of survey: bitterness toward health care professionals for not having done everything that was possible (crude risk ratio [RR], 3.5; 95% CI, 2.3 to 5.1) and for having stopped treatment (RR, 3.4; 95% CI, 2.1 to 6.0), self-destructiveness (eg, self-injury [RR, 1.7; 95% CI, 1.2 to 2.4]), and psychological problems (eg, moderate to severe depression according to the Patient Health Questionnaire–9 [RR, 2.3; 95% CI, 1.5 to 3.5]). Conclusion In cancer-bereaved former adolescents, distrust in the health care provided to the dying parent is associated with a higher risk of negative long-term outcomes. The health care professionals involved in this care might play an important role in safeguarding the trust of adolescents.
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Affiliation(s)
- Kim Beernaert
- Kim Beernaert, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Ulrika Kreicbergs, Ersta Sköndal Bräcke University College; Ulrika Kreicbergs, Tommy Nyberg, Gunnar Steineck, and Tove Bylund-Grenklo, Karolinska Institutet, Stockholm; Carl Johan Fürst, Lund University, Lund; Gunnar Steineck, The Sahlgrenska Academy, Gothenburg; Tove Bylund-Grenklo, Linnaeus University, Växjö, Sweden; and Tommy Nyberg, University of Cambridge, Cambridge, United Kingdom
| | - Ulrika Kreicbergs
- Kim Beernaert, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Ulrika Kreicbergs, Ersta Sköndal Bräcke University College; Ulrika Kreicbergs, Tommy Nyberg, Gunnar Steineck, and Tove Bylund-Grenklo, Karolinska Institutet, Stockholm; Carl Johan Fürst, Lund University, Lund; Gunnar Steineck, The Sahlgrenska Academy, Gothenburg; Tove Bylund-Grenklo, Linnaeus University, Växjö, Sweden; and Tommy Nyberg, University of Cambridge, Cambridge, United Kingdom
| | - Carl Johan Fürst
- Kim Beernaert, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Ulrika Kreicbergs, Ersta Sköndal Bräcke University College; Ulrika Kreicbergs, Tommy Nyberg, Gunnar Steineck, and Tove Bylund-Grenklo, Karolinska Institutet, Stockholm; Carl Johan Fürst, Lund University, Lund; Gunnar Steineck, The Sahlgrenska Academy, Gothenburg; Tove Bylund-Grenklo, Linnaeus University, Växjö, Sweden; and Tommy Nyberg, University of Cambridge, Cambridge, United Kingdom
| | - Tommy Nyberg
- Kim Beernaert, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Ulrika Kreicbergs, Ersta Sköndal Bräcke University College; Ulrika Kreicbergs, Tommy Nyberg, Gunnar Steineck, and Tove Bylund-Grenklo, Karolinska Institutet, Stockholm; Carl Johan Fürst, Lund University, Lund; Gunnar Steineck, The Sahlgrenska Academy, Gothenburg; Tove Bylund-Grenklo, Linnaeus University, Växjö, Sweden; and Tommy Nyberg, University of Cambridge, Cambridge, United Kingdom
| | - Gunnar Steineck
- Kim Beernaert, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Ulrika Kreicbergs, Ersta Sköndal Bräcke University College; Ulrika Kreicbergs, Tommy Nyberg, Gunnar Steineck, and Tove Bylund-Grenklo, Karolinska Institutet, Stockholm; Carl Johan Fürst, Lund University, Lund; Gunnar Steineck, The Sahlgrenska Academy, Gothenburg; Tove Bylund-Grenklo, Linnaeus University, Växjö, Sweden; and Tommy Nyberg, University of Cambridge, Cambridge, United Kingdom
| | - Tove Bylund-Grenklo
- Kim Beernaert, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Ulrika Kreicbergs, Ersta Sköndal Bräcke University College; Ulrika Kreicbergs, Tommy Nyberg, Gunnar Steineck, and Tove Bylund-Grenklo, Karolinska Institutet, Stockholm; Carl Johan Fürst, Lund University, Lund; Gunnar Steineck, The Sahlgrenska Academy, Gothenburg; Tove Bylund-Grenklo, Linnaeus University, Växjö, Sweden; and Tommy Nyberg, University of Cambridge, Cambridge, United Kingdom
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