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Gill FJ, Hashem Z, Stegmann R, Aoun SM. The support needs of parent caregivers of children with a life-limiting illness and approaches used to meet their needs: A scoping review. Palliat Med 2021; 35:76-96. [PMID: 33103579 DOI: 10.1177/0269216320967593] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Provision of paediatric palliative care is complex and optimally covers meeting the individual needs of a heterogenous population of children and their parent caregivers throughout a life-limiting illness. It is unclear whether existing approaches comprehensively address parent caregivers' needs. AIM To examine support needs of parents caring for children with life limiting illnesses and identify specific approaches used to identify and address needs. DESIGN A scoping review. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL and ProQuest Central, were searched for peer reviewed English language full text research published from 2008 to 2019. Study quality appraisal was undertaken. Fourteen quantitative, 18 qualitative and 12 mixed methods studies were synthesised and themed using summative content analysis and mapped to the Parent Supportive Care Needs Framework (PSCNF). RESULTS Themes were communication, choice, information, practical, social, psychological, emotional and physical. Communication and choice were central and additional to domains of the PSCNF. Unmet were needs for supporting siblings, for respite care, out of hours, psychological, home and educational support. Six articles reported using instruments to identify parent carer support needs. CONCLUSION Support needs of parent caregivers of children with life limiting illnesses are substantial and heterogenous. While studies report evidence of burden and distress in parent caregivers, this rarely translates into improvements in practice through the development of interventions. A systematic and regular assessment of individual parent caregiver support needs is required by using instruments appropriate to use in clinical practice to move the focus to palliative care interventions and improved services for parents.
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Affiliation(s)
- Fenella J Gill
- Perth Children's Hospital, Child and Adolescent Health Service, Nedlands, Western Australia, Australia.,School of Nursing, Midwifery and Paramedicine, Faculty Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Zahraa Hashem
- School of Nursing, Midwifery and Paramedicine, Faculty Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Roswitha Stegmann
- School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Samar M Aoun
- School of Psychology and Public Health, La Trobe University, Victoria, Australia.,Perron Institute for Neurological and Translational Science, Western Australia, Australia
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Hully M, Barnerias C, Chabalier D, Le Guen S, Germa V, Deladriere E, Vanhulle C, Cuisset JM, Chabrol B, Cances C, Vuillerot C, Espil C, Mayer M, Nougues MC, Sabouraud P, Lefranc J, Laugel V, Rivier F, Louvier UW, Durigneux J, Napuri S, Sarret C, Renouil M, Masurel A, Viallard ML, Desguerre I. Palliative Care in SMA Type 1: A Prospective Multicenter French Study Based on Parents' Reports. Front Pediatr 2020; 8:4. [PMID: 32133329 PMCID: PMC7039815 DOI: 10.3389/fped.2020.00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/07/2020] [Indexed: 01/30/2023] Open
Abstract
Spinal muscular atrophy type 1 (SMA-1) is a severe neurodegenerative disorder, which in the absence of curative treatment, leads to death before 1 year of age in most cases. Caring for these short-lived and severely impaired infants requires palliative management. New drugs (nusinersen) have recently been developed that may modify SMA-1 natural history and thus raise ethical concerns about the appropriate level of care for patients. The national Hospital Clinical Research Program (PHRC) called "Assessment of clinical practices of palliative care in children with Spinal Muscular Atrophy Type 1 (SMA-1)" was a multicenter prospective study conducted in France between 2012 and 2016 to report palliative practices in SMA-1 in real life through prospective caregivers' reports about their infants' management. Thirty-nine patients were included in the prospective PHRC (17 centers). We also studied retrospective data regarding management of 43 other SMA-1 patients (18 centers) over the same period, including seven treated with nusinersen, in comparison with historical data from 222 patients previously published over two periods of 10 years (1989-2009). In the latest period studied, median age at diagnosis was 3 months [0.6-10.4]. Seventy-seven patients died at a median 6 months of age[1-27]: 32% at home and 8% in an intensive care unit. Eighty-five percent of patients received enteral nutrition, some through a gastrostomy (6%). Sixteen percent had a non-invasive ventilation (NIV). Seventy-seven percent received sedative treatment at the time of death. Over time, palliative management occurred more frequently at home with increased levels of technical supportive care (enteral nutrition, oxygenotherapy, and analgesic and sedative treatments). No statistical difference was found between the prospective and retrospective patients for the last period. However, significant differences were found between patients treated with nusinersen vs. those untreated. Our data confirm that palliative care is essential in management of SMA-1 patients and that parents are extensively involved in everyday patient care. Our data suggest that nusinersen treatment was accompanied by significantly more invasive supportive care, indicating that a re-examination of standard clinical practices should explicitly consider what treatment pathways are in infants' and caregivers' best interest. This study was registered on clinicaltrials.gov under the reference NCT01862042 (https://clinicaltrials.gov/ct2/show/study/NCT01862042?cond=SMA1&rank=8).
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Affiliation(s)
- Marie Hully
- Pediatric Neurology Department, Necker-Enfants Malades Hospital, APHP, Paris, France.,Physical Rehabilitation Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Christine Barnerias
- Pediatric Neurology Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Delphine Chabalier
- Pediatric Neurology Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Sophie Le Guen
- Clinical Research Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Virginie Germa
- Physical Rehabilitation Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Elodie Deladriere
- Physical Rehabilitation Department, Necker-Enfants Malades Hospital, APHP, Paris, France
| | | | - Jean-Marie Cuisset
- Pediatric Neurology Department and Neuromuscular Diseases Reference Center, CHU, Lille, France
| | - Brigitte Chabrol
- Pediatric Neurology Department, La Timone Hospital, APHM, Marseille, France
| | - Claude Cances
- Pediatric Neurology Department, Enfants Hospital, Toulouse, France
| | - Carole Vuillerot
- Pediatric Physical Rehabilitation Department, Femme Mère Enfants Hospital, Bron, France
| | - Caroline Espil
- Pediatric Neurology Department, Pellegrin Hospital, Bordeaux, France
| | - Michele Mayer
- Pediatric Neurology Department, Armand Trousseau Hospital, APHP, Paris, France
| | | | | | - Jeremie Lefranc
- Pediatric Neurology Department, Morvan Hospital, Brest, France
| | - Vincent Laugel
- Pediatric Neurology Department, Hautepierre Hospital, Strasbourg, France
| | - Francois Rivier
- Pediatric Neurology Department & Neuromuscular Diseases Reference Center AOC, CHU Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Ulrike Walther Louvier
- Pediatric Neurology Department & Neuromuscular Diseases Reference Center AOC, CHU Montpellier, Montpellier, France
| | - Julien Durigneux
- Pediatric Neurology Department, University Hospital, Angers, France
| | - Sylvia Napuri
- Pediatric Department, South Hospital, Rennes, France
| | - Catherine Sarret
- Pediatric Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Michel Renouil
- Pediatric Department, St-Pierre Hospital, Saint-Denis, France
| | - Alice Masurel
- Genetic Department, Children Hospital, CHU Dijon, Dijon, France
| | - Marcel-Louis Viallard
- Palliative Care Team, Necker-Enfants Malades Hospital, APHP, Paris, France.,Research Team "ETRES", UMR des Cordeliers, Université de Paris, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Necker-Enfants Malades Hospital, APHP, Paris, France
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