Family-centred care: a qualitative study of Chinese and South Asian immigrant parents' experiences of care in paediatric oncology

Prediction of family-centered care on the unmet care needs of parents of pediatric oncology patients and their psychosocial problems

BACKGROUND/OBJECTIVES

It was aimed to determine the predictive power of family-centered care of parents of children with cancer on their unmet care needs and psychosocial problems (anxiety, depression, stress). This study was conducted as a descriptive, correlational, and cross-sectional study.

DESIGN/METHODS

The study was conducted on 136 parents at a university hospital between January and September 2023, involving parents of children receiving care at the pediatric oncology clinic. Data collection instruments included an Information Form, Family Inventory of Needs Pediatric II (FINPED-II), Family-Centered Care Scale (FCCS), and Depression Anxiety Stress Scale (DASS-21). Data were analyzed using IBM SPSS 28, employing Pearson correlation analysis and linear regression to assess the relationships between variables.

RESULTS

The study revealed significant positive correlations between Family-Centered Care and Met Needs (r = .676, p < .001) and significant negative correlations between Met Needs and Stress scores (r = -.256, p < .001). Additionally, there were positive correlations between Anxiety and Depression scores (r = .700, p < .001), Anxiety and Stress scores (r = .768, p < .001), and Depression and Stress scores (r = .835, p < .001). Family-centered care significantly predicted Met Needs (p < .001) and accounted for 47% of the variation in Anxiety, Depression, Stress, and Family Inventory of Needs scores.

CONCLUSION

The findings highlight that family-centered care significantly predicts Met Needs, emphasizing its pivotal role in supporting parents of children with cancer. These findings underscore the importance of family-centered care in pediatric oncology, but also point to the need for further studies to address identified limitations and provide a comprehensive understanding of this complex healthcare dynamic.

Hospital healthcare experiences of children and young people with life-threatening or life-shortening conditions, and their parents: scoping reviews and resultant conceptual frameworks

BACKGROUND

Patient experience is a core component of healthcare quality. Patient-reported experience measures (PREMs) are increasingly used to assess this, but there are few paediatric PREMs. This paper reports the first stage of developing two such measures, one for children and young people (0-18 years) (CYP) with a life-threatening or life-shortening condition (LT/LSC), and one for their parents. It comprised parallel scoping reviews of qualitative evidence on the elements of health service delivery and care that matter to, or impact on, CYP (Review 1) and parents (Review 2).

METHODS

Medline and PsychINFO (1/1/2010 - 11/8/2020) and CINAHL Complete (1/1/2010 - 4/7/2020) were searched and records identified screened against inclusion criteria. A thematic approach was used to manage and analyse relevant data, informed by existing understandings of patient/family experiences as comprising aspects of staff's attributes, their actions and behaviours, and organisational features. The objective was to identity the data discrete elements of health service delivery and care which matter to, or impact on, CYP or parents which, when organised under higher order conceptual domains, created separate conceptual frameworks.

RESULTS

18,531 records were identified. Sparsity of data on community-based services meant the reviews focused only on hospital-based (inpatient and outpatient) experiences. 53 studies were included in Review 1 and 64 in Review 2. For Review 1 (CYP), 36 discrete elements of healthcare experience were identified and organized under 8 higher order domains (e.g. staff's empathetic qualities; information-sharing/decision making; resources for socializing/play). In Review 2 (parents), 55 elements were identified and organized under 9 higher order domains. Some domains were similar to those identified in Review 1 (e.g. professionalism; information-sharing/decision-making), others were unique (e.g. supporting parenting; access to additional support).

CONCLUSIONS

Multiple and wide-ranging aspects of the way hospital healthcare is organized and delivered matters to and impacts on CYP with LT/LSCs, and their parents. The aspects that matter differ between CYP and parents, highlighting the importance of measuring and understanding CYP and parent experience seperately. These findings are key to the development of patient/parent experience measures for this patient population and the resultant conceptual frameworks have potential application in service development.

The Experience of Informal Newcomer Cancer Caregivers with Limited Language Proficiency: A Scoping Review

This scoping review explored what is known about the experiences of informal cancer caregivers (CGs) who are newcomers with limited language proficiency. A literature search was performed in seven databases and the search yielded 11,289 articles. After duplicate removal and title and abstract screening, 216 articles underwent full text review and 57 articles and were synthesized. Most studies (n = 41, 72%) were qualitative and were published in North America (n = 35, 61%). Most CG participants were female (69%) and only 19 studies explicitly identified the CG country of origin. Of those that did, 26% originated from Asia, with most migrating from East Asia. Significant challenges were experienced by newcomer CGs and chief among these were related to communication challenges with HCPs that were exacerbated by a lack of availability of medical interpreters and the complexity of oncology health information. Efforts are needed to better integrate newcomer CGs into cancer care.

Application of nursing presence to family-centered care: Supporting nursing practice in pediatric oncology

PURPOSE

In pediatric care settings, family-centered care (FCC) is an integral way to ensure family involvement in their child's care and has been known to improve health outcomes and families' psychosocial well-being. Similarly, nursing presence is deemed beneficial in the formation of authentic nurse-patient relationships and is known to facilitate healing and improve satisfaction for the patient and their family. The objective of this article is to explore how nursing presence supports FCC by closely examining the four concepts of FCC as described by Institute for Patient- and Family-Centered Care: dignity and respect, information sharing, participation, and collaboration. A case study is also presented to demonstrate how nursing presence can be applied in FCC, when caring for a pediatric oncology patient.

CONCLUSION

Nursing presence is essential in FCC since it plays a key role in the formation of relationships, a fundamental element in the four concepts. Attributes of nursing presence can be interwoven in the FCC framework and have positive clinical, social, and emotional outcomes for the patient and family. Although literature has explored associations between FCC and nursing presence, there is need for more scientific research to justify this argument to support the improvement of quality of family nursing care and strengthen the FCC model.

PRACTICE IMPLICATIONS

The four concepts of FCC lay a foundation for a model of care that can be enhanced by nursing presence, potentially providing a remedy for depersonalization of healthcare by improving nurse patient relationships in pediatric care settings. Nursing presence becomes less ambiguous when enacted in a FCC framework, revealing attributes that may be cultivated in family nursing to improve therapeutic relationships among nurses and family caregivers.

South Asians Active Together (SAATH): Protocol for a multilevel physical activity intervention trial for South Asian American mother and daughter dyads

South Asian (SA), including Asian Indian and Pakistani Americans, have a high burden of cardiometabolic risk factors and low levels of physical activity (PA). Increasing PA in the U.S. population is a national priority; however, SA American women and girls experience unique barriers to PA that are not addressed by current promotion efforts. To address this gap, our community-based participatory research partnership developed the South Asians Active Together (SAATH) intervention. This study is a two-arm randomized clinical trial to evaluate the effects, mediators, and implementation of the 18-week SAATH intervention. A total of 160 mother-daughter dyads will be randomized in a 1:1 ratio to the SAATH intervention and control groups. The intervention was designed for mother-daughter dyads and targets individual, interpersonal, and family levels through (1) group exercise classes, (2) mother-daughter discussions, and (3) peer group discussions. The intervention targets the environment level through community partner meetings aimed at creating environment changes to enhance PA opportunities for SA women and girls. The control group will receive PA education materials. We hypothesize that dyads who receive the intervention will have significantly greater increases in moderate- and vigorous-intensity PA (MVPA) from baseline to 4 months, compared to the control group. MVPA will be measured at 12 months in intervention participants to examine if changes are sustained. A process evaluation will use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. This study will fill knowledge gaps about the effectiveness and implementation of culturally adapted, community-based PA interventions for SA women and girls.

Multilevel barriers and facilitators of communication in pediatric oncology: A systematic review

Multiple factors can facilitate or impede the fulfillment of communication functions in pediatric cancer. In this systematic review, we evaluated 109 studies from the preceding 20 years that presented qualitative or quantitative evidence of barriers or facilitators to communication in pediatric cancer. Using a multilevel framework developed in our prior study, we then analyzed and categorized the levels of barriers and facilitators identified in included studies. The vast majority of studies focused on individual-level barriers, rather than team, organization/system, collaborating hospital, community, or policy-level barriers. Future studies should explore the full range of factors that affect communication.

Exploring the process of health in mothers of children with cerebral palsy: Changing “clinical reasoning”

Introduction

The issue of the health status of mothers of children with disability is one that is beginning to be addressed more fully. This study aimed to explore the process of health in mothers during caregiving of children with cerebral palsy (CP).

Method

A qualitative research method with a grounded theory approach was used, including purposive and theoretical sampling. A constant comparative analysis method was adopted, and data were gathered from 15 mothers with CP children through interviews.

Results

The results were grouped into six main categories: Self-neglecting of their health, facing challenges in caring their children, physical and psychosocial damages, perceiving threat of health problems from concern to action, trying to regain their health, and caring in a complex context. “Facing challenges in caring” was extracted as a core concept.

Conclusion

Results showed an urgent need to establish family-centered services in clinical settings and change the “way of thinking” of the health provider system.

Putting the Patient First: A Scoping Review of Patient Desires in Canada

Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.

The Family-Centered Care Assessment Scale: Development and Psychometric Evaluation in a Turkish Sample

PURPOSE

The purpose of this study was to develop a family-centered care assessment scale for the parents of hospitalized children and to evaluate the psychometric characteristics of the new scale.

METHOD

This is a methodological study carried out in three phases. The study was conducted between on September 2017 and February 2018 with the parents of 360 children treated at the pediatric clinics of two medical faculty hospitals in Konya.

DESIGN/METHODS

The study was conducted with parents (n = 360). The data was collected via the Socio-demographic Information Form, the Family-Centered Care Scale (parallel form) and the draft scale developed by the researcher. Data was analyzed by construct validity index, exploratory and confirmatory factor analyses. End of the exploratory factor analysis FCCAS consisted of 21 items and three sub-dimensions. The content validity index was 0.92. The internal consistency coefficient (Cronbach's Alpha) was 0.94 for the total scale. The strong correlations was found between test and re-test (r = 0.90, p < .001). Confirmatory factor analysis has confirmed the three-factor structure.

CONCLUSION

In this study developed family-centered care assessment scale (FCCAS) is a valid and reliable measurement tool.

PRACTICE IMPLICATIONS

This scale can be used to evaluate family-centered care in pediatric clinics (excluding neonatal care units). It can be used as a measurement tool in descriptive and intervention studies examining family centered care.

Do parents of children with cancer want to participate in treatment decision-making?

PURPOSE

This study aimed to describe parents' preferences regarding their role in treatment decision-making when a child has cancer and examines whether their preferences were related to parents sociodemographic characteristics (sex and education level), patients' characteristics (age group and treatment status), and healthcare context features (parents' perception of family-centered care).

METHODS

Two hundred and twenty-eight parents of children/adolescents with cancer were recruited from two Portuguese pediatric oncology wards. Participants provided sociodemographic and clinical information. The Control Preferences Scale for Pediatrics was used to assess the parents' preferred role in treatment decision-making. The Measure of Process of Care assessed the parents' perception of family-centered care (family-centered services and providing general information subscales).

RESULTS

Results showed that parents preferred a passive-collaborative role (45.2%), followed by collaborative (27.2%), passive (21.0%), and active-collaborative (6.6%). None preferred an active role. Chi-square test showed that the group of parents preferring a passive role had a lower proportion of more-educated parents, compared to those preferring active-collaborative or collaborative roles. Additionally, groups did not proportionally differ according to the parents' sex, patients' age, and treatment status. A multivariate analysis of variance showed that parents preferring an active-collaborative role reported lower mean scores on family-centered services compared to those preferring passive-collaborative and passive roles. Finally, no significant differences were found concerning providing general information.

CONCLUSIONS

This study's findings may guide professionals in identifying parents' preferences regarding their participation in treatment decision-making process. Mapping their preferences may support professionals in promoting desirable levels of parental involvement in decisions in pediatric oncology context.

A three-step model of stress management for health leaders

The current healthcare system is often as highly stressful environment for patients, their families, and for the employees of the system. Health leaders also experience stress, which can have profound repercussions if not well managed. This article describes the impact of stress on the brain and nervous system functioning of health leaders, then, drawing on evidence from the literature, presents a three-step model for managing stress at the individual, team/organizational, and system levels.

An Ecological Exploration of Facilitators to Participation in a Mosque-Based Physical Activity Program for South Asian Muslim Women

BACKGROUND

This descriptive qualitative study informed by an ecological framework explored factors influencing South Asian Muslim women's decisions to participate in a mosque-based physical activity intervention.

METHODS

Individual, face-to-face, semistructured interviews were conducted in English, Hindi, or Urdu with 12 South Asian Muslim women at their home or mosque in Ontario, Canada. All interviews were audio-recorded, transcribed verbatim and managed, sorted, and analyzed for themes through a process of descriptive analysis.

RESULTS

The participants described as follows: (1) intrapersonal facilitators, which included their feelings, beliefs, and motivations to continue with this intervention; (2) interpersonal facilitators detailing the support that they had received from others during the intervention; and (3) environmental facilitators, which highlighted convenience and access to physical activity opportunities in a local community setting.

CONCLUSION

This intervention displayed how South Asian Muslim women were motivated to continue with the mosque-based physical activity intervention due to interpersonal, intrapersonal, and environmental facilitators. The findings can be used to increase further understanding of how mosques may provide culturally and religiously sensitive contexts for physical activity interventions for South Asian Muslim women.

Personal social networks and organizational affiliation of South Asians in the United States

Background

Understanding the social lives of South Asian immigrants in the United States (U.S) and their influence on health can inform interpersonal and community-level health interventions for this growing community. This paper describe the rationale, survey design, measurement, and network properties of 700 South Asian individuals in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) social networks ancillary study.

Methods

MASALA is a community-based cohort, established in 2010, to understand risk factors for cardiovascular disease among South Asians living in the U.S. Survey data collection on personal social networks occurred between 2014 and 2017. Network measurements included size, composition, density, and organizational affiliations. Data on participants’ self-rated health and social support functions and health-related discussions among network members were also collected.

Results

Participants’ age ranged from 44 to 84 (average 59 years), and 57% were men. South Asians had large (size=5.6, SD=2.6), kin-centered (proportion kin=0.71, SD=0.28), and dense networks. Affiliation with religious and spiritual organizations was perceived as beneficial to health. Emotional closeness with network members was positively associated with participants’ self-rated health (p-value <0.001), and networks with higher density and more kin were significantly associated with health-related discussions.

Discussion

The MASALA networks study advances research on the cultural patterning of social relationships and sources of social support in South Asians living in the U.S. Future analyses will examine how personal social networks and organizational affiliations influence South Asians’ health behaviors and outcomes.

Trial registration

ClinicalTrials.gov identifier: NCT02268513

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5128-z) contains supplementary material, which is available to authorized users.

New Trends and Recent Care Approaches in Pediatric Oncology Nursing

Increased incidence of children diagnosed with cancer and survivors was an impact on changes in pediatric hemato-oncology nursing care. In this review article, it is aimed to investigate the new trends and recent care approaches in pediatric oncology nursing. The recent care topics were common in the literature as family-centered care, technology-based care, program development, primary care of child, health-care provider, survivors and home care, and nonpharmacological care. All of the topics contribute to perform evidence-based care for health promotion and well-being in pediatric hemato-oncology nursing. Research reviews showed that many current topics for the care of children and their parents have entered in the literature. There is a need for more randomized controlled studies to improve the level of evidence of new nursing approaches.

Towards culturally competent paediatric oncology care. A qualitative study from the perspective of care providers

In order to gain more insight on the influence of ethnic diversity in paediatric cancer care, the perspectives of care providers were explored. Semi-structured interviews were conducted among 12 paediatric oncologists and 13 nurses of two different paediatric oncology wards and were analysed using a framework method. We found that care providers described the contact with Turkish and Moroccan parents as more difficult. They offered two reasons for this: (1) language barriers between care provider and parents hindered the exchange of information; (2) cultural barriers between care provider and parents about sharing the diagnosis and palliative perspective hindered communication. Care providers reported different solutions to deal with these barriers, such as using an interpreter and improving their cultural knowledge about their patients. They, however, were not using interpreters sufficiently and were unaware of the importance of eliciting parents' perspectives. Communication techniques to overcome dilemmas between parents and care providers were not used and care providers were unaware of stereotypes and prejudice. Care providers should be offered insight in cultural barriers they are unaware of. Training in cultural competence might be a possibility to overcome manifest barriers.

Development of Quality Metrics to Evaluate Pediatric Hematologic Oncology Care in the Outpatient Setting

There are currently no clinic-level quality of care metrics for outpatient pediatric oncology. We sought to develop a list of quality of care metrics for a leukemia-lymphoma (LL) clinic using a consensus process that can be adapted to other clinic settings. Medline-Ovid was searched for quality indicators relevant to pediatric oncology. A provisional list of 27 metrics spanning 7 categories was generated and circulated to a Consensus Group (CG) of LL clinic medical and nursing staff. A Delphi process comprising 2 rounds of ranking generated consensus on a final list of metrics. Consensus was defined as ≥70% of CG members ranking a metric within 2 consecutive scores. In round 1, 19 of 27 (70%) metrics reached consensus. CG members' comments resulted in 4 new metrics and revision of 8 original metrics. All 31 metrics were included in round 2. Twenty-four of 31 (77%) metrics reached consensus after round 2. Thirteen were chosen for the final list based on highest scores and eliminating redundancy. These included: patient communication/education; pain management; delay in access to clinical psychology, documentation of chemotherapy, of diagnosis/extent of disease, of treatment plan and of follow-up scheme; referral to transplant; radiation exposure during follow-up; delay until chemotherapy; clinic cancellations; and school attendance. This study provides a model of quality metric development that other clinics may use for local use. The final metrics will be used for ongoing quality improvement in the LL clinic.

Caracterização dos cuidados centrados na família em oncologia pediátrica em Portugal

Objetivo

Este estudo teve como objetivo caracterizar as perceções parentais dos Cuidados Centrados na Família (CCF) em função de fatores sociodemográficos e clínicos no contexto da oncologia pediátrica em Portugal.

Método

Participaram neste estudo 204 cuidadores de crianças com cancro acompanhadas em duas unidades de oncologia pediátrica. Os participantes forneceram dados sociodemográficos e preencheram a Medida dos Processos de Cuidados (MPOC-20), composta por duas subescalas: Serviços e Informação Geral. Os médicos oncologistas pediátricos facultaram informação clínica.

Resultados

A idade de crianças e pais estava positivamente associada às perceções parentais dos CCF (Serviços e Informação Geral) como mais centrados na família. Análises multivariadas da variância revelaram que pais de crianças (vs. adolescentes), pais que concluíram o ensino superior (vs. escolaridade igual/inferior ao 12º ano) e pais de crianças em tratamento antineoplásico (vs. fora de tratamento) percecionaram os cuidados como menos centrados na família (Serviços e Informação Geral). Não se verificaram diferenças em função do tempo desde o diagnóstico, do número de internamentos e da intensidade do tratamento.

Conclusão

Os resultados sugerem que os pais mais novos que concluíram o ensino superior, pais de crianças mais novas e a receber tratamento, poderão constituir grupos em maior risco de percecionar os cuidados de saúde como menos centrados na família.

Cross-cultural care encounters in paediatric care: minority ethnic parents' experiences

BACKGROUND

Because of worldwide migration, the healthcare staff in general as well as in paedi"atric care specifically is challenged increasingly by people from various ethnic backgrounds. The challenge is related to providing culturally competent care and effectively communicating with people from diverse cultural and ethnic backgrounds who have different health beliefs, practices, values and languages. This also applies to the Swedish society and to Swedish paediatric care.

AIM

The purpose of this study was to describe the expectations and experiences of cross-cultural care encounters among minority ethnic parents in Swedish paediatric care.

METHOD

A qualitative design was used in the study. Data were collected using semi-structured interviews between October 2011 and March 2012. The sample consisted of 12 parents of minority ethnic backgrounds who had their child in a ward at a children's hospital in the Stockholm County Council. The interviews were analysed using manifest content analysis.

ETHICAL CONSIDERATIONS

The Regional Ethical Review Committee approved the study (Ref: Nr: 2011/927-31/5).

RESULTS

The analysis of the interviews led to three categories: fundamentals in nursing, cultural sensitivity and understanding, and influencing conditions.

CONCLUSIONS

Generic knowledge and skills of nurses outweighed the need for the nurses to have culture-specific knowledge of their patients or relatives in cross-cultural care encounters. Language skills and the availability of bilingual nurses in a multi-ethnic society can facilitate communication and increase parents' satisfaction in cross-cultural care encounters.

Factors influencing intercultural doctor-patient communication: a realist review

OBJECTIVE

Due to migration, doctors see patients from different ethnic backgrounds. This causes challenges for the communication. To develop training programs for doctors in intercultural communication (ICC), it is important to know which barriers and facilitators determine the quality of ICC. This study aimed to provide an overview of the literature and to explore how ICC works.

METHODS

A systematic search was performed to find literature published before October 2012. The search terms used were cultural, communication, healthcare worker. A realist synthesis allowed us to use an explanatory focus to understand the interplay of communication.

RESULTS

In total, 145 articles met the inclusion criteria. We found ICC challenges due to language, cultural and social differences, and doctors' assumptions. The mechanisms were described as factors influencing the process of ICC and divided into objectives, core skills and specific skills. The results were synthesized in a framework for the development of training.

CONCLUSION

The quality of ICC is influenced by the context and by the mechanisms. These mechanisms translate into practical points for training, which seem to have similarities with patient-centered communication.

PRACTICE IMPLICATIONS

Training for improving ICC can be developed as an extension of the existing training for patient-centered communication.

Involving parents in managing their child's long-term condition-a concept synthesis of family-centered care and partnership-in-care

BACKGROUNG: Fostering effective engagement, collaboration and empowerment are central to supporting parents caring for children with long-term conditions.

METHODS

A concept synthesis was undertaken to identify the shared antecedents and attributes underpinning models of family-centered care and partnership-in-care.

RESULTS

Thirty studies were reviewed; antecedents of models related to unclear roles, entrenched professional practices, and lack of guidelines supporting their implementation; with central attributes being building trust, listening to parent concerns and valuing parents' knowledge of their child.

CONCLUSION

The key attributes are outlined in a practical framework of involvement which may promote parent-professional collaboration for families of children with long-term conditions.