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Deming RS, Wolfe J, DeCourcey DD. Weighing Distress and Benefit: Understanding the Research Participation Experiences of Bereaved Parents of Children With Complex Chronic Conditions. J Pain Symptom Manage 2021; 62:39-47.e1. [PMID: 33279601 DOI: 10.1016/j.jpainsymman.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
CONTEXT Improving end-of-life care for children with complex chronic conditions (CCCs) requires parental perspectives. The vulnerability of bereaved parents has historically been a research barrier and studies describing their research participation experience are lacking. OBJECTIVES To examine the research participation experience of bereaved parents of children with CCCs and to identify factors associated with distress or benefit. METHODS In this cross-sectional study, parents of deceased children who received care at Boston Children's Hospital between 2006 and 2015 completed survey questions describing their research participation experience after completing the Survey About Caring for Children with CCCs. Multivariable logistic regression was used to identify factors associated with perceived distress or benefit with participation. Free responses were analyzed using qualitative techniques. RESULTS One hundred fourteen (54%) of 211 eligible parents completed the survey a median of 3.9 years (interquartile range, 2.1-6.5) after their child's death. Most parents felt comfortable (78%) and reported benefit (88%) from survey participation. Only 6% of parents reported "a great deal" of distress with participation, and of those, 67% still found it beneficial. Being at least moderately spiritual was associated with benefit (adjusted odds ratio 7.12 [95% CI: 1.58-32.1]), while parental decisional regret was associated with distress (adjusted odds ratio 3.41 [95% CI: 1.33-8.72]). Benefit was the most common domain identified, with parents expressing appreciation for the opportunity to help others and share their story. CONCLUSION A majority of parents responded to questions about their child's end-of-life care without significant distress. When present, distress was often accompanied by a perception that participation was beneficial.
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Affiliation(s)
- Rachel S Deming
- Division of Pediatric Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.
| | - Joanne Wolfe
- Division of Pediatric Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Danielle D DeCourcey
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA; Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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2
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Holmen H, Riiser K, Winger A. Home-Based Pediatric Palliative Care and Electronic Health: Systematic Mixed Methods Review. J Med Internet Res 2020; 22:e16248. [PMID: 32130127 PMCID: PMC7070344 DOI: 10.2196/16248] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/05/2019] [Accepted: 12/14/2019] [Indexed: 01/23/2023] Open
Abstract
Background Children and families in pediatric palliative care depend on close contact with health care personnel, and electronic health (eHealth) is suggested to support care at home by facilitating their remote interactions. Objective This study aimed to identify and review the use of eHealth to communicate and support home-based pediatric palliative care and appraise the methodological quality of the published research. Methods We conducted a convergent, systematic mixed methods review and searched Medical Literature Analysis and Retrieval System Online (Medline), EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus for eligible papers. Studies evaluating 2-way communication technology for palliative care for children aged ≤18 years and applying quantitative, qualitative, or mixed methods from 2012 to 2018 were eligible for inclusion. Quantitative and qualitative studies were equally valued during the search, screening, extraction, and analysis. Quantitative data were transformed into qualitative data and analyzed using a thematic analysis. Overall, 2 independent researchers methodologically appraised all included studies. Results We identified 1277 citations. Only 7 papers were eligible for review. Evaluating eHealth interventions in pediatric palliative care poses specific methodological and ethical challenges. eHealth to facilitate remote pediatric palliative care was acknowledged both as an intrusion and as a support at home. Reluctance toward eHealth was mainly identified among professionals. Conclusions The strengths of the conclusions are limited by the studies’ methodological challenges. Despite the limitless possibilities held by new technologies, research on eHealth in home-based pediatric palliative care is scarce. The affected children and families appeared to hold positive attitudes toward eHealth, although their views were less apparent compared with those of the professionals. Trial Registration PROSPERO CRD42018119051; https://tinyurl.com/rtsw5ky
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3
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Religious and cultural challenges in paediatrics palliative care: A review of literature. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2019. [DOI: 10.1016/j.phoj.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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4
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Steele R, Bosma H, Johnston MF, Cadell S, Davies B, Siden H, Straatman L. Research Priorities in Pediatric Palliative Care: A Delphi Study. J Palliat Care 2019. [DOI: 10.1177/082585970802400402] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rose Steele
- School of Nursing, Faculty of Health, York University, Toronto, Ontario
| | - Harvey Bosma
- School of Social Work, University of British Columbia, Vancouver, British Columbia
| | | | - Susan Cadell
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Betty Davies
- Department of Family Health Care Nursing, University of California, San Francisco, California, USA
| | - Hal Siden
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Lynn Straatman
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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5
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Weaver MS, Mooney-Doyle K, Kelly KP, Montgomery K, Newman AR, Fortney CA, Bell CJ, Spruit JL, Kurtz Uveges M, Wiener L, Schmidt CM, Madrigal VN, Hinds PS. The Benefits and Burdens of Pediatric Palliative Care and End-of-Life Research: A Systematic Review. J Palliat Med 2019; 22:915-926. [PMID: 30835596 DOI: 10.1089/jpm.2018.0483] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study is to report the benefits and burdens of palliative research participation on children, siblings, parents, clinicians, and researchers. Background: Pediatric palliative care requires research to mature the science and improve interventions. A tension exists between the desire to enhance palliative and end-of-life care for children and their families and the need to protect these potentially vulnerable populations from untoward burdens. Methods: Systematic review followed PRISMA guidelines with prepared protocol registered as PROSPERO #CRD42018087304. MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and The Cochrane Library were searched (2000-2017). English-language studies depicting the benefits or burdens of palliative care or end-of-life research participation on either pediatric patients and/or their family members, clinicians, or study teams were eligible for inclusion. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results: Twenty-four studies met final inclusion criteria. The benefit or burden of palliative care research participation was reported for the child in 6 papers; siblings in 2; parents in 19; clinicians in 3; and researchers in 5 papers. Benefits were more heavily emphasized by patients and family members, whereas burdens were more prominently emphasized by researchers and clinicians. No paper utilized a validated benefit/burden scale. Discussion: The lack of published exploration into the benefits and burdens of those asked to take part in pediatric palliative care research and those conducting the research is striking. There is a need for implementation of a validated benefit/burden instrument or interview measure as part of pediatric palliative and end-of-life research design and reporting.
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Affiliation(s)
- Meaghann S Weaver
- 1Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Kim Mooney-Doyle
- 2Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Katherine Patterson Kelly
- 3Department of Nursing Science, Professional Practice, and Quality Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kathleen Montgomery
- 4Department of Nursing, American Family Children's Hospital, Madison, Wisconsin
| | - Amy R Newman
- 5College of Nursing, University of Utah, Salt Lake City, Utah.,6Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Christine A Fortney
- 7Martha S. Pitzer Center for Women, Children & Youth, College of Nursing, Ohio State University, Columbus, Ohio
| | - Cynthia J Bell
- 8College of Nursing, Wayne State University, Detroit, Michigan
| | | | - Melissa Kurtz Uveges
- 9Center for Bioethics, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lori Wiener
- 10National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Cynthia M Schmidt
- 11McGoogan Library of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Vanessa N Madrigal
- 12Division of Critical Care Medicine, Department of Pediatrics, Children's National Health Systems, George Washington University, Washington, DC
| | - Pamela S Hinds
- 13Department of Nursing Science, Professional Practice & Quality, Children's National Health System, George Washington University, Washington, DC.,14Department of Pediatrics, George Washington University, Washington, DC
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Ulrich LR, Gruber D, Hach M, Boesner S, Haasenritter J, Kuss K, Seipp H, Gerlach FM, Erler A. Study protocol: evaluation of specialized outpatient palliative care (SOPC) in the German state of Hesse (ELSAH study) - work package II: palliative care for pediatric patients. BMC Palliat Care 2018; 17:14. [PMID: 29304799 PMCID: PMC5755278 DOI: 10.1186/s12904-017-0268-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background In 2007, the European Association of Palliative Care (EAPC) provided a comprehensive set of recommendations and standards for the provision of adequate pediatric palliative care. A number of studies have shown deficits in pediatric palliative care compared to EAPC standards. In Germany, pediatric palliative care patients can be referred to specialized outpatient palliative care (SOPC) services, which are known to enhance quality of life, e.g. by avoiding hospitalization. However, current regulations for the provision of SOPC in Germany do not account for the different circumstances and needs of children and their families compared to adult palliative care patients. The “Evaluation of specialized outpatient palliative care (SOPC) in the German state of Hesse (ELSAH)” study aims to perform a needs assessment for pediatric patients (children, adolescents and young adults) receiving SOPC. This paper presents the study protocol for this assessment (work package II). Methods/Design The study uses a sequential mixed-methods study design with a focus on qualitative research. Data collection from professional and family caregivers and, as far as possible, pediatric patients, will involve both a written questionnaire based on European recommendations for pediatric palliative care, and semi-structured interviews. Additionally, professional caregivers will take part in focus group discussions and participatory observations. Interviews and focus groups will be tape- or video-recorded, transcribed verbatim and analyzed in accordance with the principles of grounded theory (interviews) and content analysis (focus groups). A structured field note template will be used to record notes taken during the participatory observations. Statistical Package for Social Sciences (SPSS, version 22 or higher) will be used for descriptive statistical analyses. The qualitative data analyses will be software-assisted by MAXQDA (version 12 or higher). Discussion This study will provide important information on what matters most to family caregivers and pediatric patients receiving SOPC. The results will add valuable knowledge to the criteria that distinguish SOPC for pediatric from SOPC for adult patients, and will provide an indication of how the German SOPC rule of procedure can be optimized to satisfy the special needs of pediatric patients. Trial registration Internet Portal of the German Clinical Trials Register (www.germanctr.de, DRKS-ID: DRKS00012431).
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Affiliation(s)
- Lisa-R Ulrich
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany.
| | - Dania Gruber
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany
| | - Michaela Hach
- Professional Association of Specialized Outpatient Palliative Care in Hesse, Wiesbaden, Germany
| | - Stefan Boesner
- Department of General Practice and Family Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Joerg Haasenritter
- Department of General Practice and Family Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Katrin Kuss
- Department of General Practice and Family Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Hannah Seipp
- Department of General Practice and Family Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany
| | - Antje Erler
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany
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7
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Nelson M, Kelly D, McAndrew R, Smith P. 'Just gripping my heart and squeezing': Naming and explaining the emotional experience of receiving bad news in the paediatric oncology setting. PATIENT EDUCATION AND COUNSELING 2017; 100:1751-1757. [PMID: 28478124 DOI: 10.1016/j.pec.2017.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explore recipients' perspectives on the range and origins of their emotional experiences during their 'bad news' consultations. METHODS Participants were four bereaved families of children who had changed from active treatment to palliative care in paediatric oncology. Data was collected using emotional touchpoint storytelling. The names (descriptors) given to the emotional experiences were linguistically classified. Explanations of their perceived origins were examined using applied thematic analysis. RESULTS 26 descriptors were given, relating to bodily sensations, affective states, evaluations and cognitive conditions. Three themes were identified in the origins of these experiences - 'becoming aware', 'the changes' and 'being in this situation'. Parents described strong emotional displays during the consultation including physical collapse. These related to the internal process of 'becoming aware'. Three descriptors were given as originating from the clinicians and their delivery of the news - 'supported', 'included', 'trusting'. CONCLUSIONS Recipients perceive their emotional experiences as mainly originating from the news itself, and perceived consequences of it, rather than its delivery. Strong emotional reactions during the interaction are not necessarily an indicator of ineffectual delivery. PRACTICE IMPLICATIONS Findings offer a thematic framing that may support and deepen practitioners understanding of recipients' emotional reactions during bad news consultations.
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Affiliation(s)
- Mia Nelson
- School of Health in Social Science, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Heath Park Campus, Cardiff, CF14 4XN, United Kingdom.
| | - Rachel McAndrew
- Dpt Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, 9 Sciennes Road, Edinburgh, EH9 1LF, United Kingdom.
| | - Pam Smith
- School of Health in Social Science, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
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8
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Hudson BF, Oostendorp LJM, Candy B, Vickerstaff V, Jones L, Lakhanpaul M, Bluebond-Langner M, Stone P. The under reporting of recruitment strategies in research with children with life-threatening illnesses: A systematic review. Palliat Med 2017; 31:419-436. [PMID: 27609607 PMCID: PMC5405809 DOI: 10.1177/0269216316663856] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Researchers report difficulties in conducting research with children and young people with life-limiting conditions or life-threatening illnesses and their families. Recruitment is challenged by barriers including ethical, logistical and clinical considerations. AIM To explore how children and young people (aged 0-25 years) with life-limiting conditions or life-threatening illnesses and their families were identified, invited and consented to research published in the last 5 years. DESIGN Systematic review. DATA SOURCES MEDLINE, PsycINFO, Web of Science, Sciences Citation Index and SCOPUS were searched for original English language research published between 2009 and 2014, recruiting children and young people with life-limiting conditions or life-threatening illness and their families. RESULTS A total of 215 studies - 152 qualitative, 54 quantitative and 9 mixed methods - were included. Limited recruitment information but a range of strategies and difficulties were provided. The proportion of eligible participants from those screened could not be calculated in 80% of studies. Recruitment rates could not be calculated in 77%. A total of 31% of studies recruited less than 50% of eligible participants. Reasons given for non-invitation included missing clinical or contact data, or clinician judgements of participant unsuitability. Reasons for non-participation included lack of interest and participants' perceptions of potential burdens. CONCLUSION All stages of recruitment were under reported. Transparency in reporting of participant identification, invitation and consent is needed to enable researchers to understand research implications, bias risk and to whom results apply. Research is needed to explore why consenting participants decide to take part or not and their experiences of research recruitment.
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Affiliation(s)
- Briony F Hudson
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Linda JM Oostendorp
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
| | - Paddy Stone
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
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9
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Riffin C, Kenien C, Ghesquiere A, Dorime A, Villanueva C, Gardner D, Callahan J, Capezuti E, Reid MC. Community-based participatory research: understanding a promising approach to addressing knowledge gaps in palliative care. ANNALS OF PALLIATIVE MEDICINE 2017; 5:218-24. [PMID: 27481321 DOI: 10.21037/apm.2016.05.03] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/22/2016] [Indexed: 11/06/2022]
Abstract
Concern over the need for effective and accessible healthcare for individuals with advanced chronic illness has drawn attention to the significant gaps in our knowledge of palliative medicine. To advance our understanding of this field, community-based participatory research (CBPR) is proposed as a tool for future research initiatives. This paper offers a rationale for how CBPR may be employed to address specific gaps in palliative care research. Several examples where this approach has been used previously are described, and potential obstacles to implementing this research method are delineated. Despite challenges to incorporating CBPR to palliative care research, this approach holds substantial potential to advance our current understanding of the field and promote sensitivity for future programs, practices and policies.
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Affiliation(s)
- Catherine Riffin
- Department of Human Development, College of Human Ecology, Ithaca, NY, USA.
| | - Cara Kenien
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Angela Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, NY, USA
| | - Ashley Dorime
- Northeast Business Group on Health, New York, NY, USA
| | | | - Daniel Gardner
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, NY, USA
| | - Jean Callahan
- Legal Aid Society, Brooklyn Neighborhood Office, New York, NY, USA
| | - Elizabeth Capezuti
- Hunter College School of Nursing of the City University of New York, New York, NY, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
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10
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Jamieson L, Wong ICK, Craig F, Christiansen N, Brombley K, Tuleu C, Harrop E. Palliative medicines for children - a new frontier in paediatric research. ACTA ACUST UNITED AC 2016; 69:377-383. [PMID: 27739059 DOI: 10.1111/jphp.12615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/05/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This paper seeks to highlight from a UK perspective the current lack of a research evidence base in paediatric palliative care that has resulted in a paucity of available medicines with appropriate formulations (strength and dosage form) to provide symptom management for children with life-limiting illnesses and to raise awareness of this group of 'therapeutic orphans'. Currently, clinicians have limited, often unsuitable medication choices for their paediatric palliative care patients, with little hope of moving away from the status quo. KEY FINDINGS Most medicines used in children receiving palliative care are old and off-patent drugs, developed for and tested in an adult population. Many are not available in suitable formulations (dosage form and strength) for administration to children, and there are often no age-related profiles of adverse drug reactions or for safe dosing. SUMMARY Existing regional paediatric palliative care networks and support organisations should lobby funding bodies and the academic community to support appropriate research for this group of therapeutic orphans. Support must also be provided to pharmaceutical companies in the development of suitable products with appropriate formulations.
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Affiliation(s)
| | | | - Finella Craig
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, UCL Institute of Child Health, London, UK
| | - Nanna Christiansen
- CAG Lead Pharmacist Women and Children & Lead Clinical Pharmacist for Paediatrics, Barts Health NHS Trust, Pathology and Pharmacy Building, London, UK
| | | | | | - Emily Harrop
- Helen & Douglas House Hospices, Oxford, Oxfordshire, UK
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11
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van der Geest IM, van den Heuvel-Eibrink MM, Zwaan CM, Pieters R, Passchier J, Darlington ASE. Participation in a clinical trial for a child with cancer is burdensome for a minority of children. Acta Paediatr 2016; 105:1100-4. [PMID: 26991953 DOI: 10.1111/apa.13405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/02/2016] [Accepted: 03/11/2016] [Indexed: 11/27/2022]
Abstract
AIM This study explored how parents who had lost a child to cancer felt about them taking part in a clinical trial. METHODS A retrospective questionnaire was sent to parents who had lost a child to cancer. They were asked whether their child took part in a clinical trial during their palliative phase, their motives for their child's participation, how they perceived their child's burden and whether they would, hypothetically speaking, enrol again. RESULTS The 24 parents of 16 deceased children who had participated in a clinical trial explained their motives for their child's participation. The most common answers, with multiple responses, were treatment for future patients (n = 16), hope for a cure (n = 9) and prolonging their child's life (n = 6). Eight parents said that participating was not burdensome for their child and four said it was very burdensome, with others answering in between. None of the parents would decline participation if they would be in the same situation again. CONCLUSION Performing clinical trials, even in a vulnerable population, such as children with cancer at the end of life, may not always lead to increased burden. None of the parents would in future, given the same circumstances, decline participation in a clinical trial.
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Affiliation(s)
- Ivana M.M. van der Geest
- Department of Paediatric Oncology/Haematology; Erasmus MC-Sophia Children's Hospital; Rotterdam Netherlands
- Princess Maxima Centre for Paediatric Oncology; Utrecht Netherlands
| | | | - C. Michel Zwaan
- Department of Paediatric Oncology/Haematology; Erasmus MC-Sophia Children's Hospital; Rotterdam Netherlands
| | - Rob Pieters
- Princess Maxima Centre for Paediatric Oncology; Utrecht Netherlands
| | - Jan Passchier
- Department of Clinical Psychology; VU University Amsterdam; Amsterdam Netherlands
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12
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Darbyshire P, Mischo-Kelling M, Lochner L, Messerschmidt-Grandi C. ‘Fighting for care’: parents' perspectives of children's palliative care in South Tyrol, Italy. Int J Palliat Nurs 2015; 21:542-7. [DOI: 10.12968/ijpn.2015.21.11.542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Maria Mischo-Kelling
- Professor of Nursing, University of Applied Science Ravensburg-Weingarten, Germany
| | - Lukas Lochner
- Medical Tutor, at Claudiana College of Health-Care Professions, Bolzano/Bozen, Italy
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13
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14
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Crocker JC, Beecham E, Kelly P, Dinsdale AP, Hemsley J, Jones L, Bluebond-Langner M. Inviting parents to take part in paediatric palliative care research: a mixed-methods examination of selection bias. Palliat Med 2015; 29:231-40. [PMID: 25519146 PMCID: PMC4361415 DOI: 10.1177/0269216314560803] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recruitment to paediatric palliative care research is challenging, with high rates of non-invitation of eligible families by clinicians. The impact on sample characteristics is unknown. AIM To investigate, using mixed methods, non-invitation of eligible families and ensuing selection bias in an interview study about parents' experiences of advance care planning (ACP). DESIGN We examined differences between eligible families invited and not invited to participate by clinicians using (1) field notes of discussions with clinicians during the invitation phase and (2) anonymised information from the service's clinical database. SETTING Families were eligible for the ACP study if their child was receiving care from a UK-based tertiary palliative care service (Group A; N = 519) or had died 6-10 months previously having received care from the service (Group B; N = 73). RESULTS Rates of non-invitation to the ACP study were high. A total of 28 (5.4%) Group A families and 21 (28.8%) Group B families (p < 0.0005) were invited. Family-clinician relationship appeared to be a key factor associated qualitatively with invitation in both groups. In Group A, out-of-hours contact with family was statistically associated with invitation (adjusted odds ratio 5.46 (95% confidence interval 2.13-14.00); p < 0.0005). Qualitative findings also indicated that clinicians' perceptions of families' wellbeing, circumstances, characteristics, engagement with clinicians and anticipated reaction to invitation influenced invitation. CONCLUSION We found evidence of selective invitation practices that could bias research findings. Non-invitation and selection bias should be considered, assessed and reported in palliative care studies.
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Affiliation(s)
- Joanna C Crocker
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, UCL Institute of Child Health, London, UK Health Experiences Institute, University of Oxford, Oxford, UK
| | - Emma Beecham
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, UCL Institute of Child Health, London, UK Marie Curie Palliative Care Research Unit, UCL Division of Psychiatry, London, UK
| | - Paula Kelly
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, UCL Institute of Child Health, London, UK Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Andrew P Dinsdale
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, UCL Institute of Child Health, London, UK
| | - June Hemsley
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, UCL Institute of Child Health, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Unit, UCL Division of Psychiatry, London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, UCL Institute of Child Health, London, UK Department of Sociology, Anthropology and Criminal Justice, Rutgers University, Camden, NJ, USA
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15
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Steele R, Cadell S, Siden H, Andrews G, Smit Quosai T, Feichtinger L. Impact of research participation on parents of seriously ill children. J Palliat Med 2014; 17:788-96. [PMID: 24871891 DOI: 10.1089/jpm.2013.0529] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a paucity of research evidence to guide health care providers' practice in pediatric palliative care. At the same time, some clinicians and Institutional Review Boards are reluctant to approve such studies because of concerns about further burdening families. Yet, there is some evidence that research participation can have positive effects for families. OBJECTIVE To obtain parents' perceptions about their experience of participating in one of two research studies. DESIGN Descriptive, quantitative survey. SETTING/SUBJECTS Caregivers of children with life-threatening conditions (n=323) who were caring for the child at home. MEASUREMENTS Researcher-designed Impact of Participation questionnaire. RESULTS Few differences between the two groups were found on Impact responses. Not a single parent reported regretting participating in their study and almost all (96.3%) reported that conducting research about family's experiences in pediatric palliative care had value. Just over three-quarters (76.2%) did not find participation at all painful, and 73.7% reported that participation was about as painful as expected, with 23.2% reporting less painful. Approximately half (50.5%) said that participation had at least some positive effect and only three parents reported any negative effect. An overwhelming majority (93.4%) would recommend participation to other parents in a similar situation. CONCLUSIONS Participation in research for families with children who have a life-threatening condition is not only acceptable to parents, but may in fact have a positive effect. Although clinicians and Institutional Review Boards may be hesitant to fully support such research, it is clear that conducting research in the field of pediatric palliative care is important.
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Affiliation(s)
- Rose Steele
- 1 School of Nursing, Faculty of Health, York University , Toronto, Ontario, Canada
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Suffering indicators in terminally ill children from the parental perspective. Eur J Oncol Nurs 2013; 17:720-5. [DOI: 10.1016/j.ejon.2013.04.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 02/04/2013] [Accepted: 04/05/2013] [Indexed: 11/20/2022]
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Price J, Nicholl H. Interviewing Parents for Qualitative Research Studies: Using an ABCD Model to Manage the Sensitivities and Issues. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/13575279.2012.743870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Montoya-Juárez R, García-Caro MP, Calderón CC, Rio-Valle JS, Sorroche-Navarro C, Quintana FC. [Suffering in children experiencing a terminal disease: the perspective of parents and professionals]. Rev Esc Enferm USP 2013; 46:1300-5. [PMID: 23380770 DOI: 10.1590/s0080-62342012000600003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 02/24/2012] [Indexed: 11/22/2022] Open
Abstract
Situation diagnosis using exploratory and descriptive scientific methodology (participant observation with descriptive statistical treatment) in order to identify nursing' practices in the area of health promotion during a nursing child health consultation. The 31 consultations observed (n = 31) showed that the majority of observations occurred in children younger than 2 years being the most discussed topic feed with predominant use of expository methodology. There was also little use of informational support and when used relate to the themes of security and nutrition. Most providers raised questions and there was limited registration of the interaction between provider and child with an expenditure averaging of 23 minutes per consultation. Given the results and reflecting about them stands out as intervention the construction of a health promotion manual with the integration of theory and evidence of good practice in this area.
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Bradford N, Armfield NR, Young J, Smith AC. The case for home based telehealth in pediatric palliative care: a systematic review. BMC Palliat Care 2013; 12:4. [PMID: 23374676 PMCID: PMC3584741 DOI: 10.1186/1472-684x-12-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 11/22/2012] [Indexed: 11/10/2022] Open
Abstract
Background Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. Results There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Conclusion Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology.
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Affiliation(s)
- Natalie Bradford
- Centre for Online Health, School of Medicine, The University of Queensland, Brisbane, Australia.
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Malcolm C, Hain R, Gibson F, Adams S, Anderson G, Forbat L. Challenging symptoms in children with rare life-limiting conditions: findings from a prospective diary and interview study with families. Acta Paediatr 2012; 101:985-92. [PMID: 22452449 DOI: 10.1111/j.1651-2227.2012.02680.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim was to describe the nature, frequency, severity and management challenges of symptoms in children with two rare life-limiting conditions [Mucopolysaccharide (MPS) and Batten disease]. METHODS This was an embedded mixed-method study set in the UK between 2009 and 2011. Twenty-six children from 23 families took part. Seventeen children had an MPS condition [MPS III (Sanfilippo) n = 15; MPS I (Hurler) n = 1; MPS IVA (Morquio); n = 1]. Nine children had Batten disease. Prospective data relating to symptoms were collected over 8 weeks using a symptom diary, and qualitative retrospective interviews with families were conducted. Main outcome measures included frequency, severity rating and identification of most challenging symptoms to manage. RESULTS The most common and severe symptoms in MPS III were agitation, repetitive behaviours, hyperactivity and disturbed sleep, and in Batten disease were agitation, joint stiffness, secretions, and disturbed sleep. The data highlighted the high prevalence of behavioural symptoms. Distress caused to families by symptoms was not related simply to their occurrence, but to difficulty in management, likelihood of control and extent to which they signalled disease progression and decline. CONCLUSION In challenging contrast to the dominant biomedical framing of these rare conditions it was behavioural symptoms, rather than the physical ones, that families documented as most frequent, severe and challenging to manage. The diary developed for this study has potential use in aiding parents and clinicians to document and communicate concerns about symptoms.
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Affiliation(s)
- C Malcolm
- School of Nursing, Midwifery and Health, University of Stirling, UK
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Vasserman-Stokes EA, Cronan TA, Sadler MS. Factors that influence the likelihood of hiring a health care advocate for a chronically ill child. J Pediatr Health Care 2012; 26:27-36. [PMID: 22153141 DOI: 10.1016/j.pedhc.2010.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 06/15/2010] [Accepted: 06/19/2010] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In response to the increasing complexity of the health care system, the field of health care advocacy has emerged. However, little is known about variables that may influence a person's likelihood of hiring a health care advocate (HCA) for their chronically ill child. METHODS Severity (high or low) and probability of mortality (high or low) of a child's chronic illness and the child's age (1, 7, or 13 years) were manipulated using vignettes. The dependent variable was a composite score of the eight items used to measure the participants' likelihood of hiring an HCA. RESULTS Participants (N = 1052) were more likely to hire an HCA for a child who was 1 year old than for a child who was 13 years old. Participants were more likely to hire an HCA for a child whose chronic illness was low rather than high in severity and whose chronic illness was high rather than low in probability of mortality. DISCUSSION Use of an HCA may increase patient satisfaction, decrease medical errors, and enhance pediatric health outcomes.
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Tomlinson D, Hendershot E, Bartels U, Maloney AM, Armstrong C, Wrathall G, Sung L. Concordance Between Couples Reporting Their Child’s Quality of Life and Their Decision Making in Pediatric Oncology Palliative Care. J Pediatr Oncol Nurs 2011; 28:319-25. [DOI: 10.1177/1043454211418666] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In children 18 years and younger with cancer and no reasonable chance for cure the authors used a cross-sectional study design to (1) describe concordance between fathers’ and mothers’ evaluation of quality of life (QoL) and (2) determine parental correlation for how factors such as hope, anticipated QoL, and prolonged survival time influence decisions between supportive care alone versus aggressive chemotherapy. Both parents of 13 children performed PedsQL 4.0 Generic Core Scales, Acute Cancer Module, and Multidimensional Fatigue Scale. Concordance was assessed using intraclass correlation coefficient (ICC). Parents reported preferences of supportive care versus aggressive chemotherapy in a hypothetical scenario and rated factors that influenced decision making. Concordance was variable across QoL domains, better for physical health (ICC = 0.46), nausea (ICC = 0.61), general fatigue (ICC = 0.50), and sleep/rest fatigue (ICC = 0.76). Correlation was variable between parents on the influence of factors on their decision, with particularly poor correlation for importance of hope ( r = −0.24). Variable concordance was reported between parental assessment of child QoL and factors influencing their decision making, suggesting parents may have different perspectives in decision making and that understanding both is important in clinical care.
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Affiliation(s)
| | | | - Ute Bartels
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Factors affecting treatment choices in paediatric palliative care: Comparing parents and health professionals. Eur J Cancer 2011; 47:2182-7. [DOI: 10.1016/j.ejca.2011.04.038] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 04/05/2011] [Accepted: 04/28/2011] [Indexed: 11/24/2022]
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Tomlinson D, Hinds PS, Bartels U, Hendershot E, Sung L. Parent reports of quality of life for pediatric patients with cancer with no realistic chance of cure. J Clin Oncol 2011; 29:639-45. [PMID: 21245433 DOI: 10.1200/jco.2010.31.4047] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare quality of life of children with cancer with no reasonable chance of cure reported by parents 6 months or fewer versus more than 6 months before death. PATIENTS AND METHODS This cross-sectional study included children between the ages of 2 and 18 years with cancer and no reasonable chance of cure at The Hospital for Sick Children, Toronto, Ontario, Canada. Parents reported quality of life on behalf of their children. Outcomes were the PedsQL 4.0 Generic Core Scales, Acute Cancer Module, and Multidimensional Fatigue Scale. RESULTS Seventy-three parents of children participated. Compared with children who survived more than 6 months (n = 43), those who died at 6 months or fewer (n = 30) had significantly worse physical health (mean difference, 15.9; 95% CI, 1.8 to 30.0; P = .028), more pain and hurt (mean difference, 15.5; 95% CI, 0.9 to 30.0; P = .037), and worse general fatigue (mean difference, 15.8; 95% CI, 2.4 to 29.1; P = .021) and sleep/rest fatigue (mean difference, 16.0; 95% CI, 3.5 to 28.5; P = .013). Among the entire cohort, those with leukemia/lymphoma had worse physical and psychosocial quality of life compared with those with solid or brain tumors. Recent stem-cell transplantation was associated with worse psychosocial health. CONCLUSION Parents of children with cancer reported worse physical health, pain, and fatigue proximal to death. Those with leukemia/lymphoma were at higher risk for impaired quality of life. This knowledge can help in the design of targeted interventions to improve quality of life for children dying as a result of cancer.
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Affiliation(s)
- Deborah Tomlinson
- Division of Haematology/Oncology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
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Complementary and alternative medicine use in pediatric cancer reported during palliative phase of disease. Support Care Cancer 2010; 19:1857-63. [PMID: 20972804 DOI: 10.1007/s00520-010-1029-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The objectives of this study were to assess the frequency, types, and potential determinants of complementary and alternative medicine (CAM) use, and consideration of CAM use, collected from parents with children during the palliative phase of disease. METHODS Eligible parent respondents were identified by their primary care team. Demographic information and questionnaires were completed by the parent in the presence of a research nurse (DT). We conducted univariate logistic regression to identify predictors of parents who considered CAM use and children who actually used CAM. Descriptions of types of CAM were categorized according to the National Center for Complementary and Alternative Medicine. RESULTS A total of 77 parents participated. Only 22 children (29%) had received some type of CAM, with 42 parents (55%) having considered its use for their child. Whole medical systems (n = 17) and biologically based therapies (n = 15) were the most frequently considered CAM, with whole medical systems (n = 6) being the most frequently used CAM. Family and disease variables were not indicative of CAM use. However, parents with higher education and those with a family member with cancer were more likely to consider CAM use, while parents were less likely to consider CAM as children were farther from time of relapse. CONCLUSIONS The study provides initial insight into CAM use, and consideration of use, in children with cancer receiving palliative care. Further research is required to determine if the gap between CAM use and consideration is important, why this gap exists, and whether CAM has beneficial effects in this population.
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Knapp CA, Madden VL, Curtis C, Sloyer PJ, Shenkman EA. Assessing non-response bias in pediatric palliative care research. Palliat Med 2010; 24:340-7. [PMID: 20123943 DOI: 10.1177/0269216309351466] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
National experts have recognized a need for increased research in pediatric palliative care. However, when conducting research it is important to use rigorous methods, report significant and non-significant findings, and include information on responders and non-responders. Most studies do not present information on non-responders, yet this is critical as the results many not be generalizable if there are inherent differences between the two groups. Using survey data from parents whose children with life-limiting illnesses were enrolled in Florida's publicly funded pediatric palliative care program called Partners in Care: Together for Kids; this study investigates whether non-response bias exists, and if so, what characteristics are associated with non-response. Bivariate and multivariate analyses were conducted to determine whether individual characteristics differed between responders and non-responders. Throughout our analyses, we conducted the analyses using different ways in which 'non-response' can be defined. Our results suggest that regardless of how non-response is defined, Black, non-Hispanic parents were less likely to participate than White non-Hispanic parents. However, we also found that of the Black, non-Hispanic parents who did not participate, their primary reason for doing so was that they had non-working or disconnected phone numbers. Only 3% of the Black, non-Hispanic parents who did not participate flatly refused. Information from this study can be used to design interventions aimed at increasing minority participation in pediatric palliative care research.
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Affiliation(s)
- Caprice A Knapp
- Departments of Epidemiology and Health Policy Research, University of Florida, Gainesville FL, USA.
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Cadell S, Ho G, Jacques L, Wilson K, Davies B, Steele R. Considerations for ethics in multisite research in paediatric palliative care. Palliat Med 2009; 23:274-5. [PMID: 19251832 DOI: 10.1177/0269216309103122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- S Cadell
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Kitchener, Ontario, Canada
| | - G Ho
- Department of Psychology, Simon Fraser University, British Columbia, Canada
| | - L Jacques
- School of Nursing, University of British Columbia, British Columbia, Canada
| | - K Wilson
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Kitchener, Ontario, Canada
| | - B Davies
- Department of Health Care Nursing, University of California, San Francisco, California, USA
| | - R Steele
- School of Nursing, York University, Toronto, Ontario, Canada
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