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Sievers Y, Roser K, Scheinemann K, Michel G, Ilic A. The information needs of relatives of childhood cancer patients and survivors: A systematic review of quantitative evidence. PATIENT EDUCATION AND COUNSELING 2024; 126:108316. [PMID: 38788309 DOI: 10.1016/j.pec.2024.108316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/04/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE We aimed to: (1) summarize the quantitative evidence on the information needs of relatives of childhood cancer patients, survivors, and children deceased from cancer; and (2) identify factors associated with these needs. METHODS PubMed, PsycINFO, Scopus, and CINAHL were systematically searched. The methodological quality of all included publications was assessed, and the extracted data were analyzed using narrative synthesis. RESULTS Of 5810 identified articles, 45 were included. Information needs were classified as unmet, met (satisfied), and unspecified and categorized into five domains: medical information, cancer-related consequences, lifestyle, family, and support. Most unmet information needs concerned cancer-related consequences (e.g., late effects), while information needs on support were generally met. Migrant background and higher education were associated with higher information needs among parents. Siblings had lower information needs than parents. CONCLUSION This systematic review provides a comprehensive overview of the information needs of relatives in the context of childhood cancer, showing that information on cancer-related consequences is needed most often. The socioeconomic background of the relatives needs continued consideration throughout the cancer trajectory. PRACTICE IMPLICATIONS Our findings suggest the need for personalized information. Healthcare professionals should adapt their communication strategies to respond to the different and evolving needs of all affected relatives.
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Affiliation(s)
- Yara Sievers
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Katharina Roser
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Katrin Scheinemann
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Division of Hematology and Oncology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland; Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Canada
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Anica Ilic
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Thomas R, Pesut B, Siden H, Treschow M, Puurveen G. Developing competencies for volunteer navigators to support caregivers of children living with medical complexity: a mixed-method e-Delphi study. Palliat Care Soc Pract 2023; 17:26323524231209060. [PMID: 37954463 PMCID: PMC10634257 DOI: 10.1177/26323524231209060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
Background Providing specially trained volunteer navigators is one promising strategy for supporting the increasing number of family caregivers who are caring for children living with medical complexity. Objective The objective of this study was to develop consensus on the role and competencies required for volunteer navigators who support caregivers of children living with medical complexity. Design This was a mixed-method study using modified e-Delphi and focus group methods. In phase 1, a modified e-Delphi survey with 20 family caregivers and a focus group with 4 family caregivers were conducted to develop consensus on their unmet needs and the potential roles of a volunteer to meet those needs. In phase 2, a modified e-Delphi survey was conducted with experts to develop consensus on the volunteer competencies required to meet the roles identified by family caregivers in phase 1. Results Findings from phase 1 resulted in 36 need-related items over 8 domains: communication, daily life and chores, emotional support, information and knowledge, respite, support with decision-making, and sharing the caregiving experience. Concerns about the volunteer role included the potential lack of commitment in the absence of remuneration, the complexity of the child's condition that was beyond the role of a volunteer, and a preference for support from individuals they knew. Findings from the phase 2 Delphi survey with professionals resulted in 22 competencies, derived from the roles identified in phase 1, that would be required of volunteers who wished to support these family caregivers. Conclusion This study provides insight into a role for volunteers in meeting the needs of family caregivers of children living with medical complexity. A volunteer with lived experience and adequate preparation can assist with meeting some of these important needs. Further research is required to better understand the feasibility and acceptability of such a role.
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Affiliation(s)
- Robyn Thomas
- The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Barbara Pesut
- The University of British Columbia Okanagan, 1147 Research Way, Kelowna, BC V1V 1V7, Canada
| | - Hal Siden
- The University of British Columbia, Canuck Place Children’s Hospice and BC Children’s Hospital, Vancouver, BC, Canada
| | - Michael Treschow
- The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Gloria Puurveen
- The University of British Columbia Okanagan, Kelowna, BC, Canada
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Hrdlickova L, Polakova K, Loucka M. Innovative communication approaches for initializing pediatric palliative care: perspectives of family caregivers and treating specialists. BMC Palliat Care 2023; 22:152. [PMID: 37814302 PMCID: PMC10563209 DOI: 10.1186/s12904-023-01269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Effective cooperation between a pediatric palliative care team (PPCT), primary treating specialists, patients and families is crucial for high quality care of children with complex life-limiting conditions. Several barriers among patients, families and treating specialists have been identified in the context of initializing pediatric palliative care. The aim of the study was to assess the experience with initial pediatric palliative care consultations from perspectives of family caregivers and treating physicians with a special focus on two innovative approaches: attendance of the treating specialist and the opportunity for parents to give feedback on the written report from the consultation. METHODS This was a qualitative study using semi-structured interviews with family caregivers of children with malignant and non-malignant disease and their treating specialists. Framework analysis was used to guide the data collection and data analysis. RESULTS In total, 12 family caregivers and 17 treating specialists were interviewed. Four main thematic categories were identified: (1) expectations, (2) content and evaluation, (3) respect and support from the team and (4) consultation outcomes. Parents viewed the consultation as a unique opportunity to discuss difficult topics. They perceived the attendance of the treating specialist at the initial consultation as very important for facilitating communication. Treating specialists valued the possibility to learn more about psychosocial issues of the child and the family while attending the initial palliative care consultation. All participants perceived the written report from the consultation as useful for further medical decisions. Family members appreciated the chance to give feedback on the consultation report. CONCLUSIONS Our study identified several clinically relevant issues that can help initialize pediatric palliative care and establish effective collaboration between families and PPCT and treating specialists. Supporting treating specialists in their ability to explain the role of palliative care is important in order to reduce the risk of misunderstanding or unrealistic expectations. Developing more specific expectations seems to be one of the ways to further increase the effectiveness of initial consultations. The results of the study can be especially helpful for the initial phase of implementing pediatric palliative care and initializing the process of setting up a collaborative relationship with palliative care teams in the hospital.
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Affiliation(s)
- Lucie Hrdlickova
- Department of Pediatric Hematology and Oncology, University Hospital Motol, V Uvalu 84, Prague, 5,150 06, Czech Republic.
- Pediatric Supportive Care Team, University Hospital Motol, Prague, Czech Republic.
- First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Kristyna Polakova
- Center for Palliative Care, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Loucka
- Center for Palliative Care, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Papworth A, Hackett J, Beresford B, Murtagh F, Weatherly H, Hinde S, Bedendo A, Walker G, Noyes J, Oddie S, Vasudevan C, Feltbower RG, Phillips B, Hain R, Subramanian G, Haynes A, Fraser LK. Regional perspectives on the coordination and delivery of paediatric end-of-life care in the UK: a qualitative study. BMC Palliat Care 2023; 22:117. [PMID: 37587514 PMCID: PMC10428585 DOI: 10.1186/s12904-023-01238-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Provision of and access to paediatric end-of-life care is inequitable, but previous research on this area has focused on perspectives of health professionals in specific settings or children with specific conditions. This qualitative study aimed to explore regional perspectives of the successes, and challenges to the equitable coordination and delivery of end-of-life care for children in the UK. The study provides an overarching perspective on the challenges of delivering and coordinating end-of-life care for children in the UK, and the impact of these on health professionals and organisations. Previous research has not highlighted the successes in the sector, such as the formal and informal coordination of care between different services and sectors. METHODS Semi-structured interviews with Chairs of the regional Palliative Care Networks across the UK. Chairs or co-Chairs (n = 19) of 15/16 Networks were interviewed between October-December 2021. Data were analysed using thematic analysis. RESULTS Three main themes were identified: one standalone theme ("Communication during end-of-life care"); and two overarching themes ("Getting end-of-life services and staff in the right place", with two themes: "Access to, and staffing of end-of-life care" and "Inconsistent and insufficient funding for end-of-life care services"; and "Linking up healthcare provision", with three sub-themes: "Coordination successes", "Role of the networks", and "Coordination challenges"). Good end-of-life care was facilitated through collaborative and network approaches to service provision, and effective communication with families. The implementation of 24/7 advice lines and the formalisation of joint-working arrangements were highlighted as a way to address the current challenges in the specialism. CONCLUSIONS Findings demonstrate how informal and formal relationships between organisations and individuals, enabled early communication with families, and collaborative working with specialist services. Formalising these could increase knowledge and awareness of end of life care, improve staff confidence, and overall improve professionals' experiences of delivering care, and families' experiences of receiving it. There are considerable positives that come from collaborative working between different organisations and sectors, and care could be improved if these approaches are funded and formalised. There needs to be consistent funding for paediatric palliative care and there is a clear need for education and training to improve staff knowledge and confidence.
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Affiliation(s)
- Andrew Papworth
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Julia Hackett
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK.
- Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Bryony Beresford
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK
- Social Policy Research Unit, University of York, York, YO10 5DD, UK
| | - Fliss Murtagh
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Helen Weatherly
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Andre Bedendo
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | | | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, LL57 2EF, UK
| | - Sam Oddie
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | | | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, LS2 9NL, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - Richard Hain
- All-Wales Paediatric Palliative Care Network, Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK
- College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
| | | | - Andrew Haynes
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Lorna K Fraser
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK
- Department of Health Sciences, University of York, York, YO10 5DD, UK
- Cicely Saunders Institute, Kings College London, Bessemer Road, London, SE5 9PJ, UK
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Hammer NM, Bidstrup PE, Brok J, Devantier M, Sjøgren P, Schmiegelow K, Larsen A, Kurita GP, Olsen M, Larsen HB. Home-Based Specialized Pediatric Palliative Care: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2023; 65:e353-e368. [PMID: 36621694 DOI: 10.1016/j.jpainsymman.2022.12.139] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 12/17/2022] [Indexed: 01/07/2023]
Abstract
CONTEXT Although specialized pediatric palliative care (SPPC) teams increasingly provide home-based care, the evidence of its impact has not yet been systematically evaluated. OBJECTIVES To examine the impact of home-based SPPC in children and adolescents with life-limiting conditions, regarding place of death, quality of life and symptom burden. METHODS We searched Medline, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus for studies comparing children and adolescents with life-limiting conditions receiving home-based SPPC with children and adolescents not receiving home-based SPPC, or studies reporting before-and-after measurements. We included studies that reported on place of death, quality of life and/or symptoms. Two authors independently screened the articles, extracted data, and assessed quality. Results were synthesized as a systematic narrative synthesis and meta-analysis, using a random-effects model. RESULTS We included five studies, which reported on 392 children and adolescents. Meta-analysis showed that receiving home-based SPPC was associated with a more than fourfold increased likelihood of home death (risk ratio 4.64, 95% confidence interval 3.06-7.04; 3 studies; n=296). Most studies reported improved quality of life and reduced symptom burden. The included studies were of low to moderate quality with a high risk of bias. CONCLUSION This systematic review suggests that home-based SPPC is associated with increased likelihood of home death, and might be associated with improved quality of life and reduced symptom burden. The small number of studies and an overall high risk of bias, however, makes the overall strength of evidence low.
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Affiliation(s)
- Nanna Maria Hammer
- Copenhagen Palliative Team for Children and Adolescents, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., M.O.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., K.S., M.O., H.B.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences (N.M.H., M.D., K.S., G.P.K., H.B.L.), University of Copenhagen, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological aspects of Cancer, Danish Cancer Society Research Center (P.E.B.), Copenhagen, Denmark; Institute of Psychology (P.E.B.), University of Copenhagen, Copenhagen, Denmark
| | - Jesper Brok
- Department of Paediatric Oncology and Haematology, Department of Paediatrics and Adolescent Medicine (J.B.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Minna Devantier
- Copenhagen Palliative Team for Children and Adolescents, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., M.O.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., K.S., M.O., H.B.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences (N.M.H., M.D., K.S., G.P.K., H.B.L.), University of Copenhagen, Copenhagen, Denmark
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology (P.S., G.P.K.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., K.S., M.O., H.B.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences (N.M.H., M.D., K.S., G.P.K., H.B.L.), University of Copenhagen, Copenhagen, Denmark
| | - Anders Larsen
- The University Hospitals' Centre for Health Research (A.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Geana Paula Kurita
- Department of Clinical Medicine, Faculty of Health and Medical Sciences (N.M.H., M.D., K.S., G.P.K., H.B.L.), University of Copenhagen, Copenhagen, Denmark; Section of Palliative Medicine, Department of Oncology (P.S., G.P.K.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Multidisciplinary Pain Centre, Department of Anaesthesiology, Pain and Respiratory Support (G.P.K.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marianne Olsen
- Copenhagen Palliative Team for Children and Adolescents, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., M.O.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., K.S., M.O., H.B.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Pediatrics and Adolescent Medicine (M.O.), Section of Pediatric Hematology and Oncology, Aalborg University Hospital, Aalborg, Denmark.
| | - Hanne Bækgaard Larsen
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., K.S., M.O., H.B.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences (N.M.H., M.D., K.S., G.P.K., H.B.L.), University of Copenhagen, Copenhagen, Denmark
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Ristevski E, Leach M, Bolton E, Spargo M, Byrne A, Khalil H. Rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to palliative and end-of-life clients and carers. Palliat Support Care 2022; 20:823-831. [PMID: 36942580 DOI: 10.1017/s1478951521001644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to rural residing palliative and end-of-life clients and carers. We further sought to determine correlates of knowledge gaps to inform workforce education and planning. METHOD Nurses from a rural area of Victoria, Australia, were invited to complete an electronic questionnaire rating their knowledge against 6 national palliative care standards and 10 screening and assessment tools. A 5-point scale of (1) No experience to (5) Can teach others was used to rate knowledge. Results were classified into three categories: practice gaps, areas of consolidation, and strengths. Descriptive and logistical regression was used to analyze data. RESULTS A total of 122 of 165 nurses (response rate = 74%) completed the survey. Of these nurses, 87% were Registered Nurses, 43% had ≥10 years' experience in palliative care, and 40% had palliative care training. The majority of practices across the standards and screening and assessment tools were rated as knowledge strengths (N = 55/67, 82%). Gaps and areas of consolidation were in the use of client and carer assessment tools, the care of specific populations such as children, supporting carers with appropriate referrals, resources, and grief, and facilitating the processes of reporting a death to the coroner. Lack of formal training and lower years of experience were found to be associated with practice gaps. SIGNIFICANCE OF RESULTS Our study found rural nurses were confident in their knowledge and skills in the majority of psychosocial care. As generalist nurses make up the majority of the rural nursing workforce, further research should be undertaken on what educational strategies are needed to support and upskill rural community-based nurses to undertake formal training in palliative care.
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Affiliation(s)
- Eli Ristevski
- Monash Rural Health Warragul, Monash University, Victoria, Australia
| | - Michael Leach
- Monash Rural Health Bendigo, Monash University, Victoria, Australia
| | - Ellen Bolton
- Monash Rural Health Warragul, Monash University, Victoria, Australia
| | - Melissa Spargo
- Gippsland Region Palliative Care Consortium, Victoria, Australia
| | - Anny Byrne
- Gippsland Region Palliative Care Consortium, Victoria, Australia
| | - Hanan Khalil
- College of Science, Health & Engineering, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Mazhari F, Heidari S, Iranmanesh S, Sabzevari S. Examining the mother's supportive role caring for a child with cancer. Int J Palliat Nurs 2022; 28:531-539. [DOI: 10.12968/ijpn.2022.28.11.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Childhood cancer is a stressful experience for patients and their families; it has a profound effect on families emotionally, psychologically and financially. The mother's supportive role affects the child's treatment outcomes and the health of all family members. Aims: This study was conducted to describe the experiences of mothers of children with cancer. Methods: A total of 14 mothers of children with cancer were recruited using purposive sampling. In-depth semi-structured interviews were conducted using a qualitative inductive content analysis. Data were analysed using Graneheim et al's (2004) approach. Findings: According to data analysis, the mother's supportive role can be depicted across four subthemes: ‘being genuinely present with a sick child’; ‘keeping the family together and strengthening its cohesion’; ‘providing compassionate collaborative care for peers’; and ‘empowering the self and taking charge of one's own life’. The main overarching theme extracted from this study was ‘sacrifice’. Conclusion: This study results suggest that the mothers’ supportive role is relying on their own personal power, in which they not only give the care to the child, family and counterparts, but also drive personal growth and empowerment of mothers. A deeper understanding of mothers’ experiences of their supportive role may enhance the quality of care and promote further paediatric approaches to palliative care.
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Affiliation(s)
- Fariba Mazhari
- Assistant Professor, Faculty of Nursing and Midwifery; Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Iran
| | - Shahin Heidari
- Assistant Professor, Faculty of Nursing and Midwifery; Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Iran
| | - Sedigheh Iranmanesh
- Associate Professor, Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Iran
| | - Sakineh Sabzevari
- Associate Professor, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Iran
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Papworth A, Hackett J, Beresford B, Murtagh F, Weatherly H, Hinde S, Bedendo A, Walker G, Noyes J, Oddie S, Vasudevan C, Feltbower R, Phillips B, Hain R, Subramanian G, Haynes A, Fraser LK. End of life care for infants, children and young people (ENHANCE): Protocol for a mixed methods evaluation of current practice in the United Kingdom [version 1; peer review: 2 approved]. NIHR OPEN RESEARCH 2022; 2:37. [PMID: 35935675 PMCID: PMC7613236 DOI: 10.3310/nihropenres.13273.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/22/2022]
Abstract
Background Although child mortality has decreased over the last few decades, around 4,500 infants and children die in the UK every year, many of whom require palliative care. There is, however, little evidence on paediatric end-of-life care services. The current National Institute for Health and Care Excellence (NICE) guidance provides recommendations about what should be offered, but these are based on low quality evidence. The ENHANCE study aims to identify and investigate the different models of existing end-of-life care provision for infants, children, and young people in the UK, including an assessment of the outcomes and experiences for children and parents, and the cost implications to families and healthcare providers. Methods This mixed methods study will use three linked workstreams and a cross-cutting health economics theme to examine end-of-life care models in three exemplar clinical settings: infant, children and young adult cancer services (PTCs), paediatric intensive care units (PICUs), and neonatal units (NNUs).Workstream 1 (WS1) will survey current practice in each setting and will result in an outline of the different models of care used. WS2 is a qualitative comparison of the experiences of staff, parents and patients across the different models identified. WS3 is a quantitative assessment of the outcomes, resource use and costs across the different models identified. Discussion Results from this study will contribute to an understanding of how end-of-life care can provide the greatest benefit for children at the end of their lives. It will also allow us to understand the likely benefits of additional funding in end-of-life care in terms of patient outcomes.
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Affiliation(s)
- Andrew Papworth
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Julia Hackett
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Bryony Beresford
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
- Social Policy Research Unit, University of York, Heslington, York, YO10 5DD, UK
| | - Fliss Murtagh
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Helen Weatherly
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Andre Bedendo
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | | | - Jane Noyes
- School of Health Sciences, Bangor University, Fron Heulog, Bangor, LL57 2EF, UK
| | - Sam Oddie
- Bradford Hospitals National Health Service Trust, Bradford, BD9 6RJ, UK
| | | | - Richard Feltbower
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9NL, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, UK, York, YO10 5DD, UK
| | - Richard Hain
- All-Wales Paediatric Palliative Care Network, Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK
- College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
| | - Gayathri Subramanian
- Manchester University National Health Service Foundation Trust, Manchester, M13 9WL, UK
| | - Andrew Haynes
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Lorna K Fraser
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
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Abstract
Purpose of this Review The purpose of this review is to describe the evolution of palliative care in paediatric oncology, the needs of children and their families in a paediatric oncology setting, palliative care referral practices in paediatric oncology, outcomes of palliative care referral in paediatric oncology and models of palliative care in paediatric oncology. Recent Findings Cancer constitutes 5.2% of the palliative care needs in children. Approximately, 90% of children with cancer lives in low and middle-income countries, constituting 84% of the global burden of childhood cancers. Children in low and middle-income countries have low cure rates and high death rates making palliative care relevant in a paediatric oncology setting. Children with cancer experience pain and physical symptoms, low mood, anxiety, and fear. They feel less resilient, experience low self-worth, and have challenges coping with the illness. The families lead very stressful lives, navigating the hospital environment, and dealing with uncertainties of the future. Palliative care referral in children with cancer improves physical symptoms, emotional support, and quality of life. It enables communication between families and health care providers. It improves end-of-life care support to children and their families and facilitates less invasive diagnostic and therapeutic interventions at the end of life. Worldwide children with cancer are infrequently referred to palliative care and referred late in the illness trajectory. Most of the children referred to palliative care receive some form of cancer-directed therapy in their last days. Children in low and low-middle income countries are less likely to access palliative care due to a lack of awareness amongst paediatric oncologists about palliative care and the reduced number of services providing palliative care. A three-tier model is proposed to provide palliative care in paediatric oncology, where most children with palliative care needs are managed by paediatric oncologists and a smaller number with complex physical and psychosocial needs are managed by paediatric palliative care specialists. There are several palliative care models in paediatric oncology practised globally. However, no one model was considered better or superior, and the choice of model depended on the need, preferences identified, and available resources. Summary Children with cancer are sparingly referred to palliative care and referred late and oncologists and haematologists gatekeep the referral process. Knowledge on palliative care referral in paediatric oncology settings might enhance collaboration between paediatric oncology and paediatric palliative care.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Sean Hughes
- Division of Health Research, Health Innovation One, Lancaster University, Sir John Fisher Drive, Lancaster, LA1 4AT UK
| | - Nancy Preston
- Division of Health Research, Health Innovation One, Lancaster University, Sir John Fisher Drive, Lancaster, LA1 4AT UK
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10
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Mitchell S, Slowther AM, Coad J, Dale J. Experiences of healthcare, including palliative care, of children with life-limiting and life-threatening conditions and their families: a longitudinal qualitative investigation. Arch Dis Child 2021; 106:570-576. [PMID: 33199300 PMCID: PMC8142456 DOI: 10.1136/archdischild-2020-320189] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To understand the experiences and perceptions of healthcare services of children with life-limiting and life-threatening conditions and their family members, including palliative care. DESIGN Longitudinal qualitative interview study with children and their family members. Up to three in-depth interviews were conducted over 13 months with each child and family. Data were analysed using thematic analysis. SETTING Community and hospital settings in the West Midlands, UK. PARTICIPANTS Children with a diverse range of life-limiting and life-threatening conditions, aged between 5 and 18 years, and their family members. FINDINGS 31 participants from 14 families including 10 children took part in 41 interviews. Two children died during the course of the study. Children accepted their conditions as part of life and had other priorities for living. Experiences of 'fighting' a fragmented healthcare system that focused on the biomedical aspects of their care were described. The possibility of death was rarely openly discussed. Palliative care tended to be conceptualised as a distinct service or phase of a child's condition, rather than a broad approach. Access to palliative care depended on the availability of specialist services, and on trusted interpersonal relationships with healthcare professionals who could share uncertainty and the family's emotional burden. CONCLUSIONS There is an urgent need to create a more child and family centred approach that enables palliative care to be truly integrated into the wider healthcare of children with life-limiting and life-threatening conditions. Trusted, interpersonal relationships with healthcare professionals, and more effective coordination of care are fundamental to achieving this, and should be valued and enabled throughout the healthcare system.
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Affiliation(s)
- Sarah Mitchell
- Academic Unit of Primary Care, University of Warwick, Coventry, UK .,Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | | | - Jane Coad
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jeremy Dale
- Academic Unit of Primary Care, University of Warwick, Coventry, UK
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11
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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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12
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Greenfield K, Holley S, Schoth DE, Harrop E, Howard RF, Bayliss J, Brook L, Jassal SS, Johnson M, Wong I, Liossi C. A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life. Palliat Med 2020; 34:689-707. [PMID: 32228216 PMCID: PMC7521017 DOI: 10.1177/0269216320907065] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptom management for infants, children and young people at end of life is complex and challenging due to the range of conditions and differing care needs of individuals of different ages. A greater understanding of these challenges could inform the development of effective interventions. AIM To investigate the barriers and facilitators experienced by patients, carers and healthcare professionals managing symptoms in infants, children and young people at end of life. DESIGN A mixed-methods systematic review and meta-analysis was undertaken (PROSPERO ID: CRD42019124797). DATA SOURCES The Cochrane Library, PROSPERO, CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey were electronically searched from the inception of each database for qualitative, quantitative or mixed-methods studies that included data from patients, carers or healthcare professionals referring to barriers or facilitators to paediatric end-of-life symptom management. Studies underwent data extraction, quality appraisal, narrative thematic synthesis and meta-analysis. RESULTS A total of 64 studies were included (32 quantitative, 18 qualitative and 14 mixed-methods) of medium-low quality. Themes were generated encompassing barriers/facilitators experienced by carers (treatment efficacy, treatment side effects, healthcare professionals' attitudes, hospice care, home care, families' symptom management strategies) and healthcare professionals (medicine access, treatment efficacy, healthcare professionals' demographics, treatment side effects, specialist support, healthcare professionals' training, health services delivery, home care). Only one study included patients' views. CONCLUSION There is a need for effective communication between healthcare professionals and families, more training for healthcare professionals, improved symptom management planning including anticipatory prescribing, and urgent attention paid to the patients' perspective.
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Affiliation(s)
- Katie Greenfield
- School of Psychology, University of Southampton, Southampton, UK
| | - Simone Holley
- School of Psychology, University of Southampton, Southampton, UK
| | - Daniel E Schoth
- School of Psychology, University of Southampton, Southampton, UK
| | - Emily Harrop
- Helen & Douglas House Hospices, Oxford, UK.,John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard F Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Julie Bayliss
- The Louis Dundas Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lynda Brook
- Alder Hey Children's Hospital, Liverpool, UK
| | | | | | - Ian Wong
- UCL School of Pharmacy, London, UK
| | - Christina Liossi
- School of Psychology, University of Southampton, Southampton, UK.,Psychological Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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13
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Mitchell S, Bennett K, Morris A, Slowther AM, Coad J, Dale J. Achieving beneficial outcomes for children with life-limiting and life-threatening conditions receiving palliative care and their families: A realist review. Palliat Med 2020; 34:387-402. [PMID: 31431129 PMCID: PMC7074600 DOI: 10.1177/0269216319870647] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Palliative care for children and young people is a growing global health concern with significant resource implications. Improved understanding of how palliative care provides benefits is necessary as the number of children with life-limiting and life-threatening conditions rises. AIM The aim is to investigate beneficial outcomes in palliative care from the perspective of children and families and the contexts and hidden mechanisms through which these outcomes can be achieved. DESIGN This is a systematic realist review following the RAMESES standards. A protocol has been published in PROSPERO (registration no: CRD42018090646). DATA SOURCES An iterative literature search was conducted over 2 years (2015-2017). Empirical research and systematic reviews about the experiences of children and families in relation to palliative care were included. RESULTS Sixty papers were included. Narrative synthesis and realist analysis led to the proposal of context-mechanism-outcome configurations in four conceptual areas: (1) family adaptation, (2) the child's situation, (3) relationships with healthcare professionals and (4) access to palliative care services. The presence of two interdependent contexts, the 'expert' child and family and established relationships with healthcare professionals, triggers mechanisms, including advocacy and affirmation in decision-making, which lead to important outcomes including an ability to place the emphasis of care on lessening suffering. Important child and family outcomes underpin the delivery of palliative care. CONCLUSION Palliative care is a complex, multifactorial intervention. This review provides in-depth understanding into important contexts in which child and family outcomes can be achieved so that they benefit from palliative care and should inform future service development and practice.
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Affiliation(s)
- Sarah Mitchell
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Karina Bennett
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Morris
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jane Coad
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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14
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Constantinou G, Garcia R, Cook E, Randhawa G. Children's unmet palliative care needs: a scoping review of parents' perspectives. BMJ Support Palliat Care 2019; 9:439-450. [PMID: 31324615 DOI: 10.1136/bmjspcare-2018-001705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/15/2019] [Accepted: 05/29/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Children with life-limiting conditions often have complex needs, making it challenging for services to provide satisfactory care. Few studies consider whether services actually meet families' needs by exploring and identifying the parents' perspectives of unmet needs. AIM To identify what published evidence is available on the unmet needs of children with life-limiting conditions and their families, from the perspective of parents, internationally. ELIGIBILITY CRITERIA: Inclusion criteria: papers from the perspective of parents of children aged 0-19 years, who have a life-limiting condition and are receiving palliative care. Exclusion criteria: those papers not written in English, not reporting primary research and discussing children who died from stillbirth, accidental or unexpected circumstance. CHARTING METHODS A scoping review was conducted in accordance with the methods of Arksey and O'Malley. SOURCES OF EVIDENCE The electronic databases PubMed, MEDLINE, CINAHL and PsycINFO were searched. Key terms included: parent, needs, met/unmet/satisfaction, palliative/supportive/end of life care, life-limiting/life-threatening illness, infants/children/young people. RESULTS Total hit indicated 5975 papers for screening. Fifty-five papers met the scoping review criteria. The majority used mixed-methods approaches inclusive of: questionnaires, self-report measures, in-depth interviews, focus groups, case record analysis and art-based workshops. Unmet needs included: respite care, coordination and organisation of care, psychological support and professional communication skills. CONCLUSIONS The findings suggest many unmet needs from the parent's perspective, across several aspects of the Quality Standards and Children's Palliative Care Frameworks. Further research is needed which explores the parent's unmet needs in palliative care services.
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Affiliation(s)
| | | | - Erica Cook
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, UK
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15
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Roser K, Erdmann F, Michel G, Winther JF, Mader L. The impact of childhood cancer on parents' socio‐economic situation—A systematic review. Psychooncology 2019; 28:1207-1226. [DOI: 10.1002/pon.5088] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/25/2019] [Accepted: 04/05/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Katharina Roser
- Department of Health Sciences and Health PolicyUniversity of Lucerne Lucerne Switzerland
| | - Friederike Erdmann
- Childhood Cancer Research GroupDanish Cancer Society Research Center Copenhagen Denmark
| | - Gisela Michel
- Department of Health Sciences and Health PolicyUniversity of Lucerne Lucerne Switzerland
| | - Jeanette Falck Winther
- Childhood Cancer Research GroupDanish Cancer Society Research Center Copenhagen Denmark
- Department of Clinical Medicine, Faculty of HealthAarhus University Aarhus Denmark
| | - Luzius Mader
- Childhood Cancer Research GroupDanish Cancer Society Research Center Copenhagen Denmark
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16
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Abstract
OBJECTIVES Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process. METHODS A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed. RESULTS Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child's condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people's actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention. Significance of results A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular emotional and practical implications for parents. Greater understanding of this stage can improve clinician's support for parents as they care for their child.
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17
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Mooney-Doyle K, Deatrick JA, Ulrich CM, Meghani SH, Feudtner C. Parenting in Childhood Life-Threatening Illness: A Mixed-Methods Study. J Palliat Med 2017; 21:208-215. [PMID: 28972873 DOI: 10.1089/jpm.2017.0054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Parenting children with life-threatening illness (LTI) and their healthy siblings requires parents to consider their various needs. OBJECTIVE AND METHODS We conducted a concurrent, cross-sectional mixed-methods study to describe challenges parents face prioritizing tasks and goals for each child with qualitative data, compare parents' tasks and goals for children with LTI and healthy siblings with quantitative data, and describe parenting in terms of the process of prioritizing tasks and goals for all children in the family. RESULTS Participants included 31 parents of children with LTI who have healthy siblings and were admitted to a children's hospital. Qualitative interviews revealed how parents managed children's needs and their perceptions of the toll it takes. Quantitative data revealed that parents prioritized "making sure my child feels loved" highest for ill and healthy children. Other goals for healthy siblings focused on maintaining emotional connection and regularity within the family and for ill children focused on illness management. Mixed-methods analysis revealed that parents engaged in a process decision making and traded-off competing demands by considering needs which ultimately transformed the meaning of parenting. DISCUSSION Future research can further examine trade-offs and associated effects, how to support parent problem-solving and decision-making around trade-offs, and how to best offer social services alongside illness-directed care.
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Affiliation(s)
- Kim Mooney-Doyle
- 1 Department of Family and Community Health, School of Nursing, University of Maryland , Baltimore, Maryland
| | - Janet A Deatrick
- 2 Department of Family and Community Health, School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Connie M Ulrich
- 3 Department of Biobehavioral Health Sciences, School of Nursing, Center for Medical Ethics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Salimah H Meghani
- 4 Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Chris Feudtner
- 5 Department of General Pediatrics and Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
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18
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Jagt-van Kampen CT, Colenbrander DA, Bosman DK, Grootenhuis MA, Kars MC, Schouten-van Meeteren AY. Aspects and Intensity of Pediatric Palliative Case Management Provided by a Hospital-Based Case Management Team: A Comparative Study Between Children With Malignant and Nonmalignant Disease. Am J Hosp Palliat Care 2017; 35:123-131. [PMID: 28273758 PMCID: PMC5704565 DOI: 10.1177/1049909117695068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Anticipating case management is considered crucial in pediatric palliative care. In 2012, our children's university hospital initiated a specialized pediatric palliative care team (PPCT) to deliver inbound and outbound case management for children with life-shortening disease. The aim of this report is to gain insight in the first 9 months of this PPCT. METHODS Aspects of care during the first 9 months of the PPCT are presented, and comparison is made between patients with malignant disease (MD) and nonmalignant disease (NMD) in a retrospective study design. Insight in the aspects of care of all patients with a life-shortening disease was retrieved from web-based files and the hour registrations from the PPCT. RESULTS Forty-three children were supported by the PPCT during the first 9 months: 22 with MD with a median of 50 (1-267) days and 29 minutes (4-615) of case management per patient per day and 21 patients with NMD with a median of 79.5 (5-211) days and 16 minutes of case management per day (6-64). Our data show significantly more interprofessional contacts for patients with MD and more in-hospital contacts for patients with NMD. The median number of admission days per patient was 11 (0-22) for MD (44% for anticancer therapy) and 44 (0-303) for NMD (36% for infectious diseases). SIGNIFICANCE OF RESULTS This overview of aspects of pediatric palliative case management shows shorter but more intensive case management for MD in comparison with NMD. This insight in palliative case management guides the design of a PPCT.
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Affiliation(s)
- Charissa T Jagt-van Kampen
- 1 Pediatric Oncology Department, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - Derk A Colenbrander
- 2 Pediatrics Department, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - Diederik K Bosman
- 2 Pediatrics Department, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - Martha A Grootenhuis
- 3 Psychosocial Department, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.,4 Pediatric Oncology Department, Princess Máxima Center, Utrecht, the Netherlands
| | - Marijke C Kars
- 5 Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Verberne LM, Kars MC, Schouten-van Meeteren AYN, Bosman DK, Colenbrander DA, Grootenhuis MA, van Delden JJM. Aims and tasks in parental caregiving for children receiving palliative care at home: a qualitative study. Eur J Pediatr 2017; 176:343-354. [PMID: 28078429 PMCID: PMC5321698 DOI: 10.1007/s00431-016-2842-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/06/2016] [Accepted: 12/23/2016] [Indexed: 11/18/2022]
Abstract
UNLABELLED In paediatric palliative care (PPC), parents are confronted with increasing caregiving demands. More children are cared for at home, and the need for PPC of children is lengthened due to technical and medical improvements. Therefore, a clear understanding of the content of parental caregiving in PPC becomes increasingly important. The objective is to gain insight into parental caregiving based on the lived experience of parents with a child with a life-limiting disease. An interpretative qualitative study using thematic analysis was performed. Single or repeated interviews were undertaken with 42 parents of 24 children with a malignant or non-malignant disease, receiving PPC. Based on their ambition to be a 'good parent', parents caring for a child with a life-limiting disease strived for three aims: controlled symptoms and controlled disease, a life worth living for their ill child and family balance. These aims resulted in four tasks that parents performed: providing basic and complex care, organising good quality care and treatment, making sound decisions while managing risks and organising a good family life. CONCLUSION Parents need early explanation from professionals about balancing between their aims and the related tasks to get a grip on their situation and to prevent becoming overburdened. What is Known: • In paediatric palliative care, parents are confronted with increasing caregiving demands. • Parenting is often approached from the perspective of stress. What is New: • Parents strive for three aims: controlled symptoms and controlled disease, a life worth living for their child and family balance. • Parents perform four tasks: providing basic and complex care, organising good quality care, making decisions while managing risks and organising a good family life. • Professionals need insight into the parents' aims and tasks from the parental perspective to strengthen parents' resilience.
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Affiliation(s)
- Lisa M. Verberne
- 0000000090126352grid.7692.aDepartment of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Marijke C. Kars
- 0000000090126352grid.7692.aDepartment of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Antoinette Y. N. Schouten-van Meeteren
- 0000000404654431grid.5650.6Department of Pediatric Oncology, Emma Children’s Hospital, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Diederik K. Bosman
- 0000000404654431grid.5650.6Department of Pediatrics, Emma Children’s Hospital, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Derk A. Colenbrander
- 0000000404654431grid.5650.6Department of Pediatrics, Emma Children’s Hospital, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Martha A. Grootenhuis
- 0000000404654431grid.5650.6Psychosocial Department, Emma Children’s Hospital, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Princess Máxima Center for Pediatric Oncology, Lundlaan 6, 3584 AE Utrecht, The Netherlands
| | - Johannes J. M. van Delden
- 0000000090126352grid.7692.aDepartment of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
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Marc-Antoine Berthod, Yannis Papadaniel, Nicole Brzak. Entre nous, le cancer : monde du travail et dynamiques familiales autour de l’enfant gravement malade. ENFANCES, FAMILLES, GÉNÉRATIONS 2016. [DOI: 10.7202/1038109ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lorsqu’un enfant tombe gravement malade, ses parents doivent réaménager leur mode de conciliation entre sphère privée et sphère professionnelle afin d’articuler au mieux travail, famille et soins. Cet article se fonde sur une recherche anthropologique menée en Suisse durant plus de trois ans auprès de parents, de proches, de collègues et de supérieurs hiérarchiques pour analyser les incidences que ces réaménagements produisent tant sur le monde du travail que sur les dynamiques familiales. S’appuyant sur l’exemple helvétique où les personnes salariées n’ont droit qu’à trois jours pour organiser la garde de leur enfant malade, il documente les pouvoirs discrétionnaires qui sont à l’œuvre entre employés et employeurs dans ces situations, ce qui induit une gestion au cas par cas. Ce constat, loin de se limiter aux pays qui n’ont pas mis en place de mesures légales de soutien à ces parents, dénote une faille des arrangements contemporains entre État, entreprises et familles dans la prise en charge des enfants, en particulier ceux qui sont malades du cancer ; cette faille s’opère au détriment de ces parents.
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Affiliation(s)
- Marc-Antoine Berthod
- Professeur d’anthropologieDomaine travail socialHaute école spécialisée de Suisse
| | - Yannis Papadaniel
- Anthropologue, Institut des sciences socialesFaculté des sciences sociales et politiquesUniversité de
| | - Nicole Brzak
- Chargée de rechercheDomaine travail socialHaute école spécialisée de Suisse
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Experiences of Parents and General Practitioners with End-of-Life Care in Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2016; 5:64-8. [DOI: 10.1089/jayao.2015.0009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Virdun C, Brown N, Phillips J, Luckett T, Agar M, Green A, Davidson PM. Elements of optimal paediatric palliative care for children and young people: An integrative review using a systematic approach. Collegian 2015; 22:421-31. [DOI: 10.1016/j.colegn.2014.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hung YN, Liu TW, Tang ST. Determinants of Hospital Death for Taiwanese Pediatric Cancer Decedents, 2001-2010. J Pain Symptom Manage 2015; 50:685-92. [PMID: 26162507 DOI: 10.1016/j.jpainsymman.2015.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/22/2015] [Accepted: 06/01/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT Factors influencing pediatric cancer patients' place of death may have evolved with advances in medical and hospice care since earlier studies were done. OBJECTIVES To comprehensively analyze factors associated with hospital death in an unbiased population of pediatric cancer patients in Taiwan. METHODS This was a retrospective cohort study using administrative data for 1603 Taiwanese pediatric cancer patients who died in 2001-2010. Place of death was hypothesized to be associated with 1) patient sociodemographics and disease characteristics, 2) primary physician's specialty, 3) characteristics and health care resources at both the hospital and regional levels, and 4) historical trends. RESULTS Most Taiwanese pediatric cancer patients (87.4%) died in an acute care hospital. The probability of dying in hospital increased slightly over time, reaching significance only in 2009 (adjusted odds ratio [AOR], 95% CI: 2.84 [1.32-6.11]). Children were more likely to die in an acute care hospital if they resided in the most urbanized area, were diagnosed with leukemia or lymphoma (2.32 [1.39-3.87]), and received care from a pediatrician (1.58 [1.01-2.47]) in a nonprofit proprietary hospital (1.50 [1.01-2.24]) or large hospital, reaching significance for the third quartile (2.57 [1.28-5.18]) of acute care hospital beds. CONCLUSION Taiwanese pediatric cancer patients predominantly died in an acute care hospital with a slightly increasing trend of shifting place of death from home to hospital. Propensity for hospital death was determined by residential urbanization level, diagnosis, primary physician's specialty, and the primary hospital's characteristics and health care resources. Clinical interventions and health policies should ensure that resources are allocated to allow pediatric cancer patients to die in the place they and their parents prefer to achieve a good death and promote their parents' bereavement adjustment.
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Affiliation(s)
- Yen-Ni Hung
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan, Republic of China
| | - Siew Tzuh Tang
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, Republic of China.
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Parenting in the face of childhood life-threatening conditions: The ordinary in the context of the extraordinary. Palliat Support Care 2015; 14:187-98. [PMID: 26462446 DOI: 10.1017/s1478951515000905] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Uncovering what it means to be a parent during the extraordinary time of a child's life-threatening condition (LTC) is important for understanding family goals, decision making, and the work of parenting within this context. METHOD Qualitative descriptive methods were employed to describe the everyday experience of parenting both children who have an LTC and their healthy siblings. RESULTS Some 31 parents of 28 children with an LTC who have healthy siblings participated in our study. Four themes emerged from the data that describe a parental desire to maintain emotional connection with all of their children, how parents use cues from their children to know them better and develop parenting strategies, how parents change as a result of caring for a child with an LTC, and how they strive to decrease suffering for all of their children. SIGNIFICANCE OF RESULTS The findings of our study have implications for clinical practice, family-focused research, and health policy pertaining to families of children with life-threatening conditions.
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Remedios C, Willenberg L, Zordan R, Murphy A, Hessel G, Philip J. A pre-test and post-test study of the physical and psychological effects of out-of-home respite care on caregivers of children with life-threatening conditions. Palliat Med 2015; 29:223-30. [PMID: 25634634 DOI: 10.1177/0269216314560008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Respite services are recommended as an important support for caregivers of children with life-threatening conditions. However, the benefits of respite have not been convincingly demonstrated through quantitative research. AIM To determine the impact of out-of home respite care on levels of fatigue, psychological adjustment, quality of life and relationship satisfaction among caregivers of children with life-threatening conditions. DESIGN A mixed-methods, pre-test and post-test study SETTING/PARTICIPANTS A consecutive sample of 58 parental caregivers whose children were admitted to a children's hospice for out-of-home respite over an average of 4 days. RESULTS Caregivers had below-standard levels of quality of life compared to normative populations. Paired t-tests demonstrated that caregivers' average psychological adjustment scores significantly improved from pre-respite (mean = 13.9, standard error = 0.71) to post-respite (mean = 10.7, standard error = 1); p < 0.001, 95% confidence interval: 1.25-5.11). Furthermore, caregivers' average fatigue scores significantly improved from pre-respite (mean = 14.3, standard error = 0.85) to post-respite (mean = 10.9, standard error = 1.01; p < 0.001, 95% confidence interval: 1.69-7.94), and caregivers' average mental health quality of life scores significantly improved from pre-respite (mean = 44.2, standard error = 1.8) to post-respite (mean = 49.1, standard error = 1.6; p < 0.01, 95% confidence interval: -9.56 to 0.36). Qualitative data showed caregivers sought respite for relief from intensive care provision and believed this was essential to their well-being. CONCLUSION Findings indicate the effectiveness of out-of-home respite care in improving the fatigue and psychological adjustment of caregivers of children with life-threatening conditions. Study outcomes inform service provision and future research efforts in paediatric palliative care.
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Affiliation(s)
- Cheryl Remedios
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Lisa Willenberg
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Rachel Zordan
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, VIC, Australia
| | | | | | - Jennifer Philip
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, VIC, Australia
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Widger K, Tourangeau AE, Steele R, Streiner DL. Initial development and psychometric testing of an instrument to measure the quality of children's end-of-life care. BMC Palliat Care 2015; 14:1. [PMID: 25620884 PMCID: PMC4305389 DOI: 10.1186/1472-684x-14-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/05/2015] [Indexed: 11/17/2022] Open
Abstract
Background The field of pediatric palliative care is hindered by the lack of a well-defined, reliable, and valid method for measuring the quality of end-of-life care. Methods The study purpose was to develop and test an instrument to measure mothers’ perspectives on the quality of care received before, at the time of, and following a child’s death. In Phase 1, key components of quality end-of-life care for children were synthesized through a comprehensive review of research literature. These key components were validated in Phase 2 and then extended through focus groups with bereaved parents. In Phase 3, items were developed to assess structures, processes, and outcomes of quality end-of-life care then tested for content and face validity with health professionals. Cognitive testing was conducted through interviews with bereaved parents. In Phase 4, bereaved mothers were recruited through 10 children’s hospitals/hospices in Canada to complete the instrument, and psychometric testing was conducted. Results Following review of 67 manuscripts and 3 focus groups with 10 parents, 141 items were initially developed. The overall content validity index for these items was 0.84 as rated by 7 health professionals. Based on feedback from health professionals and cognitive testing with 6 parents, a 144-item instrument was finalized for further testing. In Phase 4, 128 mothers completed the instrument, 31 of whom completed it twice. Test-retest reliability, internal consistency, and construct validity were demonstrated for six subscales: Connect With Families, Involve Parents, Share Information With Parents, Share Information Among Health Professionals, Support Parents, and Provide Care at Death. Additional items with content validity were grouped in four domains: Support the Child, Support Siblings, Provide Bereavement Follow-up, and Structures of Care. Forty-eight items were deleted through psychometric testing, leaving a 95-item instrument. Conclusions There is good initial evidence for the reliability and validity of this new quality of end-of-life care instrument as a mechanism for evaluative feedback to health professionals, health systems, and policy makers to improve children’s end-of-life care. Electronic supplementary material The online version of this article (doi:10.1186/1472-684X-14-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130-155 College Street, Toronto, ON M5T 1P8 Canada
| | - Ann E Tourangeau
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130-155 College Street, Toronto, ON M5T 1P8 Canada
| | - Rose Steele
- York University, 4700 Keele Street, Toronto, ON M3J 1P3 Canada
| | - David L Streiner
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, 100 West 5th, Hamilton, ON L8N 3K7 Canada ; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
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Nakawesi J, Kasirye I, Kavuma D, Muziru B, Businge A, Naluwooza J, Kabunga G, Karamagi Y, Akankwasa E, Odiit M, Mukasa B. Palliative care needs of HIV exposed and infected children admitted to the inpatient paediatric unit in Uganda. Ecancermedicalscience 2014; 8:489. [PMID: 25624870 PMCID: PMC4303617 DOI: 10.3332/ecancer.2014.489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Indexed: 11/23/2022] Open
Abstract
Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-limiting conditions and also for their families. It is a response to the suffering and unique needs of such children. Globally there is limited documented data available on the palliative care needs of children with HIV. A retrospective review of data of all the HIV exposed and positive children who were admitted to the ward from January to December 2012 was done to document their palliative care needs. A total of 243 children were admitted to the ward during the stated period. Of these, 139 (57.2%) were female and 104 (42.8%) were male. Among them 131 (54%) were aged five years and below whereas 112 (46%) were above five years. Some of the identified palliative care needs documented included physical needs: pneumonia 46 (19%), severe acute malnutrition 38 (16%), mild and moderate acute malnutrition 23 (9.6%), and respiratory tract infections 22 (9.3%). Social needs: poor social support 21 (41%), financial instability 16 (31%), and child neglect 4 (8%). Psychological needs: antiretroviral treatment (ART) counselling 127 (36%), HIV counselling and testing for the child and family 63 (18%), adherence support 53 (15%), and others 11 (3%). Spiritual needs: discontinuing ART because of belief in spiritual healing 18 (81%), loss of hope because of severe ill health 1 (5%), and others 3 (14%). These results emphasise the need for palliative care in children with HIV even in the era of ART. The needs identified are in keeping with studies done elsewhere and are similar to the palliative care needs of children with other life-limiting illnesses such as cancer.
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Affiliation(s)
| | - Ivy Kasirye
- Mildmay Uganda, PO Box 24985, Kampala, Uganda
| | | | | | | | | | | | | | | | - Mary Odiit
- Mildmay Uganda, PO Box 24985, Kampala, Uganda
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Melin-Johansson C, Axelsson I, Jonsson Grundberg M, Hallqvist F. When a child dies: parents' experiences of palliative care-an integrative literature review. J Pediatr Nurs 2014; 29:660-9. [PMID: 25038375 DOI: 10.1016/j.pedn.2014.06.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 05/24/2014] [Accepted: 06/20/2014] [Indexed: 11/19/2022]
Abstract
The aim of this integrative review was to increase knowledge about parents' experiences of palliative care when their child is dying or has died due to illness using Whittemore and Knafl (2005) analysis process. Computerized databases were used to search the literature. Nine papers met the inclusion criteria. The analysis resulted in five categories: genuine communication, sincere relationships, respect as an expert, and alleviation of suffering and need of support, including 15 subcategories. Health professionals need education to provide high-quality pediatric palliative care. They especially need training concerning existential issues, and further studies need to be performed.
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Affiliation(s)
| | - Inge Axelsson
- Department of Nursing Sciences, Mid Sweden University, Studiegången 1, Östersund, Sweden; Child and Adolescent Medicine, Östersund hospital, Kyrkgatan 16, Östersund, Sweden
| | | | - Frida Hallqvist
- Child and Adolescent Medicine, Östersund hospital, Kyrkgatan 16, Östersund, Sweden
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Abstract
OBJECTIVE To determine how to improve care for families by obtaining their advice to health care providers and researchers after a child's death from cancer. DESIGN Families with a surviving sibling (age, 8 to 17 y) were recruited from cancer registries at 3 hospitals in the United States and Canada 3 to 12 months (M=10.4, SD=3.5) after the child's death. SETTING Data were collected in the home. PARTICIPANTS Participants (N=99) included 36 mothers, 24 fathers, and 39 siblings from 40 families. OUTCOME MEASURES Each participant completed a qualitative interview that was audio recorded, transcribed, and coded for thematic content. FINDINGS Five major themes included the need for: (a) improved communication with the medical team, (b) more compassionate care, (c) increased access to resources, (d) ongoing research, and (e) offering praise. Interwoven within the 5 themes was a subtheme of continuity of care. CONCLUSIONS Many participants were pleased with the care the child with cancer received, but others noted areas in need of improvement, particularly medical communication and continuity of care. Additional research is needed to inform interventions to improve services for families of children with life-limiting conditions.
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Arabiat DH, Altamimi A. Unmet care needs of parents of children with cancer in Jordan: implications for bed-side practice. J Clin Nurs 2012; 22:531-9. [PMID: 23240933 DOI: 10.1111/jocn.12122] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2012] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the perceived care needs of parents of children with cancer in Jordan. (1) What are the parents' priority caring needs; (2) to what extent these needs are met by the healthcare team members; (3) the parents' need for further information (4) and whether socio-demographic, disease and treatment variables predict parents' needs for further information. BACKGROUND Providing support for families caring for a child with a long-term illness has been recognised all through literature, yet studies focusing on parent needs are lacking. DESIGN Descriptive survey. METHODS A total of 98 parents from a tertiary oncology hospital in metropolitan area in Amman completed the Arabic Family Inventory of Needs-Pediatric II. RESULTS Most of the 17 needs measured by the Family Inventory of Needs-Pediatric II were considered important. Only 78% of parents needs were met by the healthcare professionals; yet, the results clearly highlighted the importance of informing parents about the child's illness, treatment and outcome. The socio-demographic variables were not significant predictors for the family needs for further information, with two major exceptions; parents with lower level of education and parents of children undergoing bone marrow transplantation or surgery. CONCLUSIONS The needs of parents vary from family to another, and healthcare professionals must become familiar to these needs and acquire the skills to direct their interventions more appropriately. The Family Inventory of Needs-Pediatric II may be a useful adjunct in assessing the parents' needs for care and for information, as well as the quality of care services provided. RELEVANCE TO CLINICAL PRACTICE Priority needs should be central in the daily care of these families and support programmes should be adopted in Jordan for planning and developing the system of care for these families, as well as their children.
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Affiliation(s)
- Diana H Arabiat
- Department of Maternal and Child Health Nursing, Faculty of Nursing, University of Jordan, Amman, Jordan.
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31
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Miller KS, Vannatta K, Vasey M, Yeager N, Compas BE, Gerhardt CA. Health literacy variables related to parents' understanding of their child's cancer prognosis. Pediatr Blood Cancer 2012; 59:914-8. [PMID: 22434779 DOI: 10.1002/pbc.24146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 02/27/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Obtaining an accurate understanding of a child's cancer prognosis can help parents make informed decisions about treatment. Research has shown that parents tend to overestimate their child's cancer prognosis relative to physicians. Thus, we examined whether the content of physician communication, parent sources of medical information, and parent demographic factors affected the association between oncologist and parent estimates of a child's cancer prognosis. PROCEDURE Families were recruited 3-8 weeks after a child's new diagnosis or relapse of cancer. Parents (77 mothers; 42 fathers) completed questionnaires regarding their sources of medical information, age, and education. The child's oncologist reported on the content of their communication with parents regarding prognosis. Parents and oncologists estimated the child's chance of 5-year survival using a visual-analogue scale. RESULTS Mothers and fathers reported a more favorable prognosis for their child, which was on average about 30% higher than oncologists. Time since diagnosis was correlated with less discrepancy between physician and mother prognosis ratings, with a similar trend noted for fathers. Agreement between oncologists and parents was better for younger fathers, but it was unrelated to physician communication, sources of medical information, or other demographic factors. CONCLUSIONS Fathers' age may be important to their understanding of their child's cancer prognosis, but we did not find support for other factors related to prognosis literacy. Given the homogeneity of our sample, future research should assess differences in parents' prognosis knowledge across cancer diagnosis, race, ethnicity, and socioeconomic status (SES), which may aid in developing interventions to improve parent understanding.
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Affiliation(s)
- Kimberly S Miller
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205-2696, USA
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Classen CF. Pediatric palliative care - The role of the patient’s family. World J Clin Pediatr 2012; 1:13-9. [PMID: 25254162 PMCID: PMC4145639 DOI: 10.5409/wjcp.v1.i3.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 08/15/2012] [Accepted: 09/23/2012] [Indexed: 02/06/2023] Open
Abstract
Whenever a child suffers, what does she or he cry Mother! What does that mean Palliative care is not a type of medicine based on objective evidence or statistics. The only relevant standard is the very individual quality of life. Nobody knows better what this actually means but the patient himself. Thus, if the mother’s presence has the biggest impact on a child’s wellbeing or comfort, she herself is the most valuable treatment modality. In nearly every publication dealing with pediatric palliative care, it is stated that palliative care does not only imply care for the sick child but also for the parents and the whole family. Usually, it is pointed out that they are suffering a lot as well. But helping them does also mean: helping the child! Of course, it means higher efforts, obligations and costs for the healthcare system. Thus the justification of this effort may be put in question; in particular, it may be argued that disorders of family members should, if necessary, be treated as such. But this is only one side of the coin! In the following, we will, based on published literature, look at the role of mothers, fathers, and siblings for the wellbeing of an ill or even dying child. As a conclusion, we will learn that if it is our task to give a dying child the best available care, helping mothers, fathers and sibling is an inevitable part of it.
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Affiliation(s)
- Carl Friedrich Classen
- Carl Friedrich Classen, Oncology/Hematology Unit, University Children's Hospital, D-18057 Rostock, Germany
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Kumar SP. Reporting of pediatric palliative care: a systematic review and quantitative analysis of research publications in palliative care journals. Indian J Palliat Care 2012; 17:202-9. [PMID: 22347775 PMCID: PMC3276817 DOI: 10.4103/0973-1075.92337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
CONTEXT Pediatric palliative care clinical practice depends upon an evidence-based decision-making process which in turn is based upon current research evidence. AIMS This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting characteristics of articles on pediatric palliative care. SETTINGS AND DESIGN This was a systematic review of palliative care journals. MATERIALS AND METHODS Twelve palliative care journals were searched for articles with "paediatric" or "children" in titles of the articles published from 2006 to 2010. The reporting rates of all journals were compared. The selected articles were categorized into practice, education, research, and administration, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original articles' category was further classified according to study designs. STATISTICAL ANALYSIS USED Descriptive analysis using frequencies and percentiles was done using SPSS for Windows, version 11.5. RESULTS The overall reporting rate among all journals was 2.66% (97/3634), and Journal of Hospice and Palliative Nursing (JHPN) had the highest reporting rate of 12.5% (1/8), followed by Journal of Social Work in End-of-Life and Palliative Care (JSWELPC) with a rate of 7.5% (5/66), and Journal of Palliative Care (JPC) with a rate of 5.33% (11/206). CONCLUSIONS The overall reporting rate for pediatric palliative care articles in palliative care journals was very low and there were no randomized clinical trials and systematic reviews found. The study findings indicate a lack of adequate evidence base for pediatric palliative care.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Kremeike K, Eulitz N, Jünger S, Sander A, Geraedts M, Reinhardt D. Paediatric palliative home care in areas of Germany with low population density and long distances: a questionnaire survey with general paediatricians. BMC Res Notes 2012; 5:498. [PMID: 22967691 PMCID: PMC3532334 DOI: 10.1186/1756-0500-5-498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 09/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2007, the patient's right to specialised palliative home care became law in Germany. However, childhood palliative care in territorial states with low patient numbers and long distances requires adapted models to ensure an area-wide maintenance. Actually, general paediatricians are the basic care providers for children and adolescents. They also provide home care. The aim of this study was to improve the knowledge about general paediatrician's involvement in and contribution to palliative care in children. FINDINGS To evaluate the current status of palliative home care provided by general paediatricians and their cooperation with other paediatric palliative care providers, a questionnaire survey was disseminated to general paediatricians in Lower Saxony, a German federal state with nearly eight million inhabitants and a predominantly rural infrastructure. Data analysis was descriptive.One hundred forty one of 157 included general paediatricians completed the questionnaire (response rate: 89.8%). A total of 792 children and adolescents suffering from life-limiting conditions were cared for by these general paediatricians in 2008. Severe cerebral palsy was the most prevalent diagnosis. Eighty-nine per cent of the general paediatricians stated that they had professional experience with paediatric palliative care.Collaboration of general paediatricians and other palliative care providers was stated as not well developed. The support by a specialised team including 24-hour on-call duty and the intensification of educational programs were emphasised. CONCLUSIONS The current regional infrastructure of palliative home care in Lower Saxony can benefit from the establishment of a coordinated network of palliative home care providers.
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Affiliation(s)
- Kerstin Kremeike
- Netzwerk für die Versorgung schwerkranker Kinder und Jugendlicher e.V, Carl-Neuberg-Straße 1, 30625 Hannover, 30625, Germany
- Department of Paediatric Haematology and Oncology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, 30625, Germany
| | - Nina Eulitz
- Netzwerk für die Versorgung schwerkranker Kinder und Jugendlicher e.V, Carl-Neuberg-Straße 1, 30625 Hannover, 30625, Germany
| | - Saskia Jünger
- Department of Palliative Medicine, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, 53127, Germany
| | - Annette Sander
- Department of Paediatric Haematology and Oncology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, 30625, Germany
| | - Max Geraedts
- Institute for Health Systems Research, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, 58448, Germany
| | - Dirk Reinhardt
- Department of Paediatric Haematology and Oncology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, 30625, Germany
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Bousso RS, Misko MD, Mendes-Castillo AMC, Rossato LM. Family management style framework and its use with families who have a child undergoing palliative care at home. JOURNAL OF FAMILY NURSING 2012; 18:91-122. [PMID: 22223493 DOI: 10.1177/1074840711427038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Palliative care settings in many countries acknowledge families as their prime focus of care, but in Brazil, to date, researchers have devoted scant attention to that practice setting. In this article, we report the findings of a study that explored how families define and manage their lives when they have a child or adolescent undergoing palliative care at home. Data included individual semistructured interviews with 14 family members of 11 different families. Interviews were transcribed and the coding procedure featured qualitative content analysis methods. The deductive coding was based on the major components of the Family Management Style Framework and the eight dimensions comprising these components. The analysis provides insight into families' daily practices and problems inherent in managing their everyday lives that are encountered when they have a child in palliative care. The article features discussion of implications for the palliative care related development of family nursing practice.
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End of life care in adolescents and young adults with cancer: experience of the adolescent unit of the Institut Gustave Roussy. Eur J Cancer 2011; 47:2735-41. [PMID: 22055005 DOI: 10.1016/j.ejca.2011.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 08/04/2011] [Accepted: 09/02/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cancer is the third leading cause of death in adolescents and young adults (AYA). Little is known, however, about how end-of-life unfolds for those who die of progressive disease. In order to better evaluate the specific needs of these patients, we performed this study providing baseline information about end-of-life care patterns for AYA in our department. PATIENTS A standardised form was used to collect data concerning all 45 patients treated for a malignancy in the Paediatric and Adolescent Oncology Department at the Gustave Roussy Institute, and who had died of progressive disease above 13 years of age, over a two-year period. RESULTS The main diagnoses were sarcomas and brain tumours. Previous cancer-directed treatment included a median of 3 different chemotherapy regimens, high-dose chemotherapy with haematopoietic stem cell support for 13% and radiotherapy for 40%. One in every four patients had been enrolled in a clinical trial at diagnosis. Median survival was 18 months after the diagnosis and 7 months after the first relapse/progression. During the last week of life, the median number of physical symptoms was 4, mostly pain and dyspnoea. Frequent psychological symptoms were sadness, anxiety, fear and guilt. End-of-life care included transfusions, artificial nutrition, corticosteroids, pain control, sedation but also palliative chemotherapy. The median time spent in hospital during the last month of life was 16 days. Most patients had died in hospital. CONCLUSIONS The terminally ill adolescent displays notable challenges to care providers and requires a holistic approach with the help of a multidisciplinary team.
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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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Knapp C, Woodworth L, Wright M, Downing J, Drake R, Fowler-Kerry S, Hain R, Marston J. Pediatric palliative care provision around the world: a systematic review. Pediatr Blood Cancer 2011; 57:361-8. [PMID: 21416582 DOI: 10.1002/pbc.23100] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 01/27/2011] [Indexed: 11/05/2022]
Abstract
Pediatric palliative care is recommended by many organizations. Yet, there is no information available on the progress that has been made in providing this care or the gaps that still exist in provision around the world. We conducted a systematic review to address this gap in knowledge. The systematic review identified 117 peer-reviewed and non-peer reviewed resources. Based on this information, each country was assigned a level of provision; 65.6% of countries had no known activities, 18.8% had capacity building activities, 9.9% had localized provision, and 5.7% had provision that was reaching mainstream providers. Understanding the geographic distribution in the level of provision is crucial for policy makers and funders.
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Affiliation(s)
- Caprice Knapp
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
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Tzuh Tang S, Hung YN, Liu TW, Lin DT, Chen YC, Wu SC, Hsia Hsu T. Pediatric End-of-Life Care for Taiwanese Children Who Died As a Result of Cancer From 2001 Through 2006. J Clin Oncol 2011; 29:890-4. [DOI: 10.1200/jco.2010.32.5639] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patterns of aggressive end-of-life (EOL) care have not been extensively explored in a pediatric cancer population, especially outside Western countries. The purpose of this population-based study was to examine trends in aggressive pediatric EOL cancer care in Taiwan. Methods Retrospective cohort study that used administrative data among 1,208 pediatric cancer decedents from 2001 through 2006. Results Taiwanese pediatric cancer patients who died in 2001 through 2006 received aggressive EOL care. The majority of these patients in their last month of life continued to receive chemotherapy (52.5%), used intensive care (57.0%), underwent intubation (40.9%), underwent mechanical ventilation (48.2%), or spent greater than 14 days (69.5%) in hospital, and they died in an acute care hospital (78.8%). Of these pediatric cancer patients, one in four received cardiopulmonary resuscitation in the month before they died, and only 7.2% received hospice care. Among those who received hospice care, 21.8% started such care within the last 3 days of life. This pattern of aggressive EOL care did not change over the study period except for significantly decreased intubation in the last month of life. Conclusion Continued chemotherapy and heavy use of life-sustaining treatments in the last month of life coupled with lack of hospice care to support Taiwanese pediatric cancer patients dying at home may lead to multiple unplanned health care encounters, prolonged hospitalization at EOL, and eventual death in an acute care hospital for the majority of these patients. Future research should design interventions that enable Taiwanese pediatric cancer patients to receive EOL care that best meets the individual or the parental needs and preferences.
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Affiliation(s)
- Siew Tzuh Tang
- From the Chang Gung University, Kwei-Shan, Tao-Yuan; Institute of Health and Welfare Policy, National Yang-Ming University; National Taiwan University Hospital; Bureau of Health Promotion, Department of Health, Taipei; National Institute of Cancer Research, National Health Research Institute, Zhunan; Hung Kuang University, Taichung, Taiwan
| | - Yen-Ni Hung
- From the Chang Gung University, Kwei-Shan, Tao-Yuan; Institute of Health and Welfare Policy, National Yang-Ming University; National Taiwan University Hospital; Bureau of Health Promotion, Department of Health, Taipei; National Institute of Cancer Research, National Health Research Institute, Zhunan; Hung Kuang University, Taichung, Taiwan
| | - Tsang-Wu Liu
- From the Chang Gung University, Kwei-Shan, Tao-Yuan; Institute of Health and Welfare Policy, National Yang-Ming University; National Taiwan University Hospital; Bureau of Health Promotion, Department of Health, Taipei; National Institute of Cancer Research, National Health Research Institute, Zhunan; Hung Kuang University, Taichung, Taiwan
| | - Dong-Tsamn Lin
- From the Chang Gung University, Kwei-Shan, Tao-Yuan; Institute of Health and Welfare Policy, National Yang-Ming University; National Taiwan University Hospital; Bureau of Health Promotion, Department of Health, Taipei; National Institute of Cancer Research, National Health Research Institute, Zhunan; Hung Kuang University, Taichung, Taiwan
| | - Yueh-Chih Chen
- From the Chang Gung University, Kwei-Shan, Tao-Yuan; Institute of Health and Welfare Policy, National Yang-Ming University; National Taiwan University Hospital; Bureau of Health Promotion, Department of Health, Taipei; National Institute of Cancer Research, National Health Research Institute, Zhunan; Hung Kuang University, Taichung, Taiwan
| | - Shiao-Chi Wu
- From the Chang Gung University, Kwei-Shan, Tao-Yuan; Institute of Health and Welfare Policy, National Yang-Ming University; National Taiwan University Hospital; Bureau of Health Promotion, Department of Health, Taipei; National Institute of Cancer Research, National Health Research Institute, Zhunan; Hung Kuang University, Taichung, Taiwan
| | - Tsui Hsia Hsu
- From the Chang Gung University, Kwei-Shan, Tao-Yuan; Institute of Health and Welfare Policy, National Yang-Ming University; National Taiwan University Hospital; Bureau of Health Promotion, Department of Health, Taipei; National Institute of Cancer Research, National Health Research Institute, Zhunan; Hung Kuang University, Taichung, Taiwan
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