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Johnson A, Ali R, An E, Wilson C, Widger K. Children's and adolescents' perspectives on living with advanced cancer: A meta-synthesis of qualitative research. Qual Life Res 2024:10.1007/s11136-024-03688-y. [PMID: 38795197 DOI: 10.1007/s11136-024-03688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE The quality of life (QOL) experiences of children and adolescents living with advanced cancer have been under-explored. Enhancing QOL for this population is a dominant goal of their healthcare yet, there has been little research identifying aspects that impact their QOL. The purpose of this meta-synthesis was to identify themes of QOL informed from the voices of children and adolescents living with advanced cancer. METHODS This meta-synthesis utilized meta-ethnography to synthesize data from individual studies in order to develop new conceptual understanding of what is important to children and adolescents about their lives when living with advanced cancer. RESULTS Our analysis identified themes of QOL relevant to children and adolescents with advanced cancer: (1) feeling supported and wanting to support others; (2) re-establishing normal; (3) suffering and emotional distress; (4) new perspectives; (5) maintaining autonomy; and (6) awareness of time. These themes differed from more traditional dimensions of QOL often applied to children and adolescents with cancer. CONCLUSION This research is novel as its developed themes originated from the direct voices and expressed perspectives of children and adolescents living with advanced cancer. This is a significant initial step toward both understanding QOL in this specific context and the measurement of QOL for this population.
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Affiliation(s)
- Andrea Johnson
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.
- The Hospital for Sick Children, Toronto, ON, Canada.
| | - Ridwaanah Ali
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
| | - Ekaterina An
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Carolyn Wilson
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
- Scarborough Health Network, Scarborough, ON, Canada
| | - Kimberley Widger
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
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Scott HM, Coombes L, Braybrook D, Harðardóttir D, Roach A, Bristowe K, Bluebond-Langner M, Fraser LK, Downing J, Farsides B, Murtagh FEM, Ellis-Smith C, Harding R. What are the anticipated benefits, risks, barriers and facilitators to implementing person-centred outcome measures into routine care for children and young people with life-limiting and life-threatening conditions? A qualitative interview study with key stakeholders. Palliat Med 2024; 38:471-484. [PMID: 38481003 PMCID: PMC11025304 DOI: 10.1177/02692163241234797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND There is a growing evidence-base underpinning implementation of person-centred outcome measures into adult palliative care. However evidence on how best to achieve this with children facing life-threatening and life-limiting conditions is limited. AIM To identify the anticipated benefits, risks, barriers and facilitators to implementing person-centred outcome measures for children with life-limiting and life-threatening conditions. DESIGN Cross-sectional qualitative semi-structured interview study with key stakeholders analysed using Framework analysis informed by the adapted-Consolidated Framework for Implementation Research. SETTING/PARTICIPANTS A total of n = 26 children with life-limiting or life-threatening conditions, n = 40 parents/carers, n = 13 siblings and n = 15 health and social care professionals recruited from six hospitals and three children's hospices and n = 12 Commissioners of health services. RESULTS All participants were supportive of future implementation of person-centred outcome measures into care. Anticipated benefits included: better understanding of patient and family priorities, improved communication and collaborative working between professionals and families and standardisation in data collection and reporting. Anticipated risks included increased workload for staff and measures not being used as intended. Implementation barriers included: acceptability and usability of outcome measures by children; burden and capacity of parents/carers regarding completion; privacy concerns; and language barriers. Implementation facilitators included designing measures using language that is meaningful to children and families, ensuring potential benefits of person-centred outcome measures are communicated to encourage 'buy-in' and administering measures with known and trusted professional. CONCLUSIONS Implementation of person-centred outcome measures offer potential benefits for children with life-limiting and life-threatening conditions. Eight recommendations are made to maximise benefits and minimise risks in implementation.
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Affiliation(s)
- Hannah May Scott
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Lucy Coombes
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Debbie Braybrook
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Daney Harðardóttir
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Anna Roach
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
- University College London, London, UK
| | - Katherine Bristowe
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Myra Bluebond-Langner
- University College London, Louis Dundas Centre for Children’s Palliative Care, London, UK
- Rutgers University, Camden, NJ, USA
| | - Lorna K Fraser
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Julia Downing
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
- International Children’s Palliative Care Network, Kampala, Uganda
| | - Bobbie Farsides
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Fliss EM Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Clare Ellis-Smith
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Richard Harding
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
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Wang Y, Ferreira E, Savageau J, Beitman A, Young M, Gabovitch E, Merriam G, Jozan A, Padgett K, Bateman S. Community-Based Pediatric Palliative Care: How Services Support Children's and Families' Quality of Life. J Palliat Med 2023; 26:1634-1643. [PMID: 37972058 DOI: 10.1089/jpm.2023.0147] [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] [Indexed: 11/19/2023] Open
Abstract
Background: The Massachusetts Department of Public Health's Pediatric Palliative Care Network (PPCN) provides Community-Based Pediatric Palliative Care (CBPPC) to children with life-limiting conditions and their families. CBPPC services aim to improve children and families' quality of life (QOL). Objectives: To identify perceived domains of QOL important for children and families and to understand whether and how CBPPC supports QOL. Design: A community-based participatory research framework was used to develop recruitment and data collection materials for eight focus groups and seven interviews. Collected data were transcribed and analyzed with an inductive approach. Setting/Subjects: A convenience sample of 33 PPCN caregivers, 20 providers, and seven key informants, including policymakers, community organizations, and hospital-based clinicians, were interviewed virtually in the United States. Measurements: Perceived QOL domains for children and families, respectively, and perceived impact of CBPPC services on QOL. Results: Reported QOL domains described as important for children were socialization/community integration and accessibility; expression/play; and physical wellness. Control or autonomy, psycho-emotional wellness, and self-care were identified as important for families. Clinical services were described as "integral to mental health" through offered spiritual support; advocacy in the community; and education. PPCN's integrative services were noted as distractions from pain and helped improve communication and bonding. Sibling support and bereavement care were also mentioned as impactful on QOL. Conclusions: Family-centered CBPPC was described as supportive of children's and families' QOL. Future studies should consider using population-based QOL measures, leveraging the QOL domains identified through this analysis and other outcome measures in a cost-effectiveness analysis.
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Affiliation(s)
- Ying Wang
- ForHealth Consulting, University of Massachusetts Chan Medical School, Shrewsbury, Massachusetts, USA
| | - Erica Ferreira
- ForHealth Consulting, University of Massachusetts Chan Medical School, Shrewsbury, Massachusetts, USA
| | - Judith Savageau
- Department of Family Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Aaron Beitman
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Megan Young
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Elaine Gabovitch
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Gail Merriam
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | | | - Kerri Padgett
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Scot Bateman
- Department of Pediatric Critical Care, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Papa S, Mercante A, Giacomelli L, Benini F. Pediatric Palliative Care: Insights into Assessment Tools andReview Instruments. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1406. [PMID: 37628404 PMCID: PMC10453330 DOI: 10.3390/children10081406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
The proper assessment of needs and outcomes in pediatric palliative care (PPC) is imperativeto ensure the best possible service to patients and families. However, given the multidimensionalnature of PPC, the low number of patients in this setting, the heterogeneity of diseases, the presenceof cognitive impairment in many patients, and the physiological development of children, outcomescan be complex and difficult to measure. Consequently, in this context, the use of standardizedand validated tools to assess the needs of children and families, to assess symptom severity, andto estimate the quality of PPC service represent a current need. Even if efforts have been made tostandardize approaches and tools for palliative care in adults, to our knowledge, a similar comprehensiveassessment of PPC has not yet been conducted to date. This narrative review provides anoverview and discusses the evaluation of tools currently applied in PPC, with an educational intentfor healthcare providers. We found that several instruments are available to assess different dimensionsof PPC. We proposed a classification into eligibility tools, patient and family needs assessmenttools, and care assessment tools. At present, two main eligibility tools exist, the PaPaS Scale and theACCAPED Scale questionnaire. Most of the tools for patient and family needs assessment have notbeen specifically validated in the PPC setting, and many may be more readily applied in researchsettings rather than in daily practice. Similar considerations can be made for tools assessing QoL,while tools assessing PPC service quality seem to be easily applied. Efforts to develop new specifictools and validate existing ones are undoubtedly advocated. However, in the patient's best interest,PPC healthcare providers should start using available tools, regardless of their validation status.
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Affiliation(s)
| | - Anna Mercante
- Child and Adolescent Neuropsychiatry Unit, Ospedale San Bortolo, 36100 Vicenza, Italy
| | | | - Franca Benini
- Pediatric Palliative Care, Pain Service, Department of Women’s and Children’s Health, University of Padua, 35122 Padua, Italy;
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Friedel M, Aujoulat I, Brichard B, Fonteyne C, Renard M, Degryse JM. The Quality of Life of Children Facing Life-Limiting Conditions and That of Their Parents in Belgium: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1167. [PMID: 37508664 PMCID: PMC10378398 DOI: 10.3390/children10071167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Paediatric palliative care (PPC) aims to improve children's quality of life, but this outcome is rarely measured in clinical care. PPC is provided in Belgium through six transmural paediatric liaison teams (PLTs) ensuring continuity of care for children with life-limiting or life-threatening conditions (LLC/LTC). This study aims to measure the quality of life (QoL) of children with LLC/LTC followed-up by PLTs and the QoL of their parents. METHODS During interviews, an original socio demographic questionnaire, the Children palliative outcome scale-version 2 (CPOS-2), the Fragebogen für Kinder und Jugendliche zur Erfassung der gesundheitsbezogenen Lebensqualität (KINDL) and the Quality of life in life-threatening Illness-Family caregiver (QOLLTI-F) were filled in by PLT members. Statistics were used to investigate significant differences between scores. Results were discussed and interpreted with six PLTs. RESULTS 73 children aged 1-18 were included in the study. Especially for items focusing on emotional items, children reported their QoL as higher than their parents did. The QoL scores were not significantly associated with the child's condition's severity. CONCLUSIONS This study provides, for the first time, an overview of the QoL of children and parents followed-up by PLTs in Belgium.
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Affiliation(s)
- Marie Friedel
- Department of Life Sciences and Medicine (DLSM), Faculty of Sciences, Technology and Medicine (FSTM), University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
- Institute of Health and Society (IRSS), Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Isabelle Aujoulat
- Faculty of Public Health, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Bénédicte Brichard
- Interface Pédiatrique, Department of Paediatric Oncology and Haematology, Cliniques Universitaires St Luc, 1200 Brussels, Belgium
| | - Christine Fonteyne
- Globul'home, Hôpital Universitaire des Enfants Reine Fabiola, 1020 Brussels, Belgium
| | - Marleen Renard
- Kites, Department of Paediatric Oncology and Haematology, Universitair Ziekenhuis Leuven, 3000 Leuven, Belgium
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
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6
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Boyden JY, Bogetz JF, Johnston EE, Thienprayoon R, Williams CSP, McNeil MJ, Patneaude A, Widger KA, Rosenberg AR, Ananth P. Measuring Pediatric Palliative Care Quality: Challenges and Opportunities. J Pain Symptom Manage 2023; 65:e483-e495. [PMID: 36736860 PMCID: PMC10106436 DOI: 10.1016/j.jpainsymman.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
Pediatric palliative care (PPC) programs vary widely in structure, staffing, funding, and patient census, resulting in inconsistency in service provision. Improving the quality of palliative care for children living with serious illness and their families requires measuring care quality, ensuring that quality measurement is embedded into day-to-day clinical practice, and aligning quality measurement with healthcare policy priorities. Yet, numerous challenges exist in measuring PPC quality. This paper provides an overview of PPC quality measurement, including challenges, current initiatives, and future opportunities. While important strides toward addressing quality measurement challenges in PPC have been made, including ongoing quality measurement initiatives like the Cambia Metrics Project, the PPC What Matters Most study, and collaborative learning networks, more work remains. Providing high-quality PPC to all children and families will require a multi-pronged approach. In this paper, we suggest several strategies for advancing high-quality PPC, which includes 1) considering how and by whom success is defined, 2) evaluating, adapting, and developing PPC measures, including those that address care disparities within PPC for historically marginalized and excluded communities, 3) improving the infrastructure with which to routinely and prospectively measure, monitor, and report clinical and administrative quality measures, 4) increasing endorsement of PPC quality measures by prominent quality organizations to facilitate accountability and possible reimbursement, and 5) integrating PPC-specific quality measures into the administrative, funding, and policy landscape of pediatric healthcare.
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Affiliation(s)
- Jackelyn Y Boyden
- Department of Family and Community Health, School of Nursing (J.Y.B.), University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Jori F Bogetz
- Department of Pediatrics, Division of Bioethics and Palliative Care (J.F.B.), University of Washington School of Medicine, Seattle, Washington, USA; Center for Clinical and Translational Research (J.F.B.), Seattle Children's Research Institute, Seattle, Washington, USA
| | - Emily E Johnston
- Department of Pediatrics, Division of Hematology and Oncology (E.E.J.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (E.E.J.), Birmingham, Alabama, USA
| | - Rachel Thienprayoon
- Department of Anesthesia, Division of Palliative Care, Cincinnati Children's Hospital Medical Center (R.T.), Cincinnati, Ohio, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center (R.T.), Cincinnati, Ohio, USA
| | - Conrad S P Williams
- Palliative Care Program and Department of Pediatrics (C.S.P.W.), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael J McNeil
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine (M.J.M.), Memphis, Tennessee, USA; St. Jude Children's Research Hospital, Division of Quality and Life and Palliative Care, Department of Oncology (M.J.M.), Memphis, Tennessee, USA
| | - Arika Patneaude
- Bioethics and Palliative Care, Seattle Children's Hospital (A.P.), Seattle, Washington, USA; University of Washington School of Social Work (A.P.), Seattle, Washington, USA; Treuman Katz Center for Pediatric Bioethics (A.P.), Seattle, Washington, USA
| | - Kimberley A Widger
- Lawrence S. Bloomberg Faculty of Nursing (K.A.W.), University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children (K.A.W.), Toronto, Ontario, Canada
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care (A.R.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School (A.R.S.), Boston, Massachusetts, USA
| | - Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine (P.A.), New Haven, Connecticut, USA; Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center (P.A.), New Haven, Connecticut, USA
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Quality of life in childhood advanced cancer: from conceptualization to assessment with the Advance QoL tool. BMC Palliat Care 2022; 21:138. [PMID: 35909112 PMCID: PMC9341040 DOI: 10.1186/s12904-022-01025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Advanced childhood cancer, a condition with no available cancer-focused treatment options, greatly impacts Quality of Life (QoL). We need appropriate assessment strategies to select adapted treatment targets, improve care and optimize communication. Our first goal was to identify the domains of patients’ QoL by combining for the first time the perspectives of patients and parents with previously collected reports in professionals. Our second goal was to develop a simple QoL assessment tool and optimize its format and content for use in the childhood advanced cancer population. Methods To identify QoL domains, we conducted qualitative interviews with 7 young patients (4 girls, 3 boys, aged 13 ± 4 yrs) and 9 parents (7 mothers, 2 fathers) from our treatment centre. We used inductive thematic content analysis to code and categorize respondents’ viewpoints. The first version of the tool (Advance QoL) was then drafted, and structured feedback was collected through interviews and a survey with 15 experts. We computed content validity indices. Results Apart from the physical, psychological, and social domains, participants insisted on four original themes: autonomy, pleasure, the pursuit of achievement, and the sense of feeling heard. This was in line with the categories found in a preliminary study involving professionals (PMID: 28137343). Experts evaluated the tool as clear, relevant, acceptable, and usable. They formulated recommendations on instructions, timeframe, and item formulations, which we implemented in the refined version. Conclusions Advance QoL is an innovative tool targeting key life domains in childhood advanced cancer. It is focused on preserved abilities and targets of care. The refined version is appropriate for adult respondents within families and professionals. Future studies will develop versions for young ages to collect the experience of patients themselves. This will open on future reliability, validity, sensitivity, and implementation studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01025-z.
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Zimmermann K, Simon M, Scheinemann K, Tinner Oehler EM, Widler M, Keller S, Fink G, Mitterer S, Gerber AK, von Felten S, Bergstraesser E. Specialised Paediatric PAlliativE CaRe: Assessing family, healthcare professionals and health system outcomes in a multi-site context of various care settings: SPhAERA study protocol. BMC Palliat Care 2022; 21:188. [PMID: 36324132 PMCID: PMC9628037 DOI: 10.1186/s12904-022-01089-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The number of children and adolescents living with life-limiting conditions and potentially in need for specialised paediatric palliative care (SPPC) is rising. Ideally, a specialised multiprofessional team responds to the complex healthcare needs of children and their families. The questions of, how SPPC is beneficial, for whom, and under what circumstances, remain largely unanswered in the current literature. This study's overall target is to evaluate the effectiveness of a SPPC programme in Switzerland with respect to its potential to improve patient-, family-, health professional-, and healthcare-related outcomes. METHODS This comparative effectiveness study applies a quasi-experimental design exploring the effectiveness of SPPC as a complex intervention at one treatment site in comparison with routine care provided in a generalised PPC environment at three comparison sites. As the key goal of palliative care, quality of life - assessed at the level of the patient-, the family- and the healthcare professional - will be the main outcome of this comparative effectiveness research. Other clinical, service, and economic outcomes will include patient symptom severity and distress, parental grief processes, healthcare resource utilisation and costs, direct and indirect health-related expenditure, place of death, and introduction of SPPC. Data will be mainly collected through questionnaire surveys and chart analysis. DISCUSSION The need for SPPC has been demonstrated through numerous epidemiological and observational studies. However, in a healthcare environment focused on curative treatment and struggling with limited resources, the lack of evidence contributes to a lack of acceptance and financing of SPPC which is a major barrier against its sustainability. This study will contribute to current knowledge by reporting individual and child level outcomes at the family level and by collecting detailed contextual information on healthcare provision. We hope that the results of this study can help guiding the expansion and sustainability of SPPC and improve the quality of care for children with life-limiting conditions and their families internationally. TRIAL REGISTRATION Registered prospectively on ClinicalTrials.gov on January 22, 2020. NCT04236180 PROTOCOL VERSION: Amendment 2, March 01, 2021.
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Affiliation(s)
- Karin Zimmermann
- Paediatric Palliative Care and Children's Research Center CRC, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Michael Simon
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Katrin Scheinemann
- grid.413357.70000 0000 8704 3732Division of Pediatric Oncology – Hematology and Palliative Care, Kinderspital, Kantonsspital Aarau AG, Tellstrasse 25, 5001 Aarau, Switzerland ,grid.449852.60000 0001 1456 7938Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland ,grid.422356.40000 0004 0634 5667Department of Pediatrics, McMaster Children’s Hospital and University, Hamilton, Canada
| | - Eva Maria Tinner Oehler
- grid.411656.10000 0004 0479 0855Division of Pediatric Heamtology and Oncology, Paediatric Palliative Care, Children’s Hospital, Inselspital, Universitätsspital Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Michèle Widler
- grid.412347.70000 0004 0509 0981Paediatric Palliative Care, Children’s Hospital Basel, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Simone Keller
- grid.411656.10000 0004 0479 0855Paediatric Palliative Care, Children’s Hospital, Inselspital, Universitätsspital Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Günther Fink
- grid.416786.a0000 0004 0587 0574Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Stefan Mitterer
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Anne-Kathrin Gerber
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Stefanie von Felten
- grid.6612.30000 0004 1937 0642Clinical Trial Unit, Department of Clinical Research, University of Basel, Basel, Switzerland ,grid.7400.30000 0004 1937 0650Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Eva Bergstraesser
- grid.412341.10000 0001 0726 4330Paediatric Palliative Care and Children’s Research Center CRC, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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Lee J, Kim MS, Kim CH, Moon YJ, Choi YH. Factors Associated With Quality of Life in Children Receiving Pediatric Palliative Care. J Pain Symptom Manage 2022; 63:395-403. [PMID: 34656653 DOI: 10.1016/j.jpainsymman.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Since pediatric palliative care (PPC) aims to improve the health-related quality of life (HRQoL) of children with life-limiting conditions (LLC), assessment of their HRQoL and identification of its determinants is crucial. OBJECTIVES To examine the clinical and family factors associated with HRQoL of children with LLC METHODS: This was a cross-sectional study of 136 pediatric patients with LLC who were enrolled in the PPC services at Seoul National University Hospital in South Korea. Patients' HRQoL was measured using the Pediatric Quality of Life 4.0. Clinical and family characteristics were gathered from the medical records and PPC registry database. RESULTS Most children with LLC have a poor HRQoL at their enrollment for PPC services with significant variation in their total HRQoL scores according to the diagnostic categories. Patients with nonmalignant conditions showed significantly lower HRQoL scores than patients with malignancy. Lower HRQoL scores were associated with more caregiver depressive symptoms. In a multivariable regression model, total HRQoL scores of patients were significantly associated with diagnostic categories and caregiver's depressive symptoms after controlling for other clinical and family variables. Physical health summary scores were significantly associated with diagnostic categories and caregiver depressive symptoms. Psychosocial health summary scores were significantly associated with diagnostic categories, patient location, and caregiver's depressive symptoms. CONCLUSION The HRQoL of children with LLC receiving PPC differed among underlying disease categories. Lower HRQoL was associated with more caregiver depressive symptoms. These findings suggest the needs for optimized intervention in palliative care for children with nonmalignant conditions and family-centered intervention to address caregivers' psychosocial problems.
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Affiliation(s)
- Jung Lee
- Integrative Care Hub (J.L., Y.J.M.), Seoul National University Children's Hospital, Seoul, South Korea
| | - Min Sun Kim
- Department of Pediatrics (M.S.K.), Seoul National University Children's Hospital, Seoul, South Korea.
| | - Cho Hee Kim
- College of Nursing (C.H.K.), Seoul National University, Seoul, South Korea
| | - Yi Ji Moon
- Integrative Care Hub (J.L., Y.J.M.), Seoul National University Children's Hospital, Seoul, South Korea
| | - Yu Hyeon Choi
- Department of Pediatrics (Y.H.C.), Hanyang University Hospital, Seoul, South Korea
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Pérez-Ardanaz B, Peláez-Cantero MJ, Morales-Asencio JM, Vellido-González C, Gómez-González A, León-Campos Á, Gutiérrez-Rodríguez L. Socioeconomic Factors and Quality of Life Perceived by Parents and Children with Complex Chronic Conditions in Spain. CHILDREN 2021; 8:children8100931. [PMID: 34682195 PMCID: PMC8534789 DOI: 10.3390/children8100931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/20/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Health-related quality of life of children with complex chronic conditions could be affected by sociodemographic factors. Most studies focus exclusively on the parents’ perceptions of quality of life. This study aimed to determine the health-related quality of life of these children, according to their parents and the children themselves. A cross-sectional study was developed on children aged over five years with complex chronic conditions. Health-related quality of life, educational attainment, and social status were evaluated. A total of 101 children were included with a mean age of 10.48 years, and 35.6% were female. The most frequent disease was oncological (28.7%). Children perceived a better health-related quality of life, compared to their parents’ assessment: median difference −8.4 (95%CI: −9.2 to −3.8). Moreover, differences were observed by socioeconomic factors. Parents and children with complex chronic conditions perceive differently the health-related quality of life. Social determinants associate with an uneven perceived quality of life.
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Affiliation(s)
- Bibiana Pérez-Ardanaz
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (A.G.-G.); (Á.L.-C.); (L.G.-R.)
| | | | - José Miguel Morales-Asencio
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (A.G.-G.); (Á.L.-C.); (L.G.-R.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951952833
| | | | - Alberto Gómez-González
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (A.G.-G.); (Á.L.-C.); (L.G.-R.)
| | - Álvaro León-Campos
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (A.G.-G.); (Á.L.-C.); (L.G.-R.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
| | - Laura Gutiérrez-Rodríguez
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (A.G.-G.); (Á.L.-C.); (L.G.-R.)
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11
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Zuniga-Villanueva G, Ramos-Guerrero JA, Osio-Saldaña M, Casas JA, Marston J, Okhuysen-Cawley R. Quality Indicators in Pediatric Palliative Care: Considerations for Latin America. CHILDREN (BASEL, SWITZERLAND) 2021; 8:250. [PMID: 33806896 PMCID: PMC8004984 DOI: 10.3390/children8030250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
Pediatric palliative care is a growing field in which the currently available resources are still insufficient to meet the palliative care needs of children worldwide. Specifically, in Latin America, pediatric palliative care services have emerged unevenly and are still considered underdeveloped when compared to other regions of the world. A crucial step in developing pediatric palliative care (PPC) programs is delineating quality indicators; however, no consensus has been reached on the outcomes or how to measure the impact of PPC. Additionally, Latin America has unique sociocultural characteristics that impact the perception, acceptance, enrollment and implementation of palliative care services. To date, no defined set of quality indicators has been proposed for the region. This article explores the limitations of current available quality indicators and describes the Latin American context and how it affects PPC development. This information can help guide the creation of standards of care and quality indicators that meet local PPC needs while considering the sociocultural landscape of Latin America and its population.
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Affiliation(s)
- Gregorio Zuniga-Villanueva
- Department of Pediatrics, Tecnologico de Monterrey, Monterrey 64849, Mexico
- Division of Pediatric Palliative Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | | | - Monica Osio-Saldaña
- Department of Global Studies, Universidad Nacional Autonoma de Mexico, Mexico City 04510, Mexico;
| | - Jessica A. Casas
- Department of Pediatric Palliative Care, Texas Children’s Hospital, Houston, TX 77030, USA; (J.A.C.); (R.O.-C.)
| | - Joan Marston
- Global Ambassador, International Children’s Palliative Care Network, Assagay 3624, South Africa;
| | - Regina Okhuysen-Cawley
- Department of Pediatric Palliative Care, Texas Children’s Hospital, Houston, TX 77030, USA; (J.A.C.); (R.O.-C.)
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12
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Abstract
Purpose of Review This paper seeks to explore the definitions of quality of life and its application to pediatric research and clinical practice. This paper also highlights some of the imperfections in evaluating patient-reported outcomes designed to measure quality of life in pediatrics. Additionally, this paper explores some of the unique challenges in promoting quality of life during the COVID-19 pandemic. Recent Findings There are numerous different measurement scales to examine quality of life in children of different ages, and with a variety of disease states. Summary Despite the number of quality of life measurement tools, not every patient population has a validated measure, including patients with palliative care needs. There is no consensus on how to incorporate findings from patient-reported outcomes into clinical practice recommendations. Professional organizations offer guidance and resources for families to encourage focus on quality of life during the COVID-19 pandemic.
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Affiliation(s)
- Teresa Vente
- Division of Palliative Care, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 117, Chicago, IL 60611 USA
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13
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Anderson LM, Papadakis JL, Vesco AT, Shapiro JB, Feldman MA, Evans MA, Weissberg-Benchell J. Patient-Reported and Parent Proxy-Reported Outcomes in Pediatric Medical Specialty Clinical Settings: A Systematic Review of Implementation. J Pediatr Psychol 2020; 45:247-265. [PMID: 31710671 DOI: 10.1093/jpepsy/jsz082] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/10/2019] [Accepted: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Youth with chronic illness are at higher risk for psychosocial difficulties, leading to a call for screening via patient-reported outcomes (PROs). The purpose of the current review is to summarize PRO implementation in pediatric medical specialty settings. A literature review of PRO implementation in these settings, conceptual issues, value and approach, legal and ethical concerns, as well as a case example of PROA in type 1 diabetes are presented. METHODS A systematic review was conducted to identify relevant articles published since the most recent Journal of Pediatric Psychology Special Issue on Evidence-Based Assessment in Pediatric Psychology (2008). RESULTS Thirty-two articles were identified and reviewed. The majority of studies reported that PROA was feasible, did not disrupt clinic flow, identified psychosocial issues warranting intervention, and was acceptable to families and providers. Response to elevated scores and impact on behavioral health referrals varied. CONCLUSION While many evidenced-based assessment measures are well-validated within pediatric chronic illness groups, the literature regarding implementation of PROs is still emerging. Research findings are promising, with PROs being feasible, acceptable, and leading to increased discussion of psychosocial issues when integrated into pediatric medical settings. Additional research is needed to evaluate the longitudinal impact of PROs and the optimal manner of responding to assessment data, particularly when clinically-elevated. Ultimately, identifying psychosocial issues in pediatric medical settings can promote optimal health and well-being of youth with chronic illness and their families.
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Affiliation(s)
| | | | - Anthony T Vesco
- Ann and Robert H. Lurie Children's Hospital of Chicago.,Northwestern University Feinberg School of Medicine
| | | | - Marissa A Feldman
- Child Development and Rehabilitation Center, Johns Hopkins All Children's Hospital
| | - Meredyth A Evans
- Ann and Robert H. Lurie Children's Hospital of Chicago.,Northwestern University Feinberg School of Medicine
| | - Jill Weissberg-Benchell
- Ann and Robert H. Lurie Children's Hospital of Chicago.,Northwestern University Feinberg School of Medicine
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14
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Friedel M, Brichard B, Boonen S, Tonon C, De Terwangne B, Bellis D, Mevisse M, Fonteyne C, Jaspard M, Schruse M, Harding R, Downing J, Namisango E, Degryse JM, Aujoulat I. Face and Content Validity, Acceptability, and Feasibility of the Adapted Version of the Children's Palliative Outcome Scale: A Qualitative Pilot Study. J Palliat Med 2020; 24:181-188. [PMID: 32679002 DOI: 10.1089/jpm.2019.0646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective: To assess the face and content validity, acceptability and feasibility of a French version of the Children's Palliative Outcome Scale (CPOS). Background: Instruments in French used to measure outcomes in pediatric palliative care are lacking. Methods: After forward-backward translation of the 12-item English CPOS to French, we conducted a qualitative pilot study. During semi structured interviews among children and parents, we used the CPOS, the Schedule for the Evaluation of Individual Quality of Life interview guide (SEIQoL) and the Quality of Life in Life-threatening Illness-Family Carer questionnaire (QOLLTI-F), in addition to three expert meetings with PLTs. Results: Fourteen children and adolescents (8-18 years) with life-limiting or life-threatening conditions cared for at home, in hospital or in respite care services, 19 parents, and 9 members of 4 pediatric liaison teams (PLTs) providing palliative care in a Belgian francophone region were included in the study. No families refused to participate. All children with verbal capacities chose to be interviewed in the presence of their parents and a PLT member. The children valued being given the opportunity to share their experiences. New QOL dimensions pertaining to social, emotional, and administrative health-care related issues were added to the original version of the 12-item CPOS, leading to a 22-item CPOS-2. Discussion: The CPOS-2 was perceived as relevant and easy to use by the principal stakeholders. Our study paves the way for a large-scale field study assessing its psychometric characteristics and its implementation in routine clinical care.
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Affiliation(s)
- Marie Friedel
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium.,Haute Ecole Léonard de Vinci, Brussels, Belgium
| | - Bénédicte Brichard
- Division of Pediatric Hematology/Oncology, Cliniques universitaires st Luc, Brussels, Belgium
| | - Sabine Boonen
- Interface pédiatrique, Cliniques universitaires st Luc, Brussels, Belgium
| | - Corinne Tonon
- Interface pédiatrique, Cliniques universitaires st Luc, Brussels, Belgium
| | | | - Dominique Bellis
- Haute Ecole Léonard de Vinci, Brussels, Belgium.,Interface pédiatrique, Cliniques universitaires st Luc, Brussels, Belgium
| | - Murielle Mevisse
- Interface pédiatrique, Cliniques universitaires st Luc, Brussels, Belgium
| | - Christine Fonteyne
- Globul'home, Hôpital universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Maud Jaspard
- Equipe liaison pédiatrique, Centre hospitalier chrétien, Clinique de l'Espérance, Liège, Belgium
| | - Marie Schruse
- Equipe liaison pédiatrique, Centre hospitalier chrétien, Clinique de l'Espérance, Liège, Belgium
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, United Kingdom
| | - Julia Downing
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, United Kingdom.,International Children's Palliative Care Network, Bristol, United Kingdom
| | - Eve Namisango
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, United Kingdom.,African Palliative Care Association, Kampala, Uganda
| | - Jean-Marie Degryse
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium.,Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Isabelle Aujoulat
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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15
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Namisango E, Bristowe K, Murtagh FE, Downing J, Powell RA, Abas M, Lohfeld L, Ali Z, Atieno M, Haufiku D, Guma S, Luyirika EB, Mwangi-Powell FN, Higginson IJ, Harding R. Towards person-centred quality care for children with life-limiting and life-threatening illness: Self-reported symptoms, concerns and priority outcomes from a multi-country qualitative study. Palliat Med 2020; 34:319-335. [PMID: 32081084 DOI: 10.1177/0269216319900137] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Paediatric life-limiting and life-threatening conditions (life-limiting conditions) place significant strain on children, families and health systems. Given high service use among this population, it is essential that care addresses their main symptoms and concerns. AIM This study aimed to identify the symptoms, concerns and other outcomes that matter to children with life-limiting conditions and their families in sub-Saharan Africa. SETTING AND PARTICIPANTS Cross-sectional qualitative study in Kenya, Namibia, South Africa and Uganda. Children/caregivers of children aged 0-17 years with life-limiting conditions were purposively sampled by age, sex and diagnosis. Children aged 7 and above self-reported; caregiver proxies reported for children below 7 and those aged 7 and above unable to self-report. RESULTS A total of 120 interviews were conducted with children with life-limiting conditions (n = 61; age range: 7-17 years), and where self-report was not possible, caregivers (n = 59) of children (age range: 0-17) were included. Conditions included advanced HIV (22%), cancer (19%), heart disease (16%) endocrine, blood and immune disorders (13%), neurological conditions (12%), sickle cell anaemia (10%) and renal disease (8%). Outcomes identified included physical concerns - pain and symptom distress; psycho-social concerns - family and social relationships, ability to engage with age-appropriate activities (e.g. play, school attendance); existential concerns - worry about death, and loss of ambitions; health care quality - child- and adolescent-friendly services. Priority psycho-social concerns and health service factors varied by age. CONCLUSION This study bridges an important knowledge gap regarding symptoms, concerns and outcomes that matter to children living with life-limiting conditions and their families and informs service development and evaluation.
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Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda.,Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Fliss Em Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.,Wolfson Palliative Care Research Center, Hull York Medical School, Hull, UK
| | - Julia Downing
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.,International Children's Palliative Care Network, Assagay, South Africa.,Palliative Care Unit, Makerere University, Kampala, Uganda
| | | | - Melanie Abas
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lynne Lohfeld
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Zipporah Ali
- Kenya Hospice and Palliative Care Association, Nairobi, Kenya
| | | | | | | | | | | | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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16
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Nagoya Y, Miyashita M, Irie W, Yotani N, Shiwaku H. Development of a Proxy Quality-of-Life Rating Scale for the End-of-Life Care of Pediatric Cancer Patients Evaluated from a Nurse's Perspective. J Palliat Med 2020; 23:82-89. [DOI: 10.1089/jpm.2018.0598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yuko Nagoya
- Department of Child Health Nursing, Tohoku University School of Medicine, Miyagi, Japan
- Miyagi Children's Hospital, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, Miyagi, Japan
| | - Wataru Irie
- Department of Child Health Nursing, Tohoku University School of Medicine, Miyagi, Japan
| | - Nobuyuki Yotani
- Division of Palliative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hitoshi Shiwaku
- Department of Child Health Nursing, Tohoku University School of Medicine, Miyagi, Japan
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17
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Harding R, Chambers L, Bluebond-Langner M. Advancing the science of outcome measurement in paediatric palliative care. Int J Palliat Nurs 2019; 25:72-79. [PMID: 30785818 DOI: 10.12968/ijpn.2019.25.2.72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: There is a lack of appropriate, validated person-centred outcome measures (PCOM) for paediatric palliative care in the scientific literature, and as a result there is not a tool to drive and evaluate care of children and young people. METHODS: In line with COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance, an expert group was convened to elicit views on the domains/items to include in a PCOM, implementation challenges and requirements for use in routine care by practitioners. Data were content analysed. RESULTS: 36 UK-wide clinicians, advocates, and researchers participated. 1) Items included were: specific symptoms, education, play and social interaction, parental time for partner and other children, sex and intimacy, and sibling wellbeing. 2) Implementation challenges: supporting children and young people to engage meaningfully, that the instrument could be seen as a 'test' of parents' care quality, raising unrealistic expectations, proxy validity. 3) There is a need for clear administration and interpretation guidance and for data ownership/access to be agreed. CONCLUSIONS: This expert meeting addressed the initial step in COSMIN guidance, informing face validity and acceptability. It provides the information necessary for the first phase of tool development and informs potential use and implementation.
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Affiliation(s)
- Richard Harding
- Herbert Dunhill Chair, Professor of Palliative Care and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, King's College London
| | | | - Myra Bluebond-Langner
- Professor and True Colours Chair in Palliative Care for Children and Young people, Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London
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18
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Friedel M, Aujoulat I, Dubois AC, Degryse JM. Instruments to Measure Outcomes in Pediatric Palliative Care: A Systematic Review. Pediatrics 2019; 143:peds.2018-2379. [PMID: 30530504 DOI: 10.1542/peds.2018-2379] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pediatric palliative care (PPC) is intended to promote children's quality of life by using a family-centered approach. However, the measurement of this multidimensional outcome remains challenging. OBJECTIVE To review the instruments used to assess the impact of PPC interventions. DATA SOURCES Five databases (Embase, Scopus, The Cochrane Library, PsychInfo, Medline) were searched. STUDY SELECTION Inclusion criteria were as follows: definition of PPC used; patients aged 0 to 18 years; diseases listed in the directory of life-limiting diseases; results based on empirical data; and combined descriptions of a PPC intervention, its outcomes, and a measurement instrument. DATA EXTRACTION Full-text articles were assessed and data were extracted by 2 independent researchers, and each discrepancy was resolved through consensus. The quality of the studies was assessed by using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers From a Variety of Fields checklist. RESULTS Nineteen of 2150 articles met the eligibility criteria. Researchers in 15 used quantitative methods, and 9 were of moderate quality. Multidimensional outcomes included health-related quality of life, spiritual well-being, satisfaction with care and/or communication, perceived social support, and family involvement in treatment or place-of-care preferences. PPC interventions ranged from home-based to hospital and respite care. Only 15 instruments (of 23 reported) revealed some psychometric properties, and only 5 included patient-reported (child) outcome measures. LIMITATIONS We had no access to the developmental process of the instruments used to present the underlying concepts that were underpinning the constructs. CONCLUSIONS Data on the psychometric properties of instruments used to assess the impact of PPC interventions were scarce. Children are not systematically involved in reporting outcomes.
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Affiliation(s)
- Marie Friedel
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium; .,Institut Parnasse-Institut Supérieur d'Enseignement Infirmier, Haute Ecole Léonard de Vinci, Brussels, Belgium; and
| | - Isabelle Aujoulat
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Anne-Catherine Dubois
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Marie Degryse
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.,Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
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19
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Widger K, Medeiros C, Trenholm M, Zuniga-Villanueva G, Streuli JC. Indicators Used to Assess the Impact of Specialized Pediatric Palliative Care: A Scoping Review. J Palliat Med 2018; 22:199-219. [PMID: 30526276 DOI: 10.1089/jpm.2018.0420] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Specialized pediatric palliative care programs aim to improve quality of life and ease distress of patients and their families across the illness trajectory. These programs require further development, which should be based on how they improve outcomes for patients, families, health care professionals, and the health care system. OBJECTIVE To identify and compare definitions of indicators used to assess the impact of specialized pediatric palliative care programs. DESIGN The scoping review protocol was prospectively registered on PROSPERO 2017 (CRD42017074090). DATE SOURCES MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Scopus, and Embase databases were searched from January 2000 to September 2018. Eligible studies included randomized controlled trials, experimental studies, or observational studies that compared specialized programs with usual care. Studies were excluded if most care recipients were older than 19 years or the article was not available in English, French, German, or Spanish. RESULTS Forty-six studies were included; one was a randomized controlled trial. We identified 82 different indicators grouped into 14 domains. The most common indicators included the following: location of death, length of stay in hospital, and number of hospital admissions. Only 22 indicators were defined identically in at least 2 studies. Only one study included children's perspectives in assessing indicators. CONCLUSIONS Many indicators were used to assess program outcomes with little definition consensus across studies. Development of a set of agreed-upon indicators to assess program impact concurrent with family and patient input is essential to advance research and practice in pediatric palliative care.
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Affiliation(s)
- Kimberley Widger
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,2 Pediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christina Medeiros
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Madeline Trenholm
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Jürg C Streuli
- 1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,3 Pediatric Ethics and Palliative Care, University Children's Hospital Zurich, Zurich, Switzerland
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20
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Researching children's perspectives in pediatric palliative care: A systematic review and meta-summary of qualitative research. Palliat Support Care 2018; 17:107-118. [DOI: 10.1017/s1478951518000172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveQualitative research is pivotal in gaining understanding of individuals’ experiences in pediatric palliative care. In the past few decades, the number of qualitative studies on pediatric palliative care has increased slightly, as has interest in qualitative research in this area. Nonetheless, a limited number of such studies have included the first-person perspective of children. The aim of this article is to understand the contribution of previous qualitative research on pediatric palliative care that included the voices of children.MethodA systematic review of qualitative studies and a meta-summary were conducted. MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and ERIC were searched without limitations on publication date or language. Eligible articles were qualitative research articles in which the participants were children ranging in age from 3 to 18 years.ResultWe retrieved 16 qualitative research articles reporting on 12 unique studies, and we selected two mixed-method articles. The meta-summary shows eight themes: the relationship with professional caregivers, pain and its management, “living beyond pain,” the relationship between pediatric patients and their families, children's view on their treatment and service provision, meanings children give to their end-of-life situation, consequences of clinical decisions, and the relationships among children in pediatric palliative care and their peers.Significance of resultsThis meta-summary presents the “state of the art” of pediatric palliative care qualitative research on children and highlights additional research areas that warrant qualitative study.
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21
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Avoine-Blondin J, Parent V, Fasse L, Lopez C, Humbert N, Duval M, Sultan S. How do professionals assess the quality of life of children with advanced cancer receiving palliative care, and what are their recommendations for improvement? BMC Palliat Care 2018; 17:71. [PMID: 29739375 PMCID: PMC5938811 DOI: 10.1186/s12904-018-0328-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background It is known that information regarding the quality of life of a patient is central to pediatric palliative care. This information allows professionals to adapt the care and support provided to children and their families. Previous studies have documented the major areas to be investigated in order to assess the quality of life, although it is not yet known what operational criteria or piece of information should be used in the context of pediatric palliative care. The present study aims to: 1) Identify signs of quality of life and evaluation methods currently used by professionals to assess the quality of life of children with cancer receiving palliative care. 2) Collect recommendations from professionals to improve the evaluation of quality of life in this context. Methods We selected a qualitative research design and applied an inductive thematic content analysis to the verbal material. Participants included 20 members of the Department of Hematology-Oncology at CHU Sainte-Justine from various professions (e.g. physicians, nurses, psychosocial staff) who had cared for at least one child with cancer receiving palliative care in the last year. Results Professionals did not have access to pre-established criteria or to a defined procedure to assess the quality of life of children they followed in the context of PPC. They reported basing their assessment on the child’s non-verbal cues, relational availability and elements of his/her environment. These cues are typically collected through observation, interpretation and by asking the child, his/her parents, and other members of the care. To improve the assessment of quality of life professionals recommended optimizing interdisciplinary communication, involving the child and the family in the evaluation process, increasing training to palliative care in hematology/oncology, and developing formalized measurement tools. Conclusion The formulation of explicit criteria to assess the quality of life in this context, along with detailed recommendations provided by professionals, support the development of systematic measurement strategy. Such a strategy would contribute to the development of common care goals and further facilitate communication between professionals and with the family. Electronic supplementary material The online version of this article (10.1186/s12904-018-0328-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Josianne Avoine-Blondin
- Centre de Psycho-Oncologie, CHU Sainte-Justine, Montréal, QC, H3T 1C5, Canada.,Department of Psychology, Université de Sherbrooke, 150, Place Charles-Le Moyne #200, Longueuil, Québec, J4K 0A8, Canada
| | - Véronique Parent
- Department of Psychology, Université de Sherbrooke, 150, Place Charles-Le Moyne #200, Longueuil, Québec, J4K 0A8, Canada
| | - Léonor Fasse
- Department of Psychology, Université de Bourgogne Franche-Comté, Esplanade Erasme, 21000, Dijon, France.,Hôpital Gustave Roussy, Villejuif, France
| | - Clémentine Lopez
- Hôpital Gustave Roussy, Villejuif, France.,Université Paris Descartes, Paris, France.,Department of child psychiatry, Gustave Roussy, 114, rue Édouard-Vaillant, 94805, Villejuif, France
| | - Nago Humbert
- Centre de Psycho-Oncologie, CHU Sainte-Justine, Montréal, QC, H3T 1C5, Canada.,Université de Montréal, Montréal, QC, Canada.,Department of Hematology/Oncology, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Michel Duval
- Centre de Psycho-Oncologie, CHU Sainte-Justine, Montréal, QC, H3T 1C5, Canada.,Université de Montréal, Montréal, QC, Canada.,Department of Hematology/Oncology, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Serge Sultan
- Centre de Psycho-Oncologie, CHU Sainte-Justine, Montréal, QC, H3T 1C5, Canada. .,Université de Montréal, Montréal, QC, Canada. .,Department of Hematology/Oncology, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada.
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22
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Donnelly JP, Downing K, Cloen J, Fragen P, Gupton AW, Misasi J, Michelson K. Development and Assessment of a Measure of Parent and Child Needs in Pediatric Palliative Care. J Pain Symptom Manage 2018; 55:1077-1084.e2. [PMID: 29288879 PMCID: PMC6282185 DOI: 10.1016/j.jpainsymman.2017.12.484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Pediatric palliative care has no evidence-based needs assessment measure. The Parent and Child Needs Survey (PCNeeds) is a new instrument designed to assess the needs of children in palliative care, including children receiving end-of-life care, and their families. OBJECTIVES This study examines the psychometrics of and respondents' perceptions about the PCNeeds. METHODS Parents of children in four outpatient pediatric palliative care programs completed the PCNeeds and the World Health Organization Quality of Life-Brief tool (WHOQOL-BREF). Parents answered questions about demographics and the experience of completing the PCNeeds. Internal scale reliability was measured with Cronbach's alpha. Validity was assessed by correlating the PCNeeds total and subscale scores with the WHOQOL-BREF subscales. Additional respondent perceptions were obtained via written comments and analyzed using content analysis. RESULTS The 93 respondents were predominantly female (n = 69, 74%); white (n = 79, 85%); college graduates (n = 71, 76%); and married or partnered (n = 75, 81%). Internal reliability was acceptable (Cronbach's α = 0.83), and validity correlations with the WHOQOL-BREF subscales were consistent with theoretical expectations (moderate negative correlations ranging from -0.36 to -0.51). The most frequently cited need not addressed by our survey was sibling impact (n = 17, 18%). Twelve parents (13%) indicated that no content was missing. The least met needs were financial impact, family impact, and the child's physical problems besides pain. Sixty-eight percent of parents (n = 63) rated completion of the survey as "easy" or "very easy." CONCLUSION Initial psychometric analysis of the PCNeeds is encouraging, but further study of reliability and validity with more diverse respondents is needed.
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Affiliation(s)
| | - Kim Downing
- Greater Illinois Pediatric Palliative Care Coalition, Chicago, Illinois, USA
| | - Jason Cloen
- CompassionNet, Lifetime Care Home Health Care and Hospice, Rochester, New York, USA
| | | | - Alyssa W Gupton
- CompassionNet, Lifetime Care Home Health Care and Hospice, Rochester, New York, USA
| | - Jen Misasi
- Greater Illinois Pediatric Palliative Care Coalition, Chicago, Illinois, USA
| | - Kelly Michelson
- Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
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23
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Identifying domains of quality of life in children with cancer undergoing palliative care: A qualitative study with professionals. Palliat Support Care 2017; 15:565-574. [DOI: 10.1017/s1478951516001048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ABSTRACTObjective:The goal of pediatric palliative care (PPC) is to maintain the quality of life (QoL) of children whose lives are threatened. However, there are sparse scientific data on the domains of QoL in this particular context, and no measurement strategies are available. The present study aims to describe the domains of QoL in the context of PPC in oncology, according to the perceptions of professional caregivers.Method:Semistructured interviews were conducted with a random sample of 20 professional caregivers from the Division of Hematology/Oncology at Le Centre Hospitalier Universitaire Sainte-Justine (Montréal, Canada). The caregivers were asked about their perceptions about the QoL of the children they have cared for in this context. The data were analyzed using inductive thematic content analysis.Results:The analysis allowed us to identify seven domains of QoL: “physical comfort,” “alleviation of psychological suffering,” “fun and the present moment,” “sense of control,” “feeling valued and appreciated,” “feeling that life goes on,” and “meaningful social relationships.”Significance of Results:Caregivers recount the regard that should be accorded to maintaining well-being and a sense of fun, as well as fostering the child's abilities, taking account of the progression of the disease, and to fulfilling his or her needs, especially social ones. Our results also demonstrate that all domains were positively referred to by professional caregivers. The data from our study will lead to better assessment of QoL according to the trajectory of a child with advanced cancer while undergoing PPC.
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24
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Coombes LH, Wiseman T, Lucas G, Sangha A, Murtagh FE. Health-related quality-of-life outcome measures in paediatric palliative care: A systematic review of psychometric properties and feasibility of use. Palliat Med 2016; 30:935-949. [PMID: 27247087 PMCID: PMC5117129 DOI: 10.1177/0269216316649155] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The number of children worldwide requiring palliative care services is increasing due to advances in medical care and technology. The use of outcome measures is important to improve the quality and effectiveness of care. AIM To systematically identify health-related quality-of-life outcome measures that could be used in paediatric palliative care and examine their feasibility of use and psychometric properties. DESIGN A systematic literature review and analysis of psychometric properties. DATA SOURCES PsychInfo, Medline and EMBASE were searched from 1 January 1990 to 10 December 2014. Hand searches of the reference list of included studies and relevant reviews were also performed. RESULTS From 3460 articles, 125 papers were selected for full-text assessment. A total of 41 articles met the eligibility criteria and examined the psychometric properties of 22 health-related quality-of-life measures. Evidence was limited as at least half of the information on psychometric properties per instrument was missing. Measurement error was not analysed in any of the included articles and responsiveness was only analysed in one study. The methodological quality of included studies varied greatly. CONCLUSION There is currently no 'ideal' outcome assessment measure for use in paediatric palliative care. The domains of generic health-related quality-of-life measures are not relevant to all children receiving palliative care and some domains within disease-specific measures are only relevant for that specific population. Potential solutions include adapting an existing measure or developing more individualized patient-centred outcome and experience measures. Either way, it is important to continue work on outcome measurement in this field.
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Affiliation(s)
- Lucy H Coombes
- Caroline Menez Research Team, Oak Centre for Children and Young People, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Theresa Wiseman
- Applied Health Research Team, The Royal Marsden NHS Foundation Trust, London, UK.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Grace Lucas
- Applied Health Research Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Amrit Sangha
- Applied Health Research Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Fliss Em Murtagh
- Department of Palliative Care, Policy & Rehabilitation, Faculty of Life Sciences and Medicine, Cicely Saunders Institute, King's College London, London, UK
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25
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Harris N, Beringer A, Fletcher M. Families' priorities in life-limiting illness: improving quality with online empowerment. Arch Dis Child 2016; 101:247-52. [PMID: 26699531 DOI: 10.1136/archdischild-2015-308769] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 11/24/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Improving quality of life (QOL) is the central focus of palliative care support for children with life-limiting illness (LLI), but achieving this can be challenging. INTERVENTION MyQuality is an online tool that enables families to choose and monitor parameters they identify as having an impact on their QOL, which aims to improve patient-professional communications and also to enhance patient empowerment within healthcare dialogues. DESIGN A longitudinal, multisite mixed-method evaluation of MyQuality. Families were invited to use MyQuality and completed semi-structured interviews and a Family Empowerment Scale (FES) at T=0 and T+3 months. PATIENTS AND SETTING Thirty-two families of children with LLIs, attending three children's hospices in one UK region. OUTCOME MEASURES Website access, usage patterns and parameter choice, FES scores and qualitative evaluation of interviews. RESULTS 23/32 families chose to use the website. Mean duration of use was 106 days (range 2-301), with families choosing two or three parameters (range 1-15), most commonly seizures (24/32), constipation (9/32), pain (6/32) and sleep problems (6/32). Mean FES scores increased over time (3.45-3.85). Interview feedback confirmed the acceptability and ease of use of the website, and the value of a graphic record of change over time to support ongoing management and collaborative review of medical, nursing or social interventions. CONCLUSIONS The identification and monitoring of patient-generated priorities via the MyQuality website empowers families and supports collaboration between parents and professionals to ensure that palliative care is truly patient and family centred.
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Affiliation(s)
- Nicola Harris
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Antonia Beringer
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Margaret Fletcher
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK United Hospitals Bristol NHS Foundation Trust, Bristol, UK
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26
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Downing J, Powell RA, Marston J, Huwa C, Chandra L, Garchakova A, Harding R. Children's palliative care in low- and middle-income countries. Arch Dis Child 2016; 101:85-90. [PMID: 26369576 DOI: 10.1136/archdischild-2015-308307] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/27/2015] [Indexed: 11/03/2022]
Abstract
One-third of the global population is aged under 20 years. For children with life-limiting conditions, palliative care services are required. However, despite 80% of global need occurring in low- and middle-income countries (LMICs), the majority of children's palliative care (CPC) is provided in high-income countries. This paper reviews the status of CPC services in LMICs--highlighting examples of best practice among service models in Malawi, Indonesia and Belarus--before reviewing the status of the extant research in this field. It concludes that while much has been achieved in palliative care for adults, less attention has been devoted to the education, clinical practice, funding and research needed to ensure children and young people receive the palliative care they need.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, London, UK Makerere University, Kampala, Uganda
| | | | - Joan Marston
- International Children's Palliative Care Network, Bloemfontein, South Africa
| | - Cornelius Huwa
- Palliative Care Support Trust, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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27
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Families' Perspectives of Quality of Life in Pediatric Palliative Care Patients. CHILDREN-BASEL 2015; 2:131-45. [PMID: 27417355 PMCID: PMC4928747 DOI: 10.3390/children2010131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/17/2022]
Abstract
Medical and academic institutions began prioritizing Pediatric Palliative Care (PPC) less than two decades ago. Although policies and institutions claim to improve the Quality of Life (QoL) of PPC patients and their families, family-defined QoL remains ambiguous. This research investigates the definitions of QoL for PPC patients according to their primary caregivers. We conducted qualitative, semi-structured focus groups of the primary caregivers of PPC patients. The transcripts were analysed for themes using inductive thematic analysis. Participants included primary caregivers of children currently receiving PPC from a healthcare institution in California. We identified several factors that primary caregivers considered components of QoL for their children. The ability to communicate and adapt or be accepted underpinned the concept of QoL for families. QoL for PPC patients was defined by primary caregivers as being able to communicate in a respectful, controlled, physically- and socially-comfortable environment. Attempts to improve QoL should focus not only on pain and symptom control, but also on enhancing opportunities for children to communicate and maintain a sense of dignity.
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28
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Abstract
There are many ways to add to children's quality of life within the hospital environment. Inpatient settings offer both opportunities and challenges with respect to providing care to children with life-threatening illnesses. The barriers to pediatric palliative care (PPC) on hospital wards, as with those in other settings, frequently stem from misconceptions. However, some barriers are intensified by characteristics of acute inpatient centers. Yet some characteristics of the inpatient setting, including the availability of human resources and unique interventions, offer creative ways to ease distress and improve quality of life for children and their families.
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Affiliation(s)
- Adam Rapoport
- Paediatric Advanced Care Team (PACT), The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Kevin Weingarten
- Paediatric Advanced Care Team (PACT), The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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29
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Abstract
The definition of palliative care is the cornerstone of a medical subspecialty that plays a particular role for all who need it, for all who practice it, and increasingly for those who try to understand it. The difficulties around the definition and terminology arise from problems in separating it from other concepts such as supportive care, constructs such as “palliative care is only about dying”, or, in children, the rather vague use of terms like life-threatening and life-limiting diseases. These weaknesses have been recognized and important steps have been taken. This review discusses current definitions as well as efforts to overcome their weaknesses and make the term palliative care—for both children and adults—more intelligible.
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Affiliation(s)
- Eva Bergstraesser
- University Children's Hospital, Department of Pediatric Palliative Care and Oncology, Zurich, Switzerland
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30
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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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31
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Kumar SP. Reporting of "quality of life": a systematic review and quantitative analysis of research publications in palliative care journals. Indian J Palliat Care 2012; 18:59-67. [PMID: 22837613 PMCID: PMC3401736 DOI: 10.4103/0973-1075.97475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
CONTEXT Palliative care clinical practice depends upon an evidence-based decision-making process which in turn is based upon current research evidence. One of the most important goals in clinical palliative care is to improve patients' quality of life (QoL). AIM This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting characteristics of articles on QoL. SETTINGS AND DESIGN This was a systematic review of palliative care journals. MATERIALS AND METHODS Twelve palliative care journals were searched for articles with "QoL" in the title of the articles published from 2006 to 2010. The reporting rates of all journals were compared. The selected articles were categorized into assessment and treatment, 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 article 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 1.95% (71/3634), and Indian Journal of Palliative Care (IJPC) had the highest reporting rate of 5.08% (3/59), followed by Palliative Medicine (PM) with 3.71% (20/538), and Palliative and Supportive Care (PSC) with 3.64% (9/247) reporting. CONCLUSIONS The overall reporting rate for QoL articles in palliative care journals was 1.95% and there were very few randomized clinical trials and systematic reviews found. The study findings indicate further high-quality research to establish an adequate evidence base for QoL.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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32
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Knapp C, Madden V, Revicki D, Feeny D, Wang H, Curtis C, Sloyer P. Health status and health-related quality of life in a pediatric palliative care program. J Palliat Med 2012; 15:790-7. [PMID: 22686119 DOI: 10.1089/jpm.2011.0504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Children with life-threatening illnesses have unique physical and psychosocial needs that pediatric palliative care programs can address. Integrated programs strive to address these needs from the point of diagnosis through death, if needed, at the same time that curative care is provided. To better understand the variation in these needs, we assessed the health status and health-related quality of life (HRQOL) of children enrolled in an integrated pediatric palliative care program. METHODS A telephone survey was conducted with 98 parents whose children were enrolled in an integrated pediatric palliative care program in Florida. The Health Utilities Index (HUI) system was used to assess health status and HRQOL. RESULTS HUI2 attribute levels show that children have the greatest impairment with moderate-to-severe burdens related to self-care, mobility, and sensation, and the least impairment with emotion. HUI3 attribute levels show that children have the greatest impairment with moderate-to-severe burdens related to ambulation and cognition and the least impairment with hearing and emotional functioning. Mean overall HUI2 and HUI3 utility scores are 0.37 and 0.15, respectively. CONCLUSION Children with life-threatening illnesses in our sample had a high level of morbidity compared with those found in other HUI studies of children with acute or chronic health conditions. Not only do our results highlight severely impaired HRQOL, they also demonstrate the wide variety of health states and needs for children in integrated palliative care programs. This information can help develop strategies to encourage more providers to participate in integrated pediatric palliative care programs.
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Affiliation(s)
- Caprice Knapp
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL 32610, USA.
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33
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Gilmer MJ, Foster TL, Bell CJ, Mulder J, Carter BS. Parental Perceptions of Care of Children at End of Life. Am J Hosp Palliat Care 2012; 30:53-8. [DOI: 10.1177/1049909112440836] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Little is known regarding the perceptions of parents about end-of-life care for their children. This study describes parental perceptions of the care of hospitalized, terminally ill children in the areas of (1) clinical management, (2) interdisciplinary support, and (3) pain and symptom management. Methods: Through a mixed methods design, researchers interviewed a representative sampling of bereaved parents via telephone. Results: Data provided evidence of areas which lack satisfaction with elements of end-of-life care of hospitalized children. Conclusion: Parental satisfaction with their child’s care during end of life indicates need for improvement in pain management, communication, and parental involvement in decision making. While education cannot guarantee desired changes in attitudes or behaviors, it may provide the essential foundation of knowledge, skills, and ethical understanding needed by professional providers.
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Affiliation(s)
- Mary Jo Gilmer
- Vanderbilt University School of Nursing, Nashville, TN, USA
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Terrah L. Foster
- Vanderbilt University School of Nursing, Nashville, TN, USA
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA
| | | | | | - Brian S. Carter
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA
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34
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Tomlinson D, Hinds PS, Bartels U, Hendershot E, Sung L. Parent reports of quality of life for pediatric patients with cancer with no realistic chance of cure. J Clin Oncol 2011; 29:639-45. [PMID: 21245433 DOI: 10.1200/jco.2010.31.4047] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare quality of life of children with cancer with no reasonable chance of cure reported by parents 6 months or fewer versus more than 6 months before death. PATIENTS AND METHODS This cross-sectional study included children between the ages of 2 and 18 years with cancer and no reasonable chance of cure at The Hospital for Sick Children, Toronto, Ontario, Canada. Parents reported quality of life on behalf of their children. Outcomes were the PedsQL 4.0 Generic Core Scales, Acute Cancer Module, and Multidimensional Fatigue Scale. RESULTS Seventy-three parents of children participated. Compared with children who survived more than 6 months (n = 43), those who died at 6 months or fewer (n = 30) had significantly worse physical health (mean difference, 15.9; 95% CI, 1.8 to 30.0; P = .028), more pain and hurt (mean difference, 15.5; 95% CI, 0.9 to 30.0; P = .037), and worse general fatigue (mean difference, 15.8; 95% CI, 2.4 to 29.1; P = .021) and sleep/rest fatigue (mean difference, 16.0; 95% CI, 3.5 to 28.5; P = .013). Among the entire cohort, those with leukemia/lymphoma had worse physical and psychosocial quality of life compared with those with solid or brain tumors. Recent stem-cell transplantation was associated with worse psychosocial health. CONCLUSION Parents of children with cancer reported worse physical health, pain, and fatigue proximal to death. Those with leukemia/lymphoma were at higher risk for impaired quality of life. This knowledge can help in the design of targeted interventions to improve quality of life for children dying as a result of cancer.
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Affiliation(s)
- Deborah Tomlinson
- Division of Haematology/Oncology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
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