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Hanna JR, Semple CJ. Mixed-methods evaluation of a face-to-face educational intervention for health and social care professionals to deliver family-centred cancer supportive care when a parent with dependent children is at end of life. Psychooncology 2024; 33:e6374. [PMID: 38977423 DOI: 10.1002/pon.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/04/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVE To deliver and evaluate an educational intervention to equip health and social care professionals (professionals) on how best to support parents at end of life with cancer concerning their dependent children (<18). METHODS An evidence-based and theory-driven face-to-face educational intervention was developed and evaluated using three levels of Kirkpatrick's Model of Evaluation. Pre-test, post-test surveys were completed immediately before-and-after the intervention using a validated self-efficacy scale and single-item questions evaluating perceived usefulness and relevance (levels one/two). Qualitative interviews ≥ 3-months post-intervention explored if, and how the intervention impacted professionals' practice (level three). Fourteen sessions were delivered at oncology settings to 347 professionals between 2021 and 2023. Two hundred seventy four professionals completed the pre-test survey, with 239 completing the post-test survey. Fourteen professionals were interviewed between three-and 19-months post-intervention. RESULTS Quantitative findings demonstrated a statistically significant improvement in self-efficacy post-educational intervention (p < 0.001). Qualitative data highlighted professionals gained new approaches to progress end of life conversations with parents, despite some familial resistance to sharing the reality of the situation with children. Positive intervention content shaping clinical practice included the bereaved parent's lived experience, communication framework and roleplay videos. Some professionals considered a booster session and opportunities to practice conversations necessary to further consolidate learning into practice. CONCLUSIONS Evidence and theory-driven education can positively impact professionals' provision of family-centred cancer care. Future studies should explore the impact of this educational intervention on familial outcomes. Alongside a sustainable delivery of this intervention, advanced communication skills programmes should incorporate parent-child end of life conversations.
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Affiliation(s)
- Jeffrey R Hanna
- School of Nursing and Paramedic Science, Ulster University, Belfast, UK
- South Eastern Health and Social Care Trust, Ulster Hospital, Dundonald, UK
| | - Cherith J Semple
- School of Nursing and Paramedic Science, Ulster University, Belfast, UK
- South Eastern Health and Social Care Trust, Ulster Hospital, Dundonald, UK
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2
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Sheehan S, Hanna JR, Drury A, McCance T, Semple CJ, O'Neill C. A Systematic Review of Educational Interventions to Equip Health and Social Care Professionals to Promote End-of-Life Supportive Care when a Parent with Dependent Children is Dying with Cancer. Semin Oncol Nurs 2023; 39:151474. [PMID: 37481410 DOI: 10.1016/j.soncn.2023.151474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES This systematic review aimed to determine the content, mode of delivery, assessment, and outcomes of educational interventions to equip health and social care professionals when delivering end of life supportive care for parents dying with cancer who have dependent children. DATA SOURCES A mixed-methods systematic review was undertaken. Six electronic database were searched from their inception until September 2023 (Medline OVID, CINAHL, EMBASE, PsycINFO, Web of Science, and ERIC), supplemented by citation chaining, grey literature searches using Google Advanced Search and relevant professional bodies. Quality assessment was conducted independently by two researchers on the included studies. A convergent integrated approach was utilised for data synthesis. CONCLUSION The review identified two educational interventions; highlighting a dearth of training opportunities to equip health and social care professionals to provide supportive care to families when a parent is at end of life with cancer. Despite health and social care professionals reported need and desire for upskilling in this area of clinical practice, there is a severe lack of evidence-based educational interventions. It is imperative that effective educational interventions are made accessible to professionals. IMPLICATIONS FOR NURSING PRACTICE There is an imminent need for robust educational interventions to be developed, as health and social care professionals often lack the knowledge, skills and confidence on how best to support families when a parent of dependent children is at end of life. Health and social care professionals engagement with high-quality, evidence-based and theory-driven educational interventions has the potential to impact professionals' provision of family-centred cancer care at end of life. This could lead to better mental and physical outcomes for the whole family at end of life and in bereavement.
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Affiliation(s)
- Sarah Sheehan
- Research Assistant, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Jeffrey R Hanna
- Research Associate, Institute of Nursing and Health Research, School of Nursing and Paramedic Science, Ulster University, Belfast, Northern Ireland
| | - Amanda Drury
- Associate Professor in General Nursing, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Tanya McCance
- The Mona Grey Professor of Nursing Research & Development, Institute of Nursing and Health Research, School of Nursing and Paramedic Science, Ulster University, Belfast, Northern Ireland
| | - Cherith J Semple
- Professor in Clinical Cancer Nursing, Institute of Nursing and Health Research, Ulster University / Cancer Services, South Eastern Health and Social Care Trust, Belfast, Northern Ireland
| | - Carla O'Neill
- Assistant Professor in Nursing, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
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Fugmann D, Richter P, Karger A, Ernstmann N, Hönig K, Bergelt C, Faller H, Maatouk I, Hornemann B, Stein B, Teufel M, Goerling U, Erim Y, Geiser F, Albus C, Senf B, Wickert M, Weis J. Caring for dependent children impacts practical and emotional problems and need for support, but not perceived distress among cancer patients. Psychooncology 2023; 32:1231-1239. [PMID: 37277899 DOI: 10.1002/pon.6173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE More than one in 10 cancer patients care for dependent children. It is unclear whether this status makes a difference in terms of the distress and associated problems they experience, or whether it is linked to differences in the need for or utilization of psychosocial support. METHODS Secondary analysis of a cross-sectional German study in National Comprehensive Cancer Centers using self-report standardized questionnaires administered to inpatients. Patients living with dependent children (n = 161) were matched by age and sex with a subsample of 161 cancer patients not living with dependent children. The resulting sample was tested for between-group differences in Distress Thermometer (DT) scores and the corresponding DT Problem List. Additionally, between-group differences in measures of the need for and utilization of psychosocial support were examined. RESULTS More than 50% of all patients suffered from clinically relevant distress. Patients living with dependent children reported significantly more practical (p < 0.001, η2 p = 0.04), family (p < 0.001, η2 p = 0.03), and emotional problems (p < 0.001, η2 p = 0.01). Although reporting a greater need for psychological support, parents with cancer were not found to more frequently utilize any type of psychosocial support. CONCLUSIONS The specific problems and needs of parents with cancer who care for dependent children are currently not sufficiently addressed in the clinical care pathways. All families should be helped to establish open and honest communication as well as understand the available support systems and what they can provide. Tailored interventions should be implemented for highly distressed families.
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Affiliation(s)
- Dominik Fugmann
- Medical Faculty, Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Peter Richter
- Medical Faculty, Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - André Karger
- Medical Faculty, Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Nicole Ernstmann
- Department of Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany
| | - Klaus Hönig
- Ulm University Clinic Department of Psychosomatic Medicine and Psychotherapy, Comprehensive Cancer Center Ulm (CCCU), Ulm, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, Greifswald Medical School, Greifswald, Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Imad Maatouk
- Department of Medical Psychology and Psychotherapy, Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Beate Hornemann
- Comprehensive Cancer Center, University Clinic Center Dresden, Dresden, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, Comprehensive Cancer Center Essen (WTZ) and LVR Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ute Goerling
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität and Berlin Institute of Health, Berlin, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine, University Clinic Center Erlangen, Erlangen, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine, University Clinic Center Bonn, Bonn, Germany
| | - Christian Albus
- Department of Psychosomatic Medicine & Center Psychooncology (CePO), University Clinic Center Cologne, Cologne, Germany
| | - Bianca Senf
- University Clinic Center Frankfurt University Cancer Center, Frankfurt, Germany
| | - Martin Wickert
- Comprehensive Cancer Center, University Clinic Center Tübingen, Tübingen, Germany
| | - Joachim Weis
- Department of Self-Help Research, Faculty of Medicine and Medical Center, Comprehensive Cancer Center, University of Freiburg, Freiburg, Germany
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4
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Kleinhaus H, Brähler E, Romer G, Ernst J. [Communicating about Parental Cancer with Minor Children: Necessity, Burden, and Issues from a Parent's Perspective]. Psychother Psychosom Med Psychol 2023; 73:85-88. [PMID: 36413984 DOI: 10.1055/a-1961-1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND In addition to coping with their own stresses, parents of minor children with cancer face the difficult task of communicating the diagnosis and its effects to their children. The aim of this study is to examine parents' perceptions of conversations with their children and to identify key topics for psychosocial support. METHODS Using a questionnaire, N=82 cancer patients with N=162 minor children were asked about their experiences when talking to their children about the disease. RESULTS Communication about the disease was perceived as necessary by most parents. This was especially the case for older children. With 143 out of 162 children (88.3%), the conversation was held. Of the 82 parents interviewed, 16.5% felt no burden as a result of the talks, 15.2% reported a very high burden. The feeling of not being able to protect the children was perceived as particularly stressful. DISCUSSION Most parents consider communication with the children to be important and seek it. However, many find this difficult, e. g. because they actually want to protect their children. Additional stress can be caused by questions from the children to which the parents cannot give an answer. CONCLUSION Psychosocial support can be helpful here. Experiences discussed by parents can help other parents in similar situations.
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Affiliation(s)
- Hannah Kleinhaus
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Mainz, Mainz, Germany
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster, Münster, Germany
| | - Jochen Ernst
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
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Høeg BL, Christensen J, Banko L, Frederiksen K, Appel CW, Dalton SO, Dyregrov A, Guldin MB, Jørgensen SE, Lytje M, Bøge P, Bidstrup PE. Psychotropic medication among children who experience parental death to cancer. Eur Child Adolesc Psychiatry 2023; 32:155-165. [PMID: 34302529 DOI: 10.1007/s00787-021-01846-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/10/2021] [Indexed: 11/27/2022]
Abstract
The psychological consequences of losing a parent to cancer are unclear. We investigated whether experiencing parental death to cancer before 18 years of age increases the risk of psychotropic medication. We used register data of all children born in Denmark between 1 January 1987 and 31 December 2016 (N = 1,488,846). We assessed rate ratios (RRs) with 95% confidence intervals (CIs) for first redeemed prescription of antidepressants, anxiolytics and hypnotics according to parental death status using Poisson multi-state models. We further examined whether the associations differed according to the gender of the deceased parent, child's age at the time of death or the parental length of illness. Cancer-bereaved children had a significantly increased risk of first prescription of psychotropic medication (rate ratio, RR 1.22, 95% confidence interval, CI 1.10-1.34 for males; RR 1.18, 95% CI 1.09-1.28 for females). Associations were strongest if the parent had the same sex as the child and if the parent died within one year of diagnosis. The risk was highest during the first six months after the loss (RR 2.35, 95% confidence interval, CI 1.48-3.73 for males; RR 1.81, 95% CI 1.17-2.80 for females). Children who lose a parent to cancer, particularly in cases when the disease progressed quickly, may need extra psychological support, especially during the first six months after the death.
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Affiliation(s)
- Beverley Lim Høeg
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Jane Christensen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Linda Banko
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Charlotte Weiling Appel
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Atle Dyregrov
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | | | - Martin Lytje
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
- Department of Patient Support and Community Activities, Danish Cancer Society, Copenhagen, Denmark
| | - Per Bøge
- Department of Patient Support and Community Activities, Danish Cancer Society, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Dalton LJ, McNiven A, Hanna JR, Rapa E. Exploring healthcare professionals' beliefs, experiences and opinions of family-centred conversations when a parent has a serious illness: A qualitative study. PLoS One 2022; 17:e0278124. [PMID: 36441706 PMCID: PMC9704560 DOI: 10.1371/journal.pone.0278124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
This study explored healthcare professionals' perceived role in talking to adult patients about sharing their diagnosis with children. Semi-structured interviews were conducted to explore healthcare professionals' beliefs about how families could and should be supported when a parent has a serious illness. Participants were 24 healthcare professionals working in primary, secondary and tertiary NHS services in the UK with adult patients diagnosed with a serious illness. Data were analysed thematically. Many healthcare professionals reported systems to identify patients' family relationships, but this information was rarely used to initiate conversations on what and how to talk to children. It was frequently assumed that someone else in the healthcare system was supporting patients with family communication. Others reported there were more urgent priorities for the consultation or considered that talking to children was a private family matter. However, several professionals did undertake these conversations, viewing this as a central part of their role. Some healthcare professionals felt they had inadequate skills or confidence to raise talking to children with their patients and indicated a need for specific training to address this. The results highlight the importance of systematically documenting patients' relationships with children so that this information can be used to inform ongoing discussions with the healthcare team about what children have been told. Patients consistently report wanting support about how to talk to children and the benefits of effective communication are well documented. Dissemination of this evidence could encourage professionals across all specialities to include family-centred communication in routine patient care. Training resources are needed so that staff feel empowered and equipped to raise these sensitive subjects with their patients.
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Affiliation(s)
- Louise J. Dalton
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Abigail McNiven
- Medical Sciences Division, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jeffrey R. Hanna
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Elizabeth Rapa
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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7
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Millar R, Bell M, Casey L. The Struggle Between Protecting Children From and Preparing Them for the Death of Their Parent: A Qualitative Study. Am J Hosp Palliat Care 2022; 40:539-543. [PMID: 36395501 DOI: 10.1177/10499091221111560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives The aim of this study was to gain a greater understanding of communicating with children about parental terminal illness from the perspective of the surviving parents. Methods A qualitative descriptive study was conducted using semi structured interviews with eligible participants. Data was analyzed using thematic analysis. Results The results highlight the pressures experienced by surviving parents, grappling with trying to support their children’s needs on a practical and emotional level, while coping with the emotional upheaval of the impending death of their partner. The issue of communication with the children starts long before the terminal phase of illness and the results confirm that this is an ongoing process that continues after the death of the parent. The need for services to be more responsive to the diverse needs of families was also apparent as a key factor in supporting families during this time. Conclusions This research provides valuable insights into the complexity of communicating with children about terminal illness from the perspective of the surviving parents. It reveals diverse views and experiences in terms of approaching communication with children and illustrates the need for services to be acutely attuned to the unique needs of parents and children throughout the disease trajectory.
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Affiliation(s)
- Rachel Millar
- Social Work Department, Our Lady’s Hospice and Care Services, Dublin, Ireland
| | - Mary Bell
- Education and Research Centre, Our Lady’s Hospice and Care Services, Dublin, Ireland
| | - Louise Casey
- Social Work Department, Our Lady’s Hospice and Care Services, Dublin, Ireland
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Harrop E, Goss S, Longo M, Seddon K, Torrens-Burton A, Sutton E, Farnell DJ, Penny A, Nelson A, Byrne A, Selman LE. Parental perspectives on the grief and support needs of children and young people bereaved during the COVID-19 pandemic: qualitative findings from a national survey. BMC Palliat Care 2022; 21:177. [PMID: 36210432 PMCID: PMC9548427 DOI: 10.1186/s12904-022-01066-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/30/2022] [Accepted: 09/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, many children and young people have experienced the death of close family members, whilst also facing unprecedented disruption to their lives. This study aimed to investigate the experiences and support needs of bereaved children and young people from the perspective of their parents and guardians. METHODS We analysed cross-sectional qualitative free-text data from a survey of adults bereaved in the UK during the pandemic. Participants were recruited via media, social media, national associations and community/charitable organisations. Thematic analysis was conducted on free text data collected from parent/guardian participants in response to a survey question on the bereavement experiences and support needs of their children. RESULTS Free-text data from 104 parent/guardian participants was included. Three main themes were identified: the pandemic-related challenges and struggles experienced by children and young people; family support and coping; and support from schools and services. Pandemic-challenges include the impacts of being separated from the relative prior to their death, isolation from peers and other family members, and disruption to daily routines and wider support networks. Examples were given of effective family coping and communication, but also of difficulties relating to parental grief and children's existing mental health problems. Schools and bereavement organisations' provision of specialist support was valued, but there was evidence of unmet need, with some participants reporting a lack of access to specialist grief or mental health support. CONCLUSION Children and young people have faced additional strains and challenges associated with pandemic bereavement. We recommend resources and initiatives that facilitate supportive communication within family and school settings, adequate resourcing of school and community-based specialist bereavement/mental health services, and increased information and signposting to the support that is available.
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Affiliation(s)
- Emily Harrop
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK.
| | - Silvia Goss
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK
| | - Mirella Longo
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK
| | - Kathy Seddon
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK
| | - Anna Torrens-Burton
- PRIME Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Eileen Sutton
- Palliative and End of Life Care Research Group, Population Health Sciences, University of Bristol, Bristol Medical School, Bristol, UK
| | | | - Alison Penny
- National Bereavement Alliance/Childhood Bereavement Network, London, UK
| | - Annmarie Nelson
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK
| | - Anthony Byrne
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, CF14 4YS, Cardiff, UK
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, University of Bristol, Bristol Medical School, Bristol, UK
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9
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Hanna JR, Semple CJ. 'I didn't know what was in front of me'-Bereaved parents' experience of adapting to life when a co-parent of dependent children has died with cancer. Psychooncology 2022; 31:1651-1659. [PMID: 35949162 PMCID: PMC9825999 DOI: 10.1002/pon.6010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE It is not clear how the bereaved parent navigates life with the children after a co-parent has died. The objective of this study is to explore bereaved parents' experience of managing life when a co-parent of dependent children has died with cancer. METHODS Twenty-one in-depth interviews were conducted with bereaved parents when a co-parent died with cancer. Data were analysed thematically. RESULTS Bereaved parents highlighted how their children was their key focus after the death of a co-parent with cancer, as they effortfully strived to be a 'perfect parent'. While some bereaved parents struggled to adapt to the role as a sole parent, others described the importance of maximising social networks to help with the practical aspects of parenting. However, most bereaved parents described intense feelings of loneliness as they navigated parenting alone. To help navigate this post-bereavement period, parents considered it important for their children to openly talk about the deceased parent. Also, meeting others who have experienced similar situations was helpful for the bereaved parent and children, providing hope for the future. Results are discussed under two themes: (1) adapting to life without the parent, and (2) a desire to keep the memory alive of the parent that died with cancer. CONCLUSIONS Bereaved parents should be encouraged to practice self-care when a co-parent has died from cancer so they can appropriately meet the needs of their children. Bereaved parents should be reassured that showing emotion in front of the children is helpful and could facilitate better grief experiences for the whole family.
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Affiliation(s)
| | - Cherith J. Semple
- School of NursingUlster UniversityNewtownabbeyUK,South Eastern Health and Social Care TrustCancer Services Ulster HospitalBelfastUK
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10
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Wickramasinghe LM, Yeo ZZ, Chong PH, Johnston B. Communicating with young children who have a parent dying of a life-limiting illness: a qualitative systematic review of the experiences and impact on healthcare, social and spiritual care professionals. BMC Palliat Care 2022; 21:125. [PMID: 35820910 PMCID: PMC9277932 DOI: 10.1186/s12904-022-01007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background Healthcare professionals play a key role in interacting with children who have a parent with a life-limiting illness. While playing such a role can be challenging, not much is known about how such interactions impact these professionals and affect their ability to render support. Methods Four databases were searched with the intention to conduct a qualitative systematic review. Articles were selected based on pre-determined inclusion and exclusion criteria. Their quality was assessed using the tool "Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields”. Findings were analysed using thematic analysis techniques outlined by Thomas and Harden as well as Sandelowski and Barroso. Review was registered with the Review Registry database. Results Three themes emerged – healthcare professionals’ discomfort; their assumptions and actions; and potentiating workplace factors. The discomfort had several dimensions: fear of making a situation worse, concern of not being able to cope with emotionally charged situations, and internal conflict that arose when their values clashed with family dynamics. Conclusion Healthcare professionals’ sense of discomfort was very pronounced. This discomfort, together with their assumptions, could impact their ability to support children. The organisation played an important role, which was reflected in the work culture, workflow and ability to collaborate with other agencies involved in supporting children. The discomfort was mitigated by having more professional experience, workplace support systems and training on communicating with children. It was apparent that the individual professional did not work alone when supporting children but alongside others within an organisation. As such, issues raised in this review will benefit from multi-faceted solutions. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01007-1.
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Affiliation(s)
- Lasitha M Wickramasinghe
- HCA Hospice, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore.
| | - Zhi Zheng Yeo
- HCA Hospice, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore
| | - Poh Heng Chong
- HCA Hospice, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, G12 8QQ, UK
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11
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Semple CJ, McCaughan E, Smith R, Hanna JR. Parent's with incurable cancer: 'Nuts and bolts' of how professionals can support parents to communicate with their dependent children. PATIENT EDUCATION AND COUNSELING 2022; 105:775-780. [PMID: 34294491 DOI: 10.1016/j.pec.2021.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Parents with incurable cancer are often uncertain how, what and when is best to tell their children about their poor prognosis and prepare them for the actual death. Despite parents' desire and need for support from health and social care professionals (HSCPs), this is often lacking. HSCPs feel ill-equipped, identifying a need for an evidence-based communication framework for professionals to use in practice, promoting parent-child communication at end of life. METHODS A systematic process, involving a systematic review and data from 76 semi-structured, face-to-face qualitative interviews from three participant populations, including HSCPs (n = 32), bereaved parents (n = 21) and funeral directors (n = 23) were triangulated. This informed the development of the 'Talking, Telling and Sharing': End of life framework (6 W Grid), guided by an expert group. RESULTS An evidence-based, theory-driven communication framework has been developed. This provides a mechanism for HSCPs to proactively and directly engage with patients, addressing their parent-child communication concerns. CONCLUSION Clear, evidence-based communication frameworks can enhance patient-provider communication in practice, particularly around sensitive and complex issue. PRACTICE IMPLICATIONS There is a need for HSCPs to encourage parents to start these difficult conversations soon after receiving the poor prognosis, to avoid crisis management when the ill-parent is actively dying or throughout the immediate bereavement period.
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Affiliation(s)
- Cherith J Semple
- Ulster University, School of Nursing, Jordanstown, UK & South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Dundonald, UK.
| | | | - Rachel Smith
- Cancer Focus Northern Ireland, Family Support Service, Belfast, UK
| | - Jeffrey R Hanna
- Oxford University, Department of Psychiatry, Warneford Hospital, Oxford, UK
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Holm M, Weber Falk M, Alvariza A, Sveen J, Kreicbergs U. How parents of dependent children reason about their partner's impending death due to cancer. DEATH STUDIES 2021; 47:1-6. [PMID: 34787534 DOI: 10.1080/07481187.2021.1992807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This paper explores how bereaved parents with dependent children reasoned about their partner's impending death due to cancer. Questionnaires were used to collect data from 42 cancer-bereaved parents of dependent children in Sweden. The results showed that most of the parents had thought, at least once, that death would be best for their partner's own sake. A few parents had also thought that it would be best for everyone if their partner died. Many parents had a wish to keep up hope, no matter what. However, living with a partner with advanced illness and dependent children was described as extremely stressful.
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Affiliation(s)
- Maja Holm
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Megan Weber Falk
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Josefin Sveen
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Ulrika Kreicbergs
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women and Child's Health, Karolinska Institutet, Stockholm, Sweden
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Hanna JR, Rapa E, Miller M, Turner M, Dalton LJ. Conversations About Children When an Important Adult Is at End of Life: An Audit. Am J Hosp Palliat Care 2021; 39:806-811. [PMID: 34538106 PMCID: PMC9210112 DOI: 10.1177/10499091211046241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Health and social care professionals report it challenging to have conversations with families when an important adult in the life of a child is at end of life, often feeling this aspect of care is the responsibility of other colleagues. This study aimed to understand professionals' perceived role in family-centered conversations as part of routine care at end of life, and how to promote this element of care in clinical practice. METHODS An audit was completed with 116 professionals who work in palliative care including doctors and nurses that attended a 2-day virtual congress. RESULTS Professionals (73.2%) felt confident about starting a conversation with adult patients at end of life about important children. However, enquiring about relationships with children was largely dependent on the age of the patient. 64.7% of respondents reported signposting families to websites and services that provide family support. Most professionals (76.7%) wanted training to equip them with the skills and confidence to having family-centered conversations at end of life, with videos demonstrating how to provide these elements of care the most preferred option. CONCLUSIONS Short training resources should be developed to equip professionals with the necessary skills toward having conversations about children with patients and relatives in clinical appointments. There is a need for professionals to ask every patient about important relationships with children.
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Affiliation(s)
- Jeffrey R Hanna
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Mary Miller
- Department of Palliative Care, Sir Michael Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Madeleine Turner
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Louise J Dalton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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Rapa E, Hanna JR, Mayland CR, Mason S, Moltrecht B, Dalton LJ. Experiences of preparing children for a death of an important adult during the COVID-19 pandemic: a mixed methods study. BMJ Open 2021; 11:e053099. [PMID: 34400462 PMCID: PMC8370837 DOI: 10.1136/bmjopen-2021-053099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objectives of this study were to investigate how families prepared children for the death of a significant adult, and how health and social care professionals provided psychosocial support to families about a relative's death during the COVID-19 pandemic. DESIGN/SETTING A mixed methods design; an observational survey with health and social care professionals and relatives bereaved during the COVID-19 pandemic in the UK, and in-depth interviews with bereaved relatives and professionals were conducted. Data were analysed thematically. PARTICIPANTS A total of 623 participants completed the survey and interviews were conducted with 19 bereaved relatives and 16 professionals. RESULTS Many children were not prepared for a death of an important adult during the pandemic. Obstacles to preparing children included families' lack of understanding about their relative's declining health; parental belief that not telling children was protecting them from becoming upset; and parents' uncertainty about how best to prepare their children for the death. Only 10.2% (n=11) of relatives reported professionals asked them about their deceased relative's relationships with children. This contrasts with 68.5% (n=72) of professionals who reported that the healthcare team asked about patient's relationships with children. Professionals did not provide families with psychosocial support to facilitate preparation, and resources were less available or inappropriate for families during the pandemic. Three themes were identified: (1) obstacles to telling children a significant adult is going to die, (2) professionals' role in helping families to prepare children for the death of a significant adult during the pandemic, and (3) how families prepare children for the death of a significant adult. CONCLUSIONS Professionals need to: provide clear and honest communication about a poor prognosis; start a conversation with families about the dying patient's significant relationships with children; and reassure families that telling children someone close to them is dying is beneficial for their longer term psychological adjustment.
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Affiliation(s)
| | | | - Catriona R Mayland
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Stephen Mason
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
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McCaughan E, Semple CJ, Hanna JR. 'Don't forget the children': a qualitative study when a parent is at end of life from cancer. Support Care Cancer 2021; 29:7695-7702. [PMID: 34143326 PMCID: PMC8550711 DOI: 10.1007/s00520-021-06341-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/06/2021] [Indexed: 01/04/2023]
Abstract
Purpose Preparation for end of life is one of the greatest challenges faced by parents with cancer who have dependent children (< 18 years old), with requirement for support from professionals. The aim of this study is to explore how parents can be best supported in relation to their children, when a parent is at end of life from cancer. Methods This is an interpretive qualitative study, using 79 semi-structured interviews with parents at end of life (n3), bereaved parents (n21), health and social care professionals (HSCPs) (n32) and funeral directors (n23). Data were analysed thematically and triangulated. Results Parents are central to preparing their children for the death of a parent. Striving for everyday ordinariness, maximising social networks, maintaining hope and making preparations for the future are helpful for families when a parent is at end of life. Most HSCPs were unaware of the challenges faced by parents at end of life, and psychosocial support was often left outside the caring realm. As a result, funeral directors noted complexities faced by the families after the death. Results are discussed under four themes: (1) communication with the children as a process, (2) coping throughout the unfolding end of life experience, (3) tension and complexities at end of life and (4) preparing for the future. Conclusions Parents should be reassured that by involving the children early in the end of life experience when the ill-parent is ‘well enough’ to parent enables them to be actively involved in supporting their child through one of the greatest life changing event. A number of recommendations are discussed for professionals. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06341-3.
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Affiliation(s)
- Eilís McCaughan
- School of Nursing, Ulster University, Cromore Road, Coleraine, BT52 1SA, Co. L'Derry, UK
| | - Cherith J Semple
- School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Co, Antrim, UK.,South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH, UK
| | - Jeffrey R Hanna
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK.
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