The Concept of Suffering in Children and Adolescents With Cancer

A Retrospective Observational Study of Problems Faced by Children and Adolescents with Cancer: A 5-year Experience from a Pediatric Psycho-Oncology Service in India

Introduction Psychological concerns are common in children and adolescents with cancer, for which they require referral to specialist services. There is a dearth of pediatric psycho-oncology services in India. There are limited studies on emotional and related distress in children.

Objectives To evaluate the types of problems and associated factors in children and adolescents with cancer referred to the pediatric psycho-oncology service in a tertiary care oncology center in India.

Materials and Methods A retrospective analysis of all referrals to the institution's pediatric psycho-oncology service over 5 years was performed. Patients newly referred to the service, up to 18 years of age, with a cancer diagnosis, on active disease-modifying treatment or supportive care or following up within 2 years of completion of treatment were included. Patients not on any disease-modifying treatment and receiving the best supportive care only were excluded as needs and problems would differ in this group. Patients whose medical records were incomplete were excluded too. Descriptive measures and tests of association were performed for analysis.

Results Of the 278 children referred to the service in 5 years, 66.5% were males. The average age was 11 years (standard deviation [SD]: 4.5). Most children had hematolymphoid cancers (58.2%). All reported problems were mainly emotional/behavioral (59%), physical health-related (21%), and academic (14%). Male children, referred from outpatient clinics and undergoing treatment with palliative intent, had more emotional problems, but these factors were not statistically significant.

Conclusion Children and adolescents with cancer had different problems, most commonly emotional/behavioral and physical health-related. Age, gender, and treatment intent were factors associated with emotional problems. Psychosocial care services for children and adolescents with cancer are necessary for low-resource settings.

The Theory of Unpleasant Symptoms in Pediatric Oncology Nursing: A Conceptual and Empirical Fit?

Symptom management knowledge is a priority for pediatric oncology nursing research. Theories and models can frame the studies of symptoms experienced during childhood cancer. This article describes and analyzes the middle-range theory, theory of unpleasant symptoms (TOUS), for its conceptual and empirical fit with pediatric oncology nursing based on its current use in adult oncology research and its limited use to date in pediatric oncology. Searches in PubMed and CINAHL databases using the keywords theory of unpleasant symptoms and cancer and covering the time period 2000 to 2017 yielded 103 abstracts for review. Twenty published reports met eligibility criteria for review; only one included pediatric oncology patients. No study to date has tested all the components of the TOUS in pediatrics. The TOUS component of performance appears to be underaddressed across completed studies that instead include a focus on patient-reported quality of life rather than on perceived behavioral or performance indicators concurrent with the subjective symptom reports. Additionally, the influence of family, essential in pediatric oncology, is absent in the majority of studies guided by the TOUS. The TOUS is a structurally complicated framework that would be a conceptual fit for pediatric oncology if family influence and perceived function were included. Studies across this population and guided by the TOUS are needed, although testing all the theorized linkages in the TOUS would likely require a large sample size of patients and, thereby, multisite approaches given that cancer is a rare disease in childhood.

Development of the Adolescent Cancer Suffering Scale

BACKGROUND

While mortality due to pediatric cancer has decreased, suffering has increased due to complex and lengthy treatments. Cancer in adolescence has repercussions on personal and physical development. Although suffering can impede recovery, there is no validated scale in French or English to measure suffering in adolescents with cancer.

OBJECTIVE

To develop an objective scale to measure suffering in adolescents with cancer.

METHODS

A methodological design for instrument development was used. Following a MEDLINE search, semistructured interviews were conducted with adolescents 12 to 19 years of age who had undergone four to six weeks of cancer treatment, and with a multidisciplinary cohort of health care professionals. Adolescents with advanced terminal cancer or cognitive impairment were excluded. Enrollment proceeded from the hematology-oncology department⁄clinic in Montreal, Quebec, from December 2011 to March 2012. Content validity was assessed by five health care professionals and four adolescents with cancer.

RESULTS

Interviews with 19 adolescents and 16 health care professionals identified six realms of suffering: physical, psychological, spiritual, social, cognitive and global. Through iterative feedback, the Adolescent Cancer Suffering Scale (ACSS) was developed, comprising 41 questions on a four-point Likert scale and one open-ended question. Content validity was 0.98, and inter-rater agreement among professionals was 88% for relevance and 86% for clarity. Adolescents considered the scale to be representative of their suffering.

CONCLUSIONS

The ACSS is the first questionnaire to measure suffering in adolescents with cancer. In future research, the questionnaire should be validated extensively and interventions developed. Once validated, the ACSS will contribute to promote a holistic approach to health with appropriate intervention or referral.

Spirituality and Spiritual Care of Adolescents and Young Adults with Cancer

OBJECTIVES

To review research on spiritual perspectives and spiritual care of adolescents and young adults (AYA) living with cancer.

DATA SOURCES

Peer-reviewed publications, book chapters, and websites of professional organizations.

CONCLUSION

There is a paucity of research specifically investigating AYA spirituality and lack of AYA-sensitive instruments to measure spirituality. Research that applies robust scientific methods to the study of AYA spirituality is needed. Research that provides evidence on which to base best practices for spiritual care that supports AYA spiritual well-being is likewise necessary.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can influence AYA health-related outcomes and experiences by providing ethical and evidence-based spiritual nurture.

The reality of hospitalisation: stories from family members of their hospital experience for adolescents and young adults living with and dying from cancer

BACKGROUND

Adolescents and Young Adults (AYAs) with cancer are being disadvantaged within the present health care system. Some of the factors identified as leading to this disadvantage include medical issues specific to AYAs with cancer, delay in diagnosis, fragmented services, lack of access to clinical trials and psychosocial life stage issues.

OBJECTIVE

A major study investigated the experience that accompanies the stages of diagnosis, treatment, dying and death of an AYA from the perspective of family members. This paper discusses the major theme of the reality of hospitalisation.

METHODS

Narrative inquiry was the methodology for this study. The participants were a self-selected purposeful sample of 26 family members. Open-ended interviews were conducted to obtain a story of the experience of having an AYA family member live with and die of cancer. A meta-narrative of the family member's experience was developed by NVivo8.

RESULTS

In amongst the mass of data this study produced, a major theme to emerge was the experience 'of the reality of hospitalisation'. Within this theme issues regarding: The place of treatment; the hospital experience; not fitting in; and, confronting illness and death were revealed.

CONCLUSION

While on the whole the cancer was treated with state of the art medicine, the experiences of the hospitalisation repeated consistently throughout this narrative reveals a failure to meet the higher order needs specific to adolescents and young adults and their families As a result this cohort were exposed to a landscape which did not facilitate a therapeutic experience, as well as would be expected for children and older adults.

The reality of hospitalisation: Stories from family members of their hospital experience for adolescents and young adults living with and dying from cancer

Abstract Background: Adolescents and Young Adults (AYA) with cancer are being disadvantaged within the present health care system. Some of the factors identified as leading to this disadvantage include medical issues specific to AYAs with cancer, delay in diagnosis, fragmented services, lack of access to clinical trials and psychosocial life stage issues Objective: A major study investigated the experience that accompanies the stages of diagnosis, treatment, dying and death of an AYA from the perspective of family members. This paper discusses the major theme of the reality of hospitalisation Methods: Narrative inquiry was the methodology for this study. The participants were a self-selected purposeful sample of 26 family members. Open-ended interviews were conducted to obtain a story of the experience of having an AYA family member live with and die of cancer. A meta-narrative of the family member's experience was developed by NVivo8. Results: In amongst the mass of data this study produced, a major theme to emerge was the experience 'of the reality of hospitalisation.' Within this theme issues regarding: the place of treatment; the hospital experience; not fitting in; and, confronting illness and death were revealed. Conclusion: While on the whole the cancer was treated with state of the art medicine, the experiences of the hospitalisation repeated consistently throughout this narrative reveals a failure to meet the higher order needs specific to adolelscents and young adults and their families As a result this cohort were exposed to a landscape which did not facilitate a therapeutic experience, as well as would be expected for children and older adults.

[Suffering in children experiencing a terminal disease: the perspective of parents and professionals]

Situation diagnosis using exploratory and descriptive scientific methodology (participant observation with descriptive statistical treatment) in order to identify nursing' practices in the area of health promotion during a nursing child health consultation. The 31 consultations observed (n = 31) showed that the majority of observations occurred in children younger than 2 years being the most discussed topic feed with predominant use of expository methodology. There was also little use of informational support and when used relate to the themes of security and nutrition. Most providers raised questions and there was limited registration of the interaction between provider and child with an expenditure averaging of 23 minutes per consultation. Given the results and reflecting about them stands out as intervention the construction of a health promotion manual with the integration of theory and evidence of good practice in this area.

Body image of children and adolescents with cancer: a metasynthesis on qualitative research findings

Children and adolescents with cancer are confronted with many challenges. This review considered studies that used qualitative methods to examine the body image experience of children and adolescents with cancer. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1960 and October 2010. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Eight papers met the inclusion criteria. The derived four metasyntheses included being distanced from the body, loss of self-identity, self-protective strategies and support, and getting rid of the shackles of the body. In conclusion, children and adolescents with cancer also experience various problems associated with changes in their body image. Repeated courses of treatment lead to loss of a normal, orderly life, and might even result in changes in interpersonal interactions. In response to body image change, individuals with cancer develop self-protective, coping strategies. Children and adolescents who experience life-threatening cancer come to face body image change positively, and might hold a confident attitude toward their future.

Children's pain perspectives

BACKGROUND

Previous studies on children's pain perspectives remain limited to English-speaking populations.

METHODS

An exploratory cross-sectional descriptive design was used to investigate the developmental progression of children's pain perspectives, including their pain experience, its definition and attributes, causality and coping. The Children's Pain Perspectives Inventory was applied to 180 healthy Spanish children. A coding system was developed following the content analysis method. Three age groups were compared: 4-6 years, corresponding to the Piagetian pre-operational stage of cognitive development; 7-11 years, corresponding to stage of concrete operations; and 12-14 years, corresponding to the period of early formal operations.

RESULTS

In children between 4 and 6, the predominant narratives related to physical injuries, the notion of causality and the definition of pain. In children between 7 and 11, the predominant narratives were those in which pain was described as a sensation in one part of the body. The view of pain as having an emotional basis significantly increased with age and was more frequent in adolescents. In contrast, children between 4-6 and 7-11 indicated that pain occurs spontaneously. The denial of any positive aspects of pain significantly decreased with age; some children between 7 and 11 referred to the 'possibility of relief', while the view that pain is a 'learning experience' was significantly more frequent among adolescents aged between 12 and 14 years. The use of cognitive strategies to control pain significantly increased with age. Between 12 and 14 years of age, adolescents communicate pain by non-verbal behaviour and reported that they do not express demands for relief.

CONCLUSIONS

There was a progression from concrete to more complex notions of pain as age increased. These results may be of use to health professionals and parents to understand how children at various developmental stages express and cope with pain and to develop tools that effectively assess and manage pain in children.

Development of data models for nursing assessment of cancer survivors using concept analysis

Objectives

Sharing of cancer-related information among healthcare professionals is crucial to ensuring the quality of long-term care for cancer survivors. Appropriate distribution of the essential facts can be achieved using data models. The purpose of this study was to develop and validate suitable data models for use in the nursing assessment of cancer survivors.

Methods

The models developed in this study were based on a modification of concept analysis developed by Walker and Avant. Our approach involved determining the purpose of the analysis, identifying data elements, defining these elements and their uses, determining critical attributes, value sets, and cardinalities, and ultimately constructing data models which were examined externally by domain experts.

Results

We developed 112 data models with 112 data elements, 29 critical attributes, 102 value sets, and 6 data types for the assessment of cancer survivors. External validation revealed that the data elements, critical attributes, and value sets proposed were comprehensive, relevant, and sufficiently useful to encompass nursing issues related to cancer survivors.

Conclusions

Data models developed in this study will contribute to ensuring the semantic consistency of data collected from cancer survivors, which will improve the quality of nursing assessments and in turn translate to improved long-term patient care.

The experience of body image of children and adolescents with cancer: A meta-synthesis

EXECUTIVE SUMMARY

Objectives: The objective of this study was to describe the body image experience of children and adolescents with cancer.

INCLUSION CRITERIA

This review considered studies that utilised qualitative methods to examine the experience of children and adolescents with cancer. The phenomena of interest were experiences of children and adolescents with cancer living in acute care, home, and community settings of any cultural context. The research was limited to studies published in Chinese or English only.

SEARCH STRATEGY

The search strategy sought to find both published and unpublished studies. CINAHL, MEDLINE, Mednar, Scius, ProQuest Dissertations and Theses, electronic theses and dissertations system and Chinese electronic periodical services were used to search the articles.Methodological quality: Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise the methodological quality of the articles. Any disagreements that arose between the reviewers were resolved through discussion with a third reviewer.

DATA EXTRACTION AND SYNTHESIS

Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.

RESULTS

Eight papers were included in the review. Four meta-syntheses emerged from the analysis: (1) Being kept away from body: Clinicians should be aware that children and adolescents with cancer feel that they are kept away from normal body, (2) Loss of self-identity: Clinicians should be aware that children and adolescents with cancer feel that they have lost their self-identity, (3) Self-protective strategies and support: Clinicians should understand the protective strategies that children and adolescents with cancer develop and utilise with support from family and friends, and (4) Getting rid of shackles of the body: There should be a strategy to facilitate the development of positive attitudes toward the illness and body image change in children and adolescents with cancer.

CONCLUSION

Children and adolescents with cancer also experience various problems associated with body image change. Repeated courses of treatment lead to loss of a normal orderly life, and may even result in changes in interpersonal interactions. In response to body image change, self-protective coping strategies are developed. Children and adolescents who experience life-threatening cancer come to face body image change positively and may hold a confident attitude towards future life.The implications for practice include: (1) Clinicians should be aware that children and adolescents with cancer feel that they are kept away from normal body; (2) Clinicians should be aware that children and adolescents with cancer feel that they have lost their self-identity; (3) Clinicians should be understand the protective strategies that children and adolescents with cancer develop and utilise with support from family and friends; (4) There should be a strategy to facilitate the development of positive attitudes toward the illness and body image change in children and adolescents with cancer.The research tools concerning social support and guidance can be further developed in the future to increase the confidence and capacity of children and adolescents with cancer to face body image change and reduce psychological stress.

The experiences of cancer-related fatigue among Chinese children with leukaemia: a phenomenological study

BACKGROUND

Although cancer-related fatigue has been given priority status for study in Western countries, unfortunately, it has not received enough attention in China. Based on a different cultural perspective, qualitative study regarding cancer-related fatigue in China can provide a cultural context for enriching the system of knowledge about fatigue.

OBJECTIVES

To explore the real-life experiences of fatigue from the perspectives of Chinese Children with leukaemia.

DESIGN

A phenomenological study.

SETTING

A paediatric haematology oncology department of a regional tertiary children's hospital in Shanghai, China.

PARTICIPANTS

A total of 14 children and adolescents with leukaemia, aged 7-18 years old, without known psychiatric or developmental disorders, was selected by purposive sampling.

METHODS

Four focus group interviews were conducted with nine open-ended, semi-structured questions.

FINDINGS

Cancer-related fatigue is a common and distressing issue for Chinese children and adolescents with leukaemia. Three themes were finally generated: 'fatigue is an open interpretation among children and adolescents', 'fatigue is not a single-dimensional aspect', and 'struggles with fatigue and balancing life suffering'. Fatigue, which is closely related to physical, psychological and situational factors, has negative affects on the participants physically, psychologically and on their cognitive well-being, and can impact the family, school and social interaction of children with leukaemia.

CONCLUSIONS

Children and adolescents could easily distinguish cancer-related fatigue from normal fatigue. The participants' message to health professionals is that fatigue is a multidimensional and multifactorial symptom that should be comprehensively understood and managed. The findings provide insight and direction for clinical practice and research regarding intervention development and education plans for cancer-related fatigue for paediatric oncology patients.

Phenomenology in Pediatric Cancer Nursing Research

What does it mean to have cancer as a child or adolescent? To understand this, researchers must study the illness from the child's point of view and listen to these children's descriptions of their “lived world.” Phenomenology is a qualitative research methodology that can be used to discover and interpret meaning. To use phenomenology congruently, the philosophical background must be understood as well as the adaptation of the philosophical basis to research in the caring sciences. Only when clinicians truly understand the meaning of this illness to the child can they design nursing interventions to ease suffering and increase quality of life in children and adolescents with cancer.

Embodied suffering: experiences of fear in adolescent girls with cancer

Previously, fear in adolescents with cancer has been sparsely described from an emic perspective. The aim of this study was to illuminate fear in adolescents with personal experience of cancer. The participants were six adolescent girls between the age of 14 and 16 years who were no longer under active treatment for cancer but still went for regular check-ups. Open interviews were conducted. Data were analysed according to the phenomenological hermeneutic method. In the result one main theme was identified: 'an embodied fear--a threat to the personal self'. This theme was built up by three separate but intertwined themes: ;experiencing fear related to the physical body', 'experiencing existential fear' and 'experiencing fear related to the social self'. In the comprehensive understanding the fear was interpreted from youth cultural aspects as well as a holistic perspective. The importance of professionals taking the whole person and their situation into account when meeting the fear is underlined.

'Having cancer changed my life, and changed my life forever': survival, illness legacy and service provision following cancer in childhood

OBJECTIVES

To explore how having cancer in childhood influences social and personal wellbeing in young adulthood.

METHODS

Questionnaires (55) eliciting lengthy written responses and in-depth interviews (32) were used with male and female survivors of cancer in childhood (aged between 18 and 28 years). Analysis drew on a combination of grounded-theory techniques and narrative analysis.

RESULTS

Three key areas are outlined relating to the characterization of survivorship by participants. These include highlighting survival as not necessarily a simple end to a cancer story, issues relating to post-cancer bodily self-concept and its gendering, and, efforts at managing uncertainties through medical interactions and information gathering.

DISCUSSION

Participant stories in this study illustrate that even in long-term survival, cancer is present as a web of ongoing influences from the original disease and treatment, as well as the social and personal aftershocks that can occur well after malignant cells have been controlled. Findings highlight the necessity for complex redevelopment of healthcare services and social support provisions for this growing population.