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Wong CI, Ilowite M, Yan A, Mahan RM, Desrochers MD, Conway M, Billett AL. Reducing ambulatory central line-associated bloodstream infections: A family-centered approach. Pediatr Blood Cancer 2024; 71:e31064. [PMID: 38761026 DOI: 10.1002/pbc.31064] [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: 03/13/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Ambulatory central line-associated bloodstream infections (CLABSIs) cause significant morbidity and mortality, especially in pediatric oncology. Few studies have had interventions directed toward caregivers managing central lines (CL) at home to reduce ambulatory CLABSI rates. We aimed to reduce and sustain our ambulatory CLABSI rate by 25% within 3 years of the start of a quality improvement intervention. PROCEDURE Plan-do-study-act cycles were implemented beginning April 2016. The main intervention was a family-centered CL care skill development curriculum for external CLs. Training began upon hospital CL insertion, followed by an ambulatory teach-back program to achieve home caregiver CL care independence. Other changes included: standardizing ambulatory nurse CL care practice (audits, a train the nurse trainer process, and workshops for independent home care agencies); developing aids for trainers and caregivers; providing supplies for clean surfaces; wide dissemination of the program; and minimizing opportunities of CLABSI (e.g., standardizing timing of CL removal). The outcome measure was the ambulatory CLABSI rate (excluding mucosal barrier injury laboratory-confirmed bloodstream infection), compared pre intervention (January 2015 to March 2016) to post intervention, including 2 years of sustainability (April 2016 to June 2023), using statistical process control charts. We estimated the total number of CLABSI and associated healthcare charges prevented. RESULTS The ambulatory CLABSI rate decreased by 52% from 0.25 to 0.12 per 1000 CL days post intervention, achieved within 27 months; 117 CLABSI were prevented, with $4.2 million hospital charges and 702 hospital days avoided. CONCLUSIONS Focusing efforts on home caregivers CL care may lead to reduction in pediatric oncology ambulatory CLABSI rates.
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Affiliation(s)
- Chris I Wong
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, University Hospitals Rainbow Babies and Children's Hospital and Division of Hematology-Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - Maya Ilowite
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Adam Yan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Riley M Mahan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Marie D Desrochers
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Margaret Conway
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amy L Billett
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
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2
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Vieira LG, Schneider G, Margatho AS, Braga FTMM, Vasques CI, Møller T, Ferreira EB, Silveira RCDCP. Teaching-Learning Programs to Prevent and Control Infections Related to Long-Term Central Venous Access Device in Cancer Patients: A Systematic Review. Semin Oncol Nurs 2024; 40:151650. [PMID: 38705798 DOI: 10.1016/j.soncn.2024.151650] [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: 01/17/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES To evaluate the effectiveness of teaching-learning programs for cancer patients and/or their caregivers or family in preventing and controlling infections associated with long-term central venous access devices. DATA SOURCES This systematic review used the CINAHL, Cochrane Library, EMBASE, LILACS, and MEDLINE via PubMed portal, Scopus, and Web of Science. Google Scholar was used for the gray literature search. The included studies were analyzed, and the obtained data were qualitatively synthesized. The risk of bias was assessed using Cochrane tools: RoB 2 and ROBINS-I. The certainty of the evidence was evaluated using the GRADE. The review protocol was registered in PROSPERO (CRD42021267530). CONCLUSION The teaching-learning programs were implemented through theoretical-practical and theoretical dimensions in five and two studies, respectively. The risk of bias in the studies was low, moderate, severe, and high in one, three, two, and one of them, respectively. The certainty was very low. Teaching-learning programs on central venous access devices care for cancer patients and/or their caregivers or families could be effective in reducing infection rates. IMPLICATIONS FOR NURSING PRACTICE This systematic review addressed the teaching-learning programs for preventing and controlling infections associated with long-term central venous access devices. We identified that the most programs were effective in reducing the infection rates. The results may influence the clinical practice of oncology nurses, and consequently, the educational strategies and methods provided not only to these patients but for caregivers and families.
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Affiliation(s)
- Leticia Genova Vieira
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Guilherme Schneider
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | - Tom Møller
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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3
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Banayat AC, Abad PJB, Bonito SR, Manahan LT, Peralta AB. Care Needs of Parents of Children With Cancer in a Low-Middle-Income Country. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:295-304. [PMID: 37885214 DOI: 10.1177/27527530231193972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background: Mapping out actual supportive care needs assists nurses in providing holistic individualized care. This study aimed to explore the care needs of parents of children with cancer in the Philippines. Method: Guided by the Supportive Care Needs Framework (SCNF), this study used an embedded mixed-method design with the quantitative revised Cancer Patient Needs Questionnaire and qualitative semistructured interviews to describe parents' care needs and priorities. Results: Filipino parents (N = 156) of children with cancer have various care needs which could be classified along the SCNF categories-practical, informational, spiritual, physical, emotional, and physical needs as ranked from highest to lowest. A number of variables were significantly associated with care needs. Solid tumor diagnosis was associated with greater practical, emotional, and psychosocial care needs; having a child who had undergone surgery was associated with more practical and spiritual care needs; and being within one year of the child's diagnosis was associated with practical, psychosocial, and spiritual care needs. Parent priority needs included (a) addressing financial needs; (b) access to temporary housing to minimize treatment-related costs; (c) support groups among parents of children with cancer as a source of information; (d) financial and social support between members of family and partners of parents of children with cancer; and (e) using prayer to facilitate acceptance. Conclusions: Supportive care needs of parents of children with cancer are important components of care that should be given recognition to enhance holistic individualized care throughout the childhood cancer experience.
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Affiliation(s)
| | - Peter James B Abad
- College of Nursing, University of the Philippines Manila, Manila, Philippines
| | - Sheila R Bonito
- College of Nursing, University of the Philippines Manila, Manila, Philippines
| | - Lydia T Manahan
- College of Nursing, University of the Philippines Manila, Manila, Philippines
| | - Arnold B Peralta
- College of Nursing, University of the Philippines Manila, Manila, Philippines
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4
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Hilario R, Cosme M, Barzola I, Bejarano G, Benavente A, Sabrera G, Celis E, Mirabal F, Huerta MDP, Carpio Z, Quispe Y, Elera E, Ascue K, Jesús M, Grados I, Allauca N, Escobedo M, Muñoz S, Ruda L, Velandres MDC, Olarte-Sierra MF, Maradiegue E, Pascual C, Vasquez L. Development and Implementation of Educational Material by Nurses for Parents/Caregivers of Children With Cancer: A Peruvian National Study. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:356-363. [PMID: 37908104 DOI: 10.1177/27527530231198202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background: Education for parents and caregivers of children with cancer is one of the fundamental roles of nurses to avoid complications, provide quality care, promote adherence to treatment and maintain basic standards of care. This study aimed to design educational material for parents and caregivers of children with cancer in Peru on general information about childhood cancer and its care. Method: Within the framework of the WHO Global Initiative for Childhood Cancer in Peru, a multicenter working group was convened by the Peruvian Ministry of Health. A comprehensive needs assessment of parents and caregivers of children with cancer was performed through a survey in June and July 2020. The survey was conducted online (via Google Forms) and in person at nine hospitals to examine the preferred method of delivery and content of information. Results: Based on the findings from the parent needs assessment, a national nursing working group developed Spanish-language audiovisual materials (i.e., diagnosis and treatment videos for nurses to educate parents and caregivers). A total of 365 parents and caregivers were included. Most respondents (56.9%) were parents of children receiving treatment. Main topics were childhood cancer overview and side effects (85%), food and nutrition (75%), and palliative care (67%); most (70.9%) preferred information through talks and videos (64.7%). Twenty-three videos were developed with support by the Pan American Health Organization and the Ministry of Health. Discussion: Assessing the educational needs of parents and caregivers of children with cancer provides a starting point in the design of targeted strategies.
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Affiliation(s)
- Rosmery Hilario
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | - Melitta Cosme
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | - Isela Barzola
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | - Giovanna Bejarano
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | - Annaly Benavente
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
- Deceased
| | - Gina Sabrera
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | - Edinho Celis
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | - Flor Mirabal
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | | | - Zulma Carpio
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | - Yuly Quispe
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | - Elizabeth Elera
- Pediatric Oncology Nursing, National Institute of Neoplastic Diseases, Lima, Peru
| | - Kathy Ascue
- Pediatric Oncology Nursing, Instituto Nacional del Niño-San Borja, Lima, Peru
| | - Maritza Jesús
- Pediatric Oncology Nursing, Hospital Nacional Guillermo Almenara Yrigoyen, Lima, Peru
| | - Ivonne Grados
- Pediatric Oncology Nursing, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Nora Allauca
- Pediatric Oncology Nursing, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Milagros Escobedo
- Pediatric Nutrition, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Sara Muñoz
- Pediatric Oncology Nursing, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Lourdes Ruda
- Psychooncology, Asociación Nacional de Psicooncología del Perú (ANPPE), Lima, Peru
| | | | - María Fernanda Olarte-Sierra
- Medical Anthropology & Global Health Institute for Cultural and Social Anthropology Universität Wien, University of Vienna, Vienna, Austria
| | - Essy Maradiegue
- Division of Prevention and Control of Cancer, Ministry of Health, Lima, Peru
| | - Claudia Pascual
- Department of Non-communicable Disease, PAHO/WHO, Lima, Peru
| | - Liliana Vasquez
- Department of Non-communicable Disease, PAHO/WHO, Washington, DC, USA
- Faculty of Medicine, University of San Martin de Porres, Research, Center of Precision Medicine, Lima, Peru
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5
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Keith KE, Wadhwa A, York J, Fazeli PL, Bhatia S, Landier W. Health Literacy in Parents of Children Newly Diagnosed With Cancer and Comprehension of Key Concepts Related to Their Child's Care. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:235-244. [PMID: 37063061 DOI: 10.1177/27527530221140076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background: There is a paucity of literature regarding health literacy in pediatric oncology. We sought to understand the relationship between health literacy and comprehension of key new diagnosis education concepts in parents of children newly diagnosed with cancer. Methods: Using data from a study evaluating a structured new diagnosis discharge teaching intervention, we performed a secondary analysis to understand the relationship between parental health literacy (Brief Health Literacy Screener: BHLS) and comprehension of six key concepts (child's diagnosis, primary oncologist, and treatment plan; seeking emergent care; fever definition; re-dosing medication). We also evaluated the association between parents self-reported sociodemographic characteristics, preferred learning style (one-item ordinal assessment) and health literacy. We tested relationships using Fisher's exact tests, independent samples t-tests, and Pearson correlations. Results: Fifty parents participated (age 35.4 ± 8.2 years [M ± SD]; 86% female; 60% non-Hispanic white; 24% with ≤high school education); nine parents (18%) scored in the BHLS low literacy range; 80% correctly responded to all six items on the key concepts questionnaire (100% comprehension). Health literacy was not significantly related to 100% comprehension or to individual key concept responses, with the exception of "child's treatment plan" (correct responses: 55.6% in low vs. 100% in adequate literacy groups; p < .001). Parental sociodemographic characteristics and preferred learning styles were not significantly related to health literacy. Discussion:Despite variability in health literacy levels, 80% of the parents comprehended all key concepts, suggesting that the intervention was effective for most parents, regardless of health literacy level.
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Affiliation(s)
- K Elizabeth Keith
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aman Wadhwa
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jocelyn York
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wendy Landier
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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6
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Ochoa-Dominguez CY, Miller KA, Banegas MP, Sabater-Minarim D, Chan RY. Psychological Impact and Coping Strategies of Hispanic Parents of Children with Cancer: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5928. [PMID: 37297532 PMCID: PMC10252186 DOI: 10.3390/ijerph20115928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
Throughout the cancer trajectory, parents of childhood cancer survivors (CCSs) may experience mental and social challenges requiring continual adaptation to cancer-induced stress. Using Lazarus and Folkman's Transactional Model of Stress and Coping framework, this qualitative study aimed to describe Hispanic parents' psychological health and explore their coping strategies. Purposive sampling was used to recruit 15 Hispanic caregivers from a safety-net hospital in Los Angeles County. To be eligible, participants had to be: the primary caregiver of a CCS who had completed active treatment, the primary caregiver or child self-identified as Hispanic, and proficient in English or Spanish. The interviews lasted approximately 60 min, were audio-recorded (in English and Spanish), and professionally transcribed. Data were analyzed following a thematic content analysis with deductive and inductive approaches on Dedoose. Participants described high levels of stress and fear when their child was diagnosed with cancer. They also shared experiencing symptoms of social anxiety, post-traumatic stress disorder, and depression. Participants' coping strategies were encompassed by three major themes: problem-focused, emotion-focused, and avoidant coping strategies. Problem-focused coping strategies included self-efficacy, behavioral change, and social support. Emotion-focused coping strategies included religious practices and positive reframing. Avoidant coping strategies included denial and self-distraction. Despite the evident disparities in psychological health for Hispanic parents of CCSs, gaps remain in designing a culturally tailored program to help alleviate the caregiver burden. This study provides insights regarding coping strategies that Hispanic caregivers use to deal with the psychological impact of their child's cancer diagnosis. Our findings also delve into the contextual and cultural factors that impact psychological adjustment.
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Affiliation(s)
- Carol Y. Ochoa-Dominguez
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92037, USA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
- Center for Health Equity Education and Research, University of California San Diego, La Jolla, CA 92037, USA
| | - Kimberly A. Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Matthew P. Banegas
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92037, USA
- Center for Health Equity Education and Research, University of California San Diego, La Jolla, CA 92037, USA
| | - Daniel Sabater-Minarim
- Center for Health Equity Education and Research, University of California San Diego, La Jolla, CA 92037, USA
- Department of Biological Sciences, University of California San Diego, San Diego, CA 92161, USA
| | - Randall Y. Chan
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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7
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Ringnér A, Björk M, Olsson C. What Was on the Parents' Minds? Changes Over Time in Topics of Person-Centred Information for Mothers and Fathers of Children with Cancer. Compr Child Adolesc Nurs 2023; 46:114-125. [PMID: 36811905 DOI: 10.1080/24694193.2023.2168790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Acquiring information about one's child's cancer diagnosis is a complex and ever-changing process, and parents' needs change over time. As yet, we know little about what information parents require at different stages of their child's illness. This paper is part of a larger randomized control trial studying the parent-centered information given to mothers and fathers. The aim of this paper was to describe the topics addressed in person-centered meetings between nurses and parents of children with cancer and how those changed over time. Using qualitative content analysis, we analyzed nurses' written summaries of 56 meetings with 16 parents and then computed for each topic the percentage of parents who brought it up at any time during the intervention. The main categories were Child's disease and treatment (addressed by 100% of parents), Consequences of treatment (88%), Emotional management for the child (75%), Emotional management for the parent (100%), Social life of the child (63%), and Social life of the parent (100%). Different topics were addressed at different points in time, and fathers raised more concerns about the child's emotional management and the consequences of treatment than mothers. This paper suggests that parental information demands change over time and differ between fathers and mothers, implying that information should be person-centered. Registered at Clinicaltrials.gov (NCT02332226).
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Affiliation(s)
- Anders Ringnér
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Maria Björk
- CHILD Research Group, Department of Nursing, School of Health and Welfare, Jönköping, Sweden
| | - Cecilia Olsson
- Department of Health Sciences, Karlstad University, Karlstad, Sweden.,Department of Bachelor in Nursing, Lovisenberg Diaconal University College, Oslo, Norway
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8
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Landier W, York JM, Wadhwa A, Adams K, Henneberg HM, Madan-Swain A, Benton B, Slater V, Zupanec S, Miller J, Tomlinson K, Richman JS, Bhatia S. A Structured Discharge Education Intervention for Parents of Newly Diagnosed Pediatric Oncology Patients. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:145-157. [PMID: 36654478 DOI: 10.1177/27527530221140058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Parents of children newly diagnosed with cancer require specialized knowledge and skills in order to safely care for their children at home. The Children's Oncology Group (COG) developed expert consensus recommendations to guide new diagnosis education; however, these recommendations have not been empirically tested. Methods: We used a sequential two-cohort study design to test a nurse-led Structured Discharge Teaching Intervention (SDTI) that operationalizes the COG expert recommendations in the setting of a tertiary children's hospital. Outcomes included parent Readiness for Hospital Discharge Scale (RHDS); Quality of Discharge Teaching Scale (QDTS); Post-Discharge Coping Difficulty (PDCD); Nurse Satisfaction; and post-discharge unplanned healthcare utilization. Results: The process for discharge education changed significantly before and after implementation of the SDTI, with significantly fewer instances of one-day discharge teaching, and higher involvement of staff nurses in teaching. Overall, parental RHDS, QDTS, and PDCD scores were similar in the unintervened and intervened cohorts. Almost 60% of patients had unplanned healthcare encounters during the first 30 days following their initial hospital discharge. Overall nurse satisfaction with the quality and process of discharge education significantly increased post-intervention. Discussion: Although the structure for and process of delivering discharge education changed significantly with implementation of the SDTI, parent RHDS and QDTS scores remained uniformly high and PDCD scores and non-preventable unplanned healthcare utilization remained similar, while nurse satisfaction with the quality and process of discharge education significantly improved, suggesting that further testing of the SDTI across diverse pediatric oncology settings is warranted.
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Affiliation(s)
- Wendy Landier
- 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jocelyn M York
- 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aman Wadhwa
- 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kandice Adams
- 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Avi Madan-Swain
- 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Sue Zupanec
- 7979Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeneane Miller
- 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Smita Bhatia
- 9968University of Alabama at Birmingham, Birmingham, AL, USA
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9
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Offenbacher R, Briggs J, Ronca K, Uong A, Ogidan-Odeseye O, Kim M, Weiser D. Retention of discharge instructions using an interdisciplinary model for at-risk children with cancer: A quality improvement initiative. Pediatr Blood Cancer 2023; 70:e30045. [PMID: 36215215 DOI: 10.1002/pbc.30045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE We sought to improve caregiver retention of critical initial hospital discharge instructions using a multidisciplinary, team-based intervention for newly diagnosed pediatric cancer patients at high risk for unfavorable outcomes. MATERIALS AND METHODS A multidisciplinary team of pediatric residents, nurses, social workers, pharmacists and hematology/oncology faculty implemented practices to optimize teaching of key discharge material as part of four Plan-Do-Study-Act intervention cycles. An 11-question survey distributed at the first post-discharge clinic visit assessed the efficacy of the intervention, as defined by caregiver retention of critical home instructions. RESULTS Thirty-nine caregivers of pediatric cancer patients in an urban academic tertiary-care children's hospital took part in this project. Overall retention of key discharge information was greater in the post-intervention cohort compared to the baseline cohort (median total scores: 89 and 63, respectively; p = .001). Improvements in the proportions of correct responses post-intervention were also observed across all subject matters: from 0.57 to 0.88 for fever guidelines (p = .059), from 0.71 to 0.78 for signs of sepsis (p = .65), from 0.57 to 1.00 for accurate choice of on-call number (p = .004), and from 0.71 to 0.94 for antiemetic management (p = .14). CONCLUSION Initiation of our comprehensive cancer-specific program to improve caregiver retention of discharge instructions at the first post-hospitalization clinic visit has been successful and sustainable. This project demonstrated that a multi-disciplinary collaborative team effort increases caregiver retention of critical health information, and this has potential to lead to improved outcomes for patients.
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Affiliation(s)
| | | | - Kristen Ronca
- Children's Hospital at Montefiore, Bronx, New York, USA
| | - Audrey Uong
- Children's Hospital at Montefiore, Bronx, New York, USA
| | | | - Mimi Kim
- Department of Epidemiology & Population Health Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Weiser
- Children's Hospital at Montefiore, Bronx, New York, USA.,Departments of Pediatrics and Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
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10
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Wang J, Bi X, Wang J, Gu Y, Zheng X, Wang Y, Wu H, Yang Q, Ma L, Liu F, Yuan C. Chinese parents' caregiving ability for children with haematological malignancies: A latent class analysis. Nurs Open 2022; 9:2073-2083. [PMID: 35437930 PMCID: PMC9190677 DOI: 10.1002/nop2.1218] [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: 08/30/2021] [Revised: 02/22/2022] [Accepted: 04/03/2022] [Indexed: 12/03/2022] Open
Abstract
Aim The aim of this study was to identify unobserved subgroups of Chinese parents’ caregiving ability for children with haematological malignancies and examine the associations of the latent class membership with individual characteristics. Design A multicentre cross‐sectional survey study was conducted. Methods A total of 392 parents of children with haematological malignancies in China were surveyed with the Hematologic Malignancies’ Family Caregiver Skills Scale and a study‐specific demographic information questionnaire. Latent class analysis (LCA) and multinomial logistic regression model were applied in data analysis. Results LCA results suggested that there existed three distinct a priori unknown classes of parents of children with haematological malignancies in regard to caregiving ability: Class 1—“high caregiving ability” class (n = 131, 33.4%), Class 2—“medium caregiving ability” class (n = 170, 43.4%) and Class 3—“low caregiving ability” class (n = 91, 23.2%). Socio‐demographics and clinical characteristics had significant associations with the latent class membership.
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Affiliation(s)
- Jingting Wang
- School of Nursing, Fudan University, Shanghai, China.,School of Nursing, The Naval Medical University, Shanghai, China
| | - Xuanyi Bi
- School of Nursing, The Naval Medical University, Shanghai, China
| | - Jichuan Wang
- Center for Translational Science, Children's National Health System, The George Washington University, Washington, District of Columbia, USA
| | - Ying Gu
- Department of Nursing, Children's Hospital of Fudan University, Shanghai, China
| | - Xianlan Zheng
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yingwen Wang
- Department of Hematology & Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Huifang Wu
- Department of Hematology, Children's Hospital of Soochow University, Suzhou, China
| | - Qi Yang
- Department of Hematology, Children's Hospital of Soochow University, Suzhou, China
| | - Linyu Ma
- Department of Hematology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Fang Liu
- Department of Nursing, Children's Hospital of Fudan University, Shanghai, China
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Bailie K, Jacques L, Phillips A, Mahon P. Exploring Perceptions of Education for Central Venous Catheter Care at Home. J Pediatr Oncol Nurs 2021; 38:157-165. [PMID: 33616461 PMCID: PMC8114452 DOI: 10.1177/1043454221992293] [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: 12/04/2022] Open
Abstract
Pediatric oncology patients with an external central venous catheter (CVC) in situ can be discharged from the hospital. Caregivers are expected to learn how to care for the CVC prior to discharge while also dealing with their child's new cancer diagnosis. This study aimed to evaluate the perceptions of a CVC education program received by caregivers to identify opportunities for improvement. A qualitative study was conducted in 3 stages, using an evidence-based co-design approach, involving caregivers and one adolescent patient discharged from the British Columbia Children's Hospital Oncology/Hematology/BMT inpatient unit. Stage I involved semi-structured interviews to gain feedback on the existing CVC education program. In Stage II, educational resources were updated or developed and implemented. For Stage III, the revised CVC education program was evaluated through a focus group and semi-structured interviews. Interview transcripts were analyzed using QSR NVivo®. The original CVC education program was overall well received. Repeated instruction and support provided by nurses was reported to have increased confidence with performing CVC skills. Participants appreciated the multimodal approach to meet learning needs and expressed interest in additional visual aids. Inconsistencies in nurses’ practice and offers of “tips and tricks” were identified to be challenging for caregivers while learning a new skill. Videos depicting CVC care were developed to provide an additional visual tool, decreased inconsistencies in care, and support to caregivers at home. Caring for a CVC at home is challenging and overwhelming for caregivers. A standardized multimodal education program is required to support caregivers at home.
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Affiliation(s)
- Kiera Bailie
- Division of Hematology, Oncology and Bone Marrow Transplant, 37210British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Lisa Jacques
- Division of Hematology, Oncology and Bone Marrow Transplant, 37210British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Angele Phillips
- Division of Hematology, Oncology and Bone Marrow Transplant, 37210British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Paula Mahon
- Division of Hematology, Oncology and Bone Marrow Transplant, 37210British Columbia Children's Hospital, Vancouver, BC, Canada.,School of Nursing, 8166The University of British Columbia, Vancouver, BC, Canada
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12
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De la Maza V, Manriquez M, Castro M, Viveros P, Fernandez M, Vogel E, Peña E, Santolaya ME, Villarroel M, Torres JP. Impact of a structured educational programme for caregivers of children with cancer on parental knowledge of the disease and paediatric clinical outcomes during the first year of treatment. Eur J Cancer Care (Engl) 2020; 29:e13294. [PMID: 32706521 DOI: 10.1111/ecc.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the impact of a structured educational programme for caregivers of children with cancer on their level of knowledge about the disease and patient's clinical outcome. METHODS This prospective, non-randomised, experimental study included caregivers of recently diagnosed children at two hospitals in Chile. Caregivers whose children were treated at the first centre were the structured education programme group (EPG), while the second hospital provided the standard care (SCG). We evaluated caregivers' level of knowledge on days 1, 10 and 90 as well as the children's clinical outcomes over 1 year of treatment. RESULTS A total of 102 caregivers were enrolled between 2014 and 2015. Only the EPG showed a significant increase in knowledge between days 1 and 90. The rate of central venous catheter infections was significantly lower in the EPG versus SCG (7% versus 26%; p = .01). The risk ratio was 0.35 (95% CI = 0.13-0.94), and a log-rank test showed a statistically significant difference between the two groups (p = .018). There were also fewer Emergency Department visits in the EPG for fever episodes. CONCLUSION Providing a structured education to caregivers increased their level of knowledge and improved the clinical outcome of their children during the first year of treatment.
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Affiliation(s)
- Verónica De la Maza
- Research Unit, Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Macarena Manriquez
- Research and Teaching Unit, Arturo López Pérez Foundation Oncology Institute, Santiago, Chile
| | | | - Paola Viveros
- Department of Pediatrics, Oncology Unit, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - María Fernandez
- Department of Pediatrics, Oncology Unit, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - Evelyn Vogel
- Department of Pediatrics, Oncology Unit, Hospital Exequiel González Cortés, Santiago, Chile
| | - Erica Peña
- Department of Pediatrics, Oncology Unit, Hospital Exequiel González Cortés, Santiago, Chile
| | - María Elena Santolaya
- Research Unit, Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile.,Infectious Diseases Unit, Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Milena Villarroel
- Department of Pediatrics, Oncology Unit, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - Juan Pablo Torres
- Research Unit, Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile.,Infectious Diseases Unit, Department of Pediatrics, Faculty of Medicine, Hospital Dr. Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
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13
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Di Giuseppe G, Pole JD, Abla O, Punnett A. Impact of Videotaped Information on the Experience of Parents of Children with Acute Lymphoblastic Leukemia. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:479-484. [PMID: 30739269 DOI: 10.1007/s13187-019-1485-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Videotaped information has been shown to be effective in reducing parental anxiety and facilitating knowledge transfer in various clinical settings. There is lack of literature on the use of videotaped information during the pediatric oncology initial family disclosure meeting. The purpose of this study was to deliver an informative DVD, highlighting information on childhood acute lymphoblastic leukemia (ALL), to parents of children with newly diagnosed ALL and to assess if the DVD provided increased levels of satisfaction and decreased levels of anxiety in parents around the time of diagnosis. We surveyed 24 parents of children on active treatment for ALL, diagnosed between the ages of 1 and 18 years from 2008 to 2016 at The Hospital for Sick Children, Toronto, Canada. Parents were provided a survey questionnaire assessing levels of satisfaction with information communicated by the healthcare team and anxiety following verbal disclosure and were asked to report satisfaction and anxiety levels immediately following viewing the DVD intervention. Twenty-three/24 (95.8%) parents surveyed reported seeking information from additional resources after disclosure. Of the 24 parents who watched the DVD, 12 (50.0%) watched it once, while 12 (50.0%) watched it twice or more. All parents were satisfied with DVD information, and there was a significant decrease in anxiety after viewing (P = 0.03). All 24 parents felt that the DVD was a useful educational tool. Videotaped information after verbal disclosure is an effective educational resource and is associated with reduced anxiety among parents of children with ALL.
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Affiliation(s)
- Giancarlo Di Giuseppe
- Division of Haematology/Oncology, Department of Paediatrics, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Pediatric Oncology Group of Ontario, Toronto, Canada
| | - Jason D Pole
- Pediatric Oncology Group of Ontario, Toronto, Canada
| | - Oussama Abla
- Division of Haematology/Oncology, Department of Paediatrics, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Angela Punnett
- Division of Haematology/Oncology, Department of Paediatrics, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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14
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Krisnana I, Sulistyarini H, Diyan Rachmawati P, Arief YS, Dwi Kurnia I. Reducing acute stress disorders in mothers of leukemic children by means of the Family Centered Empowerment module (FACE). CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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15
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Brayley J, Stanton LK, Jenner L, Paul SP. Recognition and management of leukaemia in children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:985-992. [PMID: 31393775 DOI: 10.12968/bjon.2019.28.15.985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Leukaemia is the most common cancer in children. The presenting manifestations can be wide-ranging, from a relatively well child to life-threatening complications. Symptoms can be manifested in any of the bodily systems. Undertaking a thorough clinical assessment of the child, in addition to recognising and addressing parental concerns, is vital. Furthermore, recognising that children can commonly present with musculoskeletal or abdominal symptoms increases the diagnostic yield, thereby preventing missed or late diagnoses. Childhood cancer has a huge impact on the child and their family, both at diagnosis and in the long term; providing advice and signposting families to appropriate support groups is an important aspect of their management. Nurses play a vital role in managing children with cancers, starting from raising suspicion and identifying the child with leukaemia, ensuring that high-quality care is delivered throughout their treatment, managing complications, and providing support and information to children and their families. An illustrative case study is included to highlight some of the challenges that health professionals may encounter in their clinical practice.
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Affiliation(s)
- Jessica Brayley
- Year 5 Medical Student, Peninsula College of Medicine and Dentistry, University of Plymouth, Plymouth
| | | | - Lucy Jenner
- Lecturer in Child Health Nursing, Faculty of Health and Human Sciences, University of Plymouth, Plymouth
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Tang S, Landery D, Covington G, Ward J. The Use of a Video for Discharge Education for Parents After Pediatric Stem Cell Transplantation. J Pediatr Oncol Nurs 2019. [DOI: 10.1177/1043454218818059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Caring for a child at home after hematopoietic stem cell transplant (HSCT) is challenging for parents, and discharge education is critical to ensure parents are prepared. The purpose of this study is to evaluate the feasibility and effectiveness of a discharge video intervention (DVI) as an adjunct to standard discharge teaching (SDT). Method: A two-phase study was conducted at an urban children’s hospital in the western United States. Phase 1 involved SDT alone followed by nurse-administered proficiency testing of parent knowledge in caring for their children at home using a 4-point Likert-type scale of parents of children post-allogeneic HSCT. These results informed the DVI, created in English and Spanish in Phase 2. The DVI content included topics on home cleaning, notifying the medical team, graft-versus-host disease (GVHD), diet and visitor restrictions, and outpatient visits. In Phase 2, the DVI was viewable by parents who also received SDT. Parents’ proficiency was evaluated using the same procedure as in Phase 1. Results: Thirty-four parents participated: 17 in Phase 1 (SDT), 17 in Phase 2 (SDT + DVI). The DVI was viewed by parents in Phase 2 approximately twice prior to discharge. Parents in Phase 2 had higher proficiency scores on home cleaning, signs/symptoms of GVHD, and diet restriction. Parents in Phase 1 had higher proficiency regarding notifying the team. Conclusions: The DVI was feasible and demonstrated incremental increases in parent’s proficiency related to some discharge topics.
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Affiliation(s)
- Shinyi Tang
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Dawn Landery
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Jessica Ward
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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17
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Shin JY, Kang TI, Noll RB, Choi SW. Supporting Caregivers of Patients With Cancer: A Summary of Technology-Mediated Interventions and Future Directions. Am Soc Clin Oncol Educ Book 2018; 38:838-849. [PMID: 30231412 DOI: 10.1200/edbk_201397] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper aims to review literature published on the support of cancer caregivers with health technology. Eighteen articles were reviewed to better understand cancer caregiving and categorized into four different themes: (1) design guidelines, (2) information facilitation, (3) social support, and (4) multicomponent interventions. Analysis of the current articles revealed that there are substantial gaps in knowledge regarding a range of health technologies that facilitate family caregiver support and its distribution to health institutions. Further research is needed in this area, as family caregivers are primary providers of essential elements of care to patients. Future studies should unpack existing barriers that interfere with the development of health technology interventions in cancer care.
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Affiliation(s)
- Ji Youn Shin
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Tammy I Kang
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Robert B Noll
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Sung Won Choi
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
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18
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Kelly KP, Withycombe J, Stegenga K, Rodgers C. The Why Behind the Questions: Question-asking in Parents of Children Newly Diagnosed With Cancer - A Report From the Children's Oncology Group. J Pediatr Nurs 2018; 43:23-28. [PMID: 30473153 PMCID: PMC6613215 DOI: 10.1016/j.pedn.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE For parents of children newly diagnosed with cancer, the exchange of information during initial educational processes is critical. This focused analysis was completed to describe parent question-asking during the new childhood cancer diagnosis timeframe. DESIGN & METHODS In previous research of new diagnosis education experiences, parents spoke extensively about asking questions. These data, captured in first level coding, were incorporated across higher level codes to describe how parents processed information after their child's cancer diagnosis. Using constant comparative analysis, we returned to our data to complete a focused analysis of our first level code, Asking Questions. Team members independently coded Asking Questions data from 20 parent interviews, followed by team discussions and consensus agreement for code assignment. RESULTS Parents asked questions to learn, fill an unmet need, or clarify information. Clinicians asked questions to assess parent learning. CONCLUSION Question-asking is a technique used by parents and clinicians to communicate new information, assess understanding of provided content, and/or to confirm previously provided information. PRACTICE IMPLICATIONS Clinicians can benefit from carefully listening to patients/parents and reflecting on the type of questions asked in an effort to understand the reason behind the question. This can be used to guide further education.
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Affiliation(s)
- Katherine Patterson Kelly
- Children's National Health System, Department of Nursing Research, Professional Practice, and Quality, Washington, DC USA; George Washington University School of Medicine and Health Sciences, Washington, DC USA.
| | - Janice Withycombe
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA USA.
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19
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Nurse-led Discharge in Pediatric Care: A Scoping Review. J Pediatr Nurs 2018; 41:60-68. [PMID: 29398316 DOI: 10.1016/j.pedn.2018.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 11/24/2022]
Abstract
PROBLEM Patients and caregivers frequently report feeling ill-prepared during the transition from hospital to home. Given the privileged position nurses occupy within the health care setting, they are often an appropriate health care professional to lead the discharge process. We aimed to map what is currently known about nurse-led/facilitated discharge programs, interventions, models, or frameworks for the pediatric population. ELIGIBILITY CRITERIA We conducted a scoping review following the Joanna Briggs Institute Methodology. Published literature targeting children 0-18 years old being discharged from acute care to home and describing a nurse leading the discharge planning/process was included. SAMPLE A search strategy was developed and implemented in four electronic databases; CINAHL, MEDLINE, Embase, and Web of Science. We also hand searched three high impact journals and reviewed reference lists of relevant articles. This search resulted in 1485 records. Based on our eligibility criteria, 9 articles were included in this review. Two independent reviewers screened each eligible article and extracted relevant information. RESULTS Terminology and program structure varied greatly across included studies. Critical appraisal revealed a lack of high quality research designs. CONCLUSIONS We identified a paucity of nurse-led/facilitated discharge programs evaluated within the pediatric population. The majority of studies were inadequately reported, leaving it difficult to identify development, implementation, and evaluation strategies. IMPLICATIONS Given the positive outcomes reported across all articles included in our review, future empirical research is warranted to explore this role within nursing practice.
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20
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Wilson Smith MG, Sachse K, Perry MT. Road to Home Program: A Performance Improvement Initiative to Increase Family and Nurse Satisfaction With the Discharge Education Process for Newly Diagnosed Pediatric Oncology Patients. J Pediatr Oncol Nurs 2018; 35:368-374. [DOI: 10.1177/1043454218767872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Families of children, adolescents, and young adults with a new oncology diagnosis must absorb knowledge and skills needed to care for their child at home during a period of emergent hospitalizations and intense medical interventions. Effective nurse-led teaching and discharge planning begun at diagnosis can prepare families to safely care for their child following discharge, and be a source of satisfaction. The objective of this performance improvement initiative was to increase family and nurse satisfaction with new diagnosis education and discharge. Using standard performance improvement techniques, family and nursing stakeholder satisfaction with current processes was assessed. Working from established best practice and literature review; The Road to Home was designed and implemented. This novel, comprehensive program includes a visual, interactive display of required education based on the Children’s Oncology Group Family Handbook© and hospital specific discharge materials; standardized teaching, tools and documentation for nursing; and caregiver discharge tool kits. Stakeholder input guided improvement strategies throughout the phases of implementation. Sustained increases in family and nurse satisfaction resulted from each phase. The Road to Home program is established for all families of newly diagnosed oncology patients and is meeting goals of increased family and nurse satisfaction with discharge education.
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21
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Amador DD, Marcílio AC, Soares JDSS, Marques FRB, Duarte AM, Mandetta MA. A força da informação sobre retinoblastoma para a família da criança. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Compreender a necessidade de informação da família da criança com retinoblastoma. Métodos: Estudo qualitativo fundamentado no Modelo do Cuidado Centrado no Paciente e na Família. Participaram famílias de crianças em tratamento em uma instituição referência em oncologia pediátrica. A Análise Qualitativa de Conteúdo guiou a coleta e análise dos dados. Resultados: “A força da informação sobre retinoblastoma para a família da criança” revela o valor que a família atribui à informação sobre a doença da criança, em um tempo de intenso sofrimento; os caminhos que realiza para obter as informações; e os elementos que considera essenciais para se sentir atendida em seu direito. Conclusão: Torna-se primordial que a oferta de informações respeite o tempo da família, seja honesta, contemple as perspectivas de futuro para a criança, em um espaço dialógico. Dessa maneira, promove-se uma prática fundamentada no Modelo do Cuidado Centrado no Paciente e na Família.
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Slater PJ, Fielden PE, Bradford NK. The Oncology Family App: Providing Information and Support for Families Caring for Their Child With Cancer. J Pediatr Oncol Nurs 2017; 35:94-102. [DOI: 10.1177/1043454217741874] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Oncology Family App supports families across the vast state of Queensland, Australia, with easy access to vital information, including management plans for a deteriorating child, patient specific information and other resources. This article describes the development and evaluation of this mobile app. The app was developed and tested in collaboration with parents, caregivers, and clinicians and released in November 2015. This first version featured “Statewide Hospital Contacts,” including phone numbers, links to Google maps, and 24-hour emergency contacts with click to call functionality; “When to Call” describing symptoms to look out for in a deteriorating child; “Blood Results Table”; and “Information” listing recommended websites, health care team contacts, appointments, and notes. The app was evaluated through interviews with parents, caregivers and patients and download metrics. Six months after the app release, 68% of the 38 parents and caregivers surveyed had downloaded the app. The most used modules were “Blood Results Table,” “When to Call,” and “Statewide Hospital Contacts,” but families reported using all features available. Families were enthusiastic about the support the app provided and gave useful feedback to direct future development. Using mobile health technology to support families is a novel, but rapidly growing concept. Family and caregiver feedback showed that the Oncology Family App was an efficient and convenient way to provide much needed information. A new version of the app is under development and evaluation of outcomes will be ongoing.
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Affiliation(s)
- Penelope J. Slater
- Lady Cilento Children’s Hospital, Children’s Health Queensland, South Brisbane, Queensland, Australia
| | - Philippa E. Fielden
- Lady Cilento Children’s Hospital, Children’s Health Queensland, South Brisbane, Queensland, Australia
| | - Natalie K. Bradford
- Lady Cilento Children’s Hospital, Children’s Health Queensland, South Brisbane, Queensland, Australia
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Rodgers CC, Stegenga K, Withycombe JS, Sachse K, Kelly KP. Processing Information After a Child's Cancer Diagnosis-How Parents Learn. J Pediatr Oncol Nurs 2017; 33:447-459. [PMID: 28084180 DOI: 10.1177/1043454216668825] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Parents of a child newly diagnosed with cancer must receive an extensive amount of information before their child's initial hospital discharge; however, little is known about best practices for providing this education. An interpretive descriptive study design was used to describe actual and preferred educational content, timing, and methods among parents of children newly diagnosed with cancer prior to their child's first hospital discharge. Twenty parents of children diagnosed with various malignancies participated in individual interviews 2 to 12 months after their child's diagnosis. Data were analyzed using constant comparative analysis. Education delivery occurred in a telling manner at diagnosis transitioning to a reciprocal process of teaching during the inpatient stay, then primarily back to telling immediately before discharge. Parents expressed a variety of preferred learning styles but noted that their preferences were rarely assessed by health care providers. Multiple factors influenced parents' ability to process educational information received during their child's initial hospitalization. Findings suggest that nursing practices should include assessing for influencing factors, providing anticipatory guidance, and incorporating parents' preferred learning style into the educational plan.
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Rodgers CC, Stegenga K, Withycombe JS, Sachse K, Kelly KP. Processing Information After a Child's Cancer Diagnosis-How Parents Learn. JOURNAL OF PEDIATRIC ONCOLOGY NURSING : OFFICIAL JOURNAL OF THE ASSOCIATION OF PEDIATRIC ONCOLOGY NURSES 2017. [PMID: 28084180 DOI: 10.1177/1043454216668825.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parents of a child newly diagnosed with cancer must receive an extensive amount of information before their child's initial hospital discharge; however, little is known about best practices for providing this education. An interpretive descriptive study design was used to describe actual and preferred educational content, timing, and methods among parents of children newly diagnosed with cancer prior to their child's first hospital discharge. Twenty parents of children diagnosed with various malignancies participated in individual interviews 2 to 12 months after their child's diagnosis. Data were analyzed using constant comparative analysis. Education delivery occurred in a telling manner at diagnosis transitioning to a reciprocal process of teaching during the inpatient stay, then primarily back to telling immediately before discharge. Parents expressed a variety of preferred learning styles but noted that their preferences were rarely assessed by health care providers. Multiple factors influenced parents' ability to process educational information received during their child's initial hospitalization. Findings suggest that nursing practices should include assessing for influencing factors, providing anticipatory guidance, and incorporating parents' preferred learning style into the educational plan.
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25
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KOHLSDORF M, COSTA JUNIOR ÁL, MARQUES FD. Effects of pre-consultation lists on the communicative behavior of children with cancer and their caregivers. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2016. [DOI: 10.1590/1982-02752016000400006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract This cross-sectional study present effects of pre-consultation lists on caregivers' and children's communicative behavior. Thirty-two dyads caregiver-child took part in this research, divided in three groups concerning the study design: Baseline 1, Intervention phase, and Baseline 2. Children and caregivers were individually interviewed before consultations on pediatric cancer treatment, in order to list doubts, expectations, and estimated issues to the medical visit. These themes were written down on a sheet of paper, attached to the child´s medical record cover, and would then be used as a memo in the following consultation. Results show that pre-consultation lists produced no effects on children's behavior, however the procedure was associated to specific doubts discussed by caregivers regarding dietary recommendations, coping with side effects, child development, biological aspects of cancer, and school activities. This study presents a low cost procedure that may contribute to tailor communication in pediatric settings.
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Rodgers CC, Laing CM, Herring RA, Tena N, Leonardelli A, Hockenberry M, Hendricks-Ferguson V. Understanding Effective Delivery of Patient and Family Education in Pediatric Oncology A Systematic Review From the Children's Oncology Group [Formula: see text]. J Pediatr Oncol Nurs 2016; 33:432-446. [PMID: 27450361 PMCID: PMC5235950 DOI: 10.1177/1043454216659449] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A diagnosis of childhood cancer is a life-changing event for the entire family. Parents must not only deal with the cancer diagnosis but also acquire new knowledge and skills to care safely for their child at home. Best practices for delivery of patient/family education after a new diagnosis of childhood cancer are currently unknown. The purpose of this systematic review was to evaluate the existing body of evidence to determine the current state of knowledge regarding the delivery of education to newly diagnosed pediatric oncology patients and families. Eighty-three articles regarding educational methods, content, influencing factors, and interventions for newly diagnosed pediatric patients with cancer or other chronic illnesses were systematically identified, summarized, and appraised according to the Grading of Recommendations Assessment, Development, and Evaluation criteria. Based on the evidence, 10 recommendations for practice were identified. These recommendations address delivery methods, content, influencing factors, and educational interventions for parents and siblings. Transferring these recommendations into practice may enhance the quality of education delivered by health care providers and received by patients and families following a new diagnosis of childhood cancer.
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Affiliation(s)
| | | | | | - Nancy Tena
- University of Michigan Health System, Ann Arbor, MI, USA
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27
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Landier W, Ahern J, Barakat LP, Bhatia S, Bingen KM, Bondurant PG, Cohn SL, Dobrozsi SK, Haugen M, Herring RA, Hooke MC, Martin M, Murphy K, Newman AR, Rodgers CC, Ruccione KS, Sullivan J, Weiss M, Withycombe J, Yasui L, Hockenberry M. Patient/Family Education for Newly Diagnosed Pediatric Oncology Patients. J Pediatr Oncol Nurs 2016; 33:422-431. [PMID: 27385664 DOI: 10.1177/1043454216655983] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
There is a paucity of data to support evidence-based practices in the provision of patient/family education in the context of a new childhood cancer diagnosis. Since the majority of children with cancer are treated on pediatric oncology clinical trials, lack of effective patient/family education has the potential to negatively affect both patient and clinical trial outcomes. The Children's Oncology Group Nursing Discipline convened an interprofessional expert panel from within and beyond pediatric oncology to review available and emerging evidence and develop expert consensus recommendations regarding harmonization of patient/family education practices for newly diagnosed pediatric oncology patients across institutions. Five broad principles, with associated recommendations, were identified by the panel, including recognition that (1) in pediatric oncology, patient/family education is family-centered; (2) a diagnosis of childhood cancer is overwhelming and the family needs time to process the diagnosis and develop a plan for managing ongoing life demands before they can successfully learn to care for the child; (3) patient/family education should be an interprofessional endeavor with 3 key areas of focus: (a) diagnosis/treatment, (b) psychosocial coping, and (c) care of the child; (4) patient/family education should occur across the continuum of care; and (5) a supportive environment is necessary to optimize learning. Dissemination and implementation of these recommendations will set the stage for future studies that aim to develop evidence to inform best practices, and ultimately to establish the standard of care for effective patient/family education in pediatric oncology.
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Affiliation(s)
| | - JoAnn Ahern
- 2 Western Connecticut Health Network, Danbury, CT, USA
| | - Lamia P Barakat
- 3 Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Susan L Cohn
- 6 University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | | | - Maureen Haugen
- 7 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Mary C Hooke
- 9 University of Minnesota School of Nursing, Minneapolis, MN, USA
| | | | | | - Amy R Newman
- 4 Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Marianne Weiss
- 14 Marquette University College of Nursing, Milwaukee, WI, USA
| | | | - Lise Yasui
- 16 Children's Oncology Group, Monrovia, CA, USA
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Haugen MS, Landier W, Mandrell BN, Sullivan J, Schwartz C, Skeens MA, Hockenberry M. Educating Families of Children Newly Diagnosed With Cancer. J Pediatr Oncol Nurs 2016; 33:405-413. [PMID: 27268501 DOI: 10.1177/1043454216652856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Parents/caregivers require specialized education in order to care for their child with a newly diagnosed cancer. Currently, no evidence-based guidelines exist to identify content essential for inclusion in patient/family education prior to a child's initial discharge home; this study used Delphi methodology to obtain multidisciplinary consensus regarding essential content amongst pediatric oncology experts from the Children's Oncology Group. Three questionnaire rounds were employed to identify essential content, evaluate the importance of the educational topics identified, and gain expert consensus regarding the final ranking of topics identified and whether or not each topic was considered mandatory for inclusion in education for newly diagnosed patients. Disease-specific topics were also identified for patients with leukemia, solid tumors, and central nervous system tumors. The results of this study provide, for the first time, multidisciplinary expert consensus regarding key content essential for inclusion in discharge education for newly diagnosed pediatric oncology patients.
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Affiliation(s)
- Maureen S Haugen
- 1 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Wendy Landier
- 2 University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | - Courtney Schwartz
- 1 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Withycombe JS, Andam-Mejia R, Dwyer A, Slaven A, Windt K, Landier W. A Comprehensive Survey of Institutional Patient/Family Educational Practices for Newly Diagnosed Pediatric Oncology Patients. J Pediatr Oncol Nurs 2016; 33:414-421. [PMID: 27283721 DOI: 10.1177/1043454216652857] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patient/family education is an important component of nursing practice and is essential to the care of children newly diagnosed with cancer. Practices regarding patient/family education in Children's Oncology Group (COG) treatment centers have not been well described. We used an Internet-based survey to determine current patient/family educational practices at COG institutions; participation rate was 90.5% (201/222). Patient/family education was delivered primarily by an individual (rather than a team) at 43% of institutions. Advanced practice nurses had primary responsibility for providing education at 32% of institutions. "Fever" was the most frequently reported topic considered mandatory for inclusion in education for newly diagnosed patients. More than half of institutions reported using checklists and/or end-of-shift reports to facilitate health care team communication regarding patient/family education, and 77% reported using the "teach-back" method of assessing readiness for discharge. Thirty-seven percent of institutions reported delays in hospital discharge secondary to the need for additional teaching. An understanding of current practices related to patient/family education is the first step in establishing effective interventions to improve and standardize educational practices in pediatric oncology.
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Affiliation(s)
| | - Rachel Andam-Mejia
- 2 Children's Hospital of The King's Daughters, Norfolk, VA, USA.,3 College of Health Sciences, Old Dominion University, Norfolk, VA, USA
| | - Annie Dwyer
- 4 The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Abigail Slaven
- 5 Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | | | - Wendy Landier
- 7 University of Alabama at Birmingham, Birmingham, AL, USA
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Thompson AL, Young-Saleme TK. Anticipatory Guidance and Psychoeducation as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S684-93. [PMID: 26700925 DOI: 10.1002/pbc.25721] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/03/2015] [Indexed: 01/24/2023]
Abstract
The aim of this review was to critically evaluate the literature on anticipatory guidance and psychoeducation for youth with cancer and their caregivers. Twenty-one publications were identified. Overall, psychoeducation efforts and interventions were well-liked and accepted by patients and caregivers, improved patient and family knowledge about childhood cancer, and increased patient's health locus of control. A number of modalities are effective in giving families anticipatory guidance, provided the content and delivery are matched to the needs and preferences of individual patients and caregivers. Evidence supports a strong recommendation for psychoeducation for youth with cancer and their families.
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Affiliation(s)
- Amanda L Thompson
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC
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Wang J, Yao N, Wang Y, Zhou F, Liu Y, Geng Z, Yuan C. Developing "Care Assistant": A smartphone application to support caregivers of children with acute lymphoblastic leukaemia. J Telemed Telecare 2015; 22:163-71. [PMID: 26271029 DOI: 10.1177/1357633x15594753] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/10/2015] [Indexed: 12/14/2022]
Abstract
Acute lymphoblastic leukaemia (ALL) is the most common childhood malignancy. Caring for children with ALL is an uncommon experience for parents without medical training. They urgently need professional assistance when their children are recovering at home. This paper documents the process of developing an Android application (app) "Care Assistant" for family caregivers of children with ALL. Key informant interviews and focus group studies were used before programming the app. The key informants and focus group members included: caregivers of children with ALL, cancer care physicians and nurses, and software engineers. We found several major challenges faced by caregivers: limited access to evidence-based clinic information, lack of financial and social assistance, deficient communications with doctors or nurses, lack of disease-related knowledge, and inconvenience of tracking treatments and testing results. This feedback was used to develop "Care Assistant". This app has eight modules: personal information, treatment tracking, family care, financial and social assistance, knowledge centre, self-assessment questionnaires, interactive platform, and reminders. We have also developed a web-based administration portal to manage the app. The usability and effectiveness of "Care Assistant" will be evaluated in future studies.
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Affiliation(s)
- Jingting Wang
- School of Nursing, Second Military Medical University, China
| | - Nengliang Yao
- Department of Healthcare Policy and Research, Virginia Commonwealth University, USA
| | - Yuanyuan Wang
- School of Nursing, Second Military Medical University, China
| | - Fen Zhou
- Department of Hematology, Shanghai Children’s Medical Centre, China
| | - Yanyan Liu
- School of Nursing, Second Military Medical University, China
| | - Zhaohui Geng
- School of Nursing, Second Military Medical University, China
| | - Changrong Yuan
- School of Nursing, Second Military Medical University, China
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Enskär K, Huus K, Björk M, Granlund M, Darcy L, Knutsson S. An Analytic Review of Clinical Implications From Nursing and Psychosocial Research Within Swedish Pediatric Oncology. J Pediatr Nurs 2015; 30:550-9. [PMID: 25448474 DOI: 10.1016/j.pedn.2014.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/29/2014] [Accepted: 11/01/2014] [Indexed: 11/26/2022]
Abstract
The purpose of this manuscript is to analyze researchers' suggestions for clinical implications of their findings as stated in recent published articles on nursing and psychosocial research within the setting of Swedish pediatric oncology. Identified categories included staff awareness of the effects of child illness on families; systems for care improvement; provision of quality of care, education and support; and empowerment of children and families. In order to be able to realize these clinical suggestions, expanded research is needed as well as continued education and support for staff.
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Affiliation(s)
- Karin Enskär
- School of Health Sciences, Jönköping University, Jönköping, Sweden; CHILD Research Group, Jönköping University, Jönköping, Sweden.
| | - Karina Huus
- School of Health Sciences, Jönköping University, Jönköping, Sweden; CHILD Research Group, Jönköping University, Jönköping, Sweden
| | - Maria Björk
- CHILD Research Group, Jönköping University, Jönköping, Sweden; School of Life Science, University of Skövde, Skövde, Sweden
| | - Mats Granlund
- School of Health Sciences, Jönköping University, Jönköping, Sweden; CHILD Research Group, Jönköping University, Jönköping, Sweden
| | - Laura Darcy
- CHILD Research Group, Jönköping University, Jönköping, Sweden; Institution of Health Science, University College of Borås, Borås, Sweden
| | - Susanne Knutsson
- School of Health Sciences, Jönköping University, Jönköping, Sweden; Institution of Health Science, University College of Borås, Borås, Sweden
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A Swedish perspective on nursing and psychosocial research in paediatric oncology: A literature review. Eur J Oncol Nurs 2015; 19:310-7. [DOI: 10.1016/j.ejon.2014.10.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 09/09/2014] [Accepted: 10/27/2014] [Indexed: 11/16/2022]
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Kohlsdorf M, Costa Junior ÁL. A proposal for a behavioral pre-consultation: Analysis of the use of a protocol during consultations. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2015. [DOI: 10.1590/0103-166x2015000200007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze how physicians, caregivers, and children use protocols regarding estimated issues to medical visits, procedure named pre-consultation lists, along treatment for childhood cancer. Three pediatricians and 24 dyads child-caregiver took part; each pair was interviewed before medical visits in order to report doubts, needs and issues estimated to the consultation. This list was attached to child's medical record as a memo of themes to discuss in the next medical visit. Results show that two physicians included effectively this file in their consultations and discussed a great amount of issues listed by caregivers and patients. Children did not refer to the listed issues, but parents, in smaller amounts, discussed the themes in the protocol. This procedure contributed to insert the child in consultations and it may facilitate the focus on specific themes, however the physician's main role in managing communication during pediatric medical visits is highlighted.
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Maree JE, Parker S, Kaplan L, Oosthuizen J. The Information Needs of South African Parents of Children With Cancer. J Pediatr Oncol Nurs 2015; 33:9-17. [DOI: 10.1177/1043454214563757] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Information is an important need in order for parents to be empowered to face their child’s cancer condition. To explore the information needs of parents of children with cancer treated at an academic hospital in the Gauteng Province of South Africa, a descriptive phenomenological design was selected. The study setting was an academic hospital in Johannesburg and purposive sampling included 13 parents who spoke English and were willing to participate in the study. Qualitative interviews were conducted and thematic analyses were used to analyze the data. Four themes emerged from the data: the shock of the diagnosis, information needs about the disease and investigations, living with the treatment, and communication of the information. There was no consensus on which information was needed at specific points in time and parents had different opinions on how information should be made available to them. Continuous assessment allowing individualized information, according to the preference of the parents in the language of choice, could possibly meet their information needs.
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Affiliation(s)
| | - Sarah Parker
- University of the Witwatersrand, Johannesburg, South Africa
| | - Lara Kaplan
- University of the Witwatersrand, Johannesburg, South Africa
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Njuguna F, Mostert S, Seijffert A, Musimbi J, Langat S, van der Burgt RHM, Skiles J, Sitaresmi MN, van de Ven PM, Kaspers GJL. Parental experiences of childhood cancer treatment in Kenya. Support Care Cancer 2014; 23:1251-9. [PMID: 25318695 DOI: 10.1007/s00520-014-2475-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 10/06/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE Our study explores socioeconomic, treatment-related, and psychological experiences of parents during cancer treatment of their children at an academic hospital in Kenya. METHODS This cross-sectional study used semi-structured questionnaires. Parents whose children came for cancer treatment consecutively between November 2012 and April 2013 were interviewed. RESULTS Between 2012 and 2013, 115 oncology patients attended the hospital and 75 families (response rate 65 %) were interviewed. Cancer treatment resulted in financial difficulties (89 %). More information about cancer and treatment was required (88 %). More contact with doctors was needed (83 %). At diagnosis, cancer was perceived as curable (63 %). However, parents were told by health-care providers that most children with cancer die (49 %). Parents had difficulties with understanding doctors' vocabulary (48 %). Common reasons to miss hospital appointments were travel costs (52 %) and hospital costs (28 %). Parents (95 %) used complementary alternative treatment (CAM) for their children. Health-care providers told parents not to use CAM (49 %). Parents had not discussed their CAM use with doctors (71 %). Community members isolated families because their child had cancer (25 %), believed that child was bewitched (57 %), advised to use CAM (61 %), and stopped conventional treatment (45 %). Some families (15 %) never disclosed the child's illness to community members. Parents shared experiences with other parents at the ward (97 %) and would otherwise not understand the disease and its treatment (87 %). CONCLUSIONS Parents suffer financial hardships and are dissatisfied with doctors' communication regarding their children's condition. CAM is very commonly used. Doctors need to improve their communication skills and discuss CAM more openly. Cancer programs should include more support for parents: financial assistance, a facility where parents and children can stay during the course of therapy, and parent support groups.
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Affiliation(s)
- F Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya,
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Shaikh MS, Ali SS, Khurshid M, Fadoo Z. Chromosomal Abnormalities in Pakistani Children with Acute Lymphoblastic Leukemia. Asian Pac J Cancer Prev 2014; 15:3907-9. [DOI: 10.7314/apjcp.2014.15.9.3907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Slone JS, Self E, Friedman D, Heiman H. Disparities in pediatric oncology patient education and linguistic resources: results of a national survey of pediatric oncologists. Pediatr Blood Cancer 2014; 61:333-6. [PMID: 24167088 PMCID: PMC3877218 DOI: 10.1002/pbc.24831] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Extensive patient and family education is required at the time of a new diagnosis of pediatric cancer yet little data exist regarding the availability and linguistic competency of new cancer diagnosis education provided by pediatric oncology institutions. PROCEDURE Using the American Society of Pediatric Hematology/Oncology (ASPHO) membership list, a web-based survey was conducted among a cohort of pediatric oncologists to determine pediatric oncologists' assessment of institutional resources for new cancer diagnosis education and the availability of linguistically appropriate education. RESULTS Of 1,294 ASPHO members sent email survey invitations, 573 (44.3%) responded with 429 meeting eligibility criteria. Oncologists at academic institutions reported their institutions had more availability of resources for new diagnosis education compared with those from non-academic institutions (mean 78.6 vs. 74.3; 0 [not at all]-100 [well equipped]; P = 0.05). The mean score increased with volume of new cancer diagnoses/year: small (<75) = 73.4; medium (75-149) = 76.7; large (>150) = 84.5 (P < 0.001). Oncologists at large volume institutions reported more availability of an established patient education protocol (50.8% vs. 38.1%, P < 0.001) and increased use of dedicated non-physician staff (79.9% vs. 66.1%, P = 0.02), but less use of websites for patient education (17.2% vs. 33.3%, P = 0.001). Availability of linguistically appropriate education improved with increasing institution size: small (76.4), medium (82.3), and large (84.0) patient volume (P < 0.011). CONCLUSION According to pediatric oncologists, a disparity in educational and linguistic resources for new pediatric cancer diagnosis education exists depending on institution type and size.
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Affiliation(s)
- Jeremy S Slone
- Division of Pediatric Hematology-Oncology, Vanderbilt University
| | | | - Debra Friedman
- Division of Pediatric Hematology-Oncology, Vanderbilt University
| | - Harry Heiman
- Satcher Health Leadership Institute, Morehouse School of Medicine
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Bellamy G, Gott M, Waterworth S, McLean C, Kerse N. 'But I do believe you've got to accept that that's what life's about': older adults living in New Zealand talk about their experiences of loss and bereavement support. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:96-103. [PMID: 23981112 DOI: 10.1111/hsc.12069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2013] [Indexed: 06/02/2023]
Abstract
This paper explores older people's views, experiences and sources of bereavement support following the death of a spouse, family member or other significant individual. Telephone interviews were conducted with 28 bereaved older adults recruited from the Brief Risk Identification Geriatric Health Tool trial participants in three geographically diverse District Health Boards in New Zealand. Analysis adhered to the principles of grounded theory and followed the National Centre for Social Research 'Framework' approach. Findings indicate that family and friends play a fundamental role supporting older bereaved adults, both emotionally and practically. Existing community-based organisations were identified as an important source of support following bereavement. Despite the emotional, financial and practical challenges associated with bereavement, the majority of participants questioned the role of, need for and value of formal bereavement support services. Instead, study participants cited a combination of being older and previous life experiences as factors that had enabled them to cope with these largely 'expected' events. Moreover, they demonstrated considerable resilience in managing the emotional and practical changes associated with loss and bereavement. This study poses a challenge to the argument that the growing secularisation of society has led to an increase in the use of professional bereavement services over more 'traditional' forms of support, such as family, friends and community and religious organisations. The paper highlights the value of adopting a public health-based approach as a way of optimising bereavement support via the use of existing community organisations previously known to older people. This is particularly important in those countries where the provision of bereavement support is limited due to resource constraints.
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Affiliation(s)
- Gary Bellamy
- School of Nursing, The University of Auckland, Auckland, New Zealand
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Landier W, Leonard M, Ruccione KS. Children's Oncology Group's 2013 blueprint for research: nursing discipline. Pediatr Blood Cancer 2013; 60:1031-6. [PMID: 23255369 PMCID: PMC3645887 DOI: 10.1002/pbc.24415] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 11/05/2012] [Indexed: 01/14/2023]
Abstract
Integration of the nursing discipline within cooperative groups conducting pediatric oncology clinical trials provides unique opportunities to maximize nursing's contribution to clinical care, and to pursue research questions that extend beyond cure of disease to address important gaps in knowledge surrounding the illness experience. Key areas of importance to the advancement of the nursing discipline's scientific knowledge are understanding the effective delivery of patient/family education, and reducing illness-related distress, both of which are integral to facilitating parental/child coping with the diagnosis and treatment of childhood cancer, and to promoting resilience and well-being of pediatric oncology patients and their families.
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Affiliation(s)
- Wendy Landier
- Department of Population Sciences, City of Hope, Duarte, CA 91010, USA.
| | - Marcia Leonard
- Division of Pediatric Hematology/Oncology, C. S. Mott Children’s Hospital, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Kathleen S. Ruccione
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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Carreño Moreno S. El cuidado transicional de enfermería aumenta la compentencia en el rol del cuidador del niño con cáncer. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.54439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
con cáncer pasa por una transición en su rol en la que requiere fortalecer su competencia para ejercerlo. Objetivo. Determinar el efecto de una intervención de cuidado transicional de enfermería sobre la competencia de cuidado del cuidador familiar del niño con cáncer. Materiales y métodos. Estudio experimental, el grupo experimental (n=59) recibió la intervención de cuidado transicional de enfermería “cuidando a nuestros niños con cáncer” y el grupo control (n=59) la atención convencional de la institución de salud. Se midió la competencia del cuidador familiar para el cuidado, se trató de un estudio doble ciego. El estudio contó con el aval de comités de ética institucional y llevó a cabo consentimiento informado. El análisis se realizó con las pruebas T de student y diferencia de medias estanadarizada d de Cohen. Resultados. La mayoría de los niños tuvieron diagnóstico de Leucemia 41%, con edad media de 4 años. Los cuidadores familiares son mujeres 84%, con edad media de 33 años. Se observó una diferencia entre la competencia para cuidar (p<0,001) entre el grupo experimental y control en la postratamiento, con un tamaño del efecto d= 5,14. Conclusión. La intervención “Cuidando a nuestros niños con cáncer” tiene un efecto fuerte en el aumento de la competencia para el cuidado del cuidador familiar en el proceso de transición del su rol. La intervención es aplicable a la práctica y replicable en la investigación.
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