Fear, coping and support- from the perspective of children aged 10-17-year old having acute lymphoblastic leukemia

PURPOSE

To describe experiences of fear, coping, and support in 10-17-year-old children under treatment for acute lymphoblastic leukaemia (ALL).

METHODS

A longitudinal descriptive qualitative design was adopted. Ten children participated in one to three interviews each (24 interviews in all). Interviews were analysed using a matrix-based qualitative method.

RESULTS

The variety of fears described related to uncertainty, pain and medical procedures, bodily changes and loss of control, complications, professionals' attitudes, affected school results, and social isolation. Children used various strategies to deal with fear: some more general, to cope with the whole situation, and others more related to specific events such as treatment and tests. The most reported strategies we labelled Accepting the situation, Positive thinking, and Being an active agent. Less favourable strategies were also reported. Health care professionals, families, and friends offered valuable, but different kinds of, support.

CONCLUSIONS

Children aged 10 to 17 undergoing treatment for ALL experience various fears. Each experience is individual and changes over time, but there are common patterns. Most children used problem-solving or emotional-regulation strategies, but withdrawal was also reported. Even children who can deal with fear need support from their health care professionals, families, and friends.

Nursing interventions for pediatric patients with cancer and their families: a scoping review protocol

OBJECTIVE

This scoping review will identify and map available nursing interventions provided by pediatric oncology hospital services to pediatric patients with cancer and/or their family members. The aim is to develop a comprehensive overview of the characteristics of nursing interventions and to identify potential knowledge gaps.

INTRODUCTION

Clinical nursing care is an essential part of pediatric oncology. In pediatric oncology nursing research, a shift from explanatory studies to intervention studies is recommended. The body of research on interventions for pediatric oncology patients and their families has grown in recent years. However, there are no reviews on nursing interventions currently available for pediatric oncology.

INCLUSION CRITERIA

Studies will be considered for inclusion if they refer to pediatric patients with cancer, and/or family members of a pediatric patient with cancer, who have received non-pharmacological and non-procedural nursing interventions provided by a pediatric oncology hospital service. Studies must also be peer-reviewed, published from the year 2000 onward, and written in English, Danish, Norwegian, or Swedish.

METHODS

The review will be conducted in accordance with the JBI guidelines for scoping reviews. A 3-step search strategy will be followed using the PCC mnemonic (Population, Concept, Context). The databases to be searched will include Scopus, PubMed, CINAHL, PsyclNFO, and Embase. The identified studies will be screened based on title and abstract, as well as full text, by 2 independent reviewers. Data will be extracted and managed in Covidence. A summary of the results will be presented as a narrative description, supported by tables.

The gap between expectations and reality: A qualitative study of psychosocial challenges of young childhood cancer survivors from the PACCS study

OBJECTIVE

In this sub-study from the 'PACCS' study, we explored the psychosocial experiences of children and adolescents in everyday life post-cancer treatment and the possible factors that can moderate these experiences.

METHODS

This is a qualitative explorative study using semi-structured interviews with 43 childhood cancer survivors between the ages of nine and 18 from Norway and Denmark. We conducted a secondary thematic analysis using Malterud's systematic text condensation.

RESULTS

Two main themes were identified: 'The post-treatment gap between expectations and reality' comprised two subthemes: (1) lack of mastery and feeling different and (2) lack of understanding and acceptance. The second main theme, 'Managing the gap', comprised three subthemes: (1) information and knowledge, (2) adjustments and adaptions and (3) social support and openness. The findings reveal that the psychosocial challenges resulted from the remaining ability gap(s). Measures such as tailored information, school adjustments and social support were potential dynamic factors affecting the gap(s) positively or negatively. Psychosocial challenges post-treatment are experiences of lack of acceptance and understanding from others.

CONCLUSION

To safeguard a positive transition back to everyday life, health care providers should support the survivors' psychosocial care, including getting back to school and re-entering social interactions.

Young children's experiences of support when fearful during treatment for acute lymphoblastic leukaemia-A longitudinal interview study

AIM AND OBJECTIVES

To describe young children's experiences of valuable support in managing their fears about treatment for acute lymphoblastic leukaemia. The focus was specifically on support from parents and healthcare professionals.

DESIGN

The study had a qualitative descriptive longitudinal design.

METHODS

The study analysed 35 interviews with 13 children at three different times during their treatment period. Data were analysed using a matrix-based method. The Consolidated criteria for reporting qualitative research (COREQ) guidelines have been followed.

RESULTS

Parents and healthcare professionals provide important support to children undergoing treatment for acute lymphoblastic leukaemia, although their roles differ. Children valued their parents' closeness and advocacy, being able to participate in their own care, and being given pain relief during procedures known to create pain. Valued support from healthcare professionals changed over time, from providing information and showing the tools that would be used in procedures, to paying attention to the child's needs and desires. It was more important for children to be able to choose between different alternatives in medical procedures than deciding on major treatment issues.

Randomized Clinical Trial of a Legacy Intervention for Quality of Life in Children with Advanced Cancer

Background: Legacy-making (actions/behaviors aimed at being remembered) may be a significant component for quality of life (QOL) during advanced illness and end of life. Although legacy interventions have been tested in adults, the impact of legacy activities on QOL for children has yet to be clearly defined. Objective: This study examined the impact of our newly developed web-based legacy intervention on dimensions of QOL among children (7-17 years old) with advanced cancer. Design: This single-site randomized clinical trial (RCT) used a two-group waitlist control design. The legacy intervention guided children to create digital storyboards by directing them to answer legacy questions about themselves (personal characteristics, things they like to do, and connectedness with others) and upload photographs, video, and music. Setting/Subjects: Facebook advertisements recruited children (ages 7-17) with relapsed/refractory cancer and their parents from the United States. Child-parent dyads (N = 150) were randomized to the intervention or usual care group, and 97 dyads were included for analysis. Measurements: Children and parents completed the PedsQL Cancer Module preintervention (T1) and post-intervention (T2). Results: Although not statistically significant, legacy-making demonstrated small effects in child procedural anxiety and perceived physical appearance (Cohen's d 0.35-0.28) compared to the wait-list control group. Conclusions: This study contributes important discoveries, including support for the feasibility of a RCT web-based legacy intervention for children with advanced cancer. We did not find convincing evidence supporting the hypothesis that legacy-making improved child dimensions of QOL across time. Overall, this is a null study that warrants discussion on possible reasons for limited findings. Future legacy intervention research is needed using qualitative and quantitative methods, as well as child and parent reports, to determine how such services may improve dimensions of QOL for pediatric palliative care populations. ClinicalTrials.gov number NCT04059393.

Medical procedures in children using a conceptual framework that keeps a focus on human dimensions of care - a discussion paper

Purpose: Children’s perspectives in the context of health service delivery have historically been seen as unimportant. They have been viewed as unintelligent, unable to effectively share or tell of their experiences or fully participate in their care, potentially resulting in a sense of dehumanisation.

Method: The present paper illustrates children’s experiences when undergoing medical procedures, using application of the eight dimensions of humanised care theoretical framework.

Results: Findings from six published papers were reflectively interrogated to identify implicit findings related to the dimensions of humanised care. These implicit findings show ways of caring for childrenwhichcan lead to enhanced human sensitivity in care or conversely where the dimensions of being human are obscured to greater or lesser degrees and can result in forms of dehumanisation.

Conclusions: Inadvertent dehumanising features of practice can be mediated by encouraging the inclusion of children’s own lifeworld perspective and make room for their voices in both care and research. In this way the present well documented power imbalance could be addressed. Adding the value of the theoretical framework highlights areas of need for young children to be cared for as human beings.

Experiences of Young Children With Cancer and Their Parents With Nurses' Caring Practices During the Cancer Trajectory

Children with cancer require repeated hospitalizations and the family's everyday life and routines undergo change. Concrete descriptions of how nurses act when caring for children with cancer throughout the various phases of care and treatment are sparsely highlighted in the literature. The aim of this study was to describe young children with cancer and their parents' experiences of nurses' caring practices over a 3-year period, from diagnosis to follow-up. This study is based on semistructured interviews with 25 children newly diagnosed with cancer, aged 1 to 6 years, and their parents, connected to a pediatric oncology unit in Sweden. Child and parent data were analyzed with a deductive content analysis using Swanson's theory of caring. The result shows that nurse care practices directed toward young children with cancer and their parents are to some extent similar across a 3-year period from diagnosis to follow-up but also differ in some ways. Nurses' caring practices aim to support children and parents in the transition to a "new normal." Child- and family-friendly care processes include the following: creating hope and a trustful relationship, asking rather than assuming, providing knowledge and information, performing tasks skillfully, displaying an interest in the child's and parents' life outside the hospital, and helping the family to trust in the future and other health care providers. Based on these results, we recommend the development of a standardized and structured nursing care plan or clinical guideline with detailed information on how to carry out clinical nurse care practices in the different phases.

Experiences of adolescents with cancer from diagnosis to post-treatment: a scoping review

Adolescence is a turbulent time of transition. Facing a serious health issue such as cancer during this time can be challenging and confusing. This study presents a scoping review of 33 research articles including quantitative, qualitative, mixed method, and reviews focused on the experiences of adolescents throughout the cancer journey. Extracted themes across studies identified individual, interpersonal, and environmental aspects of adolescents' experiences in each stage of this trajectory. Implications for these findings are discussed including a need for early diagnosis and treatment of adolescent cancers and developmentally appropriate clinical supports.

Posttraumatic stress in young children with cancer: Risk factors and comparison with healthy peers

OBJECTIVE

The most commonly occurring childhood cancers are diagnosed during the preschool years; yet limited psycho-oncology research has focused on this developmental time period. The primary objective was to examine rates of posttraumatic stress symptoms (PTSS) in young children with cancer and compare these findings with those of children without a history of serious illness (comparisons). The secondary aim was to examine risk and modifiable factors associated with PTSS.

METHOD

Ninety-seven caregivers of patients (n = 50) and comparisons (n = 47) aged three to six years completed diagnostic interviews for the assessment of PTSD. They also completed a survey measure of PTSS adapted from the Child Behavior Checklist (CBCL-PTSD), along with measures of their child's temperament and their own current psychological functioning.

RESULTS

On the CBCL-PTSD, no differences in PTSS were observed between children with cancer and comparisons, although many in both groups appeared at risk, with approximately 34% of children with cancer and 27% of comparisons meeting threshold scores for probable PTSD. However, using a "gold-standard" clinical-interview assessment, only three children in the patient group and no children in the comparison group met diagnostic criteria for PTSD. Parental distress and child temperament were significantly associated with PTSS scores.

CONCLUSION

Findings indicate PTSD is relatively infrequent in children with cancer, and survey measures may overestimate rates of PTSD in young children. However, other emotional or behavioral issues may be present. Ultimately, screening for potential emotional/behavioral concerns in young children with cancer is indicated, and interventions should continue to target caregiver distress.

Fear and Coping in Children 5-9 years old Treated for Acute Lymphoblastic Leukemia - A Longitudinal Interview Study

PURPOSE

The aim of this study was to describe the fears of 5- to 9-year-old children related to having acute lymphoblastic leukemia (ALL) and their strategies for coping with those fears.

DESIGN AND METHODS

The study had a qualitative descriptive longitudinal design and included a total of 35 interviews with 13 children at three different times during their treatment period. Data were analyzed using a matrix-based method inspired by the work of Miles et al. RESULTS: Initially, most children reported a fear of needles, but during the treatment period, fewer children reported this fear. Children's coping strategies also changed over time, as they wanted more involvement and control during needle-related procedures. Other fears were having adhesive tapes removed, having a nasogastric tube, and taking tablets. During the treatment period, existential fears related to the seriousness of ALL and its consequences, such as having impaired physical fitness and being different from before and different from others, became more prominent and caused feelings of loneliness and alienation.

CONCLUSIONS

The children described various fears through their treatment period, which they coped with using cognitive, emotional, and functional strategies. Over the 2.5-year period, their strategies changed.

PRACTICAL IMPLICATIONS

Because fears changed over time and varied among these different children, each child must be approached individually and attentively in every encounter.

Young children's experiences of living an everyday life with cancer - A three year interview study

PURPOSE

The young child's experiences of living with cancer are crucial to providing evidence based care. This study explores and describes experiences of everyday life of young children with cancer, over a three year period from diagnosis.

METHOD

This is a longitudinal, inductive interview study with young children with cancer, and their parents. Interviews from shortly after diagnosis, six and 12 months after diagnosis have been reanalysed. Interviews with the same children and their parents from 18 to 36 months after diagnosis have been analysed for the first time in the present paper. A longitudinal temporal analysis at category level for five synchronic data sets forms the basis for the results.

RESULTS

The child living with cancer over a three year period is described as a child apart, striving to live an everyday life. This description is built on three categories: I want to be a child like any other, I need security and control and I feel lonely and left out. Young children with cancer actively strive to understand their illness, participate in care and live an ordinary everyday life- but with ongoing feelings of social isolation and loneliness.

CONCLUSIONS

Young children with cancer need access to and ongoing contact with peers and preschool. A structured follow-up throughout the cancer trajectory and not just during active treatment, is necessary. A child-centred philosophy of care would guide the child towards attainment of health and wellbeing.

Early intervention for infants and toddlers: Applications for pediatric oncology

Young children (<3 years) with cancer are at risk for delays in development due to their disease and its required treatments and restrictions. In the United States, Part C of the Individuals with Disabilities Education Act describes a system of early intervention (EI) services for young children with delays or the potential for delays in development. Children with cancer may be eligible for EI but are rarely referred. Our objectives are to describe the critical impact of early childhood development on long-term outcomes, review current considerations for EI, and advocate for the referral to EI for young children with cancer.

Parents' Assessments of Disability in Their Children Using World Health Organization International Classification of Functioning, Disability and Health, Child and Youth Version Joined Body Functions and Activity Codes Related to Everyday Life

AIM

To help parents assess disability in their own children using World Health Organization (WHO) International Classification of Functioning, Disability and Health, Child and Youth Version (ICF-CY) code qualifier scoring and to assess the validity and reliability of the data sets obtained.

METHOD

Parents of 162 children with spina bifida, spinal muscular atrophy, muscular disorders, cerebral palsy, visual impairment, hearing impairment, mental disability, or disability following brain tumours performed scoring for 26 body functions qualifiers (b codes) and activities and participation qualifiers (d codes). Scoring was repeated after 6 months. Psychometric and Rasch data analysis was undertaken.

RESULTS

The initial and repeated data had Cronbach α of 0.96 and 0.97, respectively. Inter-code correlation was 0.54 (range: 0.23-0.91) and 0.76 (range: 0.20-0.92). The corrected code-total correlations were 0.72 (range: 0.49-0.83) and 0.75 (range: 0.50-0.87). When repeated, the ICF-CY code qualifier scoring showed a correlation R of 0.90. Rasch analysis of the selected ICF-CY code data demonstrated a mean measure of 0.00 and 0.00, respectively. Code qualifier infit mean square (MNSQ) had a mean of 1.01 and 1.00. The mean corresponding outfit MNSQ was 1.05 and 1.01. The ICF-CY code τ thresholds and category measures were continuous when assessed and reassessed by parents. Participating children had a mean of 56 codes scores (range: 26-130) before and a mean of 55.9 scores (range: 25-125) after repeat. Corresponding measures were −1.10 (range: −5.31 to 5.25) and −1.11 (range: −5.42 to 5.36), respectively. Based on measures obtained at the 2 occasions, the correlation coefficient R was 0.84. The child code map showed coherence of ICF-CY codes at each level. There was continuity in covering the range across disabilities. And, first and foremost, the distribution of codes reflexed a true continuity in disability with codes for motor functions activated first, then codes for cognitive functions, and, finally, codes for more complex functions.

CONCLUSIONS

Parents can assess their own children in a valid and reliable way, and if the WHO ICF-CY second-level code data set is functioning in a clinically sound way, it can be employed as a tool for identifying the severity of disabilities and for monitoring changes in those disabilities over time. The ICF-CY codes selected in this study might be one cornerstone in forming a national or even international generic set of ICF-CY codes for the benefit of children with disabilities, their parents, and caregivers and for the whole community supporting with children with disabilities on a daily and perpetual basis.

Objectively measured versus self-reported physical activity in children and adolescents with cancer

Objective

Existing research recognizes low levels of physical activity in pediatric patients with cancer, but much uncertainty exists about their capability to self-reflect physical activity levels. The objective of this study was to compare results of subjective self-reports and objective accelerometers regarding levels of daily walking as well as moderate-to-vigorous physical activities.

Methods

Results of the objective assessment tool StepWatchTM Activity Monitor and self-reporting with a standardized questionnaire were compared in 28 children and adolescents during cancer treatment.

Results

The patients were 13.8±2.8 years of age and 3.4±2.0 months after cancer diagnosis. The Bland-Altman plots indicated a fairly symmetrical under- and over-estimation for daily minutes of walking with the limits of agreement ranging from -100.8 to 87.3 min (d = -6.7 min). Mean difference for moderate-to-vigorous physical activity was almost zero but limits of agreement are ranging from -126.8 to 126.9 min. The comparison for the days with at least 60 min of moderate-to-vigorous physical activity showed a marked difference with 3.0±2.6 self-reported days versus only 0.1±0.4 measured days.

Conclusions

These findings suggest that physical activity in pediatric cancer patients should preferably be assessed with objective methods. Greater efforts are needed to implement supervised exercise interventions during treatment incorporating methods to improve self-reflection of physical activity.