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Silverstein A, Easton V, Barrows C, Sawyer K, Coughlin R, Mali N, Kessler A, Robinson M, Sirrine E, Spears M, Wrigley J, Baker JN, Kaye EC. Dignity in the Pediatric Population: A Systematic Review. J Pain Symptom Manage 2024:S0885-3924(24)00862-5. [PMID: 39032678 DOI: 10.1016/j.jpainsymman.2024.07.012] [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: 04/27/2024] [Revised: 07/10/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
CONTEXT Children are a uniquely vulnerable patient population with restricted abilities for self-advocacy and autonomy, risking infringement upon their dignity. Yet the concept of dignity in pediatrics remains underexplored relative to the adult literature and other outcome measures. OBJECTIVES To characterize how dignity is defined, evaluated, and/or measured in pediatrics. METHODS We conducted a systematic review following PRISMA guidelines across the following databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health, PsycINFO, Global Health, Social Science Premium Collection, and Dissertation and Theses. We included publications from database inception through April 2023, in English, involving children aged 0-18 years, and prioritizing dignity as a central theme with a focus on defining, evaluating, or measuring dignity. Study descriptions and pertinent characteristics were extracted and synthesized using a predefined form. RESULTS Forty-four articles met inclusion criteria; fewer than half comprised original research (20/44, 45%). Most studies (38/44, 86%) included description of the meaning of dignity, with emergence of salient themes around respect, communication, agency/autonomy, and privacy. Less than half (19/44, 43%) included a measurement or evaluation of dignity; approximately one-third described dignity therapy. More than one-third of publications focused on dignity at end of life (17/44, 39%) and included discussions of palliative care and hospice (15/44, 34%). CONCLUSION Relatively few published studies describe dignity in pediatrics. Opportunities exist to broaden scholarship on this topic in partnership with patients, families, and clinicians, with the goal of assessing and strengthening dignity-centered care across the illness course and at the end of life.
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Affiliation(s)
- Allison Silverstein
- Section of Palliative Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Veronica Easton
- Department of Internal Medicine, St. Bernards Medical Center, Jonesboro, AR, USA
| | - Cory Barrows
- Section of Hospice and Palliative Medicine, University of Tennessee Health Science Center, University, Memphis, TN, USA
| | - Kimberly Sawyer
- Section of Palliative Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Rachel Coughlin
- Section of Palliative Medicine, Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Nidhi Mali
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Amber Kessler
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew Robinson
- Department of Internal Medicine, Baptist Memorial Hospital, Memphis, TN, USA
| | - Erica Sirrine
- Department of Social Work, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Jordan Wrigley
- Biomedical Library, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care, Stanford University, Palo Alto, CA, USA
| | - Erica C Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Wan J, Vaughan A, Shepherd E, Coombs S, Trethewie S, Jaaniste T. Evaluation of paediatric palliative care ambulance plans: A retrospective study. J Child Health Care 2024:13674935231225714. [PMID: 38262591 DOI: 10.1177/13674935231225714] [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] [Indexed: 01/25/2024]
Abstract
Paediatric Palliative Care Ambulance Plans ('Plans') are used by New South Wales Ambulance (Australia) to support the care needs of children with life-limiting conditions. We aimed to describe the population of children with Plans and provide details regarding Plan completion, paramedic responses during ambulance callouts, and correspondence between Plan recommendations and paramedic responses. Plans lodged in January 2017-December 2019 were retrospectively coded for demographic information, completeness and care preferences. Associated paramedic callout notes (January 2018-December 2019) were coded for paramedic responses. Of 141 Plans retrieved, 38 (41.3% of those providing suggested medications) suggested medication use outside general paramedic scope of practice. Of 199 associated ambulance callouts, reasons for callout included symptom management, planned transfer, death notification and end-of-life care. Over two-thirds of callouts (n = 135, 67.8%) occurred after-hours. Most paramedic callouts (n = 124, 62.3%), excluding planned transfers, resulted in children being transported. Paramedic interventions corresponded with interventions suggested in Plans. However, only 24 (25.3%) of paramedic callout notes documented Plans being sighted. This study provided detailed information about children with palliative care needs for whom Plans were being used, the nature of these Plans and associated paramedic callouts. However, it is not known how paramedics were influenced by Plans.
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Affiliation(s)
- Julianna Wan
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Elizabeth Shepherd
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Sandra Coombs
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Susan Trethewie
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Tiina Jaaniste
- Department of Palliative Care, Sydney Children's Hospital Network, Randwick, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
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Gao Q, Yao Y, Xu Q. Guideline and Implementation of Osteosarcoma Nursing Care for Children and Adolescents. Appl Bionics Biomech 2022; 2022:2021162. [PMID: 36267672 PMCID: PMC9578899 DOI: 10.1155/2022/2021162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Clinical trials on pediatric oncology use therapeutic techniques with the overwhelming majority of children's cancer patients obtaining therapy via clinical investigation procedures. Medical treatment is scheduled according to a specific protocol for enrolled patients. These protocols often do not refer to nursing care. Nursing care, on the other hand, must complement the medical care specified in the medical research protocol. Safe treatment administration, assessment of treatment responses, patients' and families' education, and communication with the whole medical team are just a few of the critical nursing tasks that should be properly managed. Nursing care standards have been developed in this study to strike a good balance between the procedure for clinical research and the nursing care connected with it. These recommendations outline the nursing activities and considerations that must be made while caring for pediatric cancer patients who are engaged in a specific clinical investigation procedure. The objective of this study is to outline the procedure through which nursing care guidelines could be developed and evaluated. The goal of this study was to find out the involvement of nurses in the process of health education for osteosarcoma and family patients.
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Affiliation(s)
- Qian Gao
- Nursing Department, Department of Bone Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 310009, China
| | - Yuhong Yao
- Nursing Department, Department of Bone Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 310009, China
| | - Qi Xu
- Nursing Department, Department of Thoracic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, 310009, China
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Jaaniste T, Cuganesan A, Chin WLA, Tan SC, Coombs S, Heaton M, Cowan S, Aouad P, Potter D, Smith PL, Trethewie S. Living with a child who has a life-limiting condition: The functioning of well-siblings and parents. Child Care Health Dev 2022; 48:269-276. [PMID: 34766366 DOI: 10.1111/cch.12927] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/22/2021] [Accepted: 10/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Living with a child who has a life-limiting condition (LLC) is likely to have a major impact on all family members. There is a need to have a clearer understanding of the nature and extent of this impact on parents and well-siblings. The current study aimed to investigate the psychosocial functioning of well-siblings and parents living with a child with an LLC. Further, the study aimed to assess the resilience resources of both well-siblings and parents, giving consideration to how these relate to psychosocial functioning. METHODS Participants included 48 well-siblings (6-21 years) and 42 parents of children with LLCs. Parents and well-siblings independently completed validated measures of child and adult functioning and personal resilience. Parents provided demographic information about the patient and family. RESULTS The emotional, social and school functioning of well-siblings in the current study was found to be significantly poorer than published norms (all p's < .01). Parental self-reported depression, anxiety and stress scores were also all significantly poorer than published norms (all p's < .01). There was negligible agreement between well-sibling self-reported functioning and parental proxy-report of the well-siblings functioning (all r's < .126, all p's > .464). Sibling self-reported resilience was positively correlated with each of the measures of psychosocial functioning (all r's > .318, p's < .05). Parental resilience was significantly negatively correlated with depressive symptoms (r = -.369, p < .05) and anxiety symptoms (r = -.473, p < .01) but not stress scores (r = -.074, p = .644). CONCLUSION Family members living with a child who has an LLC were found to have significantly poorer psychosocial functioning than published norms. Although one cannot infer a causal direction from the current study, greater self-reported well-sibling and parental resilience were associated with aspects of better self-reported psychosocial functioning. Future studies should assess the impact of psychosocial interventions aimed at enhancing the resilience and functioning of both well-siblings and parents.
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Affiliation(s)
- Tiina Jaaniste
- Department of Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Anjali Cuganesan
- Department of Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Wei Ling Audrey Chin
- Department of Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Sarah Caellainn Tan
- Department of Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Sandra Coombs
- Department of Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Maria Heaton
- Department of Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Sue Cowan
- Department of Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Bear Cottage, Manly, NSW, Australia
| | - Phillip Aouad
- Department of Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Denise Potter
- Department of Palliative Care, Children's Hospital at Westmead, Sydney, NSW, Australia
| | | | - Susan Trethewie
- Department of Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
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5
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Boyden JY, Ersek M, Deatrick JA, Widger K, LaRagione G, Lord B, Feudtner C. What Do Parents Value Regarding Pediatric Palliative and Hospice Care in the Home Setting? J Pain Symptom Manage 2021; 61:12-23. [PMID: 32745574 PMCID: PMC9747513 DOI: 10.1016/j.jpainsymman.2020.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Children with life-shortening serious illnesses and medically-complex care needs are often cared for by their families at home. Little, however, is known about what aspects of pediatric palliative and hospice care in the home setting (PPHC@Home) families value the most. OBJECTIVES To explore how parents rate and prioritize domains of PPHC@Home as the first phase of a larger study that developed a parent-reported measure of experiences with PPHC@Home. METHODS Twenty domains of high-value PPHC@Home, derived from the National Consensus Project's Guidelines for Quality Palliative Care, the literature, and a stakeholder panel, were evaluated. Using a discrete choice experiment, parents provided their ratings of the most and least valued PPHC@Home domains. We also explored potential differences in how subgroups of parents rated the domains. RESULTS Forty-seven parents participated. Overall, highest-rated domains included Physical aspects of care: Symptom management, Psychological/emotional aspects of care for the child, and Care coordination. Lowest-rated domains included Spiritual and religious aspects of care and Cultural aspects of care. In exploratory analyses, parents who had other children rated the Psychological/emotional aspects of care for the sibling(s) domain significantly higher than parents who did not have other children (P = 0.02). Furthermore, bereaved parents rated the Caregiversupportat the end of life domain significantly higher than parents who were currently caring for their child (P = 0.04). No other significant differences in domain ratings were observed. CONCLUSION Knowing what parents value most about PPHC@Home provides the foundation for further exploration and conversation about priority areas for resource allocation and care improvement efforts.
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Affiliation(s)
- Jackelyn Y Boyden
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Mary Ersek
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Janet A Deatrick
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gwenn LaRagione
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Blyth Lord
- Courageous Parents Network, Newton, MA, USA
| | - Chris Feudtner
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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6
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Serious Illness Conversations in Pediatrics: A Case Review. CHILDREN-BASEL 2020; 7:children7080102. [PMID: 32824811 PMCID: PMC7463833 DOI: 10.3390/children7080102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/28/2020] [Accepted: 08/13/2020] [Indexed: 01/02/2023]
Abstract
The Serious Illness Conversation Guide program developed by Ariadne Labs, a Joint Center for Health Systems Innovation, includes a list of patient-centered questions designed to assist clinicians to gain a more thorough understanding of their patient's life in order to inform future care decisions. In July 2017, specialist pediatric palliative care clinicians at Canuck Place Children's Hospice (CPCH) (Vancouver, BC, Canada), adapted the original guide to use with parents of children with serious illness. This tool is referred to as the Serious Illness Conversation Guide-Peds (SICG-Peds). Using the SICG-Peds, along with enhanced communication skills, can help illuminate the parents' (child's) understanding of illness and the values they hold. Expanding the application of the guide will promote goal-based, efficient, comprehensive and consistent communication between families and clinicians and help ensure that seriously ill children receive care that is tailored to their needs through the disease trajectory. This paper explores the guide through the lens of a case study. The steps-seeking permission, assessing understanding, sharing prognosis and exploring key topics (hopes, fears, strengths, critical abilities and trade-offs)-as well as formulating clinician recommendations, are described.
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Bolognani M, Morelli PD, Scolari I, Dolci C, Fiorito V, Uez F, Graziani S, Stefani B, Zeni F, Gobber G, Bravi E, Tateo S, Soffiati M. Development of a Perinatal Palliative Care Model at a Level II Perinatal Center Supported by a Pediatric Palliative Care Network. Front Pediatr 2020; 8:574397. [PMID: 33520884 PMCID: PMC7845291 DOI: 10.3389/fped.2020.574397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022] Open
Abstract
Objective: To describe the model build up to take care of fetuses and newborns eligible to perinatal palliative care (PnPC) followed in an Italian II level perinatal center. Methods: Retrospective chart review of all fetuses and newborn infants eligible to PnPC admitted to level II perinatal center within a 4 years period. Results: Forty-five of 848 infants (0.5%) referred to II level NICU were eligible to PnPC. Twenty-seven percentage had fetal diagnosis. Twenty percentage were preterm infants at the limit of viability, 35% were newborns with life limiting or life threatening disease diagnosed in utero or at the postnatal ward, 45% were newborns not responding to intensive care intervention with high health care needs or medical complexity. Fifty-seven percentage of neonates admitted to NICU died before discharge, while 16 (35% of population considered) were discharged home. Median age at death was 4 days after birth, and delivery room death immediately after birth occurred in six patients (13%). Conclusions: Despite the paucity of our population and the high variability in disease trajectories the perinatal palliative care program build up in our region provides a reproducible method for a structured taking in charge of fetuses and neonates eligible to PnPC and their families, from the time of diagnosis to bereavement, in both outpatient and inpatient settings.
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Affiliation(s)
- Marco Bolognani
- Department of Neonatology, Santa Chiara Hospital, Trento, Italy.,Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | | | - Isabella Scolari
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Cristina Dolci
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | | | - Francesca Uez
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Silvia Graziani
- Department of Neonatology, Santa Chiara Hospital, Trento, Italy
| | - Barbara Stefani
- Department of Neonatology, Santa Chiara Hospital, Trento, Italy.,Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Francesca Zeni
- Department of Neonatology, Santa Chiara Hospital, Trento, Italy.,Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Gino Gobber
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Elena Bravi
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Saverio Tateo
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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8
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Constantinou G, Garcia R, Cook E, Randhawa G. Children's unmet palliative care needs: a scoping review of parents' perspectives. BMJ Support Palliat Care 2019; 9:439-450. [PMID: 31324615 DOI: 10.1136/bmjspcare-2018-001705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/15/2019] [Accepted: 05/29/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Children with life-limiting conditions often have complex needs, making it challenging for services to provide satisfactory care. Few studies consider whether services actually meet families' needs by exploring and identifying the parents' perspectives of unmet needs. AIM To identify what published evidence is available on the unmet needs of children with life-limiting conditions and their families, from the perspective of parents, internationally. ELIGIBILITY CRITERIA: Inclusion criteria: papers from the perspective of parents of children aged 0-19 years, who have a life-limiting condition and are receiving palliative care. Exclusion criteria: those papers not written in English, not reporting primary research and discussing children who died from stillbirth, accidental or unexpected circumstance. CHARTING METHODS A scoping review was conducted in accordance with the methods of Arksey and O'Malley. SOURCES OF EVIDENCE The electronic databases PubMed, MEDLINE, CINAHL and PsycINFO were searched. Key terms included: parent, needs, met/unmet/satisfaction, palliative/supportive/end of life care, life-limiting/life-threatening illness, infants/children/young people. RESULTS Total hit indicated 5975 papers for screening. Fifty-five papers met the scoping review criteria. The majority used mixed-methods approaches inclusive of: questionnaires, self-report measures, in-depth interviews, focus groups, case record analysis and art-based workshops. Unmet needs included: respite care, coordination and organisation of care, psychological support and professional communication skills. CONCLUSIONS The findings suggest many unmet needs from the parent's perspective, across several aspects of the Quality Standards and Children's Palliative Care Frameworks. Further research is needed which explores the parent's unmet needs in palliative care services.
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Affiliation(s)
| | | | - Erica Cook
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Chan CWH, Choi KC, Chan HYL, Wong MMH, Ling GCC, Chow KM, Chow AYM, Lo R, Sham MMK. Unfolding and displaying the influencing factors of advance directives from the stakeholder's perspective: A concept mapping approach. J Adv Nurs 2019; 75:1549-1562. [DOI: 10.1111/jan.14017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/22/2019] [Accepted: 03/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Carmen W. H. Chan
- The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong SAR China
| | - Kai C. Choi
- The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong SAR China
| | - Helen Y. L. Chan
- The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong SAR China
| | - Martin M. H. Wong
- The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong SAR China
| | - Gigi C. C. Ling
- The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong SAR China
| | - Ka M. Chow
- The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong SAR China
| | - Amy Y. M. Chow
- Department of Social Work and Social Administration The University of Hong Kong Hong Kong
| | - Raymond Lo
- Department of Medicine and Therapeutics the Chinese University of Hong Kong Hong Kong
- Bradbury Hospice Hong Kong
- Geriatrics and Palliative Medicine Shatin Hospital Hong Kong
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10
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Thepha T, Marais D, Bell J, Muangpin S. Concept mapping to reach consensus on a 6-month exclusive breastfeeding strategy model to improve the rate in Northeast Thailand. MATERNAL AND CHILD NUTRITION 2019; 15:e12823. [PMID: 30958626 PMCID: PMC6851995 DOI: 10.1111/mcn.12823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 11/26/2022]
Abstract
Background In implementation research, it is essential to involve all stakeholders in the development of complex interventions to ensure that the proposed intervention strategy is relevant and acceptable to the target area and group. The aim of this study was to involve stakeholders in conceptualising, developing, and prioritising a feasible intervention strategy to improve the 6‐month exclusive breastfeeding rate in North‐east Thailand. Concept mapping was used in a purposive sample including health care volunteers, health care professionals, and community leaders. During the first meeting, stakeholders (n = 22) expressed the generation of feasible interventions. During the second meeting, participants (n = 21) were asked to individually rate the feasibility of each intervention and to group them into relevant categories to enable multidimensional scaling and hierarchical cluster analysis. The outputs of analysis included the intervention list, cluster list, point map, point rating map, cluster map, and cluster rating map. All of these were shared with stakeholders (n = 17) during the third meeting to reach consensus on an intervention model. The final proposed intervention strategy included 15 feasible interventions in five clusters: health care services, community services, and education packages for parents, family members, and communities. These interventions were prioritised for implementation over a 3‐year period. Once the feasibility of each intervention is established, the proposed model could be implemented and incorporated into local health policy. After assessing intervention effectiveness, each intervention could be scaled up to other middle‐income countries to help improve overall maternal and child survival.
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Affiliation(s)
- Thiwawan Thepha
- Department of Advanced Midwifery, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Debbie Marais
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jacqueline Bell
- College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - Somjit Muangpin
- Department of Advanced Midwifery, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
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11
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Miller JJ, Benner K, Donohue-Dioh J, Segress M. Supporting collegiate foster youth and alumni: A mixed-method planning approach for higher education. EVALUATION AND PROGRAM PLANNING 2019; 72:67-76. [PMID: 30316035 DOI: 10.1016/j.evalprogplan.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/18/2018] [Accepted: 10/03/2018] [Indexed: 06/08/2023]
Abstract
Despite the proliferation, of on-campus academic support programs for foster youth and alumni (e.g., those formerly in foster care), few conceptual frameworks for developing these programs exist. This study employed Group Concept Mapping (GCM) methodology to delineate a conceptual framework, from the perspective of foster youth and alumni (N = 51), for the development of on-campus support initiatives. GCM is an integrated mixed-method research method that uses non-metric multidimensional scaling and hierarchical cluster analyses, to analyze qualitative data (e.g., statement form) collected during brainstorming sessions. This research was guided by two separate queries: (1) How do foster youth/alumni conceptualize support programs to support foster youth/alumni through to degree completion; and, (2) Is there a difference in priority areas of this conceptualization between current college students, and those who have dropped out of college within the last 18 months? Analyses revealed that participants conceptualized on-campus support programs via an eight-cluster solution, including Campus Awareness, Advocacy, Data Tracking, Pre-College Supports, Fostering Family Connections, Academic Financing, Campus Life, and Peer/Mentor Supports clusters. Additionally, analyses revealed significant priority ratings between areas of this conceptualization. In terms of Importance to academic success, current students rated statements in the Academic Financing and Peer/Mentor Supports clusters significantly lower than did non-students. For Feasibility, current students viewed statements in the Data Tracking, Campus Life, and Peer/Mentor Supports clusters as significantly more feasible than non-students. Pragmatic implications derived from these findings include fostering inclusive campus environments for foster youth/alumni and advocacy undertakings by institutions, on behalf of this population.
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Affiliation(s)
- J Jay Miller
- College of Social Work, University of Kentucky, United States.
| | - Kalea Benner
- College of Social Work, University of Kentucky, United States
| | | | - Melissa Segress
- College of Social Work, University of Kentucky, United States
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12
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Namisango E, Bristowe K, Allsop MJ, Murtagh FEM, Abas M, Higginson IJ, Downing J, Harding R. Symptoms and Concerns Among Children and Young People with Life-Limiting and Life-Threatening Conditions: A Systematic Review Highlighting Meaningful Health Outcomes. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 12:15-55. [DOI: 10.1007/s40271-018-0333-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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Ekberg S, Bradford NK, Herbert A, Danby S, Yates P. Healthcare Users' Experiences of Communicating with Healthcare Professionals About Children Who Have Life-Limiting Conditions: A Qualitative Systematic Review. J Palliat Med 2018; 21:1518-1528. [PMID: 29762072 DOI: 10.1089/jpm.2017.0422] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Globally, an estimated eight million children could benefit from palliative care each year. Effective communication about children with life-limiting conditions is well recognized as a critical component of high-quality pediatric palliative care. OBJECTIVE To synthesize existing qualitative research exploring healthcare users' experiences of communicating with healthcare professionals about children with life-limiting conditions. DESIGN The results of a systematic literature search were screened independently by two reviewers. Raw data and analytic claims were extracted from included studies and were synthesized using thematic analysis methods for systematic reviews. DATA SOURCES MEDLINE, PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science, ProQuest, and ScienceDirect were searched for articles published in English between 1990 and May 2017. RESULTS This review included 29 studies conducted across 11 countries and involving at least 979 healthcare users (adults [n = 914], patients [n = 25], and siblings [n = 40]). The four domains of communication experience identified through thematic synthesis are: Information, Emotion, Collaboration, and Relationship. Although included studies were from a range of settings and diverse populations, further research is needed to explore whether and how domains of communication experience differ across settings and populations. In particular, further research about children's palliative care experiences is needed. CONCLUSIONS Healthcare users typically value communication with healthcare professionals: that (1) is open and honest, (2) acknowledges emotion, (3) actively involves healthcare users, and (4) occurs within established and trusting relationships.
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Affiliation(s)
- Stuart Ekberg
- 1 Institute of Health and Biomedical Innovation , Queensland University of Technology, Brisbane, Queensland, Australia .,2 School of Psychology and Counselling, Queensland University of Technology , Queensland, Australia, Brisbane, Queensland, Australia
| | - Natalie K Bradford
- 3 Children's Health Queensland Hospital and Health Service , Brisbane, Queensland, Australia
| | - Anthony Herbert
- 3 Children's Health Queensland Hospital and Health Service , Brisbane, Queensland, Australia .,4 Children's Health Queensland Clinical Unit, Faculty of Medicine, University of Queensland , Brisbane, Queensland, Australia
| | - Susan Danby
- 5 School of Early Childhood and Inclusive Education , Queensland University of Technology, Brisbane, Queensland, Australia
| | - Patsy Yates
- 1 Institute of Health and Biomedical Innovation , Queensland University of Technology, Brisbane, Queensland, Australia .,6 School of Nursing, Queensland University of Technology , Brisbane, Queensland, Australia
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14
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Donnelly JP, Downing K, Cloen J, Fragen P, Gupton AW, Misasi J, Michelson K. Development and Assessment of a Measure of Parent and Child Needs in Pediatric Palliative Care. J Pain Symptom Manage 2018; 55:1077-1084.e2. [PMID: 29288879 PMCID: PMC6282185 DOI: 10.1016/j.jpainsymman.2017.12.484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Pediatric palliative care has no evidence-based needs assessment measure. The Parent and Child Needs Survey (PCNeeds) is a new instrument designed to assess the needs of children in palliative care, including children receiving end-of-life care, and their families. OBJECTIVES This study examines the psychometrics of and respondents' perceptions about the PCNeeds. METHODS Parents of children in four outpatient pediatric palliative care programs completed the PCNeeds and the World Health Organization Quality of Life-Brief tool (WHOQOL-BREF). Parents answered questions about demographics and the experience of completing the PCNeeds. Internal scale reliability was measured with Cronbach's alpha. Validity was assessed by correlating the PCNeeds total and subscale scores with the WHOQOL-BREF subscales. Additional respondent perceptions were obtained via written comments and analyzed using content analysis. RESULTS The 93 respondents were predominantly female (n = 69, 74%); white (n = 79, 85%); college graduates (n = 71, 76%); and married or partnered (n = 75, 81%). Internal reliability was acceptable (Cronbach's α = 0.83), and validity correlations with the WHOQOL-BREF subscales were consistent with theoretical expectations (moderate negative correlations ranging from -0.36 to -0.51). The most frequently cited need not addressed by our survey was sibling impact (n = 17, 18%). Twelve parents (13%) indicated that no content was missing. The least met needs were financial impact, family impact, and the child's physical problems besides pain. Sixty-eight percent of parents (n = 63) rated completion of the survey as "easy" or "very easy." CONCLUSION Initial psychometric analysis of the PCNeeds is encouraging, but further study of reliability and validity with more diverse respondents is needed.
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Affiliation(s)
| | - Kim Downing
- Greater Illinois Pediatric Palliative Care Coalition, Chicago, Illinois, USA
| | - Jason Cloen
- CompassionNet, Lifetime Care Home Health Care and Hospice, Rochester, New York, USA
| | | | - Alyssa W Gupton
- CompassionNet, Lifetime Care Home Health Care and Hospice, Rochester, New York, USA
| | - Jen Misasi
- Greater Illinois Pediatric Palliative Care Coalition, Chicago, Illinois, USA
| | - Kelly Michelson
- Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
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15
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Grunauer M, Mikesell C. A Review of the Integrated Model of Care: An Opportunity to Respond to Extensive Palliative Care Needs in Pediatric Intensive Care Units in Under-Resourced Settings. Front Pediatr 2018; 6:3. [PMID: 29410951 PMCID: PMC5787068 DOI: 10.3389/fped.2018.00003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/08/2018] [Indexed: 01/27/2023] Open
Abstract
It is estimated that 6.3 million children who die annually need pediatric palliative care (PPC) and that only about 10% of them receive the attention they need because about 98% of them live in under-resourced settings where PPC is not accessible. The consultative model and the integrated model of care (IMOC) are the most common strategies used to make PPC available to critically ill children. In the consultative model, the pediatric intensive care unit (PICU) team, the patient, or their family must request a palliative care (PC) consultation with the external PC team for a PICU patient to be evaluated for special care needs. While the consultation model has historically been more popular, issues related to specialist availability, referral timing, staff's personal biases, misconceptions about PC, and other factors may impede excellent candidates from receiving the attention they need in a timely manner. Contrastingly, in the IMOC, family-centered care, PC tasks, and/or PC are a standard part of the treatment automatically available to all patients. In the IMOC, the PICU team is trained to complete critical and PC tasks as a part of normal daily operations. This review investigates the claim that the IMOC is the best model to meet extensive PPC needs in PICUs, especially in low-resource settings; based on an extensive review of the literature, we have identified five reasons why this model may be superior. The IMOC appears to: (1) improve the delivery of PPC and pediatric critical care, (2) allow clinicians to better respond to the care needs of patients and the epidemiological realities of their settings in ways that are consistent with evidence-based recommendations, (3) facilitate the universal delivery of care to all patients with special care needs, (4) maximize available resources, and (5) build local capacity; each of these areas should be further researched to develop a model of care that enables clinicians to provide pediatric patients with the highest attainable standard of health care. The IMOC lays out a pathway to provide the world's sickest, most vulnerable children with access to PPC, a human right to which they are entitled by international legal conventions.
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Affiliation(s)
- Michelle Grunauer
- Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
- Pediatric Intensive Care Unit, Hospital de los Valles, Quito, Ecuador
| | - Caley Mikesell
- Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
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16
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Boyden JY, Curley MAQ, Deatrick JA, Ersek M. Factors Associated With the Use of U.S. Community-Based Palliative Care for Children With Life-Limiting or Life-Threatening Illnesses and Their Families: An Integrative Review. J Pain Symptom Manage 2018; 55:117-131. [PMID: 28807702 DOI: 10.1016/j.jpainsymman.2017.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/07/2017] [Accepted: 04/11/2017] [Indexed: 11/17/2022]
Abstract
CONTEXT As children with life-limiting illnesses (LLIs) and life-threatening illnesses (LTIs) live longer, challenges to meeting their complex health care needs arise in homes and communities, as well as in hospitals. Integrated knowledge regarding community-based pediatric palliative care (CBPPC) is needed to strategically plan for a seamless continuum of care for children and their families. OBJECTIVES The purpose of this integrative review article is to explore factors that are associated with the use of CBPPC for U.S. children with LLIs and LTIs and their families. METHODS A literature search of PubMed, CINAHL, Scopus, Google Scholar, and an ancestry search was performed to identify empirical studies and program evaluations published between 2000 and 2016. The methodological protocol included an evaluation of empirical quality and explicit data collection of synthesis procedures. RESULTS Forty peer-reviewed quantitative and qualitative methodological interdisciplinary articles were included in the final sample. Patient characteristics such as older age and a solid tumor cancer diagnosis and interpersonal factors such as family support were associated with higher CBPPC use. Organizational features were the most frequently discussed factors that increased CBPPC, including the importance of interprofessional hospice services and interorganizational care coordination for supporting the child and family at home. Finally, geography, concurrent care and hospice eligibility regulations, and funding and reimbursement mechanisms were associated with CBPPC use on a community and systemic level. CONCLUSION Multilevel factors are associated with increased CBPPC use for children with LLIs or LTIs and their families in the U.S.
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Affiliation(s)
- Jackelyn Y Boyden
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
| | - Martha A Q Curley
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Janet A Deatrick
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Mary Ersek
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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17
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Suttle ML, Jenkins TL, Tamburro RF. End-of-Life and Bereavement Care in Pediatric Intensive Care Units. Pediatr Clin North Am 2017; 64:1167-1183. [PMID: 28941542 PMCID: PMC5747301 DOI: 10.1016/j.pcl.2017.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Most childhood deaths in the United States occur in hospitals. Pediatric intensive care clinicians must anticipate and effectively treat dying children's pain and suffering and support the psychosocial and spiritual needs of families. These actions may help family members adjust to their loss, particularly bereaved parents who often experience reduced mental and physical health. Candid and compassionate communication is paramount to successful end-of-life (EOL) care as is creating an environment that fosters meaningful family interaction. EOL care in the pediatric intensive care unit is associated with challenging ethical issues, of which clinicians must maintain a sound and working understanding.
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Affiliation(s)
- Markita L. Suttle
- Department of Critical Care Medicine, Nationwide Children's Hospital
| | - Tammara L. Jenkins
- Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Robert F. Tamburro
- Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development
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18
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Miller JJ, Grise-Owens E, Addison D, Marshall M, Trabue D, Escobar-Ratliff L. Planning an organizational wellness initiative at a multi-state social service agency. EVALUATION AND PROGRAM PLANNING 2016; 56:1-10. [PMID: 27003729 DOI: 10.1016/j.evalprogplan.2016.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 05/26/2023]
Abstract
Increasingly, organizations in general, and social service organizations, specifically, are recognizing the importance of planning and evaluating organizational wellness initiatives. Yet, few participatory models for carrying out these aims exist. For this study, researchers utilized concept mapping (CM) to explicate a conceptual framework for planning, and subsequently evaluating, a wellness initiative at a multi-state social service organization. CM is a participatory approach that analyzes qualitative data via multi-dimensional scaling and hierarchical cluster analyses. Outputs include a number of visual depictions that allow researchers to explore complex relationships among sets of the data. Results from this study indicated that participants (N=64), all of whom were employees of the agency, conceptualized organizational wellness via an eight-cluster solution, or Concept Map. Priority areas of this framework, specifically importance and feasibility, were also explored. After a brief review of pertinent literature, this article explicates the CM methodology utilized in this study, describes results, discusses lessons learned, and identifies apt areas for future research.
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Affiliation(s)
- J Jay Miller
- College of Social Work, University of Kentucky, United States.
| | | | - Donia Addison
- School of Social Work, Spalding University, United States
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19
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Edwards JD. Palliative Care and End-of-Life Considerations in Children on Chronic Ventilation. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Miller JJ, Jones B. Using concept mapping as a planning tool: Child welfare citizen review panels. EVALUATION AND PROGRAM PLANNING 2015; 53:99-106. [PMID: 26343491 DOI: 10.1016/j.evalprogplan.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/05/2015] [Indexed: 06/05/2023]
Abstract
Citizen Review Panels (CRPs) are groups of citizen volunteers authorized by U.S. federal law to examine state child welfare agencies. These groups inspect policies and practices related to child protection responsibilities and are tasked with making recommendations for systemic improvement. Despite the federal mandate for each state to develop a CRP and the potential of these groups to positively impact child welfare practices, there is a dearth in the literature related to CRPs. Consequently, planning and evaluation processes of these groups vary widely. This study reports on the use of concept mapping (CM) to outline a framework for planning and subsequently evaluating the CRP in one southeastern state. CM is a mixed-method research approach that uses multi-dimensional scaling and hierarchical cluster analyses to explore an area of study. Through these analyses, the method creates visual depictions of conceptual relationships between ideas. Data yielded a seven cluster concept map that CRP members (N=36) utilized for planning processes, and subsequently for developing an internal evaluation tool. Results from this study offer a unifying framework by which CRPs, and similar groups in other areas can utilize for planning and evaluation purposes. After a review of pertinent literature on CRPs, this article explicates CM processes utilized in this study, describes results, discusses lessons learned, and outlines apposite areas for future CRP research.
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21
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Jones BL, Contro N, Koch KD. The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring. Pediatrics 2014; 133 Suppl 1:S8-15. [PMID: 24488541 DOI: 10.1542/peds.2013-3608c] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric palliative care physicians have an ethical duty to care for the families of children with life-threatening conditions through their illness and bereavement. This duty is predicated on 2 important factors: (1) best interest of the child and (2) nonabandonment. Children exist in the context of a family and therefore excellent care for the child must include attention to the needs of the family, including siblings. The principle of nonabandonment is an important one in pediatric palliative care, as many families report being well cared for during their child's treatment, but feel as if the physicians and team members suddenly disappear after the death of the child. Family-centered care requires frequent, kind, and accurate communication with parents that leads to shared decision-making during treatment, care of parents and siblings during end-of-life, and assistance to the family in bereavement after death. Despite the challenges to this comprehensive care, physicians can support and be supported by their transdisciplinary palliative care team members in providing compassionate, ethical, and holistic care to the entire family when a child is ill.
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Affiliation(s)
- Barbara L Jones
- University of Texas at Austin School of Social Work, Austin, Texas; and
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22
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Knapp C, Madden V, Revicki D, Feeny D, Wang H, Curtis C, Sloyer P. Health status and health-related quality of life in a pediatric palliative care program. J Palliat Med 2012; 15:790-7. [PMID: 22686119 DOI: 10.1089/jpm.2011.0504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Children with life-threatening illnesses have unique physical and psychosocial needs that pediatric palliative care programs can address. Integrated programs strive to address these needs from the point of diagnosis through death, if needed, at the same time that curative care is provided. To better understand the variation in these needs, we assessed the health status and health-related quality of life (HRQOL) of children enrolled in an integrated pediatric palliative care program. METHODS A telephone survey was conducted with 98 parents whose children were enrolled in an integrated pediatric palliative care program in Florida. The Health Utilities Index (HUI) system was used to assess health status and HRQOL. RESULTS HUI2 attribute levels show that children have the greatest impairment with moderate-to-severe burdens related to self-care, mobility, and sensation, and the least impairment with emotion. HUI3 attribute levels show that children have the greatest impairment with moderate-to-severe burdens related to ambulation and cognition and the least impairment with hearing and emotional functioning. Mean overall HUI2 and HUI3 utility scores are 0.37 and 0.15, respectively. CONCLUSION Children with life-threatening illnesses in our sample had a high level of morbidity compared with those found in other HUI studies of children with acute or chronic health conditions. Not only do our results highlight severely impaired HRQOL, they also demonstrate the wide variety of health states and needs for children in integrated palliative care programs. This information can help develop strategies to encourage more providers to participate in integrated pediatric palliative care programs.
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Affiliation(s)
- Caprice Knapp
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL 32610, USA.
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23
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Miller LC, Rosas SR, Hall K. Using concept mapping to describe sources of information for public health and school nursing practice. J Res Nurs 2011. [DOI: 10.1177/1744987111403883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Concept-mapping methodology was used to construct a conceptual model of information access for public health and school nursing practice. Concept mapping is an integrated mixed-methods approach that combines familiar group processes with multivariate statistical analyses to represent a group’s understanding of a phenomenon. In this project, 36 public health and school nurses brainstormed 207 unique information sources that were collated and reduced to 57 sources to allow sorting of the statements. A subgroup of 25 public health ( n = 16) and school nurses ( n = 9) sorted and rated the 57 statements to generate an eight-cluster concept map. The two-dimensional concept map revealed a sophisticated multivariate framework of information access occurring within an intricate, interrelated network of human and data-driven sources that intersect with community and professionally focused systems. Clusters of information sources included those from community groups, healthcare providers, professional organisations, educational tools, state resources, online resources, surveillance data and government-based resources. Ratings of importance, credibility and usefulness by public health and school nurses revealed overall agreement; however, some important differences of specific sources were noted. More complex than previously described, the map represents sources, means of access and systems of health information available to community-based nurses that influence their practice.
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Affiliation(s)
| | | | - Katy Hall
- Client Services Consultant, Concept Systems, Inc., USA
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24
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25
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26
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Knapp CA, Madden VL, Curtis C, Sloyer PJ, Shenkman EA. Assessing non-response bias in pediatric palliative care research. Palliat Med 2010; 24:340-7. [PMID: 20123943 DOI: 10.1177/0269216309351466] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
National experts have recognized a need for increased research in pediatric palliative care. However, when conducting research it is important to use rigorous methods, report significant and non-significant findings, and include information on responders and non-responders. Most studies do not present information on non-responders, yet this is critical as the results many not be generalizable if there are inherent differences between the two groups. Using survey data from parents whose children with life-limiting illnesses were enrolled in Florida's publicly funded pediatric palliative care program called Partners in Care: Together for Kids; this study investigates whether non-response bias exists, and if so, what characteristics are associated with non-response. Bivariate and multivariate analyses were conducted to determine whether individual characteristics differed between responders and non-responders. Throughout our analyses, we conducted the analyses using different ways in which 'non-response' can be defined. Our results suggest that regardless of how non-response is defined, Black, non-Hispanic parents were less likely to participate than White non-Hispanic parents. However, we also found that of the Black, non-Hispanic parents who did not participate, their primary reason for doing so was that they had non-working or disconnected phone numbers. Only 3% of the Black, non-Hispanic parents who did not participate flatly refused. Information from this study can be used to design interventions aimed at increasing minority participation in pediatric palliative care research.
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Affiliation(s)
- Caprice A Knapp
- Departments of Epidemiology and Health Policy Research, University of Florida, Gainesville FL, USA.
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27
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Huang IC, Shenkman EA, Madden VL, Vadaparampil S, Quinn G, Knapp CA. Measuring quality of life in pediatric palliative care: challenges and potential solutions. Palliat Med 2010; 24:175-82. [PMID: 20007819 PMCID: PMC3810279 DOI: 10.1177/0269216309352418] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Annually, about 500,000 children are coping with life-limiting illnesses in the USA. Integrated pediatric palliative care program could benefit some of these children by improving their health-related quality of life (HRQOL). To measure the effect of pediatric palliative care programs on HRQOL, a valid and reliable tool must be identified. This study aimed to validate the psychometric properties of a generic HRQOL instrument, the Pediatric Quality of Life 4.0, for children with life-limiting illnesses. Analyses were conducted using telephone survey data collected from 266 parents whose Medicaid-enrolled children had life-limiting illnesses. Results of the analyses suggest the Pediatric Quality of Life 4.0 does not have valid psychometric properties for measuring HRQOL within this population. Our study documents several challenges in using the generic instrument to measure HRQOL in pediatric palliative care setting. We point out future directions to refine or develop HRQOL instruments for this population of vulnerable children.
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Affiliation(s)
- I-Chan Huang
- Department of Epidemiology and Health Policy Research, University of Florida, 1329 SW 16th Street, Room 5277, Gainesville, Florida 32608, USA.
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28
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Hinds PS, Oakes LL, Hicks J, Powell B, Srivastava DK, Spunt SL, Harper J, Baker JN, West NK, Furman WL. "Trying to be a good parent" as defined by interviews with parents who made phase I, terminal care, and resuscitation decisions for their children. J Clin Oncol 2009; 27:5979-85. [PMID: 19805693 PMCID: PMC2793041 DOI: 10.1200/jco.2008.20.0204] [Citation(s) in RCA: 187] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Accepted: 06/18/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE When a child's cancer progresses beyond current treatment capability, the parents are likely to participate in noncurative treatment decision making. One factor that helps parents to make these decisions and remain satisfied with them afterward is deciding as they believe a good parent would decide. Because being a good parent to a child with incurable cancer has not been formally defined, we conducted a descriptive study to develop such a definition. METHODS In face-to-face interviews, 62 parents who had made one of three decisions (enrollment on a phase I study, do not resuscitate status, or terminal care) for 58 patients responded to two open-ended questions about the definition of a good parent and about how clinicians could help them fulfill this role. For semantic content analysis of the interviews, a rater panel trained in this method independently coded all responses. Inter-rater reliability was excellent. RESULTS Among the aspects of the definition qualitatively identified were making informed, unselfish decisions in the child's best interest, remaining at the child's side, showing the child that he is cherished, teaching the child to make good decisions, advocating for the child with the staff, and promoting the child's health. We also identified 15 clinician strategies that help parents be a part of making these decisions on behalf of a child with advanced cancer. CONCLUSION The definition and the strategies may be used to guide clinicians in helping parents fulfill the good parent role and take comfort afterward in having acted as a good parent.
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Affiliation(s)
- Pamela S Hinds
- School of Medicine, Department of Pediatrics, George Washington University, Washington, DC, USA.
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29
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Knapp CA. Research in Pediatric Palliative Care: Closing the Gap Between What Is and Is Not Known. Am J Hosp Palliat Care 2009; 26:392-8. [DOI: 10.1177/1049909109345147] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pediatric palliative care provides physical and psychosocial care to children with life-limiting illnesses and their families. Services are provided by physicians, nurses, volunteers, and other providers in a myriad of settings. Over the past 30 years, a portfolio of research has amassed on palliative care. Yet, much remains unknown, particularly about pediatric palliative care. This article is the first in a series and it provides a general overview of what is known and unknown about the provision and need for pediatric palliative care. Subsequent articles will focus on specific topics such as decision making and support care. The purpose of this series is to inform and promote discussion about research in pediatric palliative care.
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Affiliation(s)
- Caprice A. Knapp
- Departments of Epidemiology and Health Policy Research and the Institute for Child Health Policy, University of Florida, Gainesville, Florida,
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30
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Knapp C, Huang IC, Madden V, Vadaparampil S, Quinn G, Shenkman E. An evaluation of two decision-making scales for children with life-limiting illnesses. Palliat Med 2009; 23:518-25. [PMID: 19346274 PMCID: PMC3810449 DOI: 10.1177/0269216309104892] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Annually, about 500,000 children are coping with life-limiting illnesses. Many of these children could benefit from pediatric palliative care which provides supportive services. These services can also aid parents in decision making. In order to measure the effect of pediatric palliative care programs on decision making, a valid and reliable tool must be identified. This study aims to validate the psychometric properties of the Decisional Conflict Scale (DCS) and the COMRADE instruments for children with life-limiting illnesses. METHODS Analyses were conducted using survey data collected from 266 parents whose Medicaid enrolled children have life-limiting illnesses. RESULTS Results of the analyses suggest that the DCS has better psychometric properties for measuring decision making within the population of children with life-limiting illnesses than the COMRADE. CONCLUSION Pediatric palliative care programs should use the DCS to measure the effectiveness of services aimed at supporting families with high levels of decisional conflict.
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Affiliation(s)
- C Knapp
- Department of Epidemiology, University of Florida, Gainesville, Florida 32610, USA.
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31
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Knapp CA, Madden VL, Wang H, Kassing K, Curtis CM, Sloyer PJ, Shenkman EA. Effect of a pediatric palliative care program on nurses' referral preferences. J Palliat Med 2009; 12:1131-6. [PMID: 19698028 DOI: 10.1089/jpm.2009.0146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Florida was the first state to develop and implement a publicly funded pediatric palliative care program, which provides supportive care services to children and families from the point of diagnosis onward. Nurses employed by the Florida Department of Health, Children's Medical Services Network (CMSN) play an important role in this program as they are charged with identifying children with life-limiting illnesses in their caseloads for referral to the program. This study aims to estimate the differtences in referral preferences of nurses who work in Partners in Care: Together for Kids (PIC:TFK) program areas versus nurses who work in non-PIC:TFK areas. METHODS Mail and Web-based surveys were conducted with 279 nurses, 141 of whom work in a PIC:TFK site and 138 did not. RESULTS Results of the multivariate analyses suggest that few significant differences exist in the nurse's preferences to refer children to pediatric palliative care; however, there were significant differences in the preferred timing of referral. Nurses who work in an PIC:TFK area were 3.7 to 10.4 times as likely as nurses who do not work in a PIC:TFK area to refer children prior to the end of life. CONCLUSION Our study provides evidence that nurses who have experience with a pediatric palliative care program are more likely to refer children to programs before the end of life. While our study results are encouraging, they also suggest that as the PIC:TFK program expands nurse training will be essential for equitable and appropriate referrals across a diverse set of illnesses.
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Affiliation(s)
- Caprice A Knapp
- Department of Epidemiology, University of Florida, Gainesville, Florida 32604, USA.
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Knapp C, Madden V, Wang H, Curtis C, Sloyer P, Shenkman E. Music therapy in an integrated pediatric palliative care program. Am J Hosp Palliat Care 2009; 26:449-55. [PMID: 19666889 DOI: 10.1177/1049909109341870] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
National experts have recommended that children with life-limiting illnesses receive integrated palliative and medical care. These programs offer a variety of services, including music therapy. Using survey data from parents whose were enrolled in Florida's Partners in Care: Together for Kids (PIC:TFK) program, this study investigates parents' experiences with music therapy. About 44% of children with life-limiting illnesses and 17% of their siblings used music therapy. For children who used music therapy, multivariate results suggest that their parents were 23 times as likely to report satisfaction with the overall PIC:TFK program (P < .05) versus parents whose children did not use music therapy. Pediatric palliative care programs should include music therapy, although recruiting licensed music therapists may be challenging.
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Affiliation(s)
- Caprice Knapp
- Departments of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL, USA.
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Knapp C, Thompson L, Madden V, Shenkman E. Paediatricians' perceptions on referrals to paediatric palliative care. Palliat Med 2009; 23:418-24. [PMID: 19251829 DOI: 10.1177/0269216309102618] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children have traditionally been referred to palliative care when curative treatments were exhausted. Recently, experts have suggested that children could benefit from palliative care early in their courses of illness. Using survey data from 303 paediatricians in Florida and California, this study assesses if paediatricians would refer children to palliative care early in their course of illness. Results showed that more years in practice were associated with decreased odds of referring children to palliative care. Academic practice setting and more Medicaid patients were associated with greater odds of referral prior to the end of life. Hispanic paediatricians, those with more experience and those who practice in a hospital setting were associated with decreased odds of referral prior to the end of life. Results suggest that health planners who wish to implement or refine integrated paediatric palliative care programs should consider outreach strategies targeted at paediatricians with specific characteristics.
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Affiliation(s)
- C Knapp
- Department of Epidemiology, University of Florida, Gainesville, Florida 32610, USA.
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Abstract
O estudo teve por objetivo descrever os antecedentes, atributos e conseqüências do conceito de morte digna da criança. Utilizou-se a estratégia de análise de conceito para avaliar os 40 artigos, tendo como foco publicações nas áreas médica e de enfermagem, que estudaram ou focalizaram a morte digna da criança. Os atributos do conceito de morte digna da criança incluem: qualidade de vida, cuidado centrado na criança e na família, conhecimento específico sobre cuidados paliativos, decisão compartilhada, alívio do sofrimento da criança, comunicação clara, relacionamento de ajuda e ambiente acolhedor. Poucos artigos trazem a definição de morte digna da criança e, quando isso ocorre, essa definição é vaga e, muitas vezes, ambígua entre os vários autores. Esse aspecto indica que o conceito ainda não é consistentemente definido, demandando estudos de sua manifestação na prática clínica, contribuindo com os cuidados no final da vida em pediatria.
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Knapp CA, Madden VL, Curtis CM, Sloyer PJ, Huang IC, Thompson LA, Shenkman EA. Partners in care: together for kids: Florida's model of pediatric palliative care. J Palliat Med 2009; 11:1212-20. [PMID: 19021484 DOI: 10.1089/jpm.2008.0080] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many children with life-limiting illnesses in the United States could benefit from pediatric palliative care. However, national, state, and local barriers exist that hinder provision. One national barrier is the Medicare hospice reimbursement regulation that limits the provision of government subsidized hospice care to the final 6 months of life. In response to the critical need to provide palliative care earlier in children's illnesses, Florida became the first state to develop and implement an innovative model of care that provides services from the point of diagnosis onward, thereby waiving the 6-month reimbursement rule. In July 2005, the Partners in Care: Together for Kids program began. The program relies on partnerships between state-employed care coordinators who identify the children for possible enrollment and hospice staff who provide home and community-based services. OBJECTIVE Our objective was to describe Florida's experiences in designing, implementing, and operating the program. DESIGN Surveys were conducted with parents, hospices, and state agencies. Enrollment trends were identified using administrative data. RESULTS As of January 2008, 468 children have been enrolled in the program. Approximately 85% of parents report they are satisfied with the program and 95% of parents would recommend the program. CONCLUSION Florida's program is the first in the nation to provide government-subsidized pediatric palliative care from the point of diagnosis onwards. Lessons learned from Florida's experiences will help guide other states and health plans that desire to implement a similar model of care.
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Affiliation(s)
- Caprice A Knapp
- Department of Epidemiology, University of Florida, Gainesville, Florida 32610, USA.
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Abstract
The nurse plays a vital role in caring for patients with osteosarcoma. From the very outset when the disease is explained to the patient and his/her family, the nurse provides comfort and support, as well as enhances and explains the information provided by the physician. All aspects of medical care are addressed, and he/she is frequently the first line of communication when the patient telephones and requests information or wishes to report a problem to the physician. He/She arranges and coordinates appointments to suit the patient's medical, and often social needs to provide comprehensive care with attention to detail. This communication will provide a perspective of the role assumed by the nurse in his/her effort to ensure total care of the patient and the family.
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Affiliation(s)
- Margaret Pearson
- Solid Tumor Service, Children's Cancer Hospital, The University of Texas M. D., Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA.
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Reilly DE, Huws JC, Hastings RP, Vaughan FL. ‘When Your Child Dies You Don’t Belong in That World Any More’- Experiences of Mothers Whose Child with an Intellectual Disability has Died. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2008. [DOI: 10.1111/j.1468-3148.2008.00427.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Linton JM, Feudtner C. What accounts for differences or disparities in pediatric palliative and end-of-life care? A systematic review focusing on possible multilevel mechanisms. Pediatrics 2008; 122:574-82. [PMID: 18762528 DOI: 10.1542/peds.2007-3042] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to clarify potential mechanisms underlying differences/disparities in pediatric palliative and end-of-life care. METHODS We systematically searched online databases to identify articles relating to differences/disparities in pediatric palliative and end-of-life care, retaining 19 studies for evaluation. We then augmented this search with a broader review of the literature on the mechanisms of differences/disparities in adult palliative and end-of-life care, general pediatrics, adult medicine, and pain. RESULTS The concept of reciprocal interaction can organize and illuminate interacting mechanisms across 3 levels of human organization, namely, broader contextual influences on patients and clinicians, specific patient-provider engagements, and specific patients. By using this rubric, we identified 10 distinct mechanisms proposed in the literature. Broader contextual influences include health care system structures; access to care; and poverty, socioeconomic status, social class, and family structure. Patient-clinician engagements encompass clinician bias, prejudice, and stereotypes; concordance of race; quality of information exchange; and trust. Patient-specific features include perceptions of control; religion and spirituality; and medical conditions. CONCLUSIONS Differences and disparities in pediatric palliative and end-of-life care can be understood as arising from various mechanisms that interact across different levels of human organization, and this interactive multilevel model should be considered in designing studies or planning interventions to understand differences and to ameliorate disparities.
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Affiliation(s)
- Julie M Linton
- Division of General Pediatrics, Children's Hospital of Philadelphia, 3535 Market St, Room 1523, Philadelphia, PA 19104, USA
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Improving care of the dying: What do the experts say? JAAPA 2007; 20:38, 41-3. [DOI: 10.1097/01720610-200711000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vishwanath A, Scamurra SD. Barriers to the adoption of electronic health records: using concept mapping to develop a comprehensive empirical model. Health Informatics J 2007; 13:119-34. [PMID: 17510224 DOI: 10.1177/1460458207076468] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The study attempts to unify prior research and develop a comprehensive, empirically based conceptual model of the barriers to EHR adoption among community physicians. The model uses concept mapping, which taps the shared expertise of a group and provides reliable estimates with relatively small sample sizes. The methodology includes brainstorming of barrier statements and sorting and rating of issue statements. The model illuminates the larger structure of barriers as well as the finer details of constituent issues. Core issues are standardization and interoperability; also important are technical issues and the cost-benefit of adopting EHRs. However, psychosocial issues, the main focus of diffusion research, seem relatively peripheral. We believe the development of this model is an important first step in creating effective and measurable interventions that enhance the adoption of EHRs in healthcare.
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Affiliation(s)
- Arun Vishwanath
- School of Informatics, State University of New York at Buffalo, 333 Baldy Hall, Buffalo, NY 14260-1060, USA.
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McClement SE. Acquiring an evidence base in palliative care: challenges and future directions. Expert Rev Pharmacoecon Outcomes Res 2006; 6:37-40. [DOI: 10.1586/14737167.6.1.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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