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Champagne E, Chénard J, Simard C, Bonanno M, Bogossian A, Roberge V, Olivier-d'Avignon M, Ummel D, Fortin G, Bergeron F, Bonenfant F. Scoping Review on Transitions in the Context of Pediatric Palliative Care. J Palliat Med 2024. [PMID: 39047058 DOI: 10.1089/jpm.2023.0673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Background: Children with complex and chronic conditions receiving palliative care will likely experience many transitions during their life and their treatments. Transition periods for children with life-limiting conditions and their families can be bewildering and highly anxiety-inducing. However, clinical observations seem to point to a more heterogenous care offer, including a lack or discontinuity of services, at the expense of their quality of life. Objective: This paper aims to establish a portrait of the existing literature and identify research gaps on the multiple transitions experienced by this population. Design: A scoping review is provided, following a PRISMA protocol. MEDLINE, PubMed and CINAHL were consulted. The search strategy is based on three key concepts: (1) palliative care/complex condition, (2) child/adolescent, and (3) transition. Articles were screened with the help of Covidence. Results: A total of 72 articles are included for analysis. The aimed population is either identified by age group or by medical status. Respondents are most often parents rather than the children themselves. Transitions include: reaching adulthood, changes in care environment, changes in medical status, and school integration. Conclusion: The discussion notices a definitional murkiness about transitions and highlights the fact that the multifaceted and complex nature of transition over time is largely ignored. New research should involve a diversity of participants and include children's voices. Recommendations include clearer concept definitions, health care policies that adopt an ecosystemic approach, and professional training in the systemic family approach in palliative care.
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Affiliation(s)
- Elaine Champagne
- Chair of Religion, spirituality and health, Faculty of theology and religious sciences, Université Laval, Québec Canada
| | - Josée Chénard
- Social Work Department, Université du Québec en Outaouais, St-Jérôme Canada
| | - Chantale Simard
- Department of health sciences, Université du Québec à Chicoutimi, Canada
| | | | - Aline Bogossian
- School of Social Work, Université de Montréal, Montréal, Canada
| | - Véronique Roberge
- Department of health sciences, Université du Québec à Chicoutimi, Canada
| | | | - Deborah Ummel
- Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
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Curran JA, Lane J, McCulloch H, Keeping-Burke L, Johnson C, Wong H, Cassidy C, McIsaac JL, Lamptey DL, Clegg J, Forbes N, Breneol S, Sheriko J, Best S, Burgess S, Sinclair D, Elliot Rose A, Standing MA, Somerville M, King S, Doucet S, Flieger H, Lamb M, Parsons Leigh J, Stewart D. Uncovering the wider impact of COVID-19 measures on the lives of children with complex care needs and their families: A mixed-methods study protocol. PLoS One 2024; 19:e0305543. [PMID: 38976707 PMCID: PMC11230525 DOI: 10.1371/journal.pone.0305543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 05/31/2024] [Indexed: 07/10/2024] Open
Abstract
Existing barriers to care were exacerbated by the development and implementation of necessary public health restrictions during the COVID-19 pandemic. Children with complex care needs and their families represent a small portion of the paediatric population, and yet they require disproportionately high access to services. Little is known about the impact of COVID-19 public health measures on this population. This study will generate evidence to uncover the wider impact of COVID-19 measures on the lives of children with complex care needs and their families in relation to policy and service changes. This multi-site sequential mixed methods study will take place across the Canadian Maritime provinces and use an integrated knowledge translation approach. There are two phases to this study: 1) map COVID-19 public health restrictions and service changes impacting children with complex care needs by conducting an environmental scan of public health restrictions and service changes between March 2020 and March 2022 and interviewing key informants involved in the development or implementation of restrictions and service changes, and 2) explore how children with complex care needs and their families experienced public health restrictions and service changes to understand how their health and well-being were impacted.
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Affiliation(s)
- Janet A Curran
- IWK Health Centre, Halifax, NS, Canada
- Department of Health, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Lane
- IWK Health Centre, Halifax, NS, Canada
- Department of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Lisa Keeping-Burke
- Department of Nursing & Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | | | - Helen Wong
- Department of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Jessie-Lee McIsaac
- Department of Child and Youth Study, Mount Saint Vincent University, Halifax, NS, Canada
| | - De-Lawrence Lamptey
- Department of Child and Youth Study, Mount Saint Vincent University, Halifax, NS, Canada
| | | | - Neil Forbes
- Department of Nursing & Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | - Sydney Breneol
- Department of Health, Dalhousie University, Halifax, NS, Canada
| | | | | | | | | | | | - Mary-Ann Standing
- Centre for Health and Community Research, University of Prince Edward Island, Charlottetown, PEI, Canada
| | | | | | - Shelley Doucet
- Department of Nursing & Health Sciences, University of New Brunswick, Fredericton, NB, Canada
| | | | - Margie Lamb
- Nova Scotia Health Authority, Halifax, NS, Canada
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Quirke MB, Alexander D, Cassidy L, Walsh C, Masterson K, Hill K, Brenner M. Adolescents with Rett syndrome at critical care pathway junctures: Examining clinicians' decision to initiate invasive long-term ventilation. Eur J Paediatr Neurol 2024; 49:113-119. [PMID: 38484415 DOI: 10.1016/j.ejpn.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The initiation of invasive long-term ventilation (I-LTV) for an adolescent with Rett Syndrome (RTT) involves many serious bioethical considerations. In moving towards a more inclusive model of patient participation, transparency surrounding the main influencing factors around this decision is important. OBJECTIVE We aimed to identify the main drivers influencing a clinician's decision to support initiation of I-LTV for an adolescent with RTT. METHOD We used an anonymous online vignette-based factorial survey. The survey was distributed internationally through eight professional multi-disciplinary organisations to reach clinicians working in paediatrics. RESULTS We analysed 504 RTT vignettes completed by 246 clinicians using mixed effect regression modelling. The main three significant influencing factors identified were: parental agreement with the decision to support initiation, the family's support network, and proximity to a tertiary care centre. Additional comments from participants focused on family support, and the importance of on-going communication with the family. CONCLUSION As the rights of those with disabilities improve and participation of adolescents in decision-making becomes more established, effective communications with the family around goals of care and particular sensitivity and reflective practice around methods of consensus building will likely contribute to a positive decision-making process at this difficult time.
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Affiliation(s)
- Mary Brigid Quirke
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Denise Alexander
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Lorna Cassidy
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Kate Masterson
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Katie Hill
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Maria Brenner
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
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4
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Jenkins AM, Bayer ND, Yousefi Nooraie R, Fiscella K. Putting the Mix in Mixed Methods Research. Hosp Pediatr 2023; 13:e411-e415. [PMID: 37941418 DOI: 10.1542/hpeds.2022-007110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Research and quality improvement in pediatric hospital medicine often benefit from using mixed methods research (MMR) approaches. MMR requires the intentional collection, analysis, and mixing, or integration, of both quantitative and qualitative data to build on their complementary strengths to answer complex research questions. In this methodology paper, we define MMR, describe its characteristics, the importance of integration, and outline the core designs of explanatory sequential, exploratory sequential, and convergent MMR by illustrating practical examples from pediatric hospital medicine.
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Affiliation(s)
| | | | | | - Kevin Fiscella
- Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Neufeld A, Rahman A, Orakwue-Ononye N. Community physician perceptions of managing complex child and adolescent psychiatric patients: a self-determination theory perspective. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2023; 32:264-271. [PMID: 38034410 PMCID: PMC10686220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/20/2023] [Indexed: 12/02/2023]
Abstract
Children and adolescents with complex mental health needs often require a level of care that is unsustainable in tertiary settings. Yet, the psychological impact of this on community physicians, who are tasked with providing quality care to this population, is not well understood. Grounded in Self-Determination Theory (SDT), the present study explores how the challenges of caring for these patients is affecting community physicians' basic psychological needs (autonomy, competence, and relatedness) and intrinsic motivation. Participants from Calgary, Alberta, Canada, were invited to complete an anonymous online survey containing questions about managing complex child and adolescent psychiatric patients. We used SDT's needs-based framework and 22-item Intrinsic Motivation Inventory as a component of our pilot study, to explore and understand their ideas. Community physicians reported moderate-high interest/enjoyment and moderate perceived competence in managing complex child and adolescent patients, but little perceived choice and high tension/pressure in carrying out this task. Physician remarks provided meaningful insights into how these clinical experiences are impacting them, psychologically, and where opportunities may exist for interventions to support them and their patients. Findings from this study suggest that the participating community physicians feel interested and adequately skilled to manage complex child and adolescent psychiatric patients, but that systemic barriers are hindering their basic psychological needs and intrinsic motivation to do so. Potential explanations and implications for these findings are discussed.
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Affiliation(s)
- Adam Neufeld
- Department of Academic Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Abdul Rahman
- Department of Child and Adolescent Psychiatry, University of Calgary, Calgary, Alberta
| | - Nneka Orakwue-Ononye
- Department of Child and Adolescent Psychiatry, University of Calgary, Calgary, Alberta
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Glick AF, Farkas JS, Magro J, Shah AV, Taye M, Zavodovsky V, Rodriguez RH, Modi AC, Dreyer BP, Famiglietti H, Yin HS. Management of Discharge Instructions for Children With Medical Complexity: A Systematic Review. Pediatrics 2023; 152:e2023061572. [PMID: 37846504 PMCID: PMC10598634 DOI: 10.1542/peds.2023-061572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 10/18/2023] Open
Abstract
CONTEXT Children with medical complexity (CMC) are at risk for adverse outcomes after discharge. Difficulties with comprehension of and adherence to discharge instructions contribute to these errors. Comprehensive reviews of patient-, caregiver-, provider-, and system-level characteristics and interventions associated with discharge instruction comprehension and adherence for CMC are lacking. OBJECTIVE To systematically review the literature related to factors associated with comprehension of and adherence to discharge instructions for CMC. DATA SOURCES PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Web of Science (database initiation until March 2023), and OAIster (gray literature) were searched. STUDY SELECTION Original studies examining caregiver comprehension of and adherence to discharge instructions for CMC (Patient Medical Complexity Algorithm) were evaluated. DATA EXTRACTION Two authors independently screened titles/abstracts and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. RESULTS Fifty-one studies were included. More than half were qualitative or mixed methods studies. Few interventional studies examined objective outcomes. More than half of studies examined instructions for equipment (eg, tracheostomies). Common issues related to access, care coordination, and stress/anxiety. Facilitators included accounting for family context and using health literacy-informed strategies. LIMITATIONS No randomized trials met inclusion criteria. Several groups (eg, oncologic diagnoses, NICU patients) were not examined in this review. CONCLUSIONS Multiple factors affect comprehension of and adherence to discharge instructions for CMC. Several areas (eg, appointments, feeding tubes) were understudied. Future work should focus on design of interventions to optimize transitions.
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Affiliation(s)
| | | | - Juliana Magro
- Health Sciences Libraries, NYU Langone Health, New York, New York
| | | | | | | | | | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | | | - H. Shonna Yin
- Department of Pediatrics
- Department of Population Health, NYU Langone Health, New York, New York
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France E, Uny I, Turley R, Thomson K, Noyes J, Jordan A, Forbat L, Caes L, Silveira Bianchim M. A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments. Cochrane Database Syst Rev 2023; 10:CD014873. [PMID: 37795766 PMCID: PMC10552070 DOI: 10.1002/14651858.cd014873.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.
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Affiliation(s)
- Emma France
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Turley
- Development Directorate, Cochrane Central Executive, Cochrane, London, UK
| | - Katie Thomson
- Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Line Caes
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Mayara Silveira Bianchim
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Centre for Population Health and Wellbeing Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Huth K, Hotz A, Emara N, Robertson B, Leaversuch M, Mercer AN, Khan A, Campos ML, Liss I, Hahn PD, Graham DA, Rossi L, Thomas MV, Elias N, Morris M, Glader L, Pinkham A, Bardsley KM, Wells S, Rogers J, Berry JG, Mauskar S, Starmer AJ. Reduced Postdischarge Incidents After Implementation of a Hospital-to-Home Transition Intervention for Children With Medical Complexity. J Patient Saf 2023; 19:493-500. [PMID: 37729645 DOI: 10.1097/pts.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Prior research suggests that errors occur frequently for patients with medical complexity during the hospital-to-home transition. Less is known about effective postdischarge communication strategies for this population. We aimed to assess rates of 30-day (1) postdischarge incidents and (2) readmissions and emergency department (ED) visits before and after implementing a hospital-to-home intervention. METHODS We conducted a prospective intervention study of children with medical complexity discharged at a children's hospital from April 2018 to March 2020. A multistakeholder team developed a bundled intervention incorporating the I-PASS handoff framework including a postdischarge telephone call, restructured discharge summary, and handoff communication to outpatient providers. The primary outcome measure was rate of postdischarge incidents collected via electronic medical record review and family surveys. Secondary outcomes were 30-day readmissions and ED visits. RESULTS There were 199 total incidents and the most common were medication related (60%), equipment issues (15%), and delays in scheduling/provision of services (11%). The I-PASS intervention was associated with a 36.4% decrease in the rate of incidents per discharge (1.51 versus 0.95, P = 0.003). There were fewer nonharmful errors and quality issues after intervention (1.27 versus 0.85 per discharge, P = 0.02). The 30-day ED visit rate was significantly lower after intervention (12.6% versus 3.4%, per 100 discharges, P = 0.05). Thirty-day readmissions were 15.8% versus 10.2% postintervention (P = 0.32). CONCLUSIONS A postdischarge communication intervention for patients with medical complexity was associated with fewer postdischarge incidents and reduced 30-day ED visits. Standardized postdischarge communication may play an important role in improving quality and safety in the transition from hospital-to-home for vulnerable populations.
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Affiliation(s)
| | | | - Norah Emara
- From the Department of Pediatrics, Boston Children's Hospital
| | | | | | | | | | | | - Isabella Liss
- From the Department of Pediatrics, Boston Children's Hospital
| | - Phillip D Hahn
- Program for Patient Safety and Quality, Boston Children's Hospital
| | | | | | - Margaret V Thomas
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Nahel Elias
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Marie Morris
- From the Department of Pediatrics, Boston Children's Hospital
| | - Laurie Glader
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy Pinkham
- From the Department of Pediatrics, Boston Children's Hospital
| | | | - Sarah Wells
- From the Department of Pediatrics, Boston Children's Hospital
| | - Jayne Rogers
- From the Department of Pediatrics, Boston Children's Hospital
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9
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MacNeill L, Doucet S, Luke A. Caregiver experiences with transitions from pediatric to adult healthcare for children with complex care needs. Child Care Health Dev 2022; 48:800-808. [PMID: 35187705 DOI: 10.1111/cch.12989] [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: 08/06/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Caring for a youth with complex care needs (CCN) who is transitioning from paediatric to adult healthcare can produce many challenges. For example, caregivers must often manage their youth's care at home, coordinate care and advocate for their youth. Experiences of fragmented and uncoordinated care often result in caregivers feeling ill-prepared and uncertain about the transition process. The current study explores caregiver experiences with the transition from paediatric to adult healthcare for youth with CCN in a semi-rural Canadian province. METHODS This study used a cross-sectional qualitative descriptive design, involving semi-structured interviews with caregivers of youth with CCN who were preparing for, in the process of, or completed a transition from paediatric to adult healthcare within the province of New Brunswick, Canada. Thematic analysis focused on describing caregiver experiences with the transition from paediatric to adult healthcare. RESULTS Seventeen caregivers completed interviews for this study. Four key themes emerged relating to caregiver experiences with the transition from paediatric to adult healthcare for these youth: (1) lack of caregiver support, (2) lack of continuity of care, (3) need for collaborative care and (4) difficulty navigating transition. CONCLUSION There is a clear need to address the challenges experienced by youth with CCN and their caregivers throughout the transition from paediatric to adult healthcare. An effective transition strategy should involve early and coordinated planning between the paediatric and adult care team; continued communication across the care team throughout the transition process; and coordination among health, education and social services.
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Affiliation(s)
- Lillian MacNeill
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care (CRIC), University of New Brunswick, Saint John, New Brunswick, Canada.,Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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10
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Toulany A, Gorter JW, Harrison M. A call for action: Recommendations to improve transition to adult care for youth with complex health care needs. Paediatr Child Health 2022; 27:297-309. [PMID: 36016593 PMCID: PMC9394635 DOI: 10.1093/pch/pxac047] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 01/07/2022] [Indexed: 11/12/2022] Open
Abstract
Youth with complex health care needs, defined as those requiring specialized health care and services for physical, developmental, and/or mental health conditions, are often cared for by paediatricians and paediatric specialists. In Canada, the age at which provincial/territorial funders mandate the transfer of paediatric care to adult services varies, ranging between 16 and 19 years. The current configuration of distinct paediatric and adult care service boundaries is fragmentary, raising barriers to continuity of care during an already vulnerable developmental period. For youth, the lack of care integration across sectors can negatively impact health engagement and jeopardize health outcomes into adulthood. To address these barriers and improve transition outcomes, paediatric and adult care providers, as well as family physicians and other community partners, must collaborate in meaningful ways to develop system-based strategies that streamline and safeguard care for youth transitioning to adult services across tertiary, community, and primary care settings. Flexible age cut-offs for transfer to adult care are recommended, along with considering each youth's developmental stage and capacity as well as patient and family needs and circumstances. Specialized training and education in transitional care issues are needed to build capacity and ensure that health care providers across diverse disciplines and settings are better equipped to accept and care for young people with complex health care needs.
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Affiliation(s)
- Alene Toulany
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Jan Willem Gorter
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Megan Harrison
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
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11
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Toulany A, Gorter JW, Harrison ME. Appel à l'action : des recommandations pour améliorer la transition des jeunes ayant des besoins de santé complexes vers les soins aux adultes. Paediatr Child Health 2022; 27:297-309. [PMID: 36016598 PMCID: PMC9394631 DOI: 10.1093/pch/pxac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/07/2022] [Indexed: 11/14/2022] Open
Abstract
Les jeunes qui ont des besoins de santé complexes, définis comme ceux qui nécessitent des soins et services spécialisés en raison d'affections physiques, développementales ou mentales, sont souvent traités par des pédiatres et autres spécialistes en pédiatrie. Au Canada, l'âge auquel les bailleurs de fonds provinciaux et territoriaux exigent le transfert des soins pédiatriques aux soins pour adultes varie entre 16 et 19 ans. La délimitation actuelle entre les services de santé pédiatriques et aux adultes est fragmentaire, ce qui entrave la continuité des soins pendant une période déjà vulnérable du développement. Le peu d'intégration des soins entre les domaines peut nuire à l'engagement des jeunes en matière de santé et compromettre leur santé à l'âge adulte. Pour renverser ces obstacles et améliorer les résultats de la transition, les dispensateurs de soins pédiatriques et de soins aux adultes, de même que les médecins de famille et d'autres partenaires communautaires, doivent collaborer de manière satisfaisante à l'élaboration de stratégies systémiques qui rationalisent et préservent les soins aux jeunes en transition vers des soins aux adultes en milieu tertiaire, communautaire et primaire. Il est recommandé de privilégier des limites d'âge flexibles pour effectuer cette transition vers les soins aux adultes et de tenir compte de la phase de développement et de l'aptitude de chaque jeune, ainsi que des besoins et de la situation de chaque patient et de chaque famille. Une formation et un enseignement spécialisés sur les enjeux liés aux soins de transition s'imposent pour renforcer les capacités et s'assurer que les professionnels de la santé des diverses disciplines et des divers milieux soient mieux outillés pour accepter et traiter les jeunes qui ont des besoins de santé complexes.
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Affiliation(s)
- Alene Toulany
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
| | - Jan Willem Gorter
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
| | - Megan E Harrison
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
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12
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Breneol S, Doucet S, McIsaac JL, Riveroll A, Cassidy C, Charlton P, McCulloch H, McKibbon S, Luke A, Splane J, Curran JA. Programmes to support transitions in community care for children with complex care needs: a scoping review. BMJ Open 2022; 12:e056799. [PMID: 35803631 PMCID: PMC9272111 DOI: 10.1136/bmjopen-2021-056799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/09/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This scoping review aimed to map the range of programmes in the literature to support children and youth with complex care needs and their families during transitions in care in the community. DESIGN A scoping review of the literature. CONTEXT This review included programmes that supported the transition in care to home and between settings in the community. DATA SOURCES We implemented our strategy to search five databases: (1) PubMed; (2) CINAHL; (3) ERIC; (4) PyscINFO and (5) Social Work Abstracts. The search was last implemented on 29 April 2021. STUDY SELECTION Our search results were imported into Covidence Systematic Review Software. First, two reviewers assessed titles and abstracts against our eligibility criteria. Relevant articles were then retrieved in full and reviewed by two reviewers for inclusion. Disagreements were resolved by a third reviewer. DATA EXTRACTION Relevant data were extracted related to population, concept, context, methods and key findings pertinent to our review objective. RESULTS A total of 2482 records were identified. After our two-stage screening process, a total of 27 articles were included for analysis. Articles ranged in the type of transitions being supported and target population. The most common transition reported was the hospital-to-home transition. Intervention components primarily consisted of care coordination using a teams-based approach. The most reported barriers and enablers to implementing these transition care programmes were related to physical opportunities. LIMITATIONS Included articles were limited to English and French. CONCLUSIONS This review identified important gaps within the literature, as well as areas for future consideration to ensure the effective development and implementation of programmes to support children and youth with complex care needs during transitions in care.
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Affiliation(s)
- Sydney Breneol
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Jessie-Lee McIsaac
- Faculty of Education and Department of Child and Youth Study, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Angela Riveroll
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Christine Cassidy
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patricia Charlton
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Holly McCulloch
- Strengthening Transitions in Care Lab, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Shelley McKibbon
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Jennifer Splane
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, Halifax, Nova Scotia, Canada
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13
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Van Orne J. Care coordination for children with medical complexity and caregiver empowerment in the process: A literature review. J SPEC PEDIATR NURS 2022; 27:e12387. [PMID: 35671389 DOI: 10.1111/jspn.12387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/06/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Advances in health care have led to an increase in infants and children being discharged home with increasingly complex conditions. Children with medical complexity require care from many physicians and specialties to thrive in their home environment. While some care coordination programs are in place, these programs are often dependent upon the child living within the geographic area of a major healthcare system. Additionally, children with medical complexity often need specialized care from providers outside the participating healthcare system, placing the onus of care coordination on the child's family. This literature review aimed to examine care coordination programs for children with medical complexity and what tools have been created to empower the child's family in the process. METHOD Qualitative and quantitative research studies published from 2015 to 2021 found in Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, and Medline that included a review of a care coordination program for children with medical complexity were included. Nonresearch articles, articles written about adults, or written in languages other than English were excluded. The Johns Hopkins Nursing Evidence-Based Practice grading scale was used to appraise the evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was utilized to structure this review to deter the risk of bias. A qualitative synthesis was used to analyze and present the results. CONCLUSIONS There are varying strategies used to facilitate care coordination of children with medical complexity. Effects of care coordination on the child are inconsistent; however, the child's caregiver considers high-quality care coordination to improve quality of life. There are limited tools available for caregivers of children with medical complexity to coordinate their child's care across healthcare systems. Generalizability is a concern due to the small sample sizes of studies and underrepresentation of non-English speaking families in the research. Risk of bias is possible due to highly engaged families willing to participate in the selected research studies. PRACTICE IMPLICATIONS There is an opportunity to develop further and study care coordination tools to empower the caregivers of children with medical complexity.
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Affiliation(s)
- Julie Van Orne
- Nursing Research, Cook Children's Medical Center, Fort Worth, Texas, USA
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14
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Kelly KJ, Doucet S, Luke A, Azar R, Montelpare W. Exploring the Use of a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study. JMIR Pediatr Parent 2022; 5:e33170. [PMID: 35671082 PMCID: PMC9214619 DOI: 10.2196/33170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/11/2022] [Accepted: 05/03/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Caregivers of children and youth with complex care needs (CCN) require substantial support to ensure the well-being of their families. Web-based peer-to-peer (P2P) support groups present an opportunity for caregivers to seek and provide timely informational and emotional support. Despite the widespread use of social media for health-related support across diverse patient and caregiver populations, it is unclear how caregivers of children and youth with CCN use and potentially benefit from these groups. OBJECTIVE The aim of this study is to explore the use of a web-based P2P support group for caregivers of children and youth with CCN in New Brunswick, Canada, and investigate factors related to its use by members. METHODS The study sample consisted of individuals who joined a closed Facebook group and an analysis of content published to the group. In phase 1, a Facebook group was developed in consultation with a patient and family advisory council, and members were recruited to the group. Phase 2 of this study consisted of an observation period during which posts and related interactions (ie, likes, loves, and comments) by members were collected. In phase 3, a web-based survey was distributed, and semistructured interviews were conducted with a subsample of group members. Survey and interview data were analyzed using thematic analysis. RESULTS A total of 108 caregivers joined the Facebook group between October 2020 and March 2021. There were 93 posts with 405 comments and 542 associated interactions (448/542, 82.7% likes and 94/542, 17.3% loves). Of these 93 posts, 37 (40%) were made by group members, and 56 (60%) were made by moderators. Of the 108 members, a subsample of 39 (36.1%) completed a web-based survey, and 14 (13%) participated in the interviews. Content analyses of posts by members revealed that inquiry (17/37, 46%), informational (15/37, 41%), and emotional posts (4/37, 11%) were the most common. Emotional posts received the highest number of interactions (median 24.5). In total, 5 themes emerged from the interviews related to the use of the group and mediating factors of interactions between group members: resource for information, altruistic contribution, varying level of engagement, perceived barriers to and facilitators of group activity, and moderators as contributing members. CONCLUSIONS These findings demonstrate that caregivers of children and youth with CCN seek geography-specific P2P support groups to meet informational and social support needs. This study contributes to the knowledge on how caregivers use Facebook groups to meet their support needs through moderate and passive engagement.
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Affiliation(s)
- Katherine Jennifer Kelly
- Health Centred Research Clinic, Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care, Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, NB, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, NB, Canada
| | - Rima Azar
- Psychobiology of Stress & Health Lab, Department of Psychology, Mount Alison University, Sackville, NB, Canada
| | - William Montelpare
- Health Centred Research Clinic, Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE, Canada
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15
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Breneol S, Curran JA, Macdonald M, Montelpare W, Stewart SA, Martin-Misener R, Vine J. Children With Medical Complexity in the Canadian Maritimes: Protocol for a Mixed Methods Study. JMIR Res Protoc 2022; 11:e33426. [PMID: 35383571 PMCID: PMC9021950 DOI: 10.2196/33426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ongoing developments in the medical field have improved survival rates and long-term management of children with complex chronic health conditions. While the number of children with medical complexity is small, they use a significant amount of health resources across various health settings and sectors. Research to date exploring this pediatric population has relied primarily on quantitative or qualitative data alone, leaving significant gaps in our understanding of this population. OBJECTIVE The objective of this research is to use health administrative and family-reported data to gain an in-depth understanding of patterns of health resource use and health care needs of children with medical complexity and their families in the Canadian Maritimes. METHODS An explanatory sequential mixed methods design will be used to achieve our research objective. Phase 1 of this research will leverage the use of health administrative data to examine the prevalence and health service use of children with medical complexity. Phase 2 will use case study methods to collect multiple sources of family-reported data to generate a greater understanding of their experiences, health resource use, and health care needs. Two cases will be developed in each of the 3 provinces. Cases will be developed through semistructured interviews with families and their health care providers and health resource journaling. Findings will be triangulated from phase 1 and 2 using a joint display table to visually depict the convergence and divergence between the quantitative and qualitative findings. This triangulation will result in a comprehensive and in-depth understanding into the population of children with medical complexity. RESULTS This study will be completed in May 2022. Findings from each phase of the research and integration of the two will be reported in full in 2022. CONCLUSIONS There is a current disconnect between the Canadian health care system and the needs of children with medical complexity and their families. By combining health administrative and family-reported data, this study will unveil critical information about children with medical complexity and their families to more efficiently and effectively meet their health care needs. Results from this research will be the first step in designing patient-oriented health policies and programs to improve the health care experiences, health system use, and health outcomes of children with medical complexity and their families. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33426.
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Affiliation(s)
- Sydney Breneol
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Strengthening Transitions in Care, Izaac Walton Killam Health Centre, Halifax, NS, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Strengthening Transitions in Care, Izaac Walton Killam Health Centre, Halifax, NS, Canada
| | - Marilyn Macdonald
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - William Montelpare
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Samuel A Stewart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Ruth Martin-Misener
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Jocelyn Vine
- Strengthening Transitions in Care, Izaac Walton Killam Health Centre, Halifax, NS, Canada
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16
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McCulloch H, Breneol S, Stewart SA, Magalhaes S, Somerville M, Sheriko J, Best S, Burgess S, Jeffers E, Standing MA, King S, Clegg J, Curran JA. Identifying children with medical complexity in administrative datasets in a Canadian context: study protocol. BMJ Open 2022; 12:e057843. [PMID: 35304399 PMCID: PMC8935171 DOI: 10.1136/bmjopen-2021-057843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Children with medical complexity and their families are an important population of interest within the Canadian healthcare system. Despite representing less than 1% of the paediatric population, children with medical complexity require extensive care and account for one third of paediatric healthcare expenditures. Opportunities to conduct research to assess disparities in care and appropriate allocation of health resources relies on the ability to accurately identify this heterogeneous group of children. This study aims to better understand the population of children with medical complexity in the Canadian Maritimes, including Nova Scotia (NS), New Brunswick (NB) and Prince Edward Island (PEI). This will be achieved through three objectives: (1) Evaluate the performance of three algorithms to identify children with medical complexity in the Canadian Maritimes in administrative data; then using the 'best fit' algorithm (2) Estimate the prevalence of children with medical complexity in the Canadian Maritimes from 2003 to 2017 and (3) Describe patterns of healthcare utilisation for this cohort of children across the Canadian Maritimes. METHODS AND ANALYSIS The research will be conducted in three phases. In Phase 1, an expert panel will codevelop a gold-standard definition of paediatric medical complexity relevant to the Canadian Maritime population. A two-gate validation process will then be conducted using NS data and the gold-standard definition to determine the 'best fit' algorithm. During phase 2 the 'best fit' algorithm will be applied to estimate the prevalence of children with medical complexity in NS, NB and PEI. Finally, in phase 3 will describe patterns of healthcare utilisation across the Canadian Maritimes. ETHICS AND DISSEMINATION Ethics approval for this protocol was granted by the institutional research ethics board at the IWK Health Centre (REB # 1026245). A waiver of consent was approved. This study will use an integrated knowledge translation approach, where end users are involved in each stage of the project, which could increase uptake of the research into policy and practice. The findings of this research study will be submitted for publication and dissemination through conference presentations and with our end users.
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Affiliation(s)
- Holly McCulloch
- Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sydney Breneol
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samuel A Stewart
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sandra Magalhaes
- NB Institute for Research, Data and Training, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Mari Somerville
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jordan Sheriko
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Shauna Best
- Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Stacy Burgess
- Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Mary-Ann Standing
- Centre for Health and Community Research, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Sarah King
- Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Julie Clegg
- Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
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17
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Mitchell TK, Bray L, Blake L, Dickinson A, Carter B. 'It doesn't feel like our house anymore': The impact of medical technology upon life at home for families with a medically complex, technology-dependent child. Health Place 2022; 74:102768. [PMID: 35219047 DOI: 10.1016/j.healthplace.2022.102768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/18/2021] [Accepted: 02/11/2022] [Indexed: 11/16/2022]
Abstract
The study aimed to identify how medical technology impacts upon the home and life at home. Inductive auto-driven photo-elicitation or semi-structured interviews were conducted with technology-dependent children/young people (n = 2) and their family members (n = 15) from 10 families. Thematic analysis generated three themes: Altered physicality and look of the home; Altered sounds in the home; and 'It's worth it! Technology enables us to stay as a family'. Fundamentally, the detrimental impacts of living with medical technology were perceived as worth it as these enabled their child to be at home. Home was not home, and families were incomplete without their child at home.
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Affiliation(s)
- Tracy Karen Mitchell
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, UK.
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
| | - Lucy Blake
- Department of Health and Social Sciences, University of the West of England (UWE), Bristol, UK
| | | | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
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Brenner M, Greene J, Doyle C, Koletzko B, Del Torso S, Bambir I, De Guchtenaere A, Polychronakis T, Reali L, Hadjipanayis AA. Increasing the Focus on Children's Complex and Integrated Care Needs: A Position Paper of the European Academy of Pediatrics. Front Pediatr 2021; 9:758415. [PMID: 34926344 PMCID: PMC8671931 DOI: 10.3389/fped.2021.758415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/09/2021] [Indexed: 12/04/2022] Open
Abstract
There is wide variation in terminology used to refer to children living with complex needs, across clinical, research and policy settings. It is important to seek to reconcile this variation to support the effective development of programmes of care for this group of children and their families. The European Academy of Pediatrics (EAP) established a multidisciplinary Working Group on Complex Care and the initial work of this group examined how complex care is defined in the literature. A scoping review was conducted which yielded 87 papers with multiple terms found that refer to children living with complex needs. We found that elements of integrated care, an essential component of care delivery to these children, were repeatedly referred to, though it was never specifically incorporated into a term to describe complex care needs. This is essential for practice and policy, to continuously assert the need for integrated care where a complex care need exists. We propose the use of the term Complex and Integrated Care Needs as a suitable term to refer to children with varying levels of complexity who require continuity of care across a variety of health and social care settings.
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Affiliation(s)
- Maria Brenner
- European Academy of Paediatrics (EAP), Brussels, Belgium.,School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Josephine Greene
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Carmel Doyle
- European Academy of Paediatrics (EAP), Brussels, Belgium.,School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Berthold Koletzko
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Dr. Von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stefano Del Torso
- European Academy of Paediatrics (EAP), Brussels, Belgium.,ChildCare WorldWide, Padova, Italy
| | - Ivan Bambir
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ann De Guchtenaere
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Theofilos Polychronakis
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Laura Reali
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Studio Pediatrico, Rome, Italy
| | - Adamos A Hadjipanayis
- European Academy of Paediatrics (EAP), Brussels, Belgium.,Paediatric Department, Larnaca General Hospital, Larnaca, Cyprus.,School of Medicine, European University Cyprus, Nicosia, Cyprus
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