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Kittelsen TB, Castor C, Lee A, Kvarme LG, Winger A. "What about me?": lived experiences of siblings living with a brother or sister with a life-threatening or life-limiting condition. Int J Qual Stud Health Well-being 2024; 19:2321645. [PMID: 38404038 PMCID: PMC10898268 DOI: 10.1080/17482631.2024.2321645] [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: 11/30/2023] [Accepted: 02/18/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND There is a lack of knowledge regarding siblings' experiences of being a brother or sister of a child with a life-threatening or life-limiting condition. Siblings' perspectives are often expressed through their parents and not by siblings themselves. METHOD This study has a qualitative design within hermeneutic phenomenology. Thirteen siblings (ages 3-29) of children with cancer or genetic conditions participated in semi-structured interviews. Analyses followed a thematic analysis guided by van Manen's lifeexistentials. RESULTS One overall theme, "What about me?", illustrates that siblings of children with LT/LL conditions are dealing with their own challenges and needs in the situation while also struggling to receive attention from their parents. The overall theme derives from three subthemes: living with heavy strains, feeling disregarded, and having needs of one's own. CONCLUSION The study revealed that siblings' own needs compete with the needs of the ill child, resulting in the risk of siblings taking a step back rather than expressing what they might actually need themselves. These findings can inform healthcare professionals on the importance of educating and supporting parents and the surrounding community close to the sibling, for example, by helping schoolteachers understand how to meet siblings' needs.
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Affiliation(s)
- Trine Brun Kittelsen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | | | - Anja Lee
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital HF, Oslo, Norway
| | - Lisbeth Gravdal Kvarme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Anette Winger
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Nilsson S, Öhlén J, Nyblom S, Ozanne A, Stenmarker M, Larsdotter C. Place of death among children from 0 to 17 years of age: A population-based study from Sweden. Acta Paediatr 2024; 113:2155-2163. [PMID: 38819101 DOI: 10.1111/apa.17308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
AIM The aim of this study is to contribute to the development of paediatric palliative care by investigating, on a population basis, where children in Sweden died, from 2013 to 2019. A particular focus was on comparing two groups: children who died during their first year of life with children who died at 1-17 years of age. METHODS We hypothesised that there might be variations in place of death between the defined groups. Utilising national registry data, descriptive statistics were used to assess the distribution and variations in the place of death. Logistic regression analyses were conducted to ascertain the impact of associated factors. RESULTS Most children died in hospitals (74.7%). The hypothesis postulating divergences in the place of death between age groups was not substantiated. Sex and birthplace showed no significant differences in home deaths. Deaths due to malignancies had a relatively high likelihood of occurring at home (39.0%). For perinatal diagnoses, the incidence of home deaths was relatively low (1.5%). CONCLUSION Children who received support from a specialist palliative service in their own homes were notably less likely to die in a hospital setting compared to those who did not receive such support. An unplanned hospital visit increased the likelihood of hospital death.
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Affiliation(s)
- Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stina Nyblom
- Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margaretha Stenmarker
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics, Region Jönköping County, Jönköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Cecilia Larsdotter
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
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Munshi FM, Desai PP, Azizi B, Alabdulkarim SO, Mujlli GA, Alaskary HA, McIntire CR, Alhegelan RS, Yaqinuddin A, Izquierdo JP. The imperative of the child life profession in KSA in transforming the quality of pediatric healthcare. J Taibah Univ Med Sci 2024; 19:790-799. [PMID: 39135962 PMCID: PMC11318472 DOI: 10.1016/j.jtumed.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/08/2024] [Accepted: 06/05/2024] [Indexed: 08/15/2024] Open
Abstract
Saudi Arabia has made substantial advancements in its pediatric healthcare infrastructure. However, substantial gaps persist in addressing hospitalized children's emotional safety, and psychosocial and developmental needs. Internationally, the child life profession has evolved over decades to specifically address these needs, through interventions such as therapeutic play, age-appropriate patient education, and family support. This article evaluates the imperative for integrating the child life profession into healthcare services in Saudi Arabia to transform the quality of pediatric healthcare. An analysis of the current landscape revealed gaps in pediatric psychosocial care. These gaps are listed as national priorities in the health transformation program aimed at improving healthcare quality and enhancing well-being. Integrating the child life profession can help achieve these objectives for children and families in Saudi Arabia. This article highlights the multifaceted benefits of the child life profession in improving patient experiences, healthcare delivery efficiency, pediatric healthcare quality, and the overall well-being of children and families. Strategies for phased implementation, involving healthcare institutions, academic partners, relevant non-profit partners, and policymakers, are proposed.
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Affiliation(s)
| | | | | | | | - Gadah A Mujlli
- Princess Nourah Bint Abdulrahman University, Riyadh, KSA
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Tan WL, Sambhi SK, Shorey S. Experiences of paediatric terminal oncology patients and their parents in palliative care: A qualitative systematic review. J Pediatr Nurs 2024:S0882-5963(24)00267-7. [PMID: 39025711 DOI: 10.1016/j.pedn.2024.07.005] [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: 04/11/2024] [Revised: 07/05/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
PROBLEM The terminal phase of childhood cancer poses profound physical and mental challenges for children, simultaneously influencing parents and rendering them particularly susceptible to psychosocial issues. ELIGIBILITY CRITERIA This review included studies exploring the experiences of either: (1) paediatric terminal oncology patients aged under 18 years, (2) parents with a child facing terminal cancer undergoing palliative care, or (3) parents with a child who had undergone palliative care and died. English language, qualitative journal studies or grey literature of any care settings, geographical locations and publication years were included. Studies exploring the experiences of (1) paediatric terminal oncology not receiving palliative care from qualified healthcare professionals, and (3) non-biological parents or non-parental family members, were excluded. SAMPLE A total of 22 studies were included, published between January 2000 and December 2023. Seventy-two children (aged between 5 and 18 years old) and 236 parents (aged between 24 and 57 years old) participated across all studies. Palliative care settings mostly comprised oncology centres, hospitals and homes. RESULTS Two themes were identified from the 22 included studies: (1) Navigating rough waters and enduring hardships, and (2) Preparing for end-of-life amidst the looming threat of death. CONCLUSIONS This review underscored the importance of integrating palliative childhood cancer care in a holistic, age-specific, family-centred, person-centred and timely manner. IMPLICATIONS Paediatric oncology nurses should attend to physical and psychosocial needs of children and parents, fostering familial and social ties while recognising cultural and spiritual needs. Future research could recruit participants of varying ages, genders, and cultures.
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Affiliation(s)
- Wei Ling Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sharan Kaur Sambhi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Holistic Initiatives for Learning and Development (CHILD), Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Archer-Kuhn B, Lind C, Beltrano N, Garrisen L, Hettler J, Reilly S. Realizing an Evidence-Based Framework for the Management and Delivery of Family Support Services. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2024; 21:455-473. [PMID: 38288721 DOI: 10.1080/26408066.2024.2310599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
PURPOSE This paper reports on how service providers and academic researchers partnered to support the journey of a primary prevention organization in western Canada as they reviewed their programming against an evidence-based practice (EBP) framework. The process allows the organization to increase their EBP culture by encouraging staff understanding and uptake of their nine family support programs. It also informs service users and other stakeholders of the evidentiary status of different kinds of support services. In this way, the families become more informed and engaged partners who might easily evaluate the respective risks and benefits of the various applications. METHOD As part of the process, an evidence-based framework used a common language to assess the efficacy of the respective nine programs. RESULTS All nine programs are now mapped into the EBP framework. CONCLUSIONS This review allows staff to become more intentional and informed about the EBPs they employ to support vulnerable families and to use this knowledge to better inform the families with whom they work. This paper and the process the agency followed can be a model for other organizations who serve families experiencing short-term housing crisis, provide infant nursery care, and other support services for families with young children.
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Affiliation(s)
- Beth Archer-Kuhn
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Candace Lind
- Faculty of Nursing, University of Calgary, Calgary, Canada
| | - Natalie Beltrano
- School of Social Work, University of Windsor, Windsor, ON, Canada
| | - Lisa Garrisen
- of Programs, Children's Cottage Society, Calgary, AB, Canada
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Hammer NM, Bidstrup PE, Olsen M, Hansson H, Abitz M, Larsen HB. The experiences of grandparents involved in the home-based end-of-life care of their grandchild with cancer: A qualitative secondary data analysis. DEATH STUDIES 2024:1-11. [PMID: 38822452 DOI: 10.1080/07481187.2024.2355252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
While grandparents are often a valuable resource in home-based pediatric end-of-life care, they may also experience psychological consequences when faced with their grandchild's illness and death. In this qualitative study, we performed semi-structured interviews with seven bereaved grandparents of four children with cancer who received home-based end-of-life care and died at home at age <18. Through qualitative content analysis we identified the overarching theme: "Navigating complex and unclear roles to support the family" and five themes: (1) Providing comfort and support; (2) Balancing and adapting involvement; (3) Worrying silently; (4) Managing difficult emotions; and (5) Calling for support and understanding. The findings underline the often conflicting roles that grandparents undertake of providing support while respecting parents' autonomy and putting aside their own emotional reactions. Involving grandparents in pediatric end-of-life care may enhance family resources, but should also consider grandparents' perspectives and need for support.
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Affiliation(s)
- Nanna Maria Hammer
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Olsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine, Section of Pediatric Hematology and Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Helena Hansson
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja Abitz
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Schröder J, Riiser K, Holmen H. Healthcare personnel's perspectives on health technology in home-based pediatric palliative care: a qualitative study. BMC Palliat Care 2024; 23:137. [PMID: 38811957 PMCID: PMC11134737 DOI: 10.1186/s12904-024-01464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND In the context of pediatric palliative care, where the quality of life of children with life-limiting or life-threatening conditions is of utmost importance, the integration of health technology must support the provision of care. Research has highlighted the role of healthcare personnel when utilizing health technology in home-based pediatric palliative care, but specific knowledge of healthcare personnel's views on the technological relevance remains limited. Therefore, our study has explored potentials and limitations of health technology in home-based pediatric palliative care from the perspectives of healthcare personnel. METHODS Our study utilized a qualitative, descriptive, and exploratory design, including five focus groups with a total of 22 healthcare personnel. The participants were selected from various health regions in Norway and were experienced in providing home-based pediatric palliative care. Using reflexive thematic analysis, we interpreted data obtained from focus groups, identified patterns, and developed themes. RESULTS The analysis resulted in the development of three intersecting themes: balancing in-person interaction and time in home-based pediatric palliative care; exchange of information can improve timely and appropriate care; and the power of visual documentation in pediatric palliative care. The healthcare personnel acknowledged difficulties in fully replacing in-person interaction with health technology. However, they also emphasized potentials of health technology to facilitate information sharing and the ability to access a child's health record within interdisciplinary teams. CONCLUSION The results underscored that technology can support pediatric palliative care but must be thoughtfully integrated to ensure an individualized patient-centered approach. To maximize the benefits of health technology in enhancing home-based pediatric palliative care, future research should address the limitations of current health technology and consider the opinions for information sharing between relevant healthcare team members, the child, and their family.
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Affiliation(s)
- Judith Schröder
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, Oslo, NO-0130, Norway.
| | - Kirsti Riiser
- Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, Oslo, NO-0130, Norway
| | - Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, Oslo, NO-0130, Norway
- Division of Technology and Innovation, Intervention Centre, Oslo University Hospital, Oslo, Norway
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Winger A, Holmen H, Birgisdóttir D, Lykke C, Lövgren M, Neergaard MA, Grönroos M, Kero J, Kristinsdóttir O, Pétursdóttir ÁB, Castor C. Children with palliative care needs - the landscape of the nordic countries. BMC Palliat Care 2024; 23:118. [PMID: 38720316 PMCID: PMC11077810 DOI: 10.1186/s12904-024-01447-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND To strengthen palliative care for children in the Nordic countries, an updated status of current needs, resources, clinical services, education, and research is necessary to align and consolidate future research. A Nordic research collaboration initiative for children with palliative care needs was assembled in 2023. Building on this initiative, this paper presents an overview of pediatric palliative care (PPC) in the Nordic countries' (a) population characteristics, (b) care models and setting of care, (c) education and training, and (d) research. METHODS The Nordic initiative researchers collaboratively gathered and assessed available data on the characteristics of PPC within Denmark, Finland, Greenland, Iceland, Norway, the Faroe Islands, Sweden, and Åland. Data were compiled in a matrix with population characteristics, models- and setting of care, education and training, and areas of research in a Nordic context. The findings are narratively and descriptively presented, providing an overview of Nordic PPC. RESULTS In total, the Nordic child population comprises around six million children (0-19 years), of which about 41.200 are estimated to be living with a life-limiting and/or life-threatening condition. Healthcare services are provided through various care models, ranging from specialized care to homecare settings. Overall, there remain few opportunities for education and training with some exceptions. Also, Nordic research within PPC has been shown to be a growing field although much remains to be done. CONCLUSION This overview is the first outline of the current PPC in Nordic countries. Although some differences remain important to acknowledge, overall, the strengths and challenges faced within PPC in the Nordic countries are comparable and call for joint action to increase evidence, services, and education to better serve the children, families, and healthcare personnel within PPC. Despite the varying structural premises for PPC, research endeavors aiming to provide evidence in this field seem increasing, timely and relevant for the Nordic countries, as well as the international context.
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Affiliation(s)
- Anette Winger
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway.
| | - Heidi Holmen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
- Division of Technology and Innovation, Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Dröfn Birgisdóttir
- Department of Clinical Sciences Lund, Faculty of Medicine, The Institute for Palliative Care, Lund University, Lund, Sweden
- Region Skåne, Lund, Sweden
| | - Camilla Lykke
- Section of Palliative Medicine, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Oncology and Palliative Care, North Zealand Hospital, Hillerød, Denmark
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Advanced Pediatric Homecare, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, 171 64, Sweden
| | - Mette Asbjoern Neergaard
- Palliative Care Unit and Child & Youth Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marika Grönroos
- Department of Pediatric and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Johanna Kero
- Welfare and Health, Satakunta University of Applied Sciences, Pori, Finland
| | - Oddný Kristinsdóttir
- Pediatric department, Landspitali University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Ásta Bjarney Pétursdóttir
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
- School of Health Sciences, Faculty of Graduate Studies, University of Akureyri, Akureyri, Iceland
| | - Charlotte Castor
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Kittelsen TB, Lorentsen VB, Castor C, Lee A, Kvarme LG, Winger A. It's about living a normal life: parents' quality of life when their child has a life-threatening or life-limiting condition - a qualitative study. BMC Palliat Care 2024; 23:92. [PMID: 38589835 PMCID: PMC11003040 DOI: 10.1186/s12904-024-01417-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Pediatric palliative care (PPC) seeks to enhance the quality of life (QoL) for both children and their families. While most studies within PPC have focused on the ill child's QoL, less is known about parents' experiences of their own QoL. The aim of this study was to explore parents' QoL when their child has a life-threatening or life-limiting condition. METHODS The study has a qualitative, hermeneutic phenomenological design inspired by van Manen's phenomenology of practice. In-depth interviews were conducted with 12 fathers and 12 mothers of children living with cancer or a genetic condition. A deeper understanding of parents' lived experiences was obtained through an adapted photo elicitation method. Two rounds of thematic analysis were conducted, covering both the photo elicitation data, and interview data. RESULTS The findings describe four themes related to parents' QoL: living a normal life, giving my child a good life, having time to fulfill siblings' needs, and feeling heard and respected in the health and social care system. CONCLUSIONS The complexity of elements shaping parents' QoL is evident. The interconnectedness between parents, the ill child, siblings, and interactions with the health and social care system, highlights the need to understand and address diverse aspects in enhancing parents QoL.
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Affiliation(s)
- Trine Brun Kittelsen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Pilestredet 32, Oslo, 0167, Norway.
| | - Vibeke Bruun Lorentsen
- Faculty of Health Sciences, Institute for Nursing, VID Specialized University, Oslo, Norway
| | | | - Anja Lee
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital HF, Oslo, Norway
| | - Lisbeth Gravdal Kvarme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Pilestredet 32, Oslo, 0167, Norway
| | - Anette Winger
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Pilestredet 32, Oslo, 0167, Norway
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Maia FDOM, Guimarães LC, Misko MD, de Souza TR, Fonseca MRA. Experiences of family members of cancer patients in palliative care: a qualitative systematic review protocol. JBI Evid Synth 2024; 22:713-719. [PMID: 37921629 DOI: 10.11124/jbies-23-00090] [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: 11/04/2023]
Abstract
OBJECTIVE The objective of this review is to synthesize the experiences of family members of cancer patients in palliative care. INTRODUCTION Increasingly, palliative care is the approach advocated when a life-threatening illness has been diagnosed. Cancer patients and their families, when receiving early identification, correct assessment, and treatment of pain and other problems through palliative care, report feeling supported in their illness experience. The patients and their families also describe immediate and personalized symptom management, holistic support, decision-making guidance, and preparation for the future, including the dying process and stages of grief. A growing number of studies address palliative care patients and, in particular, the central role of family in this approach. This review will synthesize qualitative research on this subject, providing recommendations to health professionals to help them better understand the experiences and needs of family members of cancer patients receiving palliative care. INCLUSION CRITERIA The review will consider studies examining experiences of families of cancer patients in palliative care, in all types of settings and contexts. The studies will focus on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, qualitative descriptive, and mixed methods studies. METHODS The review will follow the JBI methodology for systematic reviews of qualitative evidence. The search strategy will aim to locate both published and unpublished studies, in any language, with no date restrictions. Methodological quality will be evaluated using the standard JBI critical appraisal checklist for qualitative research. The findings will be pooled using the meta-aggregation approach or will be presented in narrative format. The final synthesized findings will be graded according to the ConQual approach. REVIEW REGISTRATION PROSPERO CRD42022333937.
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Affiliation(s)
- Flávia de Oliveira Motta Maia
- School of Nursing, State University of Campinas (UNICAMP), Campinas, São Paulo, SP, Brazil
- The Brazilian Centre for Evidence-based Healthcare: A JBI Centre of Excellence, São Paulo, SP, Brazil
| | | | - Maira Deguer Misko
- School of Nursing, State University of Campinas (UNICAMP), Campinas, São Paulo, SP, Brazil
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Tafazoli Moghadam E, Tafazoli A. Providing care for siblings of children on hospice. Palliat Support Care 2024; 22:417-418. [PMID: 37818646 DOI: 10.1017/s1478951523001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Affiliation(s)
| | - Ali Tafazoli
- Hospice Kingston, Queen's University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Department of Health Care Administration, Kingston Campus, St Lawrence College, Kingston, ON, Canada
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Swasey H, Morrill D, Mott S, Engstrand S, Connor JA. Perceptions of Interprofessional Practitioners Regarding Pediatric Palliative Transports. Am J Crit Care 2024; 33:133-139. [PMID: 38424020 DOI: 10.4037/ajcc2024127] [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: 03/02/2024]
Abstract
BACKGROUND Pediatric palliative transport (PPT) is the practice of offering critically and terminally ill children requiring life-sustaining measures the opportunity to be discharged from the hospital to home or a hospice facility for end-of-life care. Although studies have shown PPT to favorably affect both children and their families, limited research exists on the perspectives of health care practitioners. OBJECTIVES To understand the experience of interprofessional practitioners who have cared for a critically or terminally ill child during a PPT and their perception of PPT as a care option. METHODS This study is a qualitative descriptive inquiry conducted using 8 focus groups. Participants included interprofessional staff from 4 specialty intensive care units, the pediatric advanced care team, and the critical care transport team at a quaternary, freestanding children's hospital. Content analysis was used to summarize themes and recommendations. RESULTS Five overarching themes were identified: PPT as a care pathway, education, communication, support, and closure. Use of PPT was perceived as aligned with the hospital's mission of family-centered care and as providing a way for the health care team to support a family's choice. Participants recommended further development of information to guide communication and processes of care that would enhance the experience for families and staff and support PPT as a care pathway. CONCLUSIONS Pediatric palliative transport is considered a feasible, valuable, and critical end-of-life intervention. The value that PPT has brought to participating families warrants continued investment in the intervention's standardization and enhancement.
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Affiliation(s)
- Harriett Swasey
- Harriett Swasey is a staff nurse, Critical Care Transport Team, Boston Children's Hospital, Boston, Massachusetts
| | - Diana Morrill
- Diana Morrill is a project coordinator, Cardiovascular, Critical Care, and Perioperative Patient Services, Boston Children's Hospital, Boston, Massachusetts
| | - Sandra Mott
- Sandra Mott is a nurse scientist, Cardiovascular and Critical Care Patient Services, Boston Children's Hospital, Boston, Massachusetts
| | - Shannon Engstrand
- Shannon Engstrand is a project coordinator, Cardiovascular, Critical Care, and Perioperative Patient Services, Boston Children's Hospital, Boston, Massachusetts
| | - Jean Anne Connor
- Jean Anne Connor is the director of nursing research, Cardiovascular, Critical Care, and Perioperative Patient Services, Boston Children's Hospital, Boston, Massachusetts, and an assistant professor of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Kubek LA, Claus B, Zernikow B, Wager J. Comparison of actigraphy with a sleep protocol maintained by professional caregivers and questionnaire-based parental judgment in children and adolescents with life-limiting conditions. BMC Palliat Care 2024; 23:52. [PMID: 38395866 PMCID: PMC10885472 DOI: 10.1186/s12904-024-01394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/19/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Actigraphy offers a promising way to objectively assess pediatric sleep. Aim of the study was investigating the extent to which actigraphy used in children and adolescents with life-limiting conditions is consistent with two other measures of sleep diagnostics. METHODS In this monocentric prospective study N = 26 children and adolescents with life-limiting conditions treated on a pediatric palliative care unit were assessed. For three consecutive nights they wore an actigraph; the 24-hours sleep protocol documented by nurses and the Sleep Screening for Children and Adolescents with Complex Chronic Conditions (SCAC) answered by parents were analyzed. Patient characteristics and the parameters sleep onset, sleep offset, wake after sleep onset (WASO), number of wake phases, total sleep time (TST) and sleep efficiency (SE) were descriptively examined. Percentage bend correlations evaluated the three measures' concordance. RESULTS Descriptively, and except for the number of waking episodes, the different measures' estimations were comparable. Significant correlations existed between actigraphy and the sleep protocol for sleep onset (r = 0.83, p = < 0.001) and sleep offset (r = 0.89, p = < 0.001), between actigraphy and SCAC for SE (r = 0.59, p = 0.02). CONCLUSION Agreement of actigraphy with the focused sleep measures seems to be basically given but to varying degrees depending on the considered parameters.
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Affiliation(s)
- Larissa Alice Kubek
- PedScience Research Institute, Datteln, Germany.
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University,Faculty of Health, School of Medicine, Witten, Germany.
| | - Benedikt Claus
- PedScience Research Institute, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University,Faculty of Health, School of Medicine, Witten, Germany
| | - Boris Zernikow
- PedScience Research Institute, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University,Faculty of Health, School of Medicine, Witten, Germany
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany
| | - Julia Wager
- PedScience Research Institute, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University,Faculty of Health, School of Medicine, Witten, Germany
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany
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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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Schröder J, Riiser K, Holmen H. The needs of healthcare personnel who provide home-based pediatric palliative care: a mixed method systematic review. BMC Health Serv Res 2024; 24:45. [PMID: 38195519 PMCID: PMC10777650 DOI: 10.1186/s12913-023-10495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Families with children who have life-limiting or life-threatening illnesses often prefer to receive care at home to maintain a sense of normalcy. However, caring for children at home is different from caring for them in a hospital, and we do not know enough about the needs of healthcare personnel who provide home-based pediatric palliative care. AIM The aim of this review was to systematically summarize, appraise and synthesize available quantitative, qualitative, and mixed methods research to identify the needs of healthcare personnel in home-based pediatric palliative care. METHODS We used the Joanna Briggs Institute methodology for mixed method systematic reviews and searched systematically in Medline, Embase, PsycINFO, CINAHL, Web of Science, AMED, and the Cochrane Library. Quantitative, qualitative and mixed methods studies from 2012 to 2021 reporting on healthcare personnel's needs, experiences, perspectives, coping strategies, and/or challenges related to home-based pediatric palliative care were eligible for inclusion. The screening was conducted independently in pairs. The quantitative data were transformed into qualitative data and analyzed using thematic synthesis. RESULTS Overall, 9285 citations were identified, and 21 studies were eligible for review. Most of the studies were qualitative and interview-based. Few studies included healthcare personnel other than doctors and nurses. Three analytical themes were developed: (1) being connected and engaged with the child and family, (2) being part of a dedicated team, and (3) ensuring the quality of home-based pediatric palliative care services. Healthcare personnel strived to deliver high-quality, home-based pediatric palliative care. Establishing a relationship with the child and their parents, collaborating within a committed team, and having sufficient resources were identified as important needs influencing healthcare personnel when providing home-based pediatric palliative care. CONCLUSION The findings underscore the importance of building trusting relationships among healthcare personnel, children, and families. It also emphasizes the significance of interdisciplinary collaboration that is effective, along with the presence of enough skilled personnel to ensure high-quality home-based pediatric palliative care. Further research is necessary to include healthcare personnel beyond doctors and nurses, as palliative care requires a team of professionals from various disciplines. Addressing the needs of healthcare personnel can ensure safe and professional palliative care for children at home.
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Affiliation(s)
- Judith Schröder
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4, Oslo, NO-0130, Norway.
| | - Kirsti Riiser
- Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4, Oslo, NO-0130, Norway
- Division of Technology and Innovation, Intervention Centre, Oslo University Hospital, Oslo, Norway
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Rubenstrunk A, Gagez AL, Hoeusler CH, Demol E, Mahieux I, Lavedrine F, Raff F, Vuylsteke J, Mazure J, Lecouffe R. Pediatric Palliative Care for a French Hospital-At-Home Facility: A Case Report. J Pediatr Health Care 2024; 38:90-96. [PMID: 37676183 DOI: 10.1016/j.pedhc.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/16/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023]
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Hansson H, Björk M, Santacroce SJ, Raunkiaer M. End-of-life palliative home care for children with cancer: A qualitative study on parents' experiences. Scand J Caring Sci 2023; 37:917-926. [PMID: 35072276 DOI: 10.1111/scs.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/16/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is insufficient knowledge available about the impact of paediatric palliative care at home on meeting family needs and ensuring the highest quality of care for the dying child. The aim of this study was to elucidate parents' experiences of how and why home-based paediatric palliative care impacted the entire family during their child's final phase of life. METHODS The study used a qualitative design. Semi-structured interviews were conducted with the bereaved parents of children who had received palliative care at home from a paediatric cancer hospital department programme that was based on collaboration with community nurses and the paediatric palliative care service. The interviews were transcribed verbatim, and qualitative content analysis was applied. The Ecocultural theory was used to explain the findings. RESULTS Three main themes emerged: (1) involvement enabling a sense of control and coping, (2) sustaining participation in everyday family life routines and (3) making room for presence and comfort during and after the end-of-life trajectory. CONCLUSION End-of-life palliative care at home can enable parents and other family members to maintain a sense of control, presence and semblance of everyday life. It contributes to managing and alleviating the burden and distress during the last phase of the child's life and during bereavement. We suggest that healthcare professionals support family members in participation and daily life routines and activities during a child's EOL care, as it affects the well-being of the entire family.
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Affiliation(s)
- Helena Hansson
- Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet and Associate Professor at Copenhagen University, Copenhagen, Denmark
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Maria Björk
- CHILD Research Group at the Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Sheila Judge Santacroce
- Beerstecher-Blackwell Distinguished Scholar at School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mette Raunkiaer
- Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, University of Southern Denmark, Nyborg, Denmark
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Noyes M, Delaney A, Lang M, Maybury M, Moloney S, Bradford N. Preparing for Death While Investing in Life: A Narrative Inquiry and Case Report of Home-Based Paediatric Palliative, End-of-Life, and After-Death Care. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1777. [PMID: 38002868 PMCID: PMC10670542 DOI: 10.3390/children10111777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
Paediatric palliative care is pivotal for addressing the complex needs of children with incurable diseases and their families. While home-based care offers a familiar and supportive environment, delivering comprehensive services in this context is challenging. The existing literature on home-based palliative care lacks detailed guidance for its organization and implementation. This qualitative narrative inquiry explores the organization and provision of home-based paediatric palliative care. Data were collected from healthcare practitioners using conversations, storytelling, and reflective journaling. Schwind's Narrative Reflective Process was applied to synthesize the data, resulting in an in-depth case description. The narrative approach illuminates the complexities of home-based paediatric palliative, end-of-life, and after-death care. Key findings encompass the importance of early-care coordination, interprofessional collaboration, effective symptom management, emotional and psychosocial support, and comprehensive end-of-life planning. Through the case study of the child patient, the challenges and strategies for providing holistic, family-centred care within the home environment are described. Practical insights gained from this report can inform the development and improvement of home-based palliative care programs, benefiting researchers, practitioners, and policymakers seeking to optimize care for children and families in similar contexts.
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Affiliation(s)
- Michelle Noyes
- Department of Paediatrics, Gold Coast University Hospital, Southport, QLD 4215, Australia; (M.N.); (M.L.); (S.M.)
| | - Angela Delaney
- Paediatric Palliative Care Service, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia;
- Centre for Children’s Health Research, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Meagan Lang
- Department of Paediatrics, Gold Coast University Hospital, Southport, QLD 4215, Australia; (M.N.); (M.L.); (S.M.)
| | - Mellissa Maybury
- Queensland Children’s Tumour Bank, Child Health Research Centre, University of Queensland, South Brisbane, QLD 4101, Australia;
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Southport, QLD 4215, Australia; (M.N.); (M.L.); (S.M.)
- School of Medicine, Griffith University, Southport, QLD 4215, Australia
| | - Natalie Bradford
- Paediatric Palliative Care Service, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia;
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, QLD 4001, Australia
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Holmen H, Winger A, Steindal SA, Riiser K, Castor C, Kvarme LG, Mariussen KL, Lee A. Patient-reported outcome measures in children, adolescents, and young adults with palliative care needs-a scoping review. BMC Palliat Care 2023; 22:148. [PMID: 37798706 PMCID: PMC10557323 DOI: 10.1186/s12904-023-01271-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Measuring outcomes facilitates evaluation of palliative services for children, adolescents, and young adults (CAYAs) with life-limiting and/or life-threatening (LL/LT) conditions. Implementation of patient-reported, proxy-reported, or patient-centered outcome measures (hereafter PROMs) is recommended to ensure palliative services. The purpose of this scoping review was to provide an overview of PROMs relevant for CAYAs living with LL/LT conditions eligible for pediatric palliative care (PPC). METHODS Arksey and O'Malley's 6-stage scoping review framework was used to guide the review. The identified citations had to report on PROMs in any context including CAYAs with LL/LT conditions up to 25 years of age. A systematic search of Medline, EMBASE, CINAHL, APA PsycInfo, Health and Psychosocial Instruments, and AMED took place in January 2021 and was updated in June 2022. Citations were screened independently by pairs of researchers. The scoping review protocol was registered, and peer-review published. RESULTS Of 3690 identified citations, 98 reports were included, of which the majority were from Western countries and about PROMs in CAYAs living with cancer or organ failure. A total of 80 PROMs were identified, assessing a range of phenomena, where quality of life and symptoms (especially pain) during the stage of ongoing care were the most frequent. There were only a few reports about outcome measures at time of diagnosis or in end-of-life care. CAYAs self-reported on the PROMs or collaborated with their parents in about half of the reports, while the remaining had proxies answering on behalf of the CAYAs. In the identified reports, PROMs were used to characterize a sample through cross-sectional or longitudinal research, and less often to assess effects of interventions. CONCLUSION The identified PROMs in the CAYA population eligible for PPC is characterized by studies in high-income countries during ongoing care, primarily in patients with cancer or organ failure. More research is needed in patients living with other LL/LT conditions, and during different stages of the disease course, especially at time of diagnosis, during transition to adulthood, and in end-of-life care. This scoping review of PROMs relevant for young patients eligible for PPC may inform future research about patient-/proxy-reported or patient-centered outcome measures in PPC. TRIAL REGISTRATION Review registration: ( https://osf.io/yfch2/ ) and published protocol (Holmen et al. Syst Rev. 10:237, 2021).
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Affiliation(s)
- Heidi Holmen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway.
| | - Anette Winger
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggt, 15B, 0456, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Kirsti Riiser
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Charlotte Castor
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Kari L Mariussen
- Lovisenberg Diaconal University College, Lovisenberggt, 15B, 0456, Oslo, Norway
| | - Anja Lee
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital HF, Nydalen, Box 4950, 0424, Oslo, Norway
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Butola S, Butola D. Issues Related to Children-Faced by Armed Forces Families When Caring for Patients in Palliative Care - A Qualitative Study. Indian J Palliat Care 2023; 29:437-446. [PMID: 38058477 PMCID: PMC10696357 DOI: 10.25259/ijpc_58_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/26/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Access to palliative care is limited, especially in rural India. Children needing care by palliative teams may themselves be patients, or siblings and children of patients. Armed forces families face characteristic lifestyle challenges - frequent transfers, living in difficult and remote areas, serving personnel staying apart from families for long periods - very different from issues faced by civilians. Military service increases the risk of psychosocial burden for serving personnel as well as families. Most depend on private and state medical services for palliative care so it is important for the palliative community to understand their issues. This study aimed to explore the issues related to children - faced by armed forces families when caring for patients in palliative care. Material and Methods Qualitative study based on thematic analysis of semi-structured interviews with caregivers - either serving personnel or their dependents, in three centres. Results Analysis of the 15 interviews showed that armed forces families face complex challenges related to children when caring for the palliative patient due to frequent movement, lack of paediatric palliative services in far-flung areas, disruption of the continuity of care, social isolation, language, and cultural barriers when living in non-native areas, inability to build and access family and community support and financial burden due to restrictive reimbursement policies. Conclusion Although medical and administrative support within the organisation provides a cushion, wives have to manage alone in the father's prolonged absence, and safety is a concern for children when living outside the campuses and serving personnel report guilt, anger, and helplessness at not being present when needed. Awareness of these issues can enable palliative workers to provide more meaningful support tailored to the needs of service families.
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Affiliation(s)
- Savita Butola
- Government of India, Border Security Force Hospital, Panisagar, Tripura, India
| | - Damini Butola
- Department of Clinical Psychology, Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Ranchi, Jharkhand, India
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Rud SA, Skagestad E, Aasebø Hauken M. Parents' experiences of paediatric palliative care in the community healthcare system: a qualitative study. Palliat Care Soc Pract 2023; 17:26323524231193036. [PMID: 37654729 PMCID: PMC10467213 DOI: 10.1177/26323524231193036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023] Open
Abstract
Background Having a child with a life-limiting illness is a situation that is relatively rare and represents a multidimensional burden on the family. Paediatric palliative care (PPC) aims to maintain the quality of life for the ill child and the family. Traditionally, most PPC has been provided at a specialist healthcare level, but research indicates that most families wish to spend as much time at home as possible. However, we have limited knowledge of PPC in community healthcare, especially from the parent's perspective. This knowledge is important to provide optimal home-based PPC. Objectives To explore parents' experiences of PPC within the community healthcare system. Design Qualitative study with an interpretive descriptive design. Methods In all, 11 parents of children with different life-limiting illnesses were interviewed after the child's death using a semi-structured interview guideline. Data were analysed using systematic text condensation. Consolidated criteria for reporting qualitative research (QOREQ) was followed. Results The parents' experiences were captured in five main themes: (i) 'Interaction with hospital and community services', (ii) 'Parents did not always get the help they needed', (iii) 'The child's needs became increasingly complex', (iv) 'When the end came' and (v) 'The parents asked for an ordinary life in an unordinary situation'. Each main theme was further elaborated by two subthemes. Conclusion Overall, the parents experienced PPC in the community as limited and fragile, and as lacking flexibility, coordination and professional competence related to the children's complex needs. There appears to be potential for improvement in PPC through improved care coordination between the hospital and the community healthcare services, involving the community healthcare system at an early timepoint in the illness trajectory, including a family focus, and providing accessibility, flexibility and care coordination of community services. Registration and reporting guidelines The study is registered in the institutional system for research project (RETTE; ID number F2082).
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Affiliation(s)
- Stine Andreassen Rud
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Eirin Skagestad
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - May Aasebø Hauken
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen. Møllendalsbakken 9, Postbox 7807, Bergen, 5020, Norway
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Hammer NM, Bidstrup PE, Brok J, Devantier M, Sjøgren P, Schmiegelow K, Larsen A, Kurita GP, Olsen M, Larsen HB. Home-Based Specialized Pediatric Palliative Care: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2023; 65:e353-e368. [PMID: 36621694 DOI: 10.1016/j.jpainsymman.2022.12.139] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 12/17/2022] [Indexed: 01/07/2023]
Abstract
CONTEXT Although specialized pediatric palliative care (SPPC) teams increasingly provide home-based care, the evidence of its impact has not yet been systematically evaluated. OBJECTIVES To examine the impact of home-based SPPC in children and adolescents with life-limiting conditions, regarding place of death, quality of life and symptom burden. METHODS We searched Medline, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus for studies comparing children and adolescents with life-limiting conditions receiving home-based SPPC with children and adolescents not receiving home-based SPPC, or studies reporting before-and-after measurements. We included studies that reported on place of death, quality of life and/or symptoms. Two authors independently screened the articles, extracted data, and assessed quality. Results were synthesized as a systematic narrative synthesis and meta-analysis, using a random-effects model. RESULTS We included five studies, which reported on 392 children and adolescents. Meta-analysis showed that receiving home-based SPPC was associated with a more than fourfold increased likelihood of home death (risk ratio 4.64, 95% confidence interval 3.06-7.04; 3 studies; n=296). Most studies reported improved quality of life and reduced symptom burden. The included studies were of low to moderate quality with a high risk of bias. CONCLUSION This systematic review suggests that home-based SPPC is associated with increased likelihood of home death, and might be associated with improved quality of life and reduced symptom burden. The small number of studies and an overall high risk of bias, however, makes the overall strength of evidence low.
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Affiliation(s)
- Nanna Maria Hammer
- Copenhagen Palliative Team for Children and Adolescents, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., M.O.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., K.S., M.O., H.B.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences (N.M.H., M.D., K.S., G.P.K., H.B.L.), University of Copenhagen, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological aspects of Cancer, Danish Cancer Society Research Center (P.E.B.), Copenhagen, Denmark; Institute of Psychology (P.E.B.), University of Copenhagen, Copenhagen, Denmark
| | - Jesper Brok
- Department of Paediatric Oncology and Haematology, Department of Paediatrics and Adolescent Medicine (J.B.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Minna Devantier
- Copenhagen Palliative Team for Children and Adolescents, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., M.O.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., K.S., M.O., H.B.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences (N.M.H., M.D., K.S., G.P.K., H.B.L.), University of Copenhagen, Copenhagen, Denmark
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology (P.S., G.P.K.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., K.S., M.O., H.B.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences (N.M.H., M.D., K.S., G.P.K., H.B.L.), University of Copenhagen, Copenhagen, Denmark
| | - Anders Larsen
- The University Hospitals' Centre for Health Research (A.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Geana Paula Kurita
- Department of Clinical Medicine, Faculty of Health and Medical Sciences (N.M.H., M.D., K.S., G.P.K., H.B.L.), University of Copenhagen, Copenhagen, Denmark; Section of Palliative Medicine, Department of Oncology (P.S., G.P.K.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Multidisciplinary Pain Centre, Department of Anaesthesiology, Pain and Respiratory Support (G.P.K.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marianne Olsen
- Copenhagen Palliative Team for Children and Adolescents, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., M.O.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., K.S., M.O., H.B.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Pediatrics and Adolescent Medicine (M.O.), Section of Pediatric Hematology and Oncology, Aalborg University Hospital, Aalborg, Denmark.
| | - Hanne Bækgaard Larsen
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine (N.M.H., M.D., K.S., M.O., H.B.L.), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences (N.M.H., M.D., K.S., G.P.K., H.B.L.), University of Copenhagen, Copenhagen, Denmark
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Barrett L, Fraser L, Noyes J, Taylor J, Hackett J. Understanding parent experiences of end-of-life care for children: A systematic review and qualitative evidence synthesis. Palliat Med 2023; 37:178-202. [PMID: 36546591 PMCID: PMC9896294 DOI: 10.1177/02692163221144084] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND An estimated 21 million children worldwide would benefit from palliative care input and over 7 million die each year. For parents of these children this is an intensely emotional and painful time through which they will need support. There is a lack of synthesised research about how parents experience the care delivered to their child at the end of life. AIM To systematically identify and synthesise qualitative research on parents' experiences of end-of-life care of their child. DESIGN A qualitative evidence synthesis was conducted. The review protocol was registered in PROSPERO (CRD42021242946). DATA SOURCES MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science databases were searched for qualitative studies published post-2000 to April 2020. Studies were appraised for methodological quality and data richness. Confidence in findings was assessed by GRADE-CERQual. RESULTS About 95 studies met the eligibility criteria. A purposive sample of 25 studies was taken, of good-quality papers with rich data describing the experience of over 470 parents. There were two overarching themes: parents of children receiving end-of-life care experienced a profound need to fulfil the parental role; and care of the parent. Subthemes included establishing their role, maintaining identity, ultimate responsibility, reconstructing the parental role, and continuing parenting after death. CONCLUSIONS Services delivering end-of-life care for children need to recognise the importance for parents of being able to fulfil their parental role and consider how they enable this. What the parental role consists of, and how it's expressed, differs for individuals. Guidance should acknowledge the need to enable parents to parent at their child's end of life.
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Affiliation(s)
- Laura Barrett
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Lorna Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Jane Noyes
- School of Social Science, Bangor University, Wales, UK
| | - Jo Taylor
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Julia Hackett
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
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Grier K, Koch A, Docherty S. Pediatric Goals of Care Communication: A Socioecological Model to Guide Conversations. J Hosp Palliat Nurs 2023; 25:E24-E30. [PMID: 36622315 DOI: 10.1097/njh.0000000000000923] [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: 01/10/2023]
Abstract
The purpose of this article is to explore factors that influence pediatric patients and their parents during provider-led goals-of-care conversations. Our framework can help providers enhance holistic communication by approaching difficult topics (ie, quality of life, end of life) with an understanding of the multilayered external influences that affect patient/parent decision making. A 5-layer model is presented that describes facilitators to conversations about quality goals of care and advance directives. Each year, complex health conditions (a) affect approximately 500 000 children in the United States, 8600 of whom meet current palliative care criteria, and (b) account for over 7 million child deaths globally. Nurses can use knowledge of the unique values and culture of families with children who have complex health conditions to support them by providing high quality, ongoing goals-of-care conversations, especially if their access to pediatric palliative care is limited.
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Chelazzi C, Villa G, Lanini I, Romagnoli S, Latronico N. The adult and pediatric palliative care: differences and shared issues. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2023; 3:1. [PMID: 37386675 DOI: 10.1186/s44158-023-00085-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/05/2023] [Indexed: 07/01/2023]
Abstract
Adult and pediatric palliative care (PC) share common aims and ethical principles but differ in many organizational and practical aspects. The aim of this narrative review is to analyze these differences and focus on which key aspects of pediatric palliative care could integrate adult services for a better care of suffering patients.Interventions which are peculiar of pediatric PC respect to adult PC include: an earlier referral to the PC service to identify the needs and plan the interventions at an earlier stage of the disease; consequently, a more systematic cooperation with the disease-specific physicians to reduce the burden of treatments; a better integration with the community and the social surroundings of the patients, to prevent social isolation and preserve their social role; a more dynamic organization of the PC services, to give patients the chance of being stabilized at in-hospital or residential settings and subsequently discharged and cared at home whenever possible and desired; the implementation of respite care for adults, to help the families coping with the burden of the disease of their beloved and promote the home-based PC.This review underlines the relevance of some key-aspects of pediatric PC that can be beneficial also within PC of adults. Its findings give the chance for a more dynamic and modern organization of adult PC services and may serve as a basis of future research for new interventions.
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Affiliation(s)
- Cosimo Chelazzi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
- Unit of Palliative Care and Integrated Home Service, Spedali Civili University Hospital, Brescia, Italy.
| | - Gianluca Villa
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Stefano Romagnoli
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
- "Alessandra BONO" University Research Center On LOng Term Outcome (LOTO) in Survivors of Critical Illness, University of Brescia, Brescia, Italy
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26
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Hammer NM, Hansson H, Pedersen LH, Abitz M, Sjøgren P, Schmiegelow K, Bidstrup PE, Larsen HB, Olsen M. Intersectoral collaboration in home-based end-of-life pediatric cancer care: A qualitative multiple-case study integrating families' and professionals' experiences. Palliat Med 2023; 37:149-162. [PMID: 36397271 DOI: 10.1177/02692163221135350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Many children and adolescents with incurable cancer and their families prefer to receive end-of-life care and to die at home. This implies a transition of care from hospital to home and presupposes the establishment of a well-functioning collaboration between the family and professionals across health care sectors. AIM To identify and explore key elements of home-based end-of-life care collaboration for children with cancer, as experienced by their parents and grandparents and the hospital- and community-based professionals involved. DESIGN Descriptive qualitative multiple-case study. Data were collected by semi-structured interviews and written responses to open-ended questions, and analyzed inductively across cases using qualitative content analysis. SETTING/PARTICIPANTS Cases comprised a criterion sample of five children (aged <18 years), who died of cancer at home. Cases were represented by the children's bereaved parents (n = 8) and grandparents (n = 7), and community-based professionals (n = 16). Also, hospital-based professionals (n = 10) were interviewed about the children's end-of-life care through group interviews. RESULTS We identified five main themes, describing key elements of the end-of-life collaboration: Establishing the collaboration, Bolstering family life, Elucidating organization and integration, Managing challenges, and Closing the collaboration. These themes all came under the overarching theme: A mutual trust-based collaboration. On this basis, we developed the "Home-Based Pediatric End-of-Life Care Model for Children with Cancer." CONCLUSIONS By highlighting key elements in the family-centered, intersectoral and interprofessional end-of-life care collaboration, our "Home-Based Pediatric End-of-Life Care Model for Children with Cancer" offers a framework for further optimization of home-based end-of-life care services for children with cancer and their families.
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Affiliation(s)
- Nanna Maria Hammer
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helena Hansson
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Line Hjøllund Pedersen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maja Abitz
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Olsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Pediatrics and Adolescent Medicine, Section of Pediatric Hematology and Oncology, Aalborg University Hospital, Aalborg, Denmark
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Karakul A, Kıratlı D, Ardahan Akgül E, Çelik T. The experiences of parents of children in pediatric palliative care: A qualitative study. J Pediatr Nurs 2022; 67:107-115. [PMID: 36087413 DOI: 10.1016/j.pedn.2022.08.015] [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: 05/04/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aims to better understand the experiences of mothers of children receiving pediatric palliative care. DESIGN AND METHODS The qualitative phenomenological method was used to determine the mothers' experiences. The study sample included 15 mothers. Individual interviews, an introductory information form and a semi-structured interview form were used for data collection. The data were analyzed with Colaizzi's seven-step method. MAXQDA was used for coding and creating themes. RESULTS Three main themes of the interviews emerged; family experiences, social life and care in the palliative care unit. The mothers said that family relationships were affected, that they experience fear of loss, that they experience depression, that all responsibility for treatment and care lies with the mothers, and that there is no social support. Mothers said that they are in the same place as mothers of children in similar situations and that they are happy and comfortable because they have single rooms. In addition, the mothers stated that they are very afraid of the COVID-19 virus infecting their children and therefore losing their children. CONCLUSIONS The mothers experienced some problems such as fear of loss, depression, care burden, social support, exclusion, daily life, social relationships, feeling safe, and emotional effect. PRACTICE IMPLICATIONS Pediatric nurses need to understand mothers' anxiety, grief, relationships with their children, and coping strategies to provide support.
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Affiliation(s)
- Atiye Karakul
- Tarsus University, Faculty of Health Sciences, Department of Nursing, Turkey.
| | - Didem Kıratlı
- University of Health Sciences Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Turkey
| | - Esra Ardahan Akgül
- İzmir Kâtip Çelebi University, Faculty of Health Sciences, Department of Pediatric Nursing, Turkey
| | - Tanju Çelik
- University of Health Sciences Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Turkey
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28
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Riiser K, Holmen H, Winger A, Steindal SA, Castor C, Kvarme LG, Lee A, Lorentsen VB, Misvaer N, Früh EA. Stories of paediatric palliative care: a qualitative study exploring health care professionals' understanding of the concept. BMC Palliat Care 2022; 21:187. [PMID: 36273144 PMCID: PMC9587603 DOI: 10.1186/s12904-022-01077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background By sharing patient stories, health care professionals (HCPs) may communicate their attitudes, values and beliefs about caring and treatment. Previous qualitative research has shown that HCPs usually associate paediatric palliative care (PPC) with death or dying and that they find the concept challenging to understand and difficult to implement. Attending to HCPs’ stories may provide a richer account of their understanding of PPC. Thus, the aim of this study was to explore PPC stories narrated by HCPs to gain increased insight into their understanding of what PPC entails. Methods This qualitative study collected data from four focus group interviews with 21 HCPs from different units in two Norwegian hospitals. Stories told by the HCPs to illustrate their comprehension of PPC were analysed following thematic analysis procedures. Results Four themes were identified illustrating what PPC meant to the participants: creating spaces for normality, providing tailored support for the family, careful preparations for saying goodbye and experiencing dilemmas and distress. The stories centred on family care, particularly relating to dramatic or affective situations when the death of a child was imminent. Conclusion The stories reflect how the HCPs view PPC as a specific field of health care that requires particular professional sensitivity, including good communication, collaboration and planning. Thus, the HCPs in this study demonstrated knowledge about the core qualities needed to succeed in PPC. However, similar to previous research, the stories illustrate that how HCPs speak about PPC is strongly associated with end-of-life care, and by that the HCPs do not capture the breadth of the PPC concept. The findings highlight the importance of increasing knowledge about the meaning and content of PPC among HCPs in order to maintain quality of life for all children with life-limiting or life-threatening conditions throughout their illness trajectory.
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Affiliation(s)
- Kirsti Riiser
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway.
| | - Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggt. 15b, NO-0456, Oslo, Norway
| | - Charlotte Castor
- Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 00, Lund, Box 157, Sweden
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Anja Lee
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, NO-0424, Ullevål, Nydalen, Oslo, PO Box 4950, Norway
| | - Vibeke Bruun Lorentsen
- Department of Nursing, Faculty of Health Studies, VID Specialized University, NO-0319, Vinderen, Oslo, PO Box 184, Norway
| | - Nina Misvaer
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
| | - Elena Albertini Früh
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, NO-0130, Oslo, PO Box 4, Norway
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29
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Wager J, Kubek LA, Brenner M, Calmanti S, Doyle C, Lövgren M, Kreicbergs U, Kremer L, Le Moine P, Robert G, Schuiling-Otten M, Schröder-Bäck P, Verhagen E, Zernikow B. Expert survey on coverage and characteristics of pediatric palliative care in Europe - a focus on home care. BMC Palliat Care 2022; 21:185. [PMID: 36244981 PMCID: PMC9575204 DOI: 10.1186/s12904-022-01078-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background For children with life-limiting conditions home care is a key component of pediatric palliative care. However, poor information is available on service coverage and in particular on country-specific pediatric palliative home care characteristics. The aim of the study was therefore to describe the association between pediatric palliative care coverage and national activities and obtain detailed information on the pediatric palliative home care structure in different European countries. Methods Online survey with in-country experts from N = 33 European countries. Results Pediatric palliative home care (65.6%) represented the most pediatric palliative care units (15.6%) and the least common services. National documents constituted the most widespread national pediatric palliative care activity (59.4%) and were associated with available services. Pediatric palliative home care could be mostly accessed as a service free of charge to families (95.2%) from the time of a child's diagnosis (85.7%). In most countries, oncological and non-oncological patients were cared for in pediatric palliative home care. Only a minority of home care teams covered home-ventilated children. Pediatric palliative home care usually comprised medical care (81.0%), care coordination (71.4%), nursing care (75.0%) and social support (57.1%). Most countries had at least two professional groups working in home care teams (81.0%), mostly physicians and nurses. In many countries, pediatric palliative home care was not available in all regions and did not offer a 24 h-outreach service. Conclusions Pediatric palliative care provision in Europe is heterogeneous. Further work on country-specific structures is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01078-0.
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Affiliation(s)
- Julia Wager
- PedScience Research Institute, Herdieckstraße 5b, 45711, Datteln, Germany.,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Larissa Alice Kubek
- PedScience Research Institute, Herdieckstraße 5b, 45711, Datteln, Germany. .,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems, University College, Dublin, Ireland
| | - Sara Calmanti
- Accompagnement Et Information (CREAI) en Faveur Des Populations Vulnérables, Centre Régional d'Etudes, Bretagne, France
| | - Carmel Doyle
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | | | | | - Leontien Kremer
- Princess Máxima Center for Pediatric Oncology, 3584 CS, Utrecht, The Netherlands
| | - Philippe Le Moine
- Equipe Ressource Régionale de Soins Palliatifs Pédiatriques La BRISE, Bretagne, France
| | - Guillaume Robert
- Equipe Ressource Régionale de Soins Palliatifs Pédiatriques La BRISE, Bretagne, France
| | | | - Peter Schröder-Bäck
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Eduard Verhagen
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boris Zernikow
- PedScience Research Institute, Herdieckstraße 5b, 45711, Datteln, Germany.,Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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30
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Donovan LA, Slater PJ, Delaney AM, Baggio SJ, Herbert AR. Building capability in paediatric palliative care and enhancing education through the voice of parents: the Quality of Care Collaborative Australia. Palliat Care Soc Pract 2022; 16:26323524221128835. [PMID: 36225949 PMCID: PMC9549082 DOI: 10.1177/26323524221128835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The greater proportion of children with a life-limiting condition (LLC) and
their families want to remain at home as much as possible. Building
capability in paediatric palliative care (PPC) for generalist health and
social care professionals in nonmetropolitan regions through the Quality of
Care Collaborative Australia (QuoCCA) has improved access to palliative care
for families, regardless of where they live. Aim: To understand the experience of families whose child has received specialist
PPC, to ensure future service capability development is informed by lived
experience. Design: A retrospective, descriptive study in which parents participated in a
semi-structured telephone interview guided by Discovery Interview
methodology. Inductive thematic analysis identified the major learnings from
participants. Participants: Parents caring for a child referred to the specialist PPC service, who
received a pop-up visit and whose child is stable or who are more than 6
months bereaved. Results: Eleven parents (n = 9 mothers; n = 2
fathers) of children with an LLC (n = 5) or whose child had
died (n = 6) participated in an interview. The overarching
themes and subthemes were as follows: (1) burden of suffering, in which
parents described grieving for the life once anticipated, confronting many
life transitions and seeking quality of life for their child and (2)
umbrella of support, in which parents built partnerships with professional
support, activated a network of care around their family and sought
responses to their whole family’s needs. Conclusion: Parents caring for a child with an LLC described significant personal,
familial, social and existential adjustments. This study integrates a
relational learning approach with QuoCCA education grounded in the
relationships between children, families and professionals. Learning from
lived experience in PPC education enhances the preparedness of generalist
health and social care professionals to join a child and their family
throughout their various life transitions and facilitates the goal to remain
at home within their community for as long as possible. Education in PPC is
an imperative component of service models, enabling regional services to
gain confidence and capability in the context of a dying child and their
family, empowered and informed through the voice of the family. Plain Language Summary Enhancing palliative care for children through education informed by
the experience of families It is often the wish of many children/young people with a life-limiting
condition to stay at home with their families as much as possible. It is
important that specialist palliative care services provide training and
mentoring to the family’s local care professionals to support the delivery
of good care, particularly those in rural and remote areas. This article aims to integrate the lived experience of families with
palliative care education, so that the education reflects and addresses the
needs that they express. Parents were interviewed by telephone using a method called Discovery
Interviews. This is an open interview process, guided by a spine that
describes the main points of palliative care. Parents can openly talk about
their experience, focusing on the areas that are important to them.
Interviews were studied by four researchers, and emerging themes were
discussed and summarised. The study included parents whose child/young person was receiving support
from specialist palliative care and bereaved parents whose child had died
more than 6 months ago. In total, eleven parents (nine mothers and two
fathers) were interviewed, five participants had children currently
receiving palliative care and six were bereaved. The overarching themes were as follows: Burden of suffering, in which parents described grieving for the life they
had expected, confronting transitions and seeking good quality of life for
their child. Umbrella of support, in which parents built partnerships with care teams and
activated a network of care to address the needs of their whole family. This study allowed the families’ perspectives to be integrated into the
palliative care education of care professionals in the family’s local area.
The lived experience of families prepared care professionals to support
families with the care of their child/young person, allowing them to remain
at home as long as possible.
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Affiliation(s)
- Leigh A. Donovan
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane, QLD,
AustraliaCollaboraide Consultancy, Minjerribah, QLD, Australia
| | | | - Angela M. Delaney
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane, QLD,
Australia
| | - Sarah J. Baggio
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane, QLD,
Australia
| | - Anthony R. Herbert
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane,
Queensland, AustraliaCentre for Children’s Health Research, Queensland
University of Technology, Brisbane, QLD, Australia
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Bingöl H, Aydın A, Kebudi R, Umaç EH, Koç B, Yıldırım ÜM, Zülfikar B. Desires vs. conditions: A qualitative study exploring the factors affecting the place of death of child with cancer in Turkey. Eur J Cancer Care (Engl) 2022; 31:e13703. [PMID: 36131608 DOI: 10.1111/ecc.13703] [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: 03/12/2022] [Revised: 07/15/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to describe factors affecting the place of death of children with cancer at the end of life. METHODS The descriptive phenomenological approach was used. Eighteen mothers who lost their children to cancer participated in in-depth interviews. Data were analysed using MAXQDA software version. Codes and categories were developed inductively from participants' narratives. RESULTS The factors affecting the place of death of children were categorised into two main themes: (1) desires and (2) conditions. Most of the mothers reported that their deceased children wanted to be with their families at the end of life and they wanted to go home. The conditions related to health services were defined as the barriers to the death of their children in the places of death preferred by the mothers. CONCLUSION The desire to be close to the child was the main factor affecting the parents' decisions. The findings revealed the prevailing circumstances in the death place decision beyond parental desires. These were the child's health conditions, physical conditions of hospitals, and the lack of home care and paediatric palliative care services, which were factors related to the system, and the lack of other options for parents.
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Affiliation(s)
- Hülya Bingöl
- Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Ayfer Aydın
- School of Nursing, Istanbul University, Istanbul, Turkey
| | - Rejin Kebudi
- Division of Pediatric Hematology-Oncology & Department of Preventive Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | | | - Başak Koç
- Oncology Institute, Istanbul University, Istanbul, Turkey
| | | | - Bülent Zülfikar
- Division of Pediatric Hematology-Oncology & Department of Preventive Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
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32
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Ferragamo T, Pituch KJ, Sorkin T, Simon N, Lindley LC, Weaver MS. A Narrative Review of Pediatric Respite Care Initiatives in the United States. J Hosp Palliat Nurs 2022; 24:E172-E182. [PMID: 35470307 DOI: 10.1097/njh.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Families of children receiving palliative care depict lack of respite services as a top unmet need. Although the benefits of access to respite services are notable, little is known on a state-by-state basis about respite provision or funding. The study objective was to conduct a national evaluation of pediatric respite care programs to identify and describe how states provide and fund respite care for children. The study approach adhered to the Scale for the Assessment of Narrative Review Articles quality standards using multiple data sources including engagement with the existing literature, content analyses of public-facing websites, and conversations with 40 stakeholders from 15 states. States offered respite services in a variety of ways: Medicaid waivers used to fund respite care, state-funded programs that provide respite, and philanthropy-based respite facilities. This narrative review revealed the creativity involved in different settings to improve respite access, staffing, and reimbursement. Suggestions to address the unmet respite needs of families included establishing a respite home, improving Medicaid reimbursement, expanding Medicaid waiver eligibility, providing a respite benefit through Medicaid, implementing nursing workforce initiatives, and centralizing staffing databases.
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Effendy C, Uligraff DK, Sari SH, Angraini F, Chandra L. Experiences of family caregivers of children with cancer while receiving home-based pediatric palliative care in Indonesia: a qualitative study. BMC Palliat Care 2022; 21:104. [PMID: 35668398 PMCID: PMC9171947 DOI: 10.1186/s12904-022-00986-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for children living with life-threatening and life-limiting illnesses can be challenging. Parents' roles as the main caregivers can be complex with extensive responsibilities. The experiences of family caregivers can provide key insights into the provision of home-based Pediatric Palliative Care (PPC) for seriously ill children. This study is aimed at exploring the experiences of family caregivers of children diagnosed with cancer while receiving home-based PPC. METHODS This was a qualitative study. This study used semi-structured interviews which were audio-recorded with family caregivers of twelve children diagnosed with cancer who had received home-based PPC. The interviews were transcribed verbatim. The data were analyzed using qualitative content analysis. The reporting of the study was based on the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS Three main themes emerged: (1) The implementation of home-based PPC; (2) The benefits of home-based PPC; and (3) The family caregivers' hopes of the home-based PPC service and their impressions of home-based PPC. The implementation of home-based PPC described the experiences of family caregivers in receiving home-based PPC provided by nurses with particular attention to the bio-psychosocial-spiritual aspects. Family caregivers experienced several benefits from the home-based PCC service, where holistic care was provided for both the patient and the family. Family caregivers shared their hopes prior to receiving support from competent health care professionals to care for their sick child at home and improve the child's quality of life. They confirmed that these hopes were fulfilled through the home-based PPC service delivered by Rachel House. CONCLUSIONS Home-based PPC provides several benefits with a positive impact for both the children diagnosed with cancer as well as their families. Nurses involved in the home-based PPC service provide holistic care with a family-centered approach. We believe that children with terminal illnesses and their families need and deserve home-based PPC during difficult times.
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Affiliation(s)
- Christantie Effendy
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas, Gadjah Mada, Yogyakarta, Indonesia.
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Papworth A, Hackett J, Beresford B, Murtagh F, Weatherly H, Hinde S, Bedendo A, Walker G, Noyes J, Oddie S, Vasudevan C, Feltbower R, Phillips B, Hain R, Subramanian G, Haynes A, Fraser LK. End of life care for infants, children and young people (ENHANCE): Protocol for a mixed methods evaluation of current practice in the United Kingdom [version 1; peer review: 2 approved]. NIHR OPEN RESEARCH 2022; 2:37. [PMID: 35935675 PMCID: PMC7613236 DOI: 10.3310/nihropenres.13273.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/22/2022]
Abstract
Background Although child mortality has decreased over the last few decades, around 4,500 infants and children die in the UK every year, many of whom require palliative care. There is, however, little evidence on paediatric end-of-life care services. The current National Institute for Health and Care Excellence (NICE) guidance provides recommendations about what should be offered, but these are based on low quality evidence. The ENHANCE study aims to identify and investigate the different models of existing end-of-life care provision for infants, children, and young people in the UK, including an assessment of the outcomes and experiences for children and parents, and the cost implications to families and healthcare providers. Methods This mixed methods study will use three linked workstreams and a cross-cutting health economics theme to examine end-of-life care models in three exemplar clinical settings: infant, children and young adult cancer services (PTCs), paediatric intensive care units (PICUs), and neonatal units (NNUs).Workstream 1 (WS1) will survey current practice in each setting and will result in an outline of the different models of care used. WS2 is a qualitative comparison of the experiences of staff, parents and patients across the different models identified. WS3 is a quantitative assessment of the outcomes, resource use and costs across the different models identified. Discussion Results from this study will contribute to an understanding of how end-of-life care can provide the greatest benefit for children at the end of their lives. It will also allow us to understand the likely benefits of additional funding in end-of-life care in terms of patient outcomes.
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Affiliation(s)
- Andrew Papworth
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Julia Hackett
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Bryony Beresford
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
- Social Policy Research Unit, University of York, Heslington, York, YO10 5DD, UK
| | - Fliss Murtagh
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Helen Weatherly
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Andre Bedendo
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | | | - Jane Noyes
- School of Health Sciences, Bangor University, Fron Heulog, Bangor, LL57 2EF, UK
| | - Sam Oddie
- Bradford Hospitals National Health Service Trust, Bradford, BD9 6RJ, UK
| | | | - Richard Feltbower
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9NL, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, UK, York, YO10 5DD, UK
| | - Richard Hain
- All-Wales Paediatric Palliative Care Network, Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK
- College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
| | - Gayathri Subramanian
- Manchester University National Health Service Foundation Trust, Manchester, M13 9WL, UK
| | - Andrew Haynes
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Lorna K Fraser
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
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Using Communication Tools to Explore Young Siblings’ Experiences of Having a Brother or Sister with Pediatric Palliative Care Needs. CHILDREN 2022; 9:children9050641. [PMID: 35626818 PMCID: PMC9139212 DOI: 10.3390/children9050641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
Siblings of children with palliative care needs often suffer feelings of being neglected, and their needs for information and involvement are frequently unmet. This study aims to explore the experiences and feelings of siblings of children with palliative care needs, and to determine what is important to them. Nine siblings, aged 6–14 years, were interviewed using four different communication tools: See-Hear-Do pictures, including the empty body as a separate element, Bear cards, and words originating from previous sibling research. Data were analyzed using conventional content analysis. Five categories emerged concerning aspects that the siblings described about their situation and things that they found important: being part of a special family; school—a place for leisure, friends, and learning; relentless feelings of guilt and self-blame; losses and separations; and awareness of death—not if, but when. Siblings of children with rare diseases expressed an awareness that their brother or sister would die, although still felt they were part of a special, happy family. Siblings of children with palliative care needs due to an accident described relentless feelings of self-blame and guilt. The needs of siblings may vary depending on the condition that resulted in the ill sibling’s palliative care needs.
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Winger A, Früh EA, Holmen H, Kvarme LG, Lee A, Lorentsen VB, Misvær N, Riiser K, Steindal SA. Making room for life and death at the same time - a qualitative study of health and social care professionals' understanding and use of the concept of paediatric palliative care. BMC Palliat Care 2022; 21:50. [PMID: 35410275 PMCID: PMC9004044 DOI: 10.1186/s12904-022-00933-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept of pediatric palliative care (PPC) is applied differently within the healthcare system and among healthcare professionals (HCPs). To our knowledge, no studies have investigated how multidisciplinary HCPs understand the concept of PPC and the aim of this study was to explore the concept of PPC from the view of HCP in a paediatric setting. METHODS We employed an explorative and descriptive design and conducted four focus groups with a total of 21 HCPs working in hospitals with children in palliative care. The data were analysed using qualitative content analysis. RESULTS The data analysis of the concept of pediatric palliative care resulted in two themes. The first theme "A frightening concept that evokes negative emotions," contains categories to explore the meaning, named "An unfamiliar and not meaningful concept, "A concept still associated with death and dying" and "Healthcare professionals' responsibility for introducing and using the concept and, to obtain a common meaning." The second theme was named "A broad and complementary concept," containing the categories "Total care for the child and the family," "Making room for life and death at the same time" and "The meaning of alleviation and palliative care." CONCLUSIONS The included HCPs reflected differently around PPC but most of them highlighted quality of life, total care for the child and the child's family and interdisciplinary collaboration as core elements. Attention to and knowledge among HCPs might change the perception about PPC from a frightening concept to one that is accepted by all parties, implemented in practice and used as intended. However, our study reveals that there is still some work to do before PPC is understood and accepted by all those involved.
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Affiliation(s)
- Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway.
| | - Elena Albertini Früh
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Anja Lee
- Oslo University Hospital, Oslo, Norway
| | | | - Nina Misvær
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Kirsti Riiser
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway
| | - Simen A Steindal
- VID Specialized University, Oslo, Norway.,Lovisenberg Diaconal University College, Oslo, Norway
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Malcolm C, Knighting K. A realist evaluation of a home-based end of life care service for children and families: what works, for whom, how, in what circumstances and why? BMC Palliat Care 2022; 21:31. [PMID: 35255888 PMCID: PMC8902768 DOI: 10.1186/s12904-022-00921-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Children’s palliative and end of life care is underpinned internationally by a commitment to provide care and support in the family’s preferred place, which may include home, hospital or hospice. Limited evidence on models of best practice for the provision of children’s end of life care at home is available. This realist evaluation of a novel, home-based end of life care service explored what works for whom, how, in what circumstances and why. Methods Adopting principles of realist evaluation, an initial programme theory (IPT) was developed from multiple data sources including a scoping review, service documentation review, audit of service data, and qualitative data gathered from stakeholder (n = 6) and family interviews (n = 10). Three families who had used the service were identified as case studies and interviews with professionals involved in their care (n = 20) were conducted to test the IPT. The findings informed the revised CMOs illustrating the contexts and mechanisms which underpin how and why the service works and for whom. Results CMO configurations were identified explaining how and why the service works for families across five core components: anticipatory approach to care planning and delivery, advance care planning, service responsiveness and flexibility, 24/7 nurse-led service with 24-h medical support, and partnership working. Key mechanisms include establishing trusting relationships, building skills and parent confidence to deliver care, early advance care planning discussions with clear documentation, providing a single point of contact for families, workforce planning and resources to deliver the service as intended, effective communication and leadership within and between providers of the service, and use of joint policies and procedures. Recommendations for future development and expansion of the service are also discussed. Conclusions The findings highlight core components making this service a success and areas of challenge which continue to be addressed as the service develops. With increasing demand for home-based end of life care for children these components provide a structure which can help to guide service development to meet the needs of these families in other regions to ensure that children and families receive good quality care in their place of choice. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00921-8.
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Uber A, Ebelhar JS, Lanzel AF, Roche A, Vidal-Anaya V, Brock KE. Palliative Care in Pediatric Oncology and Hematopoietic Stem Cell Transplantation. Curr Oncol Rep 2022; 24:161-174. [DOI: 10.1007/s11912-021-01174-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
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Leite RC, Ribeiro CA, Cunha MLDR, Maia EBS, Ben LWD, Almeida FDA. Busca de qualidade e segurança no cuidado ao filho: interações familiares com profissionais de Home Care. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo compreender a vivência do cuidador familiar de crianças/adolescentes assistidos pela equipe multiprofissional em Home Care. Método estudo qualitativo, tendo o Interacionismo Simbólico como referencial teórico, realizado com nove famílias de crianças/adolescentes em internação domiciliar, atendidas em uma empresa de Home Care localizada em São Paulo. Os dados foram coletados entre abril e outubro de 2017, por meio de entrevistas semiestruturadas, e submetidos à análise qualitativa de conteúdo convencional. Resultados as subcategorias Vivendo em constante estado de alerta e Dando um passo à frente para garantir um cuidado seguro e qualificado evidenciaram que os familiares ressignificam o cuidado, mostrando-se alertas, no sentido de redirecionar suas ações para prover uma assistência idealizada. Conclusão o Home Care exige dos familiares o enfrentamento de novos desafios e difíceis adaptações, além da preocupação com a segurança e qualidade do atendimento, levando-os a desenvolverem estratégias para lidar com a situação. Implicações para a prática os discursos dos familiares sinalizam a urgência da inserção da temática do cuidado pediátrico em Home Care nas pautas de debates e discussões acadêmicas, e seu desdobramento em investimentos por parte de gestores e serviços de atendimento domiciliar, a fim de garantir uma assistência segura à criança/adolescente e sua família.
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Silva TCD, Nietsche EA, Cogo SB. Palliative care in Primary Health Care: an integrative literature review. Rev Bras Enferm 2021; 75:e20201335. [PMID: 34614078 DOI: 10.1590/0034-7167-2020-1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/28/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES to analyze scientific evidence on the implementation and performance of palliative care in Primary Health Care. METHODS an integrative literature review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, carried out in the PubMed, SciVerse Scopus and LILACS databases, in December 2020, without a time frame. RESULTS 22 original scientific articles were analyzed, 14 classified as evidence level VI. The objective was to understand the experiences and roles of professionals, patients and families on palliative care in Primary Health Care, articles focused on the theme of management and organization of health services and on the importance of educational interventions on the subject. FINAL CONSIDERATIONS evidence found relating palliative care in Primary Health Care points to the possibility of this care; health teams work closely with the family and their home, but the need to expand this theme is still perceived.
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Malcolm C, Knighting K. What does effective end-of-life care at home for children look like? A qualitative interview study exploring the perspectives of bereaved parents. Palliat Med 2021; 35:1602-1611. [PMID: 34109876 DOI: 10.1177/02692163211023300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND End-of-life care for children with life-shortening conditions is provided in a range of settings including hospital, hospice and home. What home-based, end-of-life care should entail or what best practice might look like is not widely reported, particularly from the perspective of parents who experienced the death of a child at home. AIM To explore the value and assess the effectiveness of an innovative model of care providing home-based, end-of-life care as perceived by families who accessed the service. DESIGN A qualitative descriptive study design was employed with in-depth semi-structured interviews conducted with bereaved parents. SETTING/PARTICIPANTS Thirteen bereaved parents of 10 children supported by the home-based end-of-life care service. RESULTS Parents reported effective aspects of end-of-life care provided at home to include: (1) ability to facilitate changes in preferred place of death; (2) trusted relationships with care providers who really know the child and family; (3) provision of child and family-centred care; (4) specialist care and support provided by the service as and when needed; and (5) quality and compassionate death and bereavement care. Parents proposed recommendations for future home-based end-of-life care including shared learning, improving access to home-based care for other families and dispelling hospice myths. CONCLUSION Parents with experience of caring for a dying child at home offer valuable input to future the policy and practice surrounding effective home-based, end-of-life care for children. New models of care or service developments should consider the key components and attributes for effective home-based end-of-life identified by bereaved parents in this study.
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Affiliation(s)
- Cari Malcolm
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - Katherine Knighting
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, England, UK
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Holmen H, Winger A, Steindal SA, Castor C, Kvarme LG, Riiser K, Mariussen KL, Lee A. Patient-reported outcome measures in pediatric palliative care-a protocol for a scoping review. Syst Rev 2021; 10:237. [PMID: 34454605 PMCID: PMC8403431 DOI: 10.1186/s13643-021-01791-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In pediatric palliative care (PPC), there is a need to involve the child's voice in situations regarding their symptoms and care needs. Patient-reported outcome measures (PROMs) can be tools to systematically gather data reported from the child or a proxy if the child is not capable to self-report in order to provide the services they need. There has been a rapid development in PROM research the last decade, and there is a need for an overview of current knowledge and experiences in the field. Thus, we aim to explore and summarize what is known from the published research about PROMs in PPC. METHODS We propose a scoping review following the framework by Arksey and O'Malley and the PRISMA Extension for Scoping Reviews checklist. A systematic search will be performed in the following databases: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), American Psychological Association (APA) PsycInfo, Health and Psychosocial Instruments (HaPI), and Allied and Complementary Medicine Database (AMED). The search will be followed by snowballing to identify key papers and significant researchers for additional citations. Covidence will facilitate the independent review of eligible citations, and data will be extracted and presented descriptively, and thematically analyzed using NVivo. DISCUSSION The scoping review suggested in this protocol will identify PROMs which have been proposed in PPC and clarify the experiences with their use. The findings of this review will be relevant for researchers and healthcare personnel caring for children and adolescents in PPC. In addition, by highlighting knowledge gaps about the use of PROMs in PPC, this review will point out future needs within this field of research, which is crucial for improving quality of care in PPC. SYSTEMATIC REVIEW REGISTRATION: https://osf.io/yfch2/ .
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Affiliation(s)
- Heidi Holmen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Post Box 4, St. Olavs Place, 0130 Oslo, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Post Box 4, St. Olavs Place, 0130 Oslo, Norway
| | - Simen A. Steindal
- Lovisenberg Diaconal University College, Lovisenberggt, 15b, 0456 Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Charlotte Castor
- Department of Health Sciences, Lund University, Box 157, 221 00 Lund, Sweden
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Post Box 4, St. Olavs Place, 0130 Oslo, Norway
| | - Kirsti Riiser
- Department of Physiotherapy, Oslo Metropolitan University, Post Box 4, St. Olavs Place, 0130 Oslo, Norway
| | - Kari L. Mariussen
- Lovisenberg Diaconal University College, Lovisenberggt, 15b, 0456 Oslo, Norway
| | - Anja Lee
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital HF, Box 4950, Nydalen, 0424 Oslo, Norway
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Fernández J, Roje D, Rossell N, Zubieta M. Public-private collaboration in the provision of palliative care for children and adolescents with cancer: A Chilean experience. Cancer Rep (Hoboken) 2021; 5:e1449. [PMID: 34050724 PMCID: PMC9199500 DOI: 10.1002/cnr2.1449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/10/2021] [Accepted: 05/12/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In Chile, children and adolescents with cancer in need of palliative care receive services through a collaborative scheme run in coordination between the hospitals of the public health system that attend children with cancer and the non-profit civil society organization Fundación Nuestros Hijos (FNH). AIM The main objective of this article is to offer a summary of the Chilean experience in the provision of palliative care services for children and adolescents with cancer, as an example of a public-private partnership that improves the quality of life and the end-of-life experience for the children, adolescents, and their families. METHODS AND RESULTS The palliative care program works with the children and their families as main members of the team, providing medical services for pain and symptom alleviation, psycho-social support, rehabilitation for the improvement of quality of life, and aid to secure the best physical conditions for the child at home or in temporary housing for the whole family. CONCLUSION The private-public collaboration between the Chilean health system and the FNH is a successful model to help families suffering the devastating loss of a child.
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Affiliation(s)
| | - Dunja Roje
- Fundación Nuestros Hijos, Santiago, Chile
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