Pediatric oncology: the use of cluster analysis to examine maternal concerns

Parental Uncertainty: Parents' Perceptions of Health-Related Quality of Life in Newly Diagnosed Children With Cancer

BACKGROUND

Parents of children with cancer are predisposed to psychological distress symptoms, such as anxiety, depression, and uncertainty. This vulnerability may exacerbate underlying mood disturbances, including trait anxiety and depression, and influence parents' perception of health-related quality of life (HRQOL) in their children.

OBJECTIVES

This study examined the relationship between parental uncertainty and parent proxy reports of HRQOL in newly diagnosed children with cancer.

METHODS

A longitudinal descriptive approach was used to examine the relationship between parental uncertainty and parent proxy reports of HRQOL in 55 parent-child dyads. Parental trait anxiety, depression, and perceived social support were evaluated as potential predictor variables.

FINDINGS

Parents of newly diagnosed children with cancer reported lower parent proxy HRQOL scores. Parental uncertainty was prevalent and affected parents' perceptions of HRQOL three months following diagnosis; however, higher social support scores buffered these negative effects.

Factors That Influence Parental Uncertainty and Health-Related Quality of Life in Children With Cancer: A Framework

The purpose of this paper is to present a conceptual-theoretical-empirical model addressing factors that influence the relation between parental uncertainty and health-related quality of life in children with cancer. The basic concepts identified and defined in the model include parental uncertainty, health-related quality of life, parental trait anxiety, parental depression, and perceived parental social support. The proposed relationships between the concepts are explained with explicit linkages to their empirical indicators. There is limited research in childhood cancer regarding the relation between parental uncertainty and health-related quality of life; therefore, the proposed model will help to better understand this relationship.

Nurse and parent perceptions associated with the Parent Education Discharge Instruction Programme in southern India

Introduction Parents of children with CHD require home care knowledge in order to ensure their child's health and safety, but there has been no research on how to achieve this in a resource-constrained environment. The aim of this investigation was to compare parent and nurse perceptions of parent readiness for discharge after a structured nurse-led parent discharge teaching programme in India. Materials and methods A pre-post design was used to compare parent and nurse perceptions of parental uncertainty and readiness for hospital discharge before and after introduction of the parent education discharge instruction programme in a paediatric cardiac surgery unit.

RESULTS

Parents (n=68) and nurses (n=63) participated in this study. After the discharge programme implementation, parents had less uncertainty (M=93.3 SD=10.7 versus M=83.6 SD=4.9, p=0.001) and ambiguity (M=40.8 SD=6.8 versus M=33.4 SD=3.7, p=0.001) about their child's illness; however, they rated themselves as being less able to cope with the transition to home (M=24.3 SD=4.1 versus 23.1 SD=2.2, p=0.001) and as having less support at home than that required (M=31.5 SD=9.9 versus 30.9 SD=3.2, p=0.001). Parents' and nurses' perception of parental readiness for hospital discharge were more closely aligned after implementation of a nurse-led discharge programme (r=0.81, p=0.001).

CONCLUSION

The results of this study suggest that the discharge programme had positive and negative effects on parental perceptions of uncertainty and readiness for discharge. Further examination is warranted to delineate these influences and to design methods for supporting parents during the transition to home care.

Keeping hope possible: a grounded theory study of the hope experience of parental caregivers who have children in treatment for cancer

BACKGROUND

Hope has been found to support parents as they care for their child with a life-limiting or life-threatening illness. However, very little research focuses on the nursing care of parents of pediatric oncology patients, and therefore, nurses may have difficulty in understanding and supporting parental well-being.

OBJECTIVE

The purpose of this qualitative study was to gain an understanding of the experience of hope for parents who care for their child in treatment for cancer.

METHODS

Using purposive theoretical sampling, 16 parents participated in this study. Thirty-three open-ended, face-to-face interviews were conducted, and 14 parent journals were collected. Analysis of the data was conducted using Charmaz's constructivist grounded theory approach.

RESULTS

A developing, substantive grounded theory was constructed. Parental hope was described as an essential, powerful, deliberate, life-sustaining, dynamic, cyclical process that was anchored in time; was calming and strengthening; and provided inner guidance through the challenging experience of preparing for the worst and hoping for the best. Parents' main concern was "fearing the loss of hope," which was ameliorated by the basic social process of "keeping hope possible" through accepting reality, establishing control, restructuring hope, and purposive positive thinking.

CONCLUSIONS

Parents journeyed through numerous transitions related to the treatment of cancer that caused feelings of uncertainty, anxiety, stress, and loss of control. Hope was identified as vital to parents.

IMPLICATIONS FOR PRACTICE

To minimize these adverse experiences, nurses can support parents' ability to keep hope possible and thus to optimize their well-being by understanding, assessing, and supporting parental hope.

A systematic review on factors and consequences of parental distress as related to childhood cancer

The literature including correlates of parental distress as related to childhood cancer is abundant. It is important to identify predictive factors and outcomes of this distress in parents. The objective of this review was to update previous syntheses on factors of distress and to identify outcomes of parents' distress in the recent literature (2007-2012). We performed a systematic review to identify all quantitative studies including measures of parental distress and associated factors during the study period. We found 56 eligible studies, of which 43 had a Low risk of bias (Cochrane guidelines). Forty-two reports included potential predictive factors. Significant relationships were found with clinical history of the child, sex of the parent, coping response and personal resources, pre-diagnosis family functioning, but not education/income or marital status. Twenty-five reports studied potential consequences of distress and focused on psychological adjustment in parents and children. Compared to past periods, a higher proportion of studies included fathers. Measures used to evaluate distress were also more homogeneous in certain domains of distress. This review underscores the need for appropriate methods for selecting participants and reporting results in future studies. Appropriate methods should be used to demonstrate causality between factors/consequences and distress.

Meshing Gears

Adolescents with cancer and their parents have to deal with the challenge of returning to their pre-diagnosis social life. The purpose of this study was to describe the subjective lived experiences of Taiwanese mothers and their adolescents who had completed cancer treatment and were returning to school. Eight Taiwanese mother-adolescent dyads were recruited by purposive sampling. Core themes were extracted using phenomenological method and dyadic analysis. Findings were metaphorically captured by the theme “meshing gears.” The mothers and their adolescents were initially like 2 gears spinning alone, side by side due to experiencing different distress related to their social roles. To move toward a normal and healthy life journey, the mothers and their adolescents worked together as a well-tuned machine. This phenomenon is similar to gears meshing without friction to keep moving forward together. Our results suggest that health care professionals should provide follow-up care and interdisciplinary school reentry services to adolescent cancer survivors to improve their quality of life.

Chemotherapy versus supportive care alone in pediatric palliative care for cancer: comparing the preferences of parents and health care professionals

BACKGROUND

The choice between palliative chemotherapy (defined as the use of cytotoxic medications delivered intravenously for the purpose of our study) and supportive care alone is one of the most difficult decisions in pediatric oncology, yet little is known about the preferences of parents and health care professionals. We compared the strength of these preferences by considering children's quality of life and survival time as key attributes. In addition, we identified factors associated with the reported preferences.

METHODS

We included parents of children whose cancer had no reasonable chance of being cured and health care professionals in pediatric oncology as participants in our study. We administered separate interviews to parents and to health care professionals. Visual analogue scales were shown to respondents to illustrate the anticipated level of the child's quality of life, the expected duration of survival and the probability of cure (shown only to health care professionals). Respondents were then asked which treatment option they would favour given these baseline attributes. In addition, respondents reported what factors might affect such a decision and ranked all factors identified in order of importance. The primary measure was the desirability score for supportive care alone relative to palliative chemotherapy, as obtained using the threshold technique.

RESULTS

A total of 77 parents and 128 health care professionals participated in our study. Important factors influencing the decision between therapeutic options were child quality-of-life and survival time among both parents and health care professionals. Hope was particularly important to parents. Parents significantly favoured chemotherapy (42/77, 54.5%) compared with health care professionals (20/128, 15.6%; p < 0.0001). The opinions of the physician and child significantly influenced the parents' desire for supportive care; for health care professionals, the opinions of parents and children were significant factors influencing this decision.

INTERPRETATION

Compared with health care professionals, parents more strongly favour aggressive treatment in the palliative phase and rank hope as a more important factor for making decisions about treatment. Understanding the differences between parents and health care professionals in the relative desirability of supportive care alone may aid in communication and improve end-of-life care for children with cancer.