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Sjuls M, Ludvigsen MS, Robstad N, Fegran L. Fathers' experiences of living with a child with a progressive life-limiting condition without curative treatment options: A qualitative systematic review. J Adv Nurs 2024; 80:1670-1685. [PMID: 37752690 DOI: 10.1111/jan.15884] [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: 04/19/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
AIM To systematically review and synthesize findings across qualitative primary studies about fathers' experiences of living with a child with a progressive life-limiting condition without curative treatment options (C3 conditions). DESIGN Systematic review and metasynthesis. METHODS Sandelowski and Barosso's qualitative research methodology guided this review and metasynthesis. A modification of Ricoeur's interpretation theory, described by Lindseth and Norberg, guided the synthesis of qualitative data. The quality of the studies was evaluated using the Joanna Briggs Institute Checklist for Qualitative Research. DATA SOURCES A systematic literature search was conducted on 6 May 2022 and updated on 19 July 2023 on MEDLINE, CINAHL Plus with Full Text, APA PsycInfo and Scopus. Inclusion criteria were English-written qualitative studies from the year 2000, from which we could extract data on fathers' experiences of living with a child from 0 to 18 years with a progressive life-limiting condition without curative treatment options. RESULTS Seven reports from Western countries contributed to the review. Through structural analysis, we developed the following themes: 'Being shattered in the perception of fatherhood', 'Establishing a new normal' and 'Striving to be acknowledged as a part of the caring team'. CONCLUSION Fathers had to establish a new normal, and they experienced anticipatory mourning, role conflicts and feeling sidelined in healthcare settings when living with a child with a C3 condition. An important issue for further research on paediatric palliative care (PPC) should be to include fathers in the research sample and report separately on fathers' or mothers' experiences instead of parents' experiences. IMPACT The findings will be of interest to healthcare personnel and multidisciplinary teams working within PPC, as they give insight into fathers' experiences and suggest interventions to increase healthcare personnel's involvement with fathers, such as telemedicine. REPORTING METHOD Following EQUATOR guidelines, the study was reported according to the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) framework. PATIENT OR PUBLIC CONTRIBUTION No patient or Public Contribution.
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Affiliation(s)
- Marianne Sjuls
- Faculty of Health and Sport Sciences, Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Mette Spliid Ludvigsen
- Department of Clinical Medicine-Randers Regional Hospital, Aarhus University, Aarhus, Denmark
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Nastasja Robstad
- Faculty of Health and Sport Sciences, Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Liv Fegran
- Faculty of Health and Sport Sciences, Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
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2
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Polakova K, Ahmed F, Vlckova K, Brearley SG. Parents' experiences of being involved in medical decision-making for their child with a life-limiting condition: A systematic review with narrative synthesis. Palliat Med 2024; 38:7-24. [PMID: 38053373 PMCID: PMC10798032 DOI: 10.1177/02692163231214414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Parental involvement in the decision-making processes about medical treatment for children with life-limiting conditions is recognised as good practice. Previous research highlighted factors affecting the decision-making process, but little is known about how parents experience their participation. AIM To explore how parents experience their participation in the process of decision-making about treatment and future care for their children with life-limiting conditions. DESIGN A systematically constructed review using narrative synthesis. The PRISMA guidelines were followed to report the findings. Databases Medline, EMBASE, SCOPUS, CINAHL and PsycINFO were searched up to December 2023. The study protocol was registered at PROSPERO (RN CRD42021215863). RESULTS From the initial 2512 citations identified, 28 papers met the inclusion criteria and were included in the review. A wide range of medical decisions was identified; stopping general or life-sustaining treatment was most frequent. Narrative synthesis revealed six themes: (1) Temporal aspects affecting the experience with decision-making; (2) Losing control of the situation; (3) Transferring the power to decide to doctors; (4) To be a 'good' parent and protect the child; (5) The emotional state of parents and (6) Sources of support to alleviate the parental experience. CONCLUSIONS Parental experiences with decision-making are complex and multifactorial. Parents' ability to effectively participate in the process is limited, as they are not empowered to do so and the circumstances in which the decisions are taking place are challenging. Healthcare professionals need to support parental involvement in an effective way instead of just formally asking them to participate.
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Affiliation(s)
- Kristyna Polakova
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
- Center for Palliative Care, Prague, Czech Republic
| | - Faraz Ahmed
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Sarah G Brearley
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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3
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Rajendran P, Jarasiunaite-Fedosejeva G, İsbir GG, Shorey S. Healthy siblings' perspectives about paediatric palliative care: A qualitative systematic review and meta-synthesis. Palliat Med 2024; 38:25-41. [PMID: 38087809 DOI: 10.1177/02692163231217597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Siblings of children requiring palliative care are often forgotten and overlooked, as the focus tends to be on the ill child and their parents. Limited knowledge of non-bereaved siblings' perspectives makes it challenging to provide appropriate support for them. A review of existing literature is thus needed to better understand the experiences of these siblings and to identify research gaps that may require further examination. AIM To consolidate the available qualitative evidence on the perspectives of non-bereaved healthy siblings regarding paediatric palliative care. DESIGN A qualitative systematic review using a meta-synthesis approach was conducted. DATA SOURCES Six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until October 2022. The search included qualitative and mixed-method studies that reported the perceptions and associations of siblings of patients receiving paediatric palliative care. Data were synthesised using thematic analysis. RESULTS Eleven studies were included. The overarching theme of the review would be 'A walking shadow: Living in the darkness shaped by the dying sibling', and three key themes and nine subthemes were identified from the included articles: (1) Changing family dynamics; (2) Impact on school and socialisation and (3) Psychological impact and coping. CONCLUSION Siblings demonstrated negative psychological impacts and were affected by changing family structure and relationships. However, socialisation with society, and varied coping skills such as cognitive coping and using distraction techniques, were significant for siblings to go through this journey and even led to some positive outcomes for them.
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Affiliation(s)
- Priyadharshni Rajendran
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Gözde Gökçe İsbir
- Midwifery Department, School of Health, Mersin University, Mersin, Turkey
| | - Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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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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Fields D, Fraser LK, Taylor J, Hackett J. What does 'good' palliative care look like for children and young people? A qualitative study of parents' experiences and perspectives. Palliat Med 2023; 37:355-371. [PMID: 36825577 PMCID: PMC10021114 DOI: 10.1177/02692163231154300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Worldwide, around 21 million children would benefit from palliative care and over 7 million babies and children die each year. Whilst provision of paediatric palliative care is advancing, there major gaps between what should be done, and what is being done, in clinical practice. In 2017, the National Institute for Health and Care Excellence (NICE) introduced a quality standard, to standardise and improve children's palliative care in England. However, there is little evidence about what good experiences of palliative care for children are, and how they relate to the quality standard for end-of-life care. AIM This study explored how the NICE quality standard featured in parental experiences of palliative care for children to understand what 'good' palliative care is. DESIGN Qualitative study, employing in-depth, telephone and video-call, semi-structured interviews. Data were analysed using thematic analysis, informed by Appreciative Inquiry. SETTING/PARTICIPANTS Participants were parents of children and young people (aged 0-17 years) in England, who were receiving palliative care, and parents whose child had died. RESULTS Fourteen mothers and three fathers were interviewed. Seven were bereaved. Parents were recruited via four children's hospices, one hospital, and via social media. Good palliative care is co-led and co-planned with trusted professionals; is integrated, responsive and flexible; encompasses the whole family; and enables parents to not only care for, but also to parent their child to end of life. CONCLUSIONS Findings have implications for informing evidence based practice and clinical guidelines, overall improving experiences of care.
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Affiliation(s)
- Diana Fields
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Lorna Katherine Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, 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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Book Review: Pediatric Palliative Care: A Model for Exemplary Practice. OMEGA-JOURNAL OF DEATH AND DYING 2022. [DOI: 10.1177/00302228221118068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Job MK, Schumacher P, Müller G, Kreyer C. The social and spiritual dimensions of parental experiences on end-of-life care of their child with cancer: A narrative review. Palliat Support Care 2022; 21:1-12. [PMID: 35048846 DOI: 10.1017/s1478951521001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Having a child with cancer is a burdensome experience for parents. Nurses need to better understand beliefs, hopes, and values of parents to holistically support them, which may have an impact on grief and depression. Thus, the aim of this paper was to highlight the social and spiritual dimensions of parental experiences on end-of-life care of their child with cancer. METHOD A narrative literature review was conducted by systematically searching databases (CINAHL Complete, Academic Search Elite, MEDLINE) for relevant literature. The contents of included studies were critically appraised regarding their methodological quality. RESULTS Eleven studies were included. In terms of the social dimension, three categories emerged that are important for parents: Being a Parent, Being in Relationship with the Child, and Being in Relationship with Health Professionals. Parents tried to maintain normality and joy for their child, but also kept control over the situation. They wanted to protect their child from suffering but also felt the need to talk to them about dying. Parents had ambivalent experiences with helpful but also burdensome staff. The spiritual dimension comprised two main categories, Hope and Faith and a Unique Bond. Hope was found to be an important source of strength, while Faith was only mentioned by some parents. For parents the emotional connection with their child constituted a source of meaning as well as a foundation, on which they based their decisions on. SIGNIFICANCE OF RESULTS A therapeutic relationship and a supportive environment can be established by healthcare professionals by noticing, encouraging the unique bond between parents and their children, as well as by reflecting and addressing the parents' challenging situation.
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Affiliation(s)
- Maria Katharina Job
- Hospital of St. John of God in Vienna, Johannes-von-Gott Platz 1, A-1020 Vienna, Austria
| | - Petra Schumacher
- Fachhochschule Krems - University of Applied Sciences Krems, Department of Health Sciences, Institute of Nursing Science, Am Campus Krems, A-3500 Krems, Austria
| | - Gerhard Müller
- UMIT - Private University for Health Sciences, Medical Informatics and Technology, Department of Nursing Science and Gerontology, Institute of Nursing Science, Eduard Wallnoefer-Zentrum 1, A-6060 Hall in Tyrol, Austria
| | - Christiane Kreyer
- UMIT - Private University for Health Sciences, Medical Informatics and Technology, Department of Nursing Science and Gerontology, Institute of Nursing Science, Eduard Wallnoefer-Zentrum 1, A-6060 Hall in Tyrol, Austria
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8
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Somanadhan S, Brinkley A, Larkin PJ. Living through liminality? Situating the transitional experience of parents of children with mucopolysaccharidoses. Scand J Caring Sci 2021; 36:614-624. [PMID: 34406667 DOI: 10.1111/scs.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mucopolysaccharidoses (MPS) are rare inherited metabolic disorders that come under category three of life-limiting conditions. Children born with this condition show no symptoms at birth, but its effects show as a progressive disease in subsequent years. The severity of the condition varies according to the specific type, ranging from very mild symptoms to, in most cases, complex healthcare needs, including mental and physical disabilities. AIMS This study aimed to elucidate the meanings of the transition experience of being a parent of a child with MPS. Van Gennep's three-stage rite of passage theory and Turner's theory of liminality were utilised to understand these families' transition experiences are learning to live with their child's ongoing progressive illness trajectory. METHODS A qualitative design utilising hermeneutic phenomenology was used. Longitudinal qualitative in-depth interviews were carried out with eight parents at a three-time point over 17-months period. RESULTS This study provided an interpretation of the lived experience of parents of children and young adults with MPS. As such, it embraces a liminal experience of living with a rare life-limiting illness and the unique passage to becoming a parent of a child with MPS. Parents reported their experience of transition from being the parent of a normal healthy child to be the parent of a child with MPS. They described their transition experience as multi-faceted and complex, neither linear nor time-bound, but rather cyclical. CONCLUSION The rites of passage conceptual framework helped to identify specific and significant unmet supportive and social care needs of these families and their children. This information will enhance the development of a substantial support system to meet the family's emotional, psychological and social needs during the illness transitions from diagnosis and throughout their illness journey.
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Affiliation(s)
- Suja Somanadhan
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Aoife Brinkley
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Philip J Larkin
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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9
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Hartley J, Bluebond-Langner M, Candy B, Downie J, Henderson EM. The Physical Health of Caregivers of Children With Life-Limiting Conditions: A Systematic Review. Pediatrics 2021; 148:peds.2020-014423. [PMID: 34155131 DOI: 10.1542/peds.2020-014423] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Parental caregiving for a child with a life-limiting condition (LLC) is complex physical and mental work. The impact of this caregiving on parents' physical health is unknown. OBJECTIVES (1) To review existing evidence on the physical health of parents caring for a child with a LLC and (2) to determine how physical health of parents is measured. DATA SOURCES Medline, Embase, PsycINFO, and Cumulative Index of Nursing and Allied Health Literature were searched. STUDY SELECTION Peer-reviewed articles were included if they reported primary data on the physical health of a caregiver of a child with a LLC. Studies were excluded if they described only the caregiver's mental health or if the caregivers were bereaved at the time of data collection. DATA EXTRACTION Of 69 335 unique citations, 81 studies were included in the review. RESULTS Caregiver health was negatively impacted in 84% of studies. Pain and sleep disturbance were the most common problems. Ways of measuring the physical health of caregiver varied widely. We found an absence of in-depth explorations of the social and economic contexts, which could potentially mitigate the impact of caregiving. Furthermore, we find health interventions tailored to this group remain largely unexplored. LIMITATIONS Studies were heterogenous in methodology, making comparisons of results across studies difficult. CONCLUSIONS These findings support the need for improving access to interventions aimed at improving physical health in this population. The rate of health-seeking behaviors, preventive health care access and screening for health conditions is understudied and represent important directions for further research.
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Affiliation(s)
- Julie Hartley
- Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute of Child Health.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom.,Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute of Child Health.,Department of Sociology, Anthropology and Criminal Justice, Rutgers University-Camden, Camden, New Jersey, New Jersey
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
| | - Jonathan Downie
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital, National Health System Foundation Trust, London, United Kingdom.,Paediatric Supportive and Palliative Care Team, Royal Hospital for Children, Glasgow, United Kingdom
| | - Ellen M Henderson
- Louis Dundas Centre for Children's Palliative Care, University College London Great Ormond Street Institute of Child Health
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Experiences of Caregivers as Clients of a Patient Navigation Program for Children and Youth with Complex Care Needs: A Qualitative Descriptive Study. Int J Integr Care 2020; 20:10. [PMID: 33250675 PMCID: PMC7664297 DOI: 10.5334/ijic.5451] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The number of Canadian children and youth with complex care needs has continued to rise, and their need for resources across all sectors can be extensive. Navigating the maze of resources and services can create confusion and impact how care is delivered and integrated. Patient navigators can help support and guide patients and caregivers through the healthcare system by matching their needs to appropriate resources with the aim to improve access and promote the integration of care. This qualitative study explored caregivers’ experiences caring for a child or youth with complex care needs, and their experiences and satisfaction as clients of a patient navigation centre. Participants included 22 clients from NaviCare/SoinsNavi, a patient navigation centre in Canada for children and youth with complex care needs and their families. Three main themes emerged: 1) caring for a child or youth with complex care needs, 2) navigating the system, and 3) the value of patient navigation. Findings suggest caregivers caring for a child or youth with complex care needs often feel overwhelmed, fearful, and alone; yet, patient navigation can be an innovative approach to support their needs through facilitating more convenient and integrated care, and improving access to education, supports, and resources.
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Mitchell S, Bennett K, Morris A, Slowther AM, Coad J, Dale J. Achieving beneficial outcomes for children with life-limiting and life-threatening conditions receiving palliative care and their families: A realist review. Palliat Med 2020; 34:387-402. [PMID: 31431129 PMCID: PMC7074600 DOI: 10.1177/0269216319870647] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Palliative care for children and young people is a growing global health concern with significant resource implications. Improved understanding of how palliative care provides benefits is necessary as the number of children with life-limiting and life-threatening conditions rises. AIM The aim is to investigate beneficial outcomes in palliative care from the perspective of children and families and the contexts and hidden mechanisms through which these outcomes can be achieved. DESIGN This is a systematic realist review following the RAMESES standards. A protocol has been published in PROSPERO (registration no: CRD42018090646). DATA SOURCES An iterative literature search was conducted over 2 years (2015-2017). Empirical research and systematic reviews about the experiences of children and families in relation to palliative care were included. RESULTS Sixty papers were included. Narrative synthesis and realist analysis led to the proposal of context-mechanism-outcome configurations in four conceptual areas: (1) family adaptation, (2) the child's situation, (3) relationships with healthcare professionals and (4) access to palliative care services. The presence of two interdependent contexts, the 'expert' child and family and established relationships with healthcare professionals, triggers mechanisms, including advocacy and affirmation in decision-making, which lead to important outcomes including an ability to place the emphasis of care on lessening suffering. Important child and family outcomes underpin the delivery of palliative care. CONCLUSION Palliative care is a complex, multifactorial intervention. This review provides in-depth understanding into important contexts in which child and family outcomes can be achieved so that they benefit from palliative care and should inform future service development and practice.
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Affiliation(s)
- Sarah Mitchell
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Karina Bennett
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Morris
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jane Coad
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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McKiernan A, Carr A, O'Keeffe L, Butler E, Quinn C, Guerin S. Levels of satisfaction with children's respite services, parental coping and family functioning. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:568-575. [PMID: 31682034 DOI: 10.1111/hsc.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/13/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
Little is known about how parents' experiences of respite services or 'short breaks' for a child with complex medical needs relate to family functioning and the manner in which parents cope. The aim of this study was to examine the relationship between parents' satisfaction with short breaks, family functioning and parental coping and to determine whether these variables change over time. The sample included 32 families receiving short breaks. A repeated measures quantitative design was used, with data collected at baseline and 12 months. The main outcome variables were satisfaction with short breaks, family functioning and parental coping. At baseline, descriptive statistics showed positive levels of satisfaction with services and coping, while family functioning scores suggested more negative profiles. Also at baseline, significant negative correlations were identified between the age of the child receiving short breaks and certain approaches to parental coping. At Time 2 (n = 17, 73% of possible responses), satisfaction with services was significantly positively correlated with aspects of family functioning and coping. Using dependent t tests, no evidence was found of significant change overtime in satisfaction or family functioning for the sample who completed data collection at both time points. However, a significant decrease in use of certain coping approaches was found over time. While parents' satisfaction levels with short breaks were high across test occasions, there is need for service development aimed at providing interventions that are tailored to ameliorate tension within the family and promote active parental coping over time.
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Affiliation(s)
- Aidan McKiernan
- School of Psychology, University College Dublin, Dublin, Ireland
- Clinical Psychology, LauraLynn Ireland's Children's Hospice, Dublin, Ireland
| | - Alan Carr
- School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Ellen Butler
- Clinical Psychology, University of Dublin Trinity College, Dublin, Ireland
| | - Claire Quinn
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
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13
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Schulz A, Jain M, Butt T, Ballinger R, Eliasson L, Macey J, Peasgood T, Olaye A, Terzakis-Snyder IA, Dyck I, West A. The Challenges of Living with and Caring for a Child or Children Affected by Neuronal Ceroid Lipofuscinosis Type 2 Disease: In-Depth Family Surveys in the United Kingdom and Germany. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2020. [DOI: 10.1590/2326-4594-jiems-2019-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Angela Schulz
- University Medical Center Hamburg-Eppendorf, Germany
| | | | | | | | | | | | | | | | | | - Iris Dyck
- NCL-Gruppe Deutschland e.V., Germany
| | - Andrea West
- Batten Disease Family Association, United Kingdom
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14
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Ho AHY, Dutta O, Tan-Ho G, Choo PY, Low XC, Chong PH, Ng C, Ganapathy S. Thematic analysis of spousal interaction patterns among Asian parents of children with chronic life-threatening illness. BMJ Open 2019; 9:e032582. [PMID: 31748309 PMCID: PMC6887006 DOI: 10.1136/bmjopen-2019-032582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This is the first known study which examines the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from the time of providing care to their child through bereavement. This study is informed by earlier findings that when a child is diagnosed with a chronic life-threatening illness, parents are faced with multiple stressors, leaving them with little time to invest in their spousal relationship. PARTICIPANTS AND SETTING A constructivist-phenomenological research paradigm was adopted and meaning-oriented interviews were conducted with 20 parental units (i.e., 6 couples, 12 lone mothers and 2 lone fathers) of Chinese, Malay and Indian ethnicities who lost their child to chronic life-threatening illness in Singapore. RESULTS Qualitative thematic analysis of the data revealed four themes, which describe the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from caregiving through bereavement. Findings reveal participants' tendency to concentrate on pragmatic, solution-focused communication during the period of caregiving (pragmatic interaction), avoid discussion about their emotional pain as a means of protecting their spouse (partner-oriented self-regulation), respect and acknowledge their spouse's personal coping strategies (empathic responding) and show greater appreciation and emotional expression within the spousal relationship after their child's death (affective appreciation). CONCLUSION Engaging in pragmatic discussions, deferring emotion-focused and potentially distressing conversations, and acknowledging their spouse's need for personal space are important coping strategies for Asian couples facing their child's chronic life-threatening illness and in the immediate aftermath of his/her death. Bereaved couples who have processed their grief individually feel ready to share their reflections with their spouse, deriving meaning and greater relational closeness through such disclosure. These findings are discussed from a cultural lens, with recommendations for healthcare professionals working with Asian parents of children with chronic life-threatening illness.
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Affiliation(s)
- Andy Hau Yan Ho
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- The Palliative Care Centre for Excellence in Education and Research (PalC), Singapore, Singapore
| | - Oindrila Dutta
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Ping Ying Choo
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Xinyi Casuarine Low
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Carolyn Ng
- Portland Institute for Loss and Transitiom, Portland, Oregon, USA
- Children's Cancer Foundation, Singapore, Singapore
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15
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Kiernan G, Courtney E, Ryan K, McQuillan R, Guerin S. Parents’ experiences of services for their child with a life-limiting neurodevelopmental disability. CHILDRENS HEALTH CARE 2019. [DOI: 10.1080/02739615.2019.1605608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Gemma Kiernan
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Eileen Courtney
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Karen Ryan
- St. Francis Hospice, Raheny, Dublin 9, Ireland
| | | | - Suzanne Guerin
- School of Psychology, Newman Building, University College Dublin, Belfield, Dublin 4, Ireland
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16
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Steele R, Bosma H, Johnston MF, Cadell S, Davies B, Siden H, Straatman L. Research Priorities in Pediatric Palliative Care: A Delphi Study. J Palliat Care 2019. [DOI: 10.1177/082585970802400402] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rose Steele
- School of Nursing, Faculty of Health, York University, Toronto, Ontario
| | - Harvey Bosma
- School of Social Work, University of British Columbia, Vancouver, British Columbia
| | | | - Susan Cadell
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Betty Davies
- Department of Family Health Care Nursing, University of California, San Francisco, California, USA
| | - Hal Siden
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Lynn Straatman
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Abstract
Progressive neuromuscular disease requires increasing degrees of respiratory support to sustain life. Each step from intermittent to continuous-and noninvasive to invasive-ventilation requires thoughtful consideration based on the goals of the patient and family, and the inherent benefits and burdens of the treatment. Tracheostomy, in particular, should not be viewed as an inevitable next step when less permanent or invasive methods prove insufficient. Like other modes of respiratory support, tracheostomy may represent a bridge to recovery of pulmonary function, or a stabilizing action in the hope that novel therapies may prove beneficial. In other situations, tracheostomy represents a destination therapy, necessitating consideration of the implications of chronic mechanical ventilation. Institutional, social, and financial considerations may affect decisions related to tracheostomy, as may implicit bias regarding quality of life. The complexity of such care and decisions highlight the need for optimal palliative care throughout the patient's life.
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Affiliation(s)
- Robert Macauley
- Cambia Health Foundation Endowed Chair in Pediatric Palliative Care, Oregon Health and Science University, 707 SW Gaines Street, Mailcode CDRCP, Portland, OR 97239, United States.
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18
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Verberne LM, Kars MC, Schouten-van Meeteren AYN, van den Bergh EMM, Bosman DK, Colenbrander DA, Grootenhuis MA, van Delden JJM. Parental experiences and coping strategies when caring for a child receiving paediatric palliative care: a qualitative study. Eur J Pediatr 2019; 178:1075-1085. [PMID: 31104108 PMCID: PMC6565652 DOI: 10.1007/s00431-019-03393-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 11/17/2022]
Abstract
Parenting and providing extensive care to a child with a life-limiting or life-threatening disease while being aware of the future loss of the child are among the most stressful parental experiences. Due to technical and medical improvements, children are living longer and are increasingly cared for at home. To align healthcare professionals' support with the needs of parents, a clear understanding of prominent experiences and main coping strategies of parents caring for a child in need of palliative care is needed. An interpretative qualitative study using thematic analysis was performed. Single or repeated interviews were undertaken with 42 parents of 24 children with malignant or non-malignant diseases receiving palliative care. Prominent reported parental experiences were daily anxiety of child loss, confrontation with loss and related grief, ambiguity towards uncertainty, preservation of a meaningful relationship with their child, tension regarding end-of-life decisions and engagement with professionals. Four closely related coping strategies were identified: suppressing emotions by keeping the loss of their child at bay, seeking support, taking control to arrange optimal childcare and adapting to and accepting the ongoing change(s).Conclusion: Parents need healthcare professionals who understand and carefully handle their worries, losses, parent-child relationship and coping strategies. What is Known: • In paediatric palliative care, parents have a daunting task in fulfilling all caregiving tasks while striving for control of their child's symptoms, a life worth living and a family balance. What is New: • Prominent experiences were: continuous management of anxiety of child loss, feelings of uncertainty, tension with end-of-life decision making and engagement with professionals. Parents experienced unique significance to their child, reinforcing a meaningful parent-child relationship. • Relevant coping strategies were: suppressing emotions, seeking support, taking control to arrange optimal care and adapting to the ongoing changes. • To provide tailored support, professionals need to understand parents' perceptions, relationship with their child and coping strategies.
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Affiliation(s)
- Lisa M. Verberne
- 0000 0004 0480 1382grid.412966.eDepartment of Pediatrics, Maastricht Universtity Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Marijke C. Kars
- 0000000090126352grid.7692.aDepartment of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | | | - Esther M. M. van den Bergh
- grid.487647.ePrincess Máxima Center for Pediatric Oncology, Lundlaan 6, 3584 AE Utrecht, The Netherlands
| | - Diederik K. Bosman
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Derk A. Colenbrander
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Martha A. Grootenhuis
- grid.487647.ePrincess Máxima Center for Pediatric Oncology, Lundlaan 6, 3584 AE Utrecht, The Netherlands
| | - Johannes J. M. van Delden
- 0000000090126352grid.7692.aDepartment of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
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Siden H, Tucker T, Derman S, Cox K, Soon GS, Hartnett C, Straatman L. Pediatric Enteral Feeding Intolerance: A New Prognosticator for Children with Life-Limiting Illness? J Palliat Care 2018. [DOI: 10.1177/082585970902500309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Harold Siden
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Tucker
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Derman
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Cox
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Gordon S. Soon
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carol Hartnett
- British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
| | - Lynn Straatman
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Gosine J, Travasso R. Building community through song: The therapeutic hospice choir. BRITISH JOURNAL OF MUSIC THERAPY 2018. [DOI: 10.1177/1359457518759960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Music enables us not only to reflect upon the world in which we live but also to become active agents in creating and shaping it and ourselves. The Treehouse Choir is an innovative, therapeutic programme open to all adult service users and staff at one of the East Anglia’s Children’s Hospices. The target group of the choir membership focuses primarily on the mothers of children receiving care at the hospice and bereaved mothers. The choir addresses the need for psychosocial support for families as they face the challenges of caring for a child with life-limiting and complex health conditions, as well as families mourning the loss of a child. This article analyzes data collected from questionnaires and interviews referring to the emotional, psychological and social benefits of participation in the choir. It examines how singing in the choir serves as a means through which individuals form a community built on shared life experiences, bridging boundaries between service provider and service user, creating a means of self-expression, and breaking down barriers to enable new lines of communication within a non-threatening environment. It also examines the role of public performances in promoting greater awareness of the services provided by the hospice.
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21
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Tatla SK, Holsti L, Andrews GS, Feichtinger L, Steele R, Siden H. Charting the territory: Describing the functional abilities of children with progressive neurological conditions. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 71:191-199. [PMID: 29054023 DOI: 10.1016/j.ridd.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/15/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
AIMS Little is known about the functional abilities of children with progressive genetic, metabolic, or neurological conditions (PNCs). In this study, children with PNCs were followed over a 2-year period to assess their functional abilities over time. Specific aims were to: 1) describe the changes in functional skills and the effects of age for children with PNCs, 2) assess changes in these children's need for caregiver assistance over time, and 3) examine relationships between these children's functional skills and need for caregiver assistance. METHODS This study involved a longitudinal, descriptive design with three assessments occurring at Baseline, Year 1, Year 2. Functional skills and caregiver assistance were assessed by the Pediatric Evaluation of Disability Inventory (PEDI). The PEDI questionnaire was completed at baseline and then yearly by parents, along with the assistance of a trained research assistant (RA). RESULTS The study was completed with 83 children (mean age at Baseline=7.1yrs, SD=4.6). Mean Functional skills scores were in the low ranges at Baseline and did not change significantly across time points (F(2, 71)=0.437, p=0.58). Time point had no effect on caregiver assistance ratings (p<0.2); however, children required greater amounts of help with self-care at later time points than for other functional domains. Statistically significant correlations were found between PEDI-Functional skills and caregiver assistance ratings (r=0.80-0.90, p<0.01). CONCLUSIONS Functional skills were low for these children overall, irrespective of age. In children with PNCs: 1) mean functional skills did not change significantly over time; 2) caregiver assistance scores remained stable and 3) functional skills and levels of caregiver assistance were strongly positively correlated. Further research to explore the long-term functional trajectory in children with a PNC is recommended.
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Affiliation(s)
- Sandy K Tatla
- BC Children's and Women's Health Centre, BC Children's Hospital Research Institute, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Liisa Holsti
- Department of Occupational Science and Occupational Therapy, University of British Columbia and BC Children's Hospital Research Institute, Clinical Support Building, V3-327, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Gail Stephanie Andrews
- University of British Columbia, BC Children's Hospital Research Institute, F611-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Leanne Feichtinger
- University of British Columbia, BC Children's Hospital Research Institute, F611-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Rose Steele
- School of Nursing, Faculty of Health, York University, Room 342 HNES Building, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Harold Siden
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, F612a-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
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22
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Lindley LC, Keim-Malpass J. Quality of paediatric hospice care for children with and without multiple complex chronic conditions. Int J Palliat Nurs 2017; 23:230-237. [PMID: 28548914 DOI: 10.12968/ijpn.2017.23.5.230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hospice care for children with multiple complex chronic conditions (MCCC) is complicated given their unique health at the end of life (EOL). Little is known about the quality of the hospice care MCCC children receive and how that might differ from children without MCCC. OBJECTIVE To compare the quality of hospice care (i.e., structures, processes, outcomes) between children with and without MCCC. METHODS This retrospective, comparative study used data from the National Home and Hospice Care Survey, which included a nationally representative sample of paediatric hospice patients. The Pearson chi-square and Wald tests for comparisons were used. RESULTS MCCC children enrolled in hospice care for over 2 months with multiple visits by hospice staff. They had low symptom burden with minimal discontinuity of care at EOL. Children without MCCC had short length of stays in hospice with few visits by nurses and other clinicians. These children had high symptom burden and significant disenrollment from hospice care to receive more aggressive treatment. CONCLUSIONS The findings revealed significant differences in paediatric hospice care between MCCC and non-MCCC children, which provides critical insight into the quality of hospice care.
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Affiliation(s)
- Lisa C Lindley
- Assistant Professor, College of Nursing, University of Tennessee, Knoxville, TN
| | - Jessica Keim-Malpass
- Assistant Professor, School of Nursing, University of Virginia, Charlottesville, VA
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23
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Collins A, Hennessy-Anderson N, Hosking S, Hynson J, Remedios C, Thomas K. Lived experiences of parents caring for a child with a life-limiting condition in Australia: A qualitative study. Palliat Med 2016; 30:950-959. [PMID: 26951065 DOI: 10.1177/0269216316634245] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Experiential studies in paediatric palliative care are needed to enable an ongoing international agenda which supports the development of responsive family supports. AIM To provide an in-depth exploration of the prevalent lived experiences of parents who are currently providing care for a child with a life-limiting condition in Australia. DESIGN Cross-sectional, prospective, qualitative study guided by an advisory group and reported according to the consolidated criteria for reporting qualitative studies. Transcripts were subjected to a thematic analysis, underpinned by an interpretative phenomenological framework. SETTING/PARTICIPANTS Purposively sampled parents (n = 14) recruited from a statewide paediatric hospice who self-identified as a 'primary caregiver' for one or more children and/or adolescents (⩽18 years) with a life-limiting condition. RESULTS Four key themes represented the prevalent experiences of parents: (1) trapped inside the house, (2) the protector, (3) living with the shadow and (4) travelling a different pathway. They describe parents' physical and social isolation, exclusion from the workforce, pervasive grief and associated impacts to their health and well-being. Limited professional and diminished social supports resulted in full ownership of care responsibility. Yet, parents embraced their role as 'protector', reporting acquired meaning and purpose. CONCLUSION This study builds upon the growing body of evidence available in paediatric palliative care internationally. The key themes highlight the substantial demand for both physical and emotional support beyond what is currently offered and call for the implementation of carefully planned support services and other societal initiatives which seek to alleviate the broad health impacts to caregivers.
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Affiliation(s)
- Anna Collins
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | | | | | - Jenny Hynson
- Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | | | - Kristina Thomas
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Palliative Care Research Network Victoria, Fitzroy, VIC, Australia
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24
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Somanadhan S, Larkin PJ. Parents' experiences of living with, and caring for children, adolescents and young adults with Mucopolysaccharidosis (MPS). Orphanet J Rare Dis 2016; 11:138. [PMID: 27724940 PMCID: PMC5057247 DOI: 10.1186/s13023-016-0521-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many rare diseases of childhood are life-threatening and chronically debilitating, so living with a rare disease is an on-going challenge for patients and their families. MPS is one of a range of rare inherited metabolic disorders (IMDs) that come under category 3 of life-limiting conditions, where there is no curative treatment available at present. Although the study of rare diseases is increasingly novel, and of clinical importance to the population, the lack of empirical data in the field to support policy and strategy development is a compelling argument for further research to be sought. METHODS This qualitative hermeneutic phenomenological study explored and interpreted Irish parents' experiences of living with and caring for children, adolescents and young adults with MPS and the impact of these diseases on their day to day life. A purposively selected sample of parents' attending the Irish National Centre for Inherited Metabolic Disorders was invited to participate in serial in-depth interviews. RESULTS A total of eight parents' (n = 8) of children with a range of MPS disorders aged from 6 months to 22 years (MPS I Hurler syndrome, Scheie syndrome), MPS II (Hunter syndrome), MPS III (Sanfilipo syndrome) and MPS VI (Maroteaux-Lamy syndrome) were interviewed at three time points over a 17 month period. The main themes identified during data analysis were described as living with MPS, living with a genetic rare disease, the stigma of a rare condition, MPS as encompassing multiple diseases, Unknown future, hospital vs. home, experience of waiting, a tough road ahead, and things in their day-to-day life with MPS. They spoke of their child's Quality of Life (QoL), their healthy children's wellbeing, and for some, the impact on their own physical and psychological wellbeing. They also reflected on issues of stigmatisation and isolation in their experience of living with a child with a rare disorder. CONCLUSION This study's findings reflect the wider literature on the impact of rare diseases, which have also indicated how caring for someone with MPS, a condition that is chronic, progressive and degenerative can impact on all dimensions of the family's life. Analysis of the findings using a hemenutic pheomenology perspecitve suggest that parents of children with MPS experience multiple cyclical movements across all five human lived existential experience, and they gradually develop ways to incorporate MPS in their day to day life. It was also evident that all the carers in this study experienced a range of uncertainties, with parents using terms such as 'no man's land' and 'future is unknown' to describe their world.
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Affiliation(s)
- S. Somanadhan
- Temple Street Children’s University Hospital, Dublin, Ireland
- University College Dublin (UCD) School of Nursing, Midwifery and Health Systems, Belfield, Dublin, Ireland
| | - P. J. Larkin
- Clinical Nursing (Palliative Care), Children’s Nursing, All-Ireland Institute of Hospice and Palliative Care, UCD School of Nursing, Midwifery and Health Systems and Our Lady’s Hospice & Care Services , Belfield, Dublin, Ireland
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25
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Eaton Russell C, Bouffet E, Beaton J, Lollis S. Balancing grief and survival: Experiences of children with brain tumors and their parents. J Psychosoc Oncol 2016; 34:376-99. [DOI: 10.1080/07347332.2016.1212448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McCann D, Bull R, Winzenberg T. Brief Report: Competence, Value and Enjoyment of Childcare Activities Undertaken by Parents of Children With Complex Needs. J Pediatr Nurs 2016; 31:e127-32. [PMID: 26733444 DOI: 10.1016/j.pedn.2015.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 12/01/2022]
Abstract
UNLABELLED Parents combine many roles when caring for a child with complex needs, but few studies measure parental value and enjoyment of childcare related activities. This study aimed to describe parental competence, enjoyment and value of childcare related activities, particularly healthcare related activities, when parenting a child with complex needs. DESIGN AND METHODS This was a pilot cross sectional study. Ten mothers of children with complex needs rated their competence, value and enjoyment of 156 childcare related activities using the Occupational Questionnaire (Smith, Kielhofner, & Hawkins Watts, 1986). RESULTS The mothers rated childcare related activities as important and rated themselves as competent to undertake them. Mothers disliked performing healthcare related activities, but enjoyed emotional care activities. CONCLUSION This study extends the current knowledge regarding the role tension described by parents of children with complex needs. The finding that parents dislike performing healthcare related activities despite self-reporting high levels of competence warrants further investigation. PRACTICE IMPLICATIONS Gaining a better understanding of the role tension described by parents of children with complex needs may enable pediatric nurses to better understand the impact of home based care provision on parents and assist them to find ways to support families so this care can continue to be provided.
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Affiliation(s)
- Damhnat McCann
- School of Health Sciences, University of Tasmania, Tasmania, Australia.
| | - Rosalind Bull
- School of Health Sciences, University of Tasmania, Tasmania, Australia
| | - Tania Winzenberg
- Menzies Institute of Medical Research & Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
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Ling J, Payne S, Connaire K, McCarron M. Parental decision-making on utilisation of out-of-home respite in children's palliative care: findings of qualitative case study research - a proposed new model. Child Care Health Dev 2016; 42:51-9. [PMID: 26547275 DOI: 10.1111/cch.12300] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 09/06/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Respite in children's palliative care aims to provide a break for family's from the routine of caring. Parental decision-making regarding the utilisation of out-of-home respite is dependent on many interlinking factors including the child's age, diagnosis, geographical location and the family's capacity to meet their child's care needs. A proposed model for out-of-home respite has been developed based on the findings of qualitative case study research. METHODS Utilising multiple, longitudinal, qualitative case study design, the respite needs and experiences of parents caring for a child with a life-limiting condition were explored. Multiple, in-depth interviews were undertaken with the parents identified by a hospital-based children's palliative care team. Data were analysed using thematic analysis. Each individual case consists of a whole study. Cross-case comparison was also conducted. RESULTS Nine families were recruited and followed for two years. A total of 19 in-depth interviews were conducted with mothers and fathers (one or both) caring for a child with a life-limiting condition in Ireland. Each family reported vastly different needs and experiences of respite from their own unique perspective. Cross-case comparison showed that for all parents utilising respite care, regardless of their child's age and condition, home was the location of choice. Many interlinking factors influencing these decisions included: past experience of in-patient care, and trust and confidence in care providers. Issues were raised regarding the impact of care provision in the home on family life, siblings and the concept of home. CONCLUSION Respite is an essential element of children's palliative care. Utilisation of out-of-home respite is heavily dependent on a number of interlinked and intertwined factors. The proposed model of care offers an opportunity to identify how these decisions are made and may ultimately assist in identifying the elements of responsive and family-focused respite that are important to families of children with life-limiting conditions.
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Affiliation(s)
- J Ling
- European Association for Palliative Care, Dublin, Ireland
| | - S Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - K Connaire
- Education Department, St Francis Hospice, Raheny, Dublin, Ireland
| | - M McCarron
- Faculty of Health Science, University of Dublin, Trinity College, Dublin, Ireland
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Nicholas DB, Beaune L, Barrera M, Blumberg J, Belletrutti M. Examining the Experiences of Fathers of Children with a Life-Limiting Illness. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2016; 12:126-144. [PMID: 27143577 DOI: 10.1080/15524256.2016.1156601] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Families who have a child diagnosed with a life-limiting illness (LLI) face substantial challenges resulting from the complexity and devastating impact of the condition and potential closeness of death. The experiences of fathers of a child with LLI have been understudied; therefore, this study explored the stresses, experiences, and strategies of these fathers, including their perceptions about support needs. Based on grounded theory, in-depth semi-structured interviews were conducted with 18 fathers of children with LLI. Six fathers had experienced the death of their child. The overarching themes were stresses, means of coping, and perceived needs for support. Generally, fathers in this study struggled relative to discursive and internalized notions of fathers as providers and protectors for their children, combined with an inability to ease their child's vulnerability to LLI. Participants were engaged in the care of their child with LLI, but several felt marginalized by health care providers in care planning and staff/family communication. Some fathers recognized and valued their support network while others had few supports. Some described personal growth and desired to help other fathers. Practice implications and recommendations include renewed application of family-centered care, overcoming presumptions about fathers' roles, and recognizing the impact of LLI beyond physical health.
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Affiliation(s)
- David B Nicholas
- a Faculty of Social Work, Central and Northern Alberta Region , University of Calgary , Edmonton , Alberta , Canada
| | - Laura Beaune
- b Department of Social Work , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Maru Barrera
- c Department of Psychology , The Hospital for Sick Children , Toronto , Ontario , Canada
- d Institute of Medical Sciences, DLSPH and OISE , University of Toronto , Toronto , Ontario , Canada
| | - Jonathan Blumberg
- e The Hospital for Sick Children Family Advisory Network , Toronto , Ontario , Canada
| | - Mark Belletrutti
- f Stollery Children's Hospital , Edmonton , Alberta , Canada
- g Department of Pediatrics , University of Alberta , Edmonton , Alberta , Canada
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Ward C, Glass N, Ford R. Care in the home for seriously ill children with complex needs: A narrative literature review. J Child Health Care 2015; 19:524-31. [PMID: 24982427 DOI: 10.1177/1367493514538327] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews contemporary literature on home care of the seriously ill child with complex care needs and the sick child/parent dyad. The literature search revealed three major themes, namely the increasing acuity of child illness, the evolving role of the parent as care provider, and the health professional as care provider. While there is much known about the complexity of care of children and the role of family in that care, little is known about what families require in terms of support and sustenance during the long years of care provision.
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Affiliation(s)
| | - Nel Glass
- Australian Catholic University, Australia
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Families of children with congenital heart disease: A literature review. Heart Lung 2015; 44:494-511. [PMID: 26404115 DOI: 10.1016/j.hrtlng.2015.08.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/13/2015] [Accepted: 08/25/2015] [Indexed: 11/21/2022]
Abstract
In 2000 and 2002, the National Heart, Lung, and Blood Institute launched two initiatives to encourage treatment innovations and research on children with heart disease and their families. Since then, no systematic reviews have examined the evidence regarding the impacts of having a child with congenital heart disease (CHD) on families. This review synthesized key findings regarding families of children with CHD, critiqued research methods, described what has been done, and provided recommendations for future inquiry. Databases searched included PubMed, CINAHL, Family & Society Studies Worldwide, Women's Studies International, and PsycINFO. The literature search followed the PRISMA guidelines. As a result, ninety-four articles were reviewed. Four major themes were derived: parents' psychological health, family life, parenting challenges, and family-focused interventions. In conclusion, while they found parents having psychological symptoms, researchers did not explore parents' appraisals of what led to their symptoms. Research is needed to explore parents' experiences and expectations.
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Abstract
One of the many difficult moments for families of children with life-limiting illnesses is to make the decision to access pediatric hospice care. Although determinants that influence families' decisions to access pediatric hospice care have been recently identified, the relationship between these determinants and access to pediatric hospice care have not been explicated or grounded in accepted healthcare theories or models. Using the Andersen Behavioral Healthcare Utilization Model, this article presents a conceptual model describing the determinants of hospice access. Predisposing (demographic; social support; and knowledge, beliefs, and values), enabling (family and community resources) and need (perceived and evaluated needs) factors were identified through the use of hospice literature. The relationships among these factors are described and implications of the model for future study and practice are discussed.
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McCann D, Bull R, Winzenberg T. Sleep deprivation in parents caring for children with complex needs at home: a mixed methods systematic review. JOURNAL OF FAMILY NURSING 2015; 21:86-118. [PMID: 25527511 DOI: 10.1177/1074840714562026] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A significant number of children with a range of complex conditions and health care needs are being cared for by parents in the home environment. This mixed methods systematic review aimed to determine the amount of sleep obtained by these parents and the extent to which the child-related overnight health or care needs affected parental sleep experience and daily functioning. Summary statistics were not able to be determined due to the heterogeneity of included studies, but the common themes that emerged are that parents of children with complex needs experience sleep deprivation that can be both relentless and draining and affects the parents themselves and their relationships. The degree of sleep deprivation varies by diagnosis, but a key contributing factor is the need for parents to be vigilant at night. Of particular importance to health care professionals is the inadequate overnight support provided to parents of children with complex needs, potentially placing these parents at risk of poorer health outcomes associated with sleep deprivation and disturbance. This needs to be addressed to enable parents to remain well and continue to provide the care that their child and family require.
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Malcolm C, Gibson F, Adams S, Anderson G, Forbat L. A relational understanding of sibling experiences of children with rare life-limiting conditions: findings from a qualitative study. J Child Health Care 2014; 18:230-40. [PMID: 23754839 DOI: 10.1177/1367493513485825] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mucopolysaccharidoses (MPS) and Batten disease are rare life-limiting conditions (LLCs) characterised by progressive and permanent physical and cognitive decline. The impact of such conditions on families, and notably on siblings, has not yet been described or documented. This paper presents data from a UK-wide study that sought to understand the family experience of supporting a child with the rare degenerative LLCs of MPS and Batten disease. The aim of this paper is to report sibling experiences related to these rare degenerative and progressive conditions, in order to inform the future development of supportive interventions. Eight siblings of children with MPS (n = 7) and Batten Disease (n = 1) participated in semi-structured qualitative interviews. A card sort technique was utilised to support and engage the children. Siblings are clearly impacted emotionally, pragmatically and relationally by the ill health of another child in the family. The data indicate four key themes which demonstrate impacts on siblings: perceptions of the condition and its symptoms, impact on daily life, emotional consequences and ways of coping. Siblings often had considerable knowledge of the condition and took on important roles in symptom management. However, these experiences were in the context of managing relationships within the family (often protecting parents from an awareness of how much they knew) and relationships at school (including distraction from learning and being bullied by peers). The data highlight how sibling experiences are generated through a combination of negative disability discourses and support through peers and family members. The data indicate how these features shift as a consequence of witnessing the advancement of their brother's or sister's condition and the emotional sequelae of disease progression. Exploration of siblings' experiences of living with such rare progressive and degenerative LLCs suggest the focus of interventions to support this group should address their emotional health and ways to overcome isolation and build connections with other siblings who share their unique experiences. Critically, the data suggest that sibling support should be cognisant of the trajectory of the illness as well as the family, school and peer relational contexts that siblings inhabit.
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Affiliation(s)
- Cari Malcolm
- School of Nursing, Midwifery and Health, University of Stirling, UK
| | - Faith Gibson
- Great Ormond Street Hospital and London South Bank University, UK
| | - Sally Adams
- School of Nursing, Midwifery and Health, University of Stirling, UKGreat Ormond Street Hospital and London South Bank University, UKCancer Care Research Centre (CCRC), School of Nursing, Midwifery and Health, University of Stirling, UK
| | - Gillian Anderson
- School of Nursing, Midwifery and Health, University of Stirling, UKGreat Ormond Street Hospital and London South Bank University, UKCancer Care Research Centre (CCRC), School of Nursing, Midwifery and Health, University of Stirling, UK
| | - Liz Forbat
- Cancer Care Research Centre (CCRC), School of Nursing, Midwifery and Health, University of Stirling, UK
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Abstract
Adolescents with congenital heart disease (CHD) are a rapidly growing population with complex medical needs and psychosocial challenges. Identity formation is an important developmental task accomplished during the teenage years. This article reviews different aspects of ongoing care that pertain to teenagers with CHD, with a particular focus on primary care issues and a summary of recommendations from various scientific societies. A successful smooth transition to the adult health care setting should achieve 2 important goals: to prevent loss of follow-up and to foster and encourage self-care behaviors.
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Affiliation(s)
- Pooja Gupta
- Division of Cardiology, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI 48201-2119, USA.
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Werner H, Latal B, Valsangiacomo Buechel E, Beck I, Landolt MA. The impact of an infant's severe congenital heart disease on the family: a prospective cohort study. CONGENIT HEART DIS 2013; 9:203-10. [PMID: 23870136 DOI: 10.1111/chd.12123] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this article is to investigate the impact of a child's severe congenital heart disease on the family and to prospectively examine the influence of disease specific and psychosocial factors on the family. DESIGN A prospective cohort study. PATIENTS Parents of 104 infants who had undergone cardiopulmonary bypass surgery before the age of 12 months for congenital heart disease were included. INTERVENTIONS None. OUTCOME MEASURES Parents completed the generic Impact on Family scale and a social support questionnaire; a large number of medical data were extracted from the patients' hospital records. RESULTS Parents most frequently reported that they were thinking about not having more children and living on a "roller coaster." No difference was found in the total Impact on Family scale score between fathers and mothers. The presence of a genetic disorder in the child and lower levels of perceived social support was significantly associated with a greater impact on the family. CONCLUSIONS The impact of an infant's congenital heart disease on the family is determined both by child's medical condition and family's psychosocial factors. Families with poorer social support network may have the greatest need for professional interventions, especially if their child has an underlying genetic disorder.
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Affiliation(s)
- Helene Werner
- Department of Psychosomatics and Psychiatry, University Children's Hospital, Zurich, Switzerland
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Wiener L, Zadeh S, Battles H, Baird K, Ballard E, Osherow J, Pao M. Allowing adolescents and young adults to plan their end-of-life care. Pediatrics 2012; 130:897-905. [PMID: 23045560 PMCID: PMC3483891 DOI: 10.1542/peds.2012-0663] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess and compare the usefulness, helpfulness, and stress associated with reviewing a previously adapted advance care planning guide, My Thoughts, My Wishes, My Voice, in comparison with the widely used adult document Five Wishes by adolescents and young adults (AYAs) living with a serious illness. METHODS Fifty-two participants (age 16-28) living with metastatic or recurrent cancer or HIV infection (acquired at birth or early in life) were presented pages randomly from My Thoughts, My Wishes, My Voice and, Five Wishes, and asked to rank 25 items on several factors, including how likely they would be to complete each statement. Participant opinion on suggested changes in content, design, format, and style was obtained and resulted in development of a new document. RESULTS AYAs living with a life-threatening illness want to be able to choose and record (1) the kind of medical treatment they want and do not want, (2) how they would liked to be cared for, (3) information for their family and friends to know, and (4) how they would like to be remembered. CONCLUSIONS AYA views of what should be included in an advance care planning guide were incorporated into a new document, Voicing My Choices, that provides youth, families and providers an opportunity to reduce the silence around the dying process by allowing an opportunity to share one's voice. We provide guidance on how to incorporate this tool into care.
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Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland 20892, USA.
| | - Sima Zadeh
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Haven Battles
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Kristin Baird
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Elizabeth Ballard
- Department of Psychology, Catholic University of America, Washington, District of Columbia;,Office of the Clinical Director, National Institute of Mental Health, Department of Health and Human Services, Bethesda, Maryland; and
| | - Janet Osherow
- Pediatric Infectious Disease Department, Georgetown University, Washington, District of Columbia
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, Department of Health and Human Services, Bethesda, Maryland; and
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Swallow V, Forrester T, Macfadyen A. Teenagers' and parents' views on a short-break service for children with life-limiting conditions: a qualitative study. Palliat Med 2012; 26:257-67. [PMID: 21474621 DOI: 10.1177/0269216311401947] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Few opportunities exist outside the home for children and teenagers with life-limiting conditions to have a break in a setting specifically designed and adequately staffed and resourced to meet their complex clinical, practical and emotional needs; until recently provision focused primarily on providing respite for parents/carers. Based on policy recommendations, a short-break service was established with the aim of working in partnership with families and voluntary and statutory agencies to provide a fun break for children and teenagers with life-limiting conditions and complement the range of services available. This qualitative study used interviews and focus groups to determine teenagers' and parents' views of the service. Three themes emerged: accessibility and communication; needs and boundaries; and shaping the service. Teenagers enjoyed regular planned residential breaks, access to skilled staff and bespoke facilities to support their needs, opportunities to meet others with life-limiting conditions and fun time away from home, thereby giving parents peace of mind, a regular planned break from care-giving, opportunities to meet other parents and to spend exclusive time with their other children. If specialist short-break services become part of the national range of services available, children and teenagers with life-limiting conditions and their parents and siblings could all benefit.
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Affiliation(s)
- Veronica Swallow
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Living through the death of a child: A qualitative study of bereaved parents’ experiences. Int J Nurs Stud 2011; 48:1384-92. [DOI: 10.1016/j.ijnurstu.2011.05.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 05/08/2011] [Accepted: 05/09/2011] [Indexed: 11/22/2022]
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Saad R, Huijer HAS, Noureddine S, Muwakkit S, Saab R, Abboud MR. Bereaved parental evaluation of the quality of a palliative care program in Lebanon. Pediatr Blood Cancer 2011; 57:310-6. [PMID: 21394892 DOI: 10.1002/pbc.23082] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 01/20/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Palliative care (PC) is important in Pediatric Oncology as more than 20% of children with cancer still die despite modern treatment. As a significant number of children reside in countries with limited resources; more research in PC is needed there. This study aimed at evaluating the quality of care provided to children with cancer at the Children's Cancer Center of Lebanon (CCCL) during their last month of life as perceived by the bereaved parents. PROCEDURE Between 2002 and 2007, 76 children with cancer treated at CCCL succumbed to their disease. Twenty-nine of the bereaved parents were interviewed at home about the symptoms and suffering experienced by their children during the last month of life, communication with the healthcare team, quality of care delivered, and recommendations for improving care. RESULTS Fatigue, anorexia, and pain were the most prevalent symptoms and edema was the most distressing. The overall communication with the healthcare team and the overall quality of care delivered was rated as "very good" to "excellent" by 86.2% and 93.1% of the participants, respectively. Parents suggested improving the organization of care, the communication, and the availability of human and material resources. CONCLUSIONS This study is the first conducted in Lebanon to evaluate the quality of pediatric palliative care (PPC). The parents' experiences in our country were similar to those described in other countries, religions, and cultures. Significant strengths and weaknesses in the management of the dying children, from the parents' perspective, were uncovered and recommendations for improving practice were made.
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Affiliation(s)
- Rima Saad
- Children's Cancer Center of Lebanon, American University of Beirut Medical Center, Beirut, Lebanon.
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40
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Schneider M, Steele R, Cadell S, Hemsworth D. Differences on psychosocial outcomes between male and female caregivers of children with life-limiting illnesses. J Pediatr Nurs 2011; 26:186-99. [PMID: 21601142 DOI: 10.1016/j.pedn.2010.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/19/2009] [Accepted: 01/07/2010] [Indexed: 11/15/2022]
Abstract
This secondary analysis of data examined the psychosocial outcomes of meaning in caregiving, self-esteem, optimism, burden, depression, spirituality, and posttraumatic growth in 273 parents caring for children with life-limiting illnesses to (a) determine if there were gender differences and (b) identify gender-specific correlations among these outcomes. Findings suggest that significant gender differences exist. Women reported higher average scores compared with men for meaning in caregiving, depression, burden, and posttraumatic growth and lower average scores for optimism. Correlations also revealed some significant differences. Health care professionals need to be aware of gender differences and tailor their interventions appropriately.
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Malcolm C, Forbat L, Anderson G, Gibson F, Hain R. Challenging symptom profiles of life-limiting conditions in children: a survey of care professionals and families. Palliat Med 2011; 25:357-64. [PMID: 21228088 DOI: 10.1177/0269216310391346] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper reports on data from the initial phase of a UK-wide study exploring life-limiting conditions (LLCs) in children where, because of their rarity, little is understood regarding the significant symptom challenges of families and care professionals who support them. In this initial phase, care professionals (n=43) and families (n=16) completed a survey to identify which rare LLCs present symptom challenges and which individual symptoms prove difficult to manage. Findings led to the prioritization of mucopolysaccharidoses, Batten Disease and leukodystrophy. Care professionals' rationales for selecting these conditions included the presence of symptoms that are very difficult to manage, a requirement for additional clinical evidence to support symptom management, and the progressive nature of these diseases where symptoms frequently change and are difficult to predict. Families identified symptoms such as behavioural difficulties, visual impairments and communication impairments as those being most difficult to manage and having most impact on quality of life for children and families.
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Affiliation(s)
- Cari Malcolm
- Cancer Care Research Centre, University of Stirling, Stirling, UK
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42
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Kim Y, Yang B. Relationship between catastrophic health expenditures and household incomes and expenditure patterns in South Korea. Health Policy 2011; 100:239-46. [DOI: 10.1016/j.healthpol.2010.08.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 08/05/2010] [Accepted: 08/05/2010] [Indexed: 11/29/2022]
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Siden H, Steele R, Brant R, Cadell S, Davies B, Straatman L, Widger K, Andrews GS. Designing and implementing a longitudinal study of children with neurological, genetic or metabolic conditions: charting the territory. BMC Pediatr 2010; 10:67. [PMID: 20854664 PMCID: PMC2954926 DOI: 10.1186/1471-2431-10-67] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 09/20/2010] [Indexed: 11/10/2022] Open
Abstract
Background Children with progressive metabolic, neurological, or chromosomal conditions and their families anticipate an unknown lifespan, endure unstable and often painful symptoms, and cope with erratic emotional and spiritual crises as the condition progresses along an uncertain trajectory towards death. Much is known about the genetics and pathophysiology of these diseases, but very little has been documented about the trajectory of symptoms for children with these conditions or the associated experience of their families. A longitudinal study design will help to close this gap in knowledge. Methods/Design Charting the Territory is a longitudinal descriptive, correlational study currently underway with children 0-19 years who are diagnosed with progressive neurological, metabolic, or chromosomal conditions and their families. The purpose of the study is to determine and document the clinical progression of the condition and the associated bio-psychosocial-spiritual experiences of the parents and siblings age 7-18 years. Approximately 300 families, both newly diagnosed children and those with established conditions, are being recruited in six Canadian cities. Children and their families are being followed for a minimum of 18 months, depending on when they enroll in the study. Family data collection will continue after the child's death if the child dies during the study period. Data collection includes monthly parental assessment of the child's symptoms; an annual functional assessment of the child; and completion of established instruments every 6 months by parents to assess family functioning, marital satisfaction, health status, anxiety, depression, stress, burden, grief, spirituality, and growth, and by siblings to assess coping and health. Impact of participation on parents is assessed after 1 year and at the end of the study. Chart reviews are conducted at enrollment and at the conclusion of the study or at the time of the child's death. Discussion Knowledge developed from this study will provide some of the first-ever detailed descriptions of the clinical symptom trajectory of these non-curable progressive conditions and the bio-psychosocial-spiritual aspects for families, from diagnosis through bereavement. Information about developing and implementing this study may be useful to other researchers who are interested in designing a longitudinal study.
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Affiliation(s)
- Harold Siden
- University of British Columbia, Vancouver, BC, Canada.
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Connor JA, Kline NE, Mott S, Harris SK, Jenkins KJ. The meaning of cost for families of children with congenital heart disease. J Pediatr Health Care 2010; 24:318-25. [PMID: 20804952 DOI: 10.1016/j.pedhc.2009.09.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 09/04/2009] [Accepted: 09/12/2009] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The purpose of this study was to describe the cost burden of congenital heart disease (CHD) and the associated social impact as experienced by families. METHOD Qualitative methods were used to collect and interpret data. Semi-structured interviews were conducted with parents of children with various degrees of CHD complexity and socioeconomic status currently admitted for congenital heart surgery at a large tertiary care regional center. RESULTS The meaning of cost burden as defined by participants resulted in the emergence of two major categories, lifestyle change and uncertainty. Cost was described beyond monetary terms and as a result, data in each category were further clustered into three underlying subcategories labeled financial, emotional, and family burden. The child's disease complexity and parent's socioeconomic status seem to be linked to higher levels of stress experienced in terms of finances, emotional drain, and family member burden. Prenatal diagnosis was noted to trigger early discussion of financial uncertainty, often resulting in altered personal spending prior to birth. DISCUSSION The cost experienced by parents of children with complex CHD was described as both life-changing and uncertain. Informing families of these types of additional stressors may allow issues of finances to be considered early in the overall preparation of caring for a child with complex CHD.
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Rishel CJ. Conceptual framework for the study of parental end-of-life decision making in pediatric blood and marrow transplantation. Oncol Nurs Forum 2010; 37:184-90. [PMID: 20189923 DOI: 10.1188/10.onf.184-190] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe a conceptual framework that will facilitate research and practice concerning parental end-of-life decision making in pediatric blood and marrow transplantation (BMT). DATA SOURCES A review of relevant literature from Ovid, CINAHL, EBSCO, MEDLINE, PsycINFO, and various sociology and theology databases was combined with experiential knowledge. DATA SYNTHESIS The method of concept and theory synthesis and derivation as described by Walker and Avant was used in the development of this framework. CONCLUSIONS Use of the proposed conceptual framework is expected to provide the organization necessary for thinking, observation, and interpretation of parental end-of-life decision making in pediatric BMT. IMPLICATIONS FOR NURSING The ability to describe the process of parental end-of-life decision making in pediatric BMT will help nurses to provide appropriate counseling, education, and support for these children and their families at the end of life. In addition, the process will help nurses to promote the well-being of the children's families after end of life.
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Lindley LC, Mark BA. Children with special health care needs: Impact of health care expenditures on family financial burden. JOURNAL OF CHILD AND FAMILY STUDIES 2010; 19:79-89. [PMID: 20495615 PMCID: PMC2872488 DOI: 10.1007/s10826-009-9286-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We investigated the relationship between health care expenditures for Special Health Care Needs (SHCN) children and family perception of financial burden. Using 2005/2006 National Survey of Children with Special Health Care Needs data, a multivariate logistic regression model was used to estimate the relationship between the SHCN child's health care expenditure and perceived financial burden, while controlling for family and child characteristics. Our analysis suggests that health care expenditures for a SHCN child of $250 and more are associated with family perception of financial burden. In addition, families with lower socioeconomic status also perceived financial burden at lower level of expenditures. Members of the health care team who treat children with SHCN have an important role in understanding and assessing family financial burden as part of the care delivery to the child and the family. Our study reinforces the need to treat the whole family as the unit of care, especially when caring for children with special health care needs.
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Affiliation(s)
- Lisa C. Lindley
- School of Nursing, University of North Carolina – Chapel Hill, Carrington Hall, CB 7460, Chapel Hill, NC 27599-7460
| | - Barbara A. Mark
- School of Nursing, University of North Carolina – Chapel Hill, Carrington Hall, CB 7460, Chapel Hill, NC 27599-7460
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Wiener L, Ballard E, Brennan T, Battles H, Martinez P, Pao M. How I wish to be remembered: the use of an advance care planning document in adolescent and young adult populations. J Palliat Med 2009; 11:1309-13. [PMID: 19115889 DOI: 10.1089/jpm.2008.0126] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Discussing end-of-life (EOL) issues is difficult with any population. These conversations are even more challenging with adolescents and young adults due to the poignancy of the situation and the need for developmentally appropriate language. OBJECTIVE To explore whether adolescents and young adults living with a life-limiting illness find it acceptable and helpful to have a planning document to share their wishes and thoughts regarding EOL care. If so, to learn about specific concerns adolescents and young adults feel are important to include in such a document. METHODS Adolescents and young adults with metastatic cancer or pediatric human immunodeficiency virus (HIV)-1 infection were presented Five Wishes, an advance directive document for adults. Each participant was asked to critically evaluate each wish in terms of whether the concepts within were considered (1) appropriate to ask individuals the participant's age; (2) helpful for other people the participant's age to think about; (3) helpful to the participant to think about; (4) stressful to contemplate. Participants were also asked to suggest modifications and additions to the document. RESULTS Twenty patients completed the survey. Ninety-five percent of the participants reported that an advance directive like Five Wishes would be "helpful" or "very helpful" to themselves, 90% stated that the document would be helpful to others, and no patients found talking about the issues in Five Wishes "stressful" or "very stressful." Participants were more interested in items concerning how they wanted to be treated and remembered than items concerning medical decision-making. CONCLUSIONS An advance care planning document may be appropriate and helpful for adolescents and young adults living with a serious illness. Future research should further validate the preferences identified by participants and explore whether an age-appropriate document can improve communication with family and staff in EOL care.
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Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute/National Institutes of Health, Bethesda, Maryland 20892, USA.
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Widger K, Steele R, Oberle K, Davies B. Exploring the Supportive Care Model as a Framework for Pediatric Palliative Care. J Hosp Palliat Nurs 2009. [DOI: 10.1097/njh.0b013e3181aada87] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Steele R, Derman S, Cadell S, Davies B, Siden H, Straatman L. Families’ transition to a Canadian paediatric hospice. Part one: planning a pilot study. Int J Palliat Nurs 2008; 14:248-56. [DOI: 10.12968/ijpn.2008.14.5.29492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rose Steele
- School of Nursing, Faculty of Health, York University, Toronto, Canada
| | - Sarah Derman
- Canuck Place Children’s Hospice, Vancouver, British Columbia, Canada
| | - Susan Cadell
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Betty Davies
- Department of Family Health Care Nursing, University of California, San Francisco, California, USA
| | - Hal Siden
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Lynn Straatman
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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