Learning to live with childhood cancer: a literature review of the parental perspective

Facilitators and barriers to the delivery of palliative care to children with life-limiting and life-threatening conditions: a qualitative study of the experiences and perceptions of healthcare professionals

OBJECTIVE

To understand healthcare system facilitators and barriers to the delivery of palliative care for children with life-limiting and life-threatening conditions and their family members.

DESIGN

Focus groups with children's palliative care professionals. Data were analysed using thematic analysis.

SETTING

Four regions of England (West Midlands, South West, Yorkshire and Humber, and London) from December 2017 to June 2018.

PARTICIPANTS

Healthcare professionals (doctors, nurses and allied healthcare professionals) working in children's palliative care services.

FINDINGS

A total of 71 healthcare professionals participated in the focus groups. Three overarching themes were identified which influenced whether and when children were referred to and started to receive palliative care: (1) the unspoken background of clinical uncertainty which often delayed palliative care; (2) the cultural 'collusion of immortality', where conversations about the possibility of dying can be avoided or deferred; and (3) the role of paediatric palliative care teams in 'illuminating the blind spot' of palliative care as well as providing hands-on care.

CONCLUSIONS

Palliative care is a holistic approach to care that focuses on quality of life for people living with life-limiting and life-threatening conditions that can be delivered alongside active treatment. There is a need to prioritise and integrate this into healthcare services for children more effectively if improvements in care are to be realised. While more specialist paediatric palliative care services are needed, the unspoken background of clinical uncertainty needs to be addressed together with the collusion of immortality within healthcare culture and organisations.

Experiences of healthcare, including palliative care, of children with life-limiting and life-threatening conditions and their families: a longitudinal qualitative investigation

OBJECTIVES

To understand the experiences and perceptions of healthcare services of children with life-limiting and life-threatening conditions and their family members, including palliative care.

DESIGN

Longitudinal qualitative interview study with children and their family members. Up to three in-depth interviews were conducted over 13 months with each child and family. Data were analysed using thematic analysis.

SETTING

Community and hospital settings in the West Midlands, UK.

PARTICIPANTS

Children with a diverse range of life-limiting and life-threatening conditions, aged between 5 and 18 years, and their family members.

FINDINGS

31 participants from 14 families including 10 children took part in 41 interviews. Two children died during the course of the study. Children accepted their conditions as part of life and had other priorities for living. Experiences of 'fighting' a fragmented healthcare system that focused on the biomedical aspects of their care were described. The possibility of death was rarely openly discussed. Palliative care tended to be conceptualised as a distinct service or phase of a child's condition, rather than a broad approach. Access to palliative care depended on the availability of specialist services, and on trusted interpersonal relationships with healthcare professionals who could share uncertainty and the family's emotional burden.

CONCLUSIONS

There is an urgent need to create a more child and family centred approach that enables palliative care to be truly integrated into the wider healthcare of children with life-limiting and life-threatening conditions. Trusted, interpersonal relationships with healthcare professionals, and more effective coordination of care are fundamental to achieving this, and should be valued and enabled throughout the healthcare system.

Uncertainty and Nursing Needs of Parents with Pediatric Cancer Patients in Different Treatment Phases: A Cross-Sectional Study

The survival rate of pediatric cancer has increased to 80%, but long-term treatment is required. During treatment, parents experience uncertainty, which affects parents’ quality of life and, even worse, their children’s health; however, the variation of that uncertainty remains under-studied. Thus, it is crucial to understand parents’ nursing needs in each distinct treatment phase to develop relevant educational content. This study investigated the uncertainty level and nursing needs of parents according to their children’s treatment phase. This cross-sectional comparative descriptive study collected survey data from 119 people at a tertiary hospital from December 2017 to April 2018. Nursing needs were ascertained using open-ended questions, and data were analyzed using quantitative content analysis. The uncertainty levels of parents of pediatric cancer patients showed statistically significant differences across treatment phases (F = 8.209, p < 0.001). Parents’ uncertainty was higher in the treatment initiation phase (87.77 ± 13.43) and when treatment was ongoing (83.33 ± 15.10) than in the post-treatment phase (75.35 ± 12.82). All three groups had nursing needs regarding infection control, diet, daily activities of living, and prognosis. Parents’ uncertainty levels and nursing needs differed across treatment phases, suggesting a need for tailored education programs to provide practical support to parents of pediatric cancer patients in each phase.

Resilience in Familial Caregivers of Children with Developmental Disabilities: A Meta-analysis

The aim of this meta-analysis was to investigate factors associated with resilience in familial caregivers of children with developmental disabilities. The protocol was registered in the PROSPERO database, with the registration number CRD42018105180. Several electronic databases were searched for studies. A random-effects meta-analysis was performed on 26 selected studies that associated resilience to an array of other variables (i.e., psychological distress, social support, coping, perceived health, life satisfaction). Overall, the significant pooled effect sizes were small to medium, ranging from r = 0.291 for coping to r = 0.442 for social support. Although the literature on the topic has improved, there is a lot of study heterogeneity and the need for focusing on male caregivers becomes evident.

Achieving beneficial outcomes for children with life-limiting and life-threatening conditions receiving palliative care and their families: A realist review

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.

Psychosocial Strength Enhancing Resilience in Adolescents and Young Adults With Cancer

The purpose of this study was to explore ways of enhancing psychosocial strengths in newly diagnosed and relapsed adolescents and young adults (AYAs) to improve their resilience. A descriptive case study was used. The adolescent resilience model (ARM) and the self-sustaining process model were applied as theories. The data were analyzed using pattern-matching logic. Semistructured interviews were conducted with 18 patients aged 12 to 24 years and discharged within 10 years. We found that the newly diagnosed and the relapsing AYAs developed the 5 strength factors of the ARM during and after treatment. Whether the individuals cultivated a positive attitude and sense of purpose early or late, the AYAs developed resilience eventually. A positive attitude and sense of purpose during the early phase of care may be essential for improving resilience. The AYAs benefited from the support of their parents, friends, and previous experience. Individualized support and social resources may be important to develop these strengths. Further research is needed to develop strengths and improve resilience in newly diagnosed AYAs.

Lebanese parents' experiences with a child with cancer

BACKGROUND

The impact of childhood cancer on the family has been studied in different cultures and continues to be an object of study and concern, In Lebanon, a country of 4 million people 282 new pediatric cases of cancer age <20 years diagnosed in 2004 were reported in 2008.

OBJECTIVES

The purpose of this study was to explore the experiences of Lebanese families living with a child with cancer.

METHOD

The study followed purposeful sampling in which 12 parents (mother or father) of a child with cancer were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironsides (1998).

RESULTS

A constitutive pattern "It is a continuous battle" and five themes emerged from the data analysis. Living with the shock of the diagnosis; Alterations in the quality of the family's life; Living with added burdens; Disease impact on the family and sibling dynamics; Living with uncertainty represent the major themes that emerged from the participants' experiences while living with a child with cancer.

CONCLUSION

The study contributes to the knowledge that would help health care professionals understand the experiences and challenges that are faced by Lebanese families living with a child with cancer. This awareness would serve as a basis for health care professionals in general and nurses in particular to understand parents' experiences, and offer support, elicit communication of feelings, and examine possibilities for forming a partnership during the challenging course of the child's illness. Supported parents are more likely to provide more effective care to their child with cancer.