Whose power/authority/knowledge? Conundrums in the experiences of parents whose children have cancer

Multilevel barriers and facilitators of communication in pediatric oncology: A systematic review

Multiple factors can facilitate or impede the fulfillment of communication functions in pediatric cancer. In this systematic review, we evaluated 109 studies from the preceding 20 years that presented qualitative or quantitative evidence of barriers or facilitators to communication in pediatric cancer. Using a multilevel framework developed in our prior study, we then analyzed and categorized the levels of barriers and facilitators identified in included studies. The vast majority of studies focused on individual-level barriers, rather than team, organization/system, collaborating hospital, community, or policy-level barriers. Future studies should explore the full range of factors that affect communication.

Caracterização dos cuidados centrados na família em oncologia pediátrica em Portugal

Objetivo

Este estudo teve como objetivo caracterizar as perceções parentais dos Cuidados Centrados na Família (CCF) em função de fatores sociodemográficos e clínicos no contexto da oncologia pediátrica em Portugal.

Método

Participaram neste estudo 204 cuidadores de crianças com cancro acompanhadas em duas unidades de oncologia pediátrica. Os participantes forneceram dados sociodemográficos e preencheram a Medida dos Processos de Cuidados (MPOC-20), composta por duas subescalas: Serviços e Informação Geral. Os médicos oncologistas pediátricos facultaram informação clínica.

Resultados

A idade de crianças e pais estava positivamente associada às perceções parentais dos CCF (Serviços e Informação Geral) como mais centrados na família. Análises multivariadas da variância revelaram que pais de crianças (vs. adolescentes), pais que concluíram o ensino superior (vs. escolaridade igual/inferior ao 12º ano) e pais de crianças em tratamento antineoplásico (vs. fora de tratamento) percecionaram os cuidados como menos centrados na família (Serviços e Informação Geral). Não se verificaram diferenças em função do tempo desde o diagnóstico, do número de internamentos e da intensidade do tratamento.

Conclusão

Os resultados sugerem que os pais mais novos que concluíram o ensino superior, pais de crianças mais novas e a receber tratamento, poderão constituir grupos em maior risco de percecionar os cuidados de saúde como menos centrados na família.

Sources of Conflict Between Families and Health Care Professionals

It is essential to examine conflict between patients and health care professionals from the patient’s perspective. The purposes of this study were to 1) identify sources of conflict, 2) determine nursing interventions that alleviate conflict, and 3) test a conceptual framework of sources of conflict. This phenomenological study focused on children with cancer and their parents’ perceptions of conflicts with health care professionals as well as what they thought helped with such conflicts. Their reports of conflict were compared to C. W. Moore’s circle of conflict conceptual framework. A purposive sample of 27 participants (9 children, 14 mothers, and 4 fathers) participated in the study. Study findings showed that conflict occurred between health care professionals and families originating from differences in expectations and desires regarding data, interests, structure, relationships, and values, consistent with C. W. Moore’s conceptual framework. Nursing interventions reported by children and parents to be helpful in preventing or alleviating conflict were identified. C. W. Moore’s framework may provide a valuable structure for assessing conflict and designing nursing interventions to alleviate conflict.

Surplus suffering, mothers don't know best: denial of mothers' reality when parenting a child with mental health issues

This paper reports on a qualitative interview study of 16 mothers whose children had received a diagnosis with one, or more, mental health issue. It is based on retrospective accounts from mothers describing the early days of noticing that something seemed a bit problematic with their child. When they tried to discuss their concerns and asked for advice from family and friends their concerns were usually dismissed. When they took the child to the doctor, the doctor initially denied the mother's own assessment of the child. Other professionals weighed in and often blamed the mother and denied her reality too. These findings are discussed in terms of the theories of surplus suffering, good and intensive mothering, mother blame and stigma. Implications for practice are considered.

Parental experience of childhood cancer using Interpretative Phenomenological Analysis

Whilst survival rates for childhood cancer have improved dramatically over the past three decades, it is still a devastating diagnosis for family members and an illness which severely disrupts the lifestyle of the family unit. Developing an understanding of the impact of the illness on the family is crucial to better support families' deal with the demands of the illness. In this study nine families in which a child was diagnosed with cancer were interviewed twice over a 12 month period, approximately 6 months apart. Using Interpretative Phenomenological Analysis, a semi-structured interview was used to explicate parent's experience of childhood cancer. The results revealed five super-ordinate themes; (1) a pivotal moment in time, (2) the experience of adaptation in relation to having a sick child, (3) the nature of support, (4) re-evaluation of values during a critical life experience and (5) the experience of optimism and altruism. Findings indicate that parents express both negative and positive experiences as they re-evaluate the meaning and purpose of life, seek to redefine themselves, often in terms of priorities, relationships, sense of community and achieve degrees of optimism and altruism. Implications for addressing the needs of parents and for further research are discussed.

Cuidadores de crianças com leucemia: exigências do tratamento e aprendizagem de novos comportamentos

O câncer na faixa pediátrica representa um contexto de perdas, incertezas, dor física e diversas dificuldades para o paciente e seus familiares. O objetivo deste estudo foi investigar as demandas específicas vivenciadas por 30 cuidadores pediátricos, bem como comportamentos favoráveis adquiridos ao longo do semestre inicial de tratamento para leucemias, a partir de entrevistas semi-estruturadas aplicadas em dois momentos. Os resultados indicaram exigências específicas, como necessidade de maior atenção e monitoramento do paciente e aumento dos gastos financeiros. Houve relatos importantes sobre a aprendizagem de novos padrões de comportamento referidos como favoráveis, tais como aquisição de comportamentos mais adaptativos a demandas do ambiente, percepção de maior autoeficácia e atuação mais ativa no tratamento, aprendizagem sobre procedimentos médicos invasivos e destituição de crenças disfuncionais associadas ao câncer. O estudo aprofunda dados indicados na literatura e destaca a importância de mais intervenções psicossociais junto a pacientes pediátricos e cuidadores.

Hospital-based home care for children with cancer

Hospital-based home care (HBHC) is widely applied in Pediatric Oncology. We reviewed the potential effect of HBHC on children's physical health and risk of adverse events, parental and child satisfaction, quality of life of children and their parents, and costs. A search of PubMed, CINAHL, and EMBASE led to identification of five studies that met the inclusion criteria. All sample sizes were small, and both the interventions and the outcome measures were diverse. Although burdened by these limitations, the studies indicate that HBHC is feasible and carries no crucial negative effects for children with cancer.

Professional caregivers' perceptions of providing information to parents of children with cancer

Information has been described as a critical part of the care for parents of children with cancer, but not much is known about how caregivers makes decisions about informing parents. This study aims to illuminate professional caregivers' perceptions of providing information to parents of children with cancer. Twenty caregivers at a Swedish pediatric oncology ward participated in four focus group interviews. The interviews were transcribed verbatim and subjected to qualitative content analysis. Two themes were found: Matching the amount of information to the parents' needs concerned situations where the amount of information provided according to the caregivers' assessment is deemed too small, appropriate, or too large. Navigating through a vague structure dealt with a disrupted setting, unclear responsibilities within the team, difficult timing, unintelligible information, and underused tools for communication. Implications for intervention development are discussed.

Advocacy: essential work for mothers of children living with cancer

This paper, based on focus group interviews with mothers whose children have had cancer, describes the advocacy work in which mothers engaged during the period of diagnosis and treatment. Among the mothers' manifold responsibilities, advocacy was one of the most compelling. It was described as if it was a taken-for-granted moral imperative. Some mothers said they felt that it was necessary because of (1) perceived errors during diagnosis or later during the process of treatment; (2) perceived understaffing; (3) advice given by other mothers or fathers; and (4) perceived lack of coordination and communication in the medical care system. Many coped with the need to advocate through educating themselves, by keeping extensive notes and journals and by talking to other parents about their experiences. The paper concludes with clinical practice implications and recommendations for policy consideration including acknowledgment of the significant role of optimal family cohesion for managing the stresses and strains of advocacy and other home health care work; appointment of parent-child advocates associated with hospitals that provide pediatric oncology care; establishment of in-service training and education for guardians and medical care teams regarding their mutual roles and responsibilities; as well as, the provision of guaranteed and paid parental leave policies for guardians whose children have a catastrophic or severe chronic medical condition.

Mother's home healthcare: emotion work when a child has cancer

Home healthcare work, involving physical labor, nursing care, medical monitoring, administrative, planning and accounting, advocacy and emotion work, is unpaid and largely invisible. This article, based on focus group interviews with mothers whose children have had cancer, describes one part of their home healthcare labor, their emotion work. Specifically, it examines how mothers: manage the moral imperatives of mothering; think about and try to manage the strong feelings, particularly of fear and uncertainty that they often have when their children are ill with cancer; work to understand and maintain their marital relationships; the strategies that seemed to help; and finally, the self-transformation that many mothers experience. The article concludes with a discussion of the substantive, theoretical, research, and policy implications of emotion work in the provision of home healthcare work.