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Lau N, Steineck A, Walsh C, Fladeboe KM, Yi-Frazier JP, Rosenberg AR, Barton K. Social support resources in adolescents and young adults with advanced cancer: a qualitative analysis. BMC Palliat Care 2024; 23:193. [PMID: 39085897 PMCID: PMC11290203 DOI: 10.1186/s12904-024-01527-y] [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: 04/05/2024] [Accepted: 07/19/2024] [Indexed: 08/02/2024] Open
Abstract
PURPOSE Adolescents and Young Adults (AYAs) with cancer are an at-risk group with unique palliative and supportive care needs. Social support in AYAs with cancer is associated with better coping, quality of life, and psychosocial well-being. Here, we extend existing research to examine the sources and types of support received by AYAs with advanced cancer. METHODS AYAs participated in a semi-structured, 1:1 interview on communication and psychosocial support needs. The present analysis focused on social support experiences for AYAs with advanced cancer. Directed content analysis was used to develop the codebook. Established social support constructs provided a coding framework. We presented our qualitative findings as a code frequency report with quantified frequency counts of all "source of support" and "type of support" codes. We assigned a global "sufficiency of support code" to each AYA. RESULTS We interviewed 32 AYAs with advanced cancer (Mage = 18, SDage = 3.2, 41% female). Most AYAs identified family (namely, caregivers) as their primary source of support and stated that family universally provided all types of support: emotional, informational, instrumental, and social companionship. They received informational and emotional support from clinicians, and received emotional support and social companionship from healthy peers, cancer peers, and their existing community. One-third of participants were coded as having "mixed support" and described a lack of support in some domains. CONCLUSION AYAs with advanced cancer described caregivers as their universal source of support, and that other support sources provided support for specific needs. Future research should continue to evaluate social support needs and family-based palliative and supportive care interventions to bolster social support resources in this high-risk group.
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Affiliation(s)
- Nancy Lau
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA.
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Angela Steineck
- MACC Fund Center for Cancer and Blood Disorders, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Casey Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Kaitlyn M Fladeboe
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Joyce P Yi-Frazier
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Krysta Barton
- Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Seattle Children's Research Institute, Seattle, WA, USA
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Mack JW, Cernik C, Xu L, Laurent CA, Fisher L, Cannizzaro N, Munneke J, Cooper RM, Lakin JR, Schwartz CM, Casperson M, Altschuler A, Wiener L, Kushi LH, Chao CR, Uno H. Use of cancer-directed therapy at the end of life among adolescents and young adults. J Natl Cancer Inst 2024; 116:1080-1086. [PMID: 38377408 PMCID: PMC11223859 DOI: 10.1093/jnci/djae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/06/2023] [Accepted: 02/15/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Adolescents and young adults frequently receive chemotherapy near death. We know less about the use of targeted agents and immunotherapy or trends over time. METHODS We conducted a retrospective cohort study of 1836 adolescents and young adults with cancer who died between 2009 and 2019 after receiving care at 1 of 3 sites (Dana-Farber Cancer Institute, Kaiser Permanente Northern California, and Kaiser Permanente Southern California). We reviewed electronic health data and medical records to examine use of cancer-directed therapy in the last 90 days of life, including chemotherapy, targeted therapy, immunotherapy, and investigational drugs. RESULTS Over the study period, 35% of adolescents and young adults received chemotherapy in the last 90 days of life; 24% received targeted therapy, 7% immunotherapy, and 5% investigational drugs. Additionally, 56% received at least 1 form of systemic cancer-directed therapy in the last 90 days of life. After adjustment for patient sex, race, ethnicity, age, site of care, diagnosis, and years from diagnosis to death, the proportion of adolescents and young adults receiving targeted therapy (odds ratio [OR] = 1.05 per year of death, 95% confidence interval [CI] = 1.02 to 1.10; P = .006), immunotherapy (OR = 1.27, 95% CI = 1.18 to 1.38; P < .0001), and any cancer-directed therapy (OR = 1.04, 95% CI = 1.01 to 1.08; P = .01) in the last 90 days of life increased over time. CONCLUSIONS More than half of adolescents and young adults receive cancer therapy in the last 90 days of life, and use of novel agents such as targeted therapy and immunotherapy is increasing over time. Although some adolescents and young adults may wish to continue cancer therapy while living with advanced disease, efforts are needed to ensure that use of cancer-directed therapy meets preferences of adolescents and young adults approaching death.
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Affiliation(s)
- Jennifer W Mack
- Division of Population Sciences, Department of Medical Oncology, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Colin Cernik
- Division of Population Sciences, Department of Medical Oncology, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lanfang Xu
- MedHealth Statistical Consulting Inc, Solon, OH, USA
| | - Cecile A Laurent
- Division of Research, Department of Research and Evaluation, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lauren Fisher
- Division of Population Sciences, Department of Medical Oncology, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nancy Cannizzaro
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Julie Munneke
- Division of Research, Department of Research and Evaluation, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Robert M Cooper
- Department of Pediatric Oncology, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Corey M Schwartz
- Division of Medical Oncology, Department of Medicine, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Andrea Altschuler
- Division of Research, Department of Research and Evaluation, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lori Wiener
- Psychosocial Support and Research Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Lawrence H Kushi
- Division of Research, Department of Research and Evaluation, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Hajime Uno
- Division of Population Sciences, Department of Medical Oncology, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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DeCourcey DD, Bernacki RE, Nava-Coulter B, Lach S, Xiong N, Wolfe J. Feasibility of a Serious Illness Communication Program for Pediatric Advance Care Planning. JAMA Netw Open 2024; 7:e2424626. [PMID: 39058485 PMCID: PMC11282445 DOI: 10.1001/jamanetworkopen.2024.24626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
Importance Pediatric advance care planning (ACP), which aims to ensure care is aligned with family goals and values, is associated with better end-of-life outcomes; however, ACP in pediatrics remains uncommon. Objectives To determine the feasibility and acceptability of the Pediatric Serious Illness Communication Program (PediSICP) and explore family-centered outcomes. Design, Setting, and Participants This cohort study was a single-group pilot study of the PediSICP in adolescents and young adults (AYAs; age ≥13 y) with serious illness, parents of seriously ill children, and interprofessional clinicians from April 2021 to March 2023 in a quaternary care pediatric hospital. Duration of follow-up was 1 month. Data were analyzed from January 2022 to March 2023. Exposure The PediSICP includes clinician training preceding an ACP communication occasion supported by communication guides and a template for electronic medical record documentation. Main Outcomes and Measures Outcomes of interest were parent, patient, and clinician experiences with and perceptions of the PediSICP. Feasibility was defined a priori as at least 70% clinician intervention completion rates. Results A total of 10 virtual trainings were conducted among 40 clinicians, including 27 physicians, 7 nurse practitioners, 5 nurses, and 1 respiratory therapist, and 30 trained clinicians (75%) conducted and documented 42 ACP conversations with 33 parents (median [IQR] age, 43 [35-51] years; 25 [76%] female) and 5 AYAs (median [IQR] age, 19 [17-19] years; 3 [60%] female) who completed the intervention. The median (IQR) conversation duration was 27 (10-45) minutes. Most clinicians (29 clinicians [97%]) agreed that they felt prepared for the conversation, and all clinicians recommended the PediSICP. Parents reported participation was worthwhile (27 parents [84%]), they felt listened to (31 parents [94%]), and would recommend the PediSICP (28 parents [85%]). Parents endorsed higher therapeutic alliance after the PediSICP intervention compared with before (The Human Connection scale mean [SD] score, 57.6 [6.4] vs 55.3 [7.8]; P = .03) and decreased anxiety immediately after the intervention (Generalized Anxiety Disorder-7-item mean [SD] score, 10.1 [7.3] vs 8.4 [6.9]; P = .003), which persisted at the 1-month follow-up (mean [SD] score, 7.7 [6.8]; P = .03). Conclusions and Relevance This pilot cohort study found that the PediSICP was feasible, acceptable, and highly valued by clinicians and parents of children with serious illness. These findings suggest that the PediSICP may empower interprofessional clinicians and improve ACP with families of children and AYAs who are seriously ill.
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Affiliation(s)
- Danielle D DeCourcey
- Department of Pediatrics, Division of Medical Critical Care, Boston Children's Hospital, Boston, Massachusetts
| | - Rachelle E Bernacki
- Division of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Brett Nava-Coulter
- Department of Pediatrics, Division of Medical Critical Care, Boston Children's Hospital, Boston, Massachusetts
| | - Sithya Lach
- Department of Pediatrics, Division of Medical Critical Care, Boston Children's Hospital, Boston, Massachusetts
| | - Niya Xiong
- Department of Data Science, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Joanne Wolfe
- Division of Supportive and Palliative Care, Mass General for Children, Boston, Massachusetts
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Tirtei E, Campello A, Sciannameo V, Asaftei SD, Meazza C, Sironi G, Longhi A, Ibrahim T, Tamburini A, Coccoli L, Crocco F, Cagnazzo C, De Luna E, Quarello P, Berchialla P, Fagioli F. Prolonged 14-day continuous infusion of high-dose ifosfamide for patients with relapsed and refractory high-grade osteosarcoma: a retrospective multicentre cohort study. BMC Cancer 2024; 24:747. [PMID: 38898388 PMCID: PMC11186082 DOI: 10.1186/s12885-024-12498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The prognosis of patients with Relapsed/Refractory Osteosarcoma (R/R OS) remains dismal without an agreement on systemic therapy. The use of High-Dose Ifosfamide (14 g/sqm) with an external pump in outpatient setting (14-IFO) in R/R OS patients is limited. This study represents the first retrospective cohort analysis focused on evaluating the activity and toxicity of 14-IFO in this setting. PATIENTS AND METHODS The study investigated 14-IFO activity, in terms of tumour response according to RECIST 1.1 criteria, as well as survival rates and toxicity, according to CTCAE v.5. RESULTS The trial enrolled 26 patients with R/R OS. The Overall Response Rate (ORR) and Disease Control Rate (DCR) obtained was 23% and 57.5%, respectively. Patients with relapsed OS showed a higher ORR (45%) and DCR (82%) compared to refractory patients, irrespective of the number of prior treatment lines received. The achievement of disease control with 14-IFO administration enabled 27% of patients to undergo new local treatment. Four-month Progression-Free Survival (PFS) was 54% for all patients and 82% for the relapsed OS sub-group. Median Overall Survival (OSurv) was 13.7 months, with 1-year OSurv of 51% for all patients and 71% for relapsed patients. Age over 18 years and the presence of refractory disease were identified as negative prognostic factors for this patient cohort. A total of 101 cycles were evaluated for toxic assessment, demonstrating a tolerable profile without grade 3-4 non-haematological toxicities. CONCLUSIONS 14-IFO should be considered a viable treatment option for R/R OS, particularly due to its well tolerated toxicity profile and the potential for home-administration, which can improve patient quality of life without compromising efficacy.
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Affiliation(s)
- Elisa Tirtei
- Paediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Anna Campello
- Paediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy.
| | - Veronica Sciannameo
- Centre for Biostatistics, Epidemiology and Public Health, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano, 10043, Italy.
| | - Sebastian Dorin Asaftei
- Paediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
| | - Cristina Meazza
- Paediatric Oncology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Paediatric Oncology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Longhi
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Toni Ibrahim
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Angela Tamburini
- Department of Paediatric Haematology-Oncology, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Luca Coccoli
- Pediatric Oncology-Hematology Unit, Stem Cell Transplantation and EURACAN Hub Center Unit, S. Chiara Hospital, AOUP, Pisa, Italy
| | - Fanj Crocco
- Paediatrics Division, Department of Health Sciences, AOU Maggiore della Carità di Novara, Piemonte Orientale University, Novara, Italy
| | - Celeste Cagnazzo
- Paediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
| | - Elvira De Luna
- Paediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
| | - Paola Quarello
- Paediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Paola Berchialla
- Centre for Biostatistics, Epidemiology and Public Health, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano, 10043, Italy
| | - Franca Fagioli
- Paediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
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Bell CJ, Spruit JL, Deatrick JA, Weaver MS, Dickens DS, Hinds PS, Kavanaugh KL. Development and Validation of a Ready-to-Talk Measure for Use in Adolescents and Young Adults Living With Advanced Cancer. Cancer Nurs 2024:00002820-990000000-00255. [PMID: 38832797 DOI: 10.1097/ncc.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND In the era of evolving and emerging therapies, adolescents and young adults (AYAs) living with advanced cancer experience a high degree of uncertainty, making palliative care and end-of-life (PCEOL) discussions difficult. Clinical conversations determine values/preferences that guide shared decision-making and goals of treatment, including end-of-life care when cancer progresses. Initiating PCEOL conversations is challenging for clinicians. OBJECTIVE This study describes the development and validation of an instrument that measures AYA readiness to engage in PCEOL clinical conversations. METHODS A Ready-to-Talk Measure (R-T-M) was developed, guided by the revised conceptual model of readiness across 3 domains (awareness, acceptance, and willingness). Content experts evaluated validity, and 13 AYAs with advanced cancer participated in cognitive interviews. Acceptability (item applicability, clarity, interpretation, sensitivity, missingness) and experiences (benefit, burden) were analyzed. RESULTS The scale content validity index was ≥0.90 for each domain. Forty-two of the 55 R-T-M items were acceptable without any change. Three items were deleted. Ten items were modified, and 3 were added. Adolescents and young adults wanted more items about friends/siblings and about AYA unique qualities for clinicians to know them better. Adolescents and young adults acknowledged benefit through talking about difficult, relevant topics. CONCLUSION Ready-to-Talk Measure validity was strengthened by deleting or modifying unclear or misinterpreted items and by adding items. Next steps include psychometric analysis to determine reliability/dimensionality and stakeholder input to make the R-T-M a clinically useful tool. IMPLICATIONS FOR PRACTICE Ready-to-Talk Measure assessment of readiness to engage in PCEOL conversations while identifying unique preferences of AYAs holds promise for facilitating ongoing discussions.
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Affiliation(s)
- Cynthia J Bell
- Author Affiliations: Department of Cancer Care Services, Corewell Health, Lemmen-Holton Cancer Pavilion, Grand Rapids (Dr Bell); and Department of Pediatrics, Palliative Care, C. S. Mott Children's Hospital, Ann Arbor (Dr Spruit), Michigan; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia (Dr Deatrick); Department of Pediatric Palliative Care, Children's Nebraska, University of Nebraska Medical Center, Omaha (Dr Weaver); Department of Pediatrics, Hematology/Oncology, University of Iowa (Dr Dickens); Department of Nursing Science, Professional Practice & Quality, Children's National Hospital, and Department of Pediatrics, George Washington University, Washington, District of Columbia (Dr Hinds); and Department of Nursing Research and Evidence Based Practice, Children's Wisconsin, Milwaukee, and University of Illinois at Chicago (Dr Kavanaugh)
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Linane H, Tanjavur B, Sullivan L. A scoping review of guidelines and frameworks for advance care planning for adolescents and young adults with life-limiting or life-threatening conditions. Palliat Med 2024; 38:504-516. [PMID: 38600067 DOI: 10.1177/02692163241242331] [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: 04/12/2024]
Abstract
BACKGROUND Advance care planning discussions are crucial in the management and support of individuals with life-limiting or life-threatening conditions. Few studies have examined best practices for advance care planning with adolescents and young adults. AIM To identify core components of current guidelines, frameworks and tools for advance care planning discussions with adolescents and young adults with life-limiting or life-threatening conditions and their families. DESIGN A scoping review of the literature was conducted followed by a thematic analysis of the included papers. The scoping review was reported according to the Joanna Briggs Institute approach to the conduct of scoping reviews. DATA SOURCES Five databases [Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, PsycInfo, PubMed and Scopus] were searched for English-language papers published between inception until January 2023. RESULTS The search yielded 2976 papers, of which 9 met the inclusion criteria. Five main themes were identified: (i) utilisation of standardised documents and protocols; (ii) shared decision-making between the adolescents and young adults, their families and the healthcare team; (iii) the importance of open and honest communication with adolescents and young adults during advance care planning discussions; (iv) individualisation and flexibility in the advance care planning process and (v) timing of advance care planning initiation. CONCLUSIONS Results highlight the importance of engaging adolescents and young adults in advance care planning and considering their unique needs when initiating and framing these discussions. Our findings can be used by healthcare professionals to inform advance care planning in this group.
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Affiliation(s)
- Hannah Linane
- Department of Paediatric Palliative Medicine, Children's Health Ireland, Dublin, Ireland
| | - Bhavana Tanjavur
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lindsay Sullivan
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
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7
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Johnston EE, Rosenberg AR. Palliative Care in Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:755-763. [PMID: 37862672 DOI: 10.1200/jco.23.00709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 08/25/2023] [Indexed: 10/22/2023] Open
Abstract
Palliative care (PC) aims to improve quality of life (QOL) for patients with serious illness and their families by recognizing and alleviating the physical, emotional, social, existential, and spiritual suffering of patients and their communities. Because adolescents and young adults (AYAs, age 15-39 years) with cancer commonly report distress across all these domains and because that distress translates to their QOL during and after their cancers, PC is particularly relevant for this population. Here, we review the evidence for PC among AYAs with cancer, including its rationale, gaps, opportunities, and implications for care delivery. For example, nearly 90% of AYAs with cancer report distressing symptoms during their treatment, those who survive report ongoing unmet psychosocial and physical health needs, and those who die from their cancers are highly likely to receive medically intense care that is discordant with their goals and values. AYA communication and decision making can be challenging because of ethical and developmental considerations regarding the patient's autonomy and competing priorities of patients and caregivers. PC interventions (including primary PC delivered by oncologists, routine PC subspecialty care, symptom tracking, advance care planning, and psychosocial programs promoting AYA resilience) are all associated with improved patient-centered outcomes. However, PC is inconsistently integrated into AYA oncology care, and access to PC programs is not equitable; marginalized groups continue to experience poorer outcomes. Ongoing and future research and clinical initiatives must continue to bridge these gaps. Improving the QOL of AYAs with cancer is a shared goal of the larger clinical oncology community, and including PC in AYA cancer care delivery can help attain that goal.
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Affiliation(s)
- Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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8
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Feifer D, Helton G, Wolfe J, Volandes A, Snaman JM. Adolescents and young adults with cancer conversations following participation in an advance care planning video pilot. Support Care Cancer 2024; 32:164. [PMID: 38367086 PMCID: PMC11288345 DOI: 10.1007/s00520-024-08372-y] [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: 10/18/2023] [Accepted: 02/11/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE Advance care planning (ACP) discussions can help adolescents and young adults (AYAs) communicate their preferences to their caregivers and clinical team, yet little is known about willingness to hold conversations, content, and evolution of care preferences. We aimed to assess change in care preferences and reasons for such changes over time and examine the reasons for engaging or not engaging in ACP discussions and content of these discussions among AYAs and their caregivers. METHODS We conducted a pilot randomized controlled trial of a novel video-based ACP tool among AYA patients aged 18-39 with advanced cancer and their caregivers. Participants were asked their care preferences at baseline, after viewing the video or hearing verbal description (post questionnaire), and again 3 months later. Three-month phone calls also queried if any ACP conversations occurred since the initial study visit. Study team notes from these phone calls were evaluated using content analysis. RESULTS Forty-five AYAs and 40 caregivers completed the 3-month follow-up. Nearly half of AYAs and caregivers changed their care preference from post questionnaire to 3-month follow-up. Increased reflection and learning on the topic (n = 45) prompted preference change, with participants often noting the nuanced and context-specific nature of these decisions (n = 20). Most AYAs (60%) and caregivers (65%) engaged in ACP conversation(s), often with a family member. Disease-related factors (n = 8), study participation (n = 8), and a desire for shared understanding (n = 6) were common reasons for initiating discussions. Barriers included disease status (n = 14) and timing (n = 12). ACP discussions focused on both specific wishes for treatment (n = 26) and general conversations about goals and values (n = 18). CONCLUSION AYAs and caregivers acknowledged the complexity of ACP decisions, identifying obstacles and aids for these discussions. Clinicians should support a personalized approach to ACP that captures these nuances, promoting ACP as an iterative, longitudinal, and collaborative process. TRIAL REGISTRATION This trial was registered 10/31/2019 with ClinicalTrials.gov (Identifier: NCT0414907).
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Affiliation(s)
- Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
- Doctor of Medicine Program, Emory School of Medicine, Atlanta, GA, USA
| | - Gabrielle Helton
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
- Doctor of Medicine Program, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Evans HE, Jessop S, Bedoya SZ, Lyon ME, Wiener L, Sansom-Daly UM. Examining the Cultural Appropriateness of Advance Care Planning Tools for Adolescents and Young Adults With Cancer: An Example of Cross-Cultural Adaptation of the Voicing My CHOiCES Tool. Curr Probl Cancer 2023; 47:101010. [PMID: 37716878 DOI: 10.1016/j.currproblcancer.2023.101010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/13/2023] [Indexed: 09/18/2023]
Abstract
Advance care planning (ACP) is crucial in supporting optimal, patient-centered care for adolescents and young adults (AYAs) with life-limiting illnesses and can reduce unwanted outcomes at end-of-life. While several ACP tools and interventions have been designed for AYAs, most of these were developed in the United States of America (USA). This paper describes a study designed to adapt the AYA ACP tool, Voicing My CHOiCES (VMC), for the Australian population. A 2-stage mixed methods approach was used. Stage 1 involved a multiperspective interview to determine changes for the new Australian VMC. Participants were AYAs between the ages of 15 to 25, healthcare professionals, and parents. For each section, participants responded to questions targeting the helpfulness and usefulness of the items as well as open-ended questions about any suggested content or formatting changes. Stage 2 used think-aloud interviews asking AYA cancer patients and survivors aged between 15 and 39 years to respond to proposed changes for the Australian VMC. Stage 1 participants suggested changes to all pages of VMC, with proposed changes being based around language, content, and format. Stage 2 participants qualitatively confirmed the acceptability of these changes. Our data suggests that even between similar Western cultures, significant adaptations can be made to make ACP tools more culturally appropriate. More research is needed to further adapt ACP tools like VMC for culturally and linguistically diverse groups and to ensure these tools can be accessed by all AYAs with life-limiting illness.
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Affiliation(s)
- Holly E Evans
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia.
| | - Sophie Jessop
- Michael Rice Department of Haematology/Oncology, Women's and Children's Hospital, Adelaide, Australia
| | - Sima Z Bedoya
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maureen E Lyon
- Center for Translational Research/Children's Research Institute, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Lori Wiener
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ursula M Sansom-Daly
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia; Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospital, Randwick, New South Wales, Australia
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10
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Mastropolo R, Altschuler A, Brock KE, Casperson M, Chao CR, Fisher L, Greenzang KA, Kushi LH, Lakin JR, Lefebvre A, Schwartz CM, Shalman DM, Wall CB, Wiener L, Mack JW. Patient, Caregiver, and Clinician Perspectives on Core Components of Therapeutic Alliance for Adolescents and Young Adults With Advanced Cancer: A Qualitative Study. JAMA Netw Open 2023; 6:e2328153. [PMID: 37556137 PMCID: PMC10413170 DOI: 10.1001/jamanetworkopen.2023.28153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/29/2023] [Indexed: 08/10/2023] Open
Abstract
Importance The patient-clinician therapeutic alliance is an important aspect of high-quality cancer care. However, components of the therapeutic alliance in adolescents and young adults (AYAs, aged 12-39 years) with cancer have not been defined. Objective To identify components of and barriers to the therapeutic alliance between AYAs, caregivers, and clinicians from the perspective of all key stakeholders. Design, Setting, and Participants In this qualitative study, semistructured in-depth interviews with patients, caregivers, and clinicians were conducted from 2018 to 2021 with no additional follow-up, with content analysis of resulting transcripts. Participants were recruited from Dana-Farber Cancer Institute, Kaiser Permanente Northern California, Kaiser Permanente Southern California, and an online cancer support community (Cactus Cancer Society). Eligible participants were English- or Spanish-speaking. Eligible patients were aged 12 to 39 years with stage IV or recurrent cancer. Eligible caregivers cared for an AYA living with advanced cancer or one who had died within 5 years. Eligible clinicians routinely provided care for AYAs with cancer. Main Outcomes and Measures Perspectives on therapeutic alliance. Results Interviews were conducted with 80 participants: 23 were patients (48% were female; 78% were White), 28 were caregivers (82% were female; 50% were White), and 29 were clinicians (69% were female; 45% were White). The mean (SD) age of patients was 29 (7.3) years. Interviews identified 6 components of therapeutic alliance: (1) compassion; (2) sense of connection; (3) clinician presence; (4) information sharing; (5) shared goals; and (6) individualization of care. While some domains were represented in prior models of therapeutic alliance, a unique domain was identified related to the need for individualization of the approach to care for AYA patients and their caregivers. Interviews also identified potential barriers to building the therapeutic alliance specific to the AYA population, including managing discordant needs between patients and caregivers and communication challenges at the end of life. Conclusions and Relevance This study identified core components and barriers to building therapeutic alliance in the AYA advanced cancer population from the perspective of all the key stakeholders in the relationship. A novel component highlighting the need for individualization was identified. This model enables a deeper understanding of how to build therapeutic alliance in the AYA advanced cancer population, which may guide clinician training and facilitate improved care for this vulnerable population.
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Affiliation(s)
- Rosemarie Mastropolo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Katharine E. Brock
- Department of Pediatric Oncology, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Mallory Casperson
- Divisions of Pediatric Oncology and Palliative Care, Cactus Cancer Society, Oakland, California
| | - Chun R. Chao
- Department of Research and Evaluation (C.R.C.), Kaiser Permanente Southern California, Pasadena
| | - Lauren Fisher
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Katie A. Greenzang
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Joshua R. Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna Lefebvre
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Corey M. Schwartz
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland
| | - Dov M. Shalman
- Department of Palliative Care, Kaiser Permanente Southern California, Pasadena
| | - Catherine B. Wall
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Jennifer W. Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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11
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Lusney N, van Breemen C, Lim E, Pawliuk C, Hussein Z. Pediatric Advance Care Planning: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1179. [PMID: 37508676 PMCID: PMC10378635 DOI: 10.3390/children10071179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
To assess current practice and provide a basis for a provincial template, clinicians at a Canadian pediatric hospice reviewed the literature surrounding pediatric advance care planning (pACP) documentation, process, and implementation for children/youth. The scoping review protocol was developed in accordance with the Joanna Briggs Institute methodology for scoping reviews, and was prospectively registered on the Open Science Framework. MEDLINE, Embase, CINAHL, the Web of Science Core Collection, and Google Scholar, as well as sources of unpublished studies and grey literature, were reviewed. Sixty-four articles met the criteria. Fifteen pACP documentation forms/tools were also identified. Overall, the included articles highlighted that pACP should be a structured, collaborative and iterative process between the family and a trusted or relevant healthcare provider, encompassing medical and non-medical issues. Few articles provided insights into specific elements recommended for advance directive forms. Identified strategies for implementation included a structured, step-by-step pACP interventional tool along with ongoing training, mentorship, and defined organizational structures for the clinician. No single specific ACP tool was acknowledged as the gold standard. Use of a pACP tool, along with ongoing provider education and communication skill development, standardized/accessible documentation, and system-wide quality improvement support, were noted as integral components of pACP.
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Affiliation(s)
- Nadine Lusney
- Canuck Place Children's Hospice, Vancouver, BC V6J 2T2, Canada
| | - Camara van Breemen
- Canuck Place Children's Hospice, Vancouver, BC V6J 2T2, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada
| | - Edlyn Lim
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada
| | - Colleen Pawliuk
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada
| | - Zahra Hussein
- Child Health British Columbia, Vancouver, BC V6J 4Y6, Canada
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12
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Snaman JM, Feifer D, Helton G, Chang Y, El-Jawahri A, Volandes AE, Wolfe J. A Pilot Randomized Trial of an Advance Care Planning Video Decision Support Tool for Adolescents and Young Adults With Advanced Cancer. J Natl Compr Canc Netw 2023; 21:715-723.e17. [PMID: 37433434 PMCID: PMC11261458 DOI: 10.6004/jnccn.2023.7021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/13/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with advanced cancer often receive intensive end-of-life care, yet it is unclear if this is goal-concordant. Advance care planning (ACP) video tools may promote identification and communication of AYA preferences. PATIENTS AND METHODS We conducted a dual-site, 1:1 pilot randomized controlled trial of a novel video-based ACP tool in 50 dyads of AYA patients aged 18 to 39 years with advanced cancer and their caregivers. ACP readiness and knowledge, preferences for future care, and decisional conflict were obtained pre, post, and 3 months after the intervention and compared between groups. RESULTS Of the 50 AYA/caregiver dyads enrolled, 25 (50%) were randomized to the intervention. Participants primarily identified as female, white, and non-Hispanic. Most AYAs (76%) and caregivers (86%) identified their overall goal as life-prolonging preintervention; less identified this goal postintervention (42% AYAs; 52% caregivers). There was no significant difference in change in proportion of AYAs or caregivers choosing life-prolonging care, CPR, or ventilation between arms postintervention or at 3 months. The change in participant scores for ACP knowledge (AYAs and caregivers) and ACP readiness (AYAs) from preintervention to postintervention was greater in the video arm compared with the control arm; the difference in caregivers' scores for decisional conflict from preintervention to postintervention in the video arm was statistically significant (15 vs 7; P=.005). Feedback from the video participants was overwhelmingly positive; of the 45 intervention participants who provided video feedback, 43 (96%) found the video helpful, 40 (89%) were comfortable viewing the video, and 42 (93%) indicated they would recommend the video to other patients facing similar decisions. CONCLUSIONS Most AYAs with advanced cancer and their caregivers preferred life-prolonging care in advanced illness, with fewer preferring this type of care postintervention. A brief video-based ACP tool was well-liked by participants and improved caregiver decisional certainty. Videos may be a useful tool to inform AYAs and caregivers about end-of-life care options and promote ACP discussions.
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Affiliation(s)
- Jennifer M. Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Yuchiao Chang
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Joanne Wolfe
- Massachusetts General Hospital, Boston, Massachusetts
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13
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O'Daffer A, Comiskey L, Scott SR, Zhou C, Bradford MC, Yi-Frazier JP, Rosenberg AR. Protocol for the promoting resilience in stress management (PRISM) intervention: a multi-site randomized controlled trial for adolescents and young adults with advanced cancer. BMC Palliat Care 2023; 22:60. [PMID: 37189149 DOI: 10.1186/s12904-023-01179-4] [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: 03/28/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer are at high risk of poor psychosocial outcomes, and evidence-based interventions designed to meet their psychosocial and communication needs are lacking. The main objective of this project is to test the efficacy of a new adaptation of the Promoting Resilience in Stress Management intervention for AYAs with Advanced Cancer (PRISM-AC). METHODS/DESIGN The PRISM-AC trial is a 2-arm, parallel, non-blinded, multisite, randomized controlled trial. 144 participants with advanced cancer will be enrolled and randomized to either usual, non-directive, supportive care without PRISM-AC ("control" arm) or with PRISM-AC ("experimental" arm). PRISM is a manualized, skills-based training program comprised of four 30-60 min, one-on-one sessions targeting AYA-endorsed resilience resources (stress-management, goal-setting, cognitive-reframing, and meaning-making). It also includes a facilitated family meeting and a fully equipped smartphone app. The current adaptation includes an embedded advance care planning module. English- or Spanish-speaking individuals 12-24 years old with advanced cancer (defined as progressive, recurrent, or refractory disease, or any diagnosis associated with < 50% survival) receiving care at 4 academic medical centers are eligible. Patients' caregivers are also eligible to participate in this study if they are able to speak and read English or Spanish, and are cognitively and physically able to participate. Participants in all groups complete surveys querying patient-reported outcomes at the time of enrollment and 3-, 6-, 9-, and 12-months post-enrollment. The primary outcome of interest is patient-reported health-related quality of life (HRQOL) and secondary outcomes of interest include patient anxiety, depression, resilience, hope and symptom burden, parent/caregiver anxiety, depression and health-related quality of life, and family palliative care activation. We will conduct intention-to-treat analysis to compare the group means of primary and secondary outcomes between PRISM-AC arm and control arm with regression models. DISCUSSION This study will provide methodologically rigorous data and evidence regarding a novel intervention to promote resilience and reduce distress among AYAs with advanced cancer. This research has the potential to offer a practical, skills-based curriculum designed to improve outcomes for this high-risk group. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03668223, September 12, 2018.
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Affiliation(s)
| | - Liam Comiskey
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Samantha R Scott
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Denver, Denver, CO, USA
| | - Chuan Zhou
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | | | | | - Abby R Rosenberg
- Dana-Farber Cancer Institute, 450 Brookline Ave, JF7, Boston, MA, 02215, USA.
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14
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O'Daffer A, Comiskey L, Scott SR, Zhou C, Bradford MC, Yi-Frazier JP, Rosenberg AR. Protocol for The Promoting Resilience in Stress Management (PRISM) Intervention: a multi-site randomized controlled trial for adolescents and young adults with advanced cancer. RESEARCH SQUARE 2023:rs.3.rs-2748874. [PMID: 37066150 PMCID: PMC10104275 DOI: 10.21203/rs.3.rs-2748874/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Adolescents and young adults (AYAs) with cancer are at high risk of poor psychosocial outcomes, and evidence-based interventions designed to meet their psychosocial and communication needs are lacking. The main objective of this project is to test the efficacy of a new adaptation of the Promoting Resilience in Stress Management intervention for AYAs with Advanced Cancer (PRISM-AC). Methods/design: The PRISM-AC trial is a 2-arm, parallel, non-blinded, multisite, randomized controlled trial. 144 participants with advanced cancer will be enrolled and randomized to either usual, non-directive, supportive care without PRISM-AC ("control" arm) or with PRISM-AC ("experimental" arm). PRISM is a manualized, skills-based training program comprised of four 30-60 minute, one-on-one sessions targeting AYA-endorsed resilience resources (stress-management, goal-setting, cognitive-reframing, and meaning-making). It also includes a facilitated family meeting and a fully equipped smartphone app. The current adaptation includes an embedded advance care planning module. English- or Spanish-speaking individuals 12-24 years old with advanced cancer (defined as progressive, recurrent, or refractory disease, or any diagnosis associated with < 50% survival) receiving care at 4 academic medical centers are eligible. Patients' caregivers are also eligible to participate in this study if they are able to speak and read English or Spanish, and are cognitively and physically able to participate. Participants in all groups complete surveys querying patient-reported outcomes at the time of enrollment and 3-, 6-, 9-, and 12-months post-enrollment. The primary outcome of interest is patient-reported health-related quality of life (HRQOL) and secondary outcomes of interest include patient anxiety, depression, resilience, hope and symptom burden, parent/caregiver anxiety, depression and health-related quality of life, and family palliative care activation. We will conduct intention-to-treat analysis to compare the group means of primary and secondary outcomes between PRISM-AC arm and control arm with regression models. Discussion This study will provide methodologically rigorous data and evidence regarding a novel intervention to promote resilience and reduce distress among AYAs with advanced cancer. This research has the potential to offer a practical, skills-based curriculum designed to improve outcomes for this high-risk group. Trial registration: ClinicalTrials.gov Identifier NCT03668223, September 12, 2018.
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15
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Sansom-Daly UM, Zhang M, Evans HE, McLoone J, Wiener L, Cohn RJ, Anazodo A, Patterson P, Wakefield CE. Adapting the Voicing My CHOiCES Advance Care Planning Communication Guide for Australian Adolescents and Young Adults with Cancer: Appropriateness, Acceptability, and Considerations for Clinical Practice. Cancers (Basel) 2023; 15:2129. [PMID: 37046790 PMCID: PMC10093261 DOI: 10.3390/cancers15072129] [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: 02/13/2023] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023] Open
Abstract
Background: Adolescents and young adults (AYAs) with life-threatening illnesses need support to discuss and voice their end-of-life choices. Voicing My CHOiCES (VMC) is a research-informed American advanced care planning guide designed to help facilitate these difficult discussions. This multi-perspective study aimed to evaluate its appropriateness, acceptability, and clinical considerations for Australian AYAs with cancer. Procedure: Forty-three participants including AYAs who were either undergoing or recently completed cancer treatment, their parents, and multidisciplinary health professionals assessed the acceptability of each VMC section quantitatively (appropriateness-yes/no, helpfulness and whether content caused stress-1 = not at all, to 5 = very) and qualitatively (sources of stress). AYAs also assessed the benefit and burden of completing several sections of the document, to inform clinical considerations. We conducted a mixed-methods analysis to obtain descriptive statistics and to identify prominent themes. Results: In terms of acceptability, almost all participants (96%) rated VMC as appropriate overall. Perceived helpfulness to their situation (to themselves/their child/their patients), to others, and stressfulness were rated, on average, as 4.1, 4.0, and 2.7/5, respectively. Stress was attributed to individual and personal factors, as well as interpersonal worries. All sections were considered more beneficial than burdensome, except for the Spiritual Thoughts section (Section 6). Conclusions: While VMC is an acceptable advance care planning guide for AYAs with cancer, changes to the guide were suggested for the Australian context. Health professionals implementing VMC will need to address and mitigate anticipated sources of stress identified here. Future research evaluating the impact of a new culturally adapted Australian VMC guide is an important next step. Finally, the clinical implications of the present study are suggested.
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Affiliation(s)
- Ursula M. Sansom-Daly
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Megan Zhang
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Holly E. Evans
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Jordana McLoone
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Lori Wiener
- National Institutes of Health, Bethesda, MD 20892, USA
| | - Richard J. Cohn
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Antoinette Anazodo
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Pandora Patterson
- Canteen Australia, Sydney, NSW 2042, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Claire E. Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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16
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Blume ED, Kirsch R, Cousino MK, Walter JK, Steiner JM, Miller TA, Machado D, Peyton C, Bacha E, Morell E. Palliative Care Across the Life Span for Children With Heart Disease: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2023; 16:e000114. [PMID: 36633003 PMCID: PMC10472747 DOI: 10.1161/hcq.0000000000000114] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM This summary from the American Heart Association provides guidance for the provision of primary and subspecialty palliative care in pediatric congenital and acquired heart disease. METHODS A comprehensive literature search was conducted from January 2010 to December 2021. Seminal articles published before January 2010 were also included in the review. Human subject studies and systematic reviews published in English in PubMed, ClinicalTrials.gov, and the Cochrane Collaboration were included. Structure: Although survival for pediatric congenital and acquired heart disease has tremendously improved in recent decades, morbidity and mortality risks remain for a subset of young people with heart disease, necessitating a role for palliative care. This scientific statement provides an evidence-based approach to the provision of primary and specialty palliative care for children with heart disease. Primary and specialty palliative care specific to pediatric heart disease is defined, and triggers for palliative care are outlined. Palliative care training in pediatric cardiology; diversity, equity, and inclusion considerations; and future research directions are discussed.
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Umaretiya PJ, Fisher L, Altschuler A, Kushi LH, Chao CR, Vega B, Rodrigues G, Josephs I, Brock KE, Buchanan S, Casperson M, Fasciano KM, Kolevska T, Lakin JR, Lefebvre A, Schwartz CM, Shalman DM, Wall CB, Wiener L, Bona K, Mack JW. "The simple life experiences that every other human gets": Desire for normalcy among adolescents and young adults with advanced cancer. Pediatr Blood Cancer 2023; 70:e30035. [PMID: 36308744 DOI: 10.1002/pbc.30035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with advanced cancer identify normalcy as an important component of quality end-of-life care. We sought to define domains of normalcy and identify ways in which clinicians facilitate or hinder normalcy during advanced cancer care. PROCEDURE This was a secondary analysis of a qualitative study that aimed to identify priority domains for end-of-life care. Content analysis of semi-structured interviews among AYAs aged 12-39 years with advanced cancer, caregivers, and clinicians was used to evaluate transcripts. Coded excerpts were reviewed to identify themes related to normalcy. RESULTS Participants included 23 AYAs with advanced cancer, 28 caregivers, and 29 clinicians. Participants identified five domains of normalcy including relationships, activities, career/school, milestones, and appearance. AYAs and caregivers identified that clinicians facilitate normalcy through exploration of these domains with AYAs, allowing flexibility in care plans, identification of short-term and long-term goals across normalcy domains, and recognizing losses of normalcy that occur during cancer care. CONCLUSIONS AYAs with cancer experience multiple threats to normalcy during advanced cancer care. Clinicians can attend to normalcy and improve AYA quality of life by acknowledging these losses through ongoing discussions on how best to support domains of normalcy and by reinforcing AYA identities beyond a cancer diagnosis.
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Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lauren Fisher
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Brenda Vega
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gilda Rodrigues
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Katharine E Brock
- Divisions of Pediatric Oncology and Palliative Care, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Karen M Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tatjana Kolevska
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland, California, USA
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anna Lefebvre
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Corey M Schwartz
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland, California, USA
| | - Dov M Shalman
- Department of Palliative Care, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Catherine B Wall
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lori Wiener
- Psychosocial Support and Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
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18
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Abdelaal M, Avery J, Chow R, Saleem N, Fazelzad R, Mosher P, Hannon B, Zimmermann C, Al-Awamer A. Palliative care for adolescents and young adults with advanced illness: A scoping review. Palliat Med 2023; 37:88-107. [PMID: 36352490 PMCID: PMC9841827 DOI: 10.1177/02692163221136160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Age-related complex medical conditions have been commonly reported among adolescents and young adults with advanced life-limiting illness. There is increasing interest in exploring their palliative care needs and end-of-life experiences. AIM This scoping review aimed to explore the available literature about providing palliative and end-of-life care to adolescents and young adults with advanced life-limiting illnesses. DESIGN Scoping review. This review was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/SPTD7). DATA SOURCES Electronic databases (MEDLINEALL, Embase, Emcare, Cochrane Central Register of Controlled Trial CENTRAL, Scopus, PsycINFO, Cochrane Database of Systematic Reviews), Google Scholar and reference lists were searched up to October 2021. We included studies reporting on adolescents and/or young adults with advanced life-limiting illnesses. There were no limitations concerning location, type of illness or study design. RESULTS We identified 51 studies published between 2002 and 2021. Most studies were published in the United States (n = 34, 67%), and nine studies (18%) reported exclusively on patients with non-malignant illnesses. Two thirds of the identified studies were case reports and retrospective chart reviews (n = 33). Three main topics were identified: Physical symptom burden (n = 26, 51%), Psychological and social needs (n = 33, 65%), and end-of-life care (n = 30, 59%). Twenty-six studies (51%) were focused only on one topic, and the age range used to identify adolescents and young adults varied based on the study location. CONCLUSION The findings of this review shed light on the different palliative care experiences and knowledge gaps related to adolescents and young adults as an underserved and vulnerable patient population. Further research needs to be dedicated toward palliative care programs tailored for adolescents and young adults.
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Affiliation(s)
- Mohamed Abdelaal
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jonathan Avery
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nasreen Saleem
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rouhi Fazelzad
- UHN Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Pamela Mosher
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Child and Adolescent Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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19
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Porter AS, Woods C, Stall M, Velrajan S, Baker JN, Mack JW, Kaye EC. Oncologist approaches to communicating uncertain disease status in pediatric cancer: a qualitative study. BMC Cancer 2022; 22:1109. [PMCID: PMC9620648 DOI: 10.1186/s12885-022-10190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/28/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Most patients with cancer and their caregivers desire honest, clear prognostic communication, yet oncologists often disclose prognosis inconsistently. Prognostic communication becomes even more challenging when disease progression is unclear or equivocal. Presently, oncologist approaches for discussing uncertain disease findings are poorly understood. Methods In this prospective, longitudinal study, we audio-recorded serial disease reevaluation conversations between children with high-risk cancer, their families, and their primary oncologists over 24 months and conducted content analysis at recorded timepoints when oncologists categorized disease progression as equivocal. Results Of the 265 medical discussions recorded across the illness course for 33 patient-parent dyads, a total of 40 recorded discussions took place at equivocal timepoints, comprising > 500 min of medical dialogue. Prognosis talk encompassed < 3% of dialogue and was absent in nearly half of equivocal discussions (17/40, 42.5%). Curability statements were identified in only two conversations. Inductive content analysis of dialogue revealed four distinct patterns for communicating equivocal disease status: (1) up-front reassurance, (2) softening the message, (3) describing possible disease progression without interpretation, (4) expressing uncertainty without discussing the bigger picture. Conclusion Oncologists rarely discuss prognosis with children with high-risk cancer and their families at timepoints when disease progression is not definitive. Formal guidance is needed to better support oncologists in navigating uncertainty while sharing honest, person- and family-centered information about prognosis. Supplementary information The online version contains supplementary material available at 10.1186/s12885-022-10190-6.
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Affiliation(s)
- Amy S. Porter
- grid.240871.80000 0001 0224 711XSt. Jude Children’s Research Hospital, Memphis, TN USA
| | - Cameka Woods
- grid.240871.80000 0001 0224 711XSt. Jude Children’s Research Hospital, Memphis, TN USA
| | - Melanie Stall
- grid.267313.20000 0000 9482 7121The University of Texas Southwestern Medical Center, Dallas, TX USA
| | | | - Justin N. Baker
- grid.240871.80000 0001 0224 711XSt. Jude Children’s Research Hospital, Memphis, TN USA
| | - Jennifer W. Mack
- grid.65499.370000 0001 2106 9910Dana-Farber Cancer Institute, Boston, MA USA ,grid.2515.30000 0004 0378 8438Boston Children’s Hospital, Boston, MA USA
| | - Erica C. Kaye
- grid.240871.80000 0001 0224 711XSt. Jude Children’s Research Hospital, Memphis, TN USA ,grid.240871.80000 0001 0224 711XDivision of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 1121, 38105 Memphis, TN USA
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20
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Music therapy and pediatric palliative care: songwriting with children in the end-of-life. World J Pediatr 2022; 18:695-699. [PMID: 35773435 DOI: 10.1007/s12519-022-00578-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/29/2022] [Indexed: 10/17/2022]
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21
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Odejide OO, Fisher L, Kushi LH, Chao CR, Vega B, Rodrigues G, Josephs I, Brock KE, Buchanan S, Casperson M, Cooper RM, Fasciano KM, Kolevska T, Lakin JR, Lefebvre A, Schwartz CM, Shalman DM, Wall CB, Wiener L, Altschuler A, Mack JW. Patient, Family, and Clinician Perspectives on Location of Death for Adolescents and Young Adults With Cancer. JCO Oncol Pract 2022; 18:e1621-e1629. [PMID: 35981281 PMCID: PMC9810128 DOI: 10.1200/op.22.00143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/24/2022] [Accepted: 07/11/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Adolescents and young adults (AYAs) with cancer have high rates of hospital deaths. It is not clear if this reflects their preferences or barriers to dying at home. METHODS Between December 2018 and January 2021, we conducted in-depth interviews with AYAs (age 12-39 years) with stage IV or recurrent cancer, family caregivers including bereaved caregivers, and clinicians of AYAs with cancer. Patients were asked about their priorities for care including location of death, caregivers were asked what was most important in the care of their AYA family member, and clinicians were asked to reflect on priorities identified through caring for AYAs. Directed content analysis was applied to interview data, and themes regarding location of death were developed. RESULTS Eighty individuals (23 AYAs, 28 caregivers, and 29 clinicians) participated in interviews. Most AYAs and caregivers preferred a home death. However, some AYAs and caregivers opted for a hospital death to alleviate caregiver burden or protect siblings from the perceived trauma of witnessing a home death. Lack of adequate services to manage intractable symptoms at home and insufficient caregiver support led some AYAs/caregivers to opt for hospital death despite a preference for home death. Participants acknowledged the value of hospice while also pointing out its limitations in attaining a home death. CONCLUSION Although most AYAs prefer to die at home, this preference is not always achieved. Robust home-based services for effective symptom management and caregiver support are needed to close the gap between preferred and actual location of death for AYAs.
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Affiliation(s)
- Oreofe O. Odejide
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Lauren Fisher
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Chun R. Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Brenda Vega
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Gilda Rodrigues
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | | | - Katharine E. Brock
- Division of Pediatric Oncology, Emory University, Atlanta, GA
- Division of Palliative Care, Emory University, Atlanta, GA
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
| | - Susan Buchanan
- Agios Pharmaceuticals, Cambridge, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Robert M. Cooper
- Pediatric Oncology, Kaiser Permanente Southern California, Pasadena, CA
| | - Karen M. Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Tatjana Kolevska
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland, CA
| | - Joshua R. Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Anna Lefebvre
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Corey M. Schwartz
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland, CA
| | - Dov M. Shalman
- Palliative Care, Kaiser Permanente Southern California, Pasadena, CA
| | - Catherine B. Wall
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Lori Wiener
- Psychosocial Support and Research Program, National Cancer Institute, Bethesda, MD
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jennifer W. Mack
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
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22
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Trang J, Herbert A, Sansom-Daly UM. How can advance care planning tools help young people's voices be heard? J Paediatr Child Health 2022; 58:1317-1322. [PMID: 35758055 DOI: 10.1111/jpc.16095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Abstract
The integration of the child or young person (CYP) in conversations around advance care planning (ACP) is an important area of paediatric practice. These discussions provide CYP with the opportunity to voice their values, goals and preferences, enabling health-care professionals to ensure they are aligned with their planned course of treatment. This process, often undertaken within the context of the child's family, empowers children to participate in decisions and experience the dignity of self-determination. It also facilitates an increased understanding between the CYP and those involved in their care. The objectives of this paper are to highlight the importance of these conversations for paediatricians and identify barriers, both real and perceived, that may prevent them from engaging with a CYP about their preferences for future care including focusing more on discussion with the parents, and concern about or not having the skills to engage the child in such sensitive conversations. Triggers that can prompt clinicians to undertake ACP are also discussed. A further complexity is that after seeking their perspective, it may become apparent that the CYP may hold different views and perspectives to their parents and/or clinician. This review article will especially examine elements of end-of-life conversations that are critical to support the important goal of listening to the voice of the CYP. This includes considerations around timing, legal aspects, ethical tensions that arise when amplifying a child's voice, clinician/team-member roles, clinical process considerations, and the use of specific interventions and ACP tools to facilitate these conversations with CYP.
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Affiliation(s)
- Jacinta Trang
- Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Anthony Herbert
- Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ursula M Sansom-Daly
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospital, Sydney, New South Wales, Australia
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23
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Voicing their choices: Advance care planning with adolescents and young adults with cancer and other serious conditions. Palliat Support Care 2022; 20:462-470. [PMID: 35876450 PMCID: PMC9315053 DOI: 10.1017/s1478951521001462] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine whether engaging in advance care planning (ACP) using a formal tool, Voicing My CHOiCES (VMC), would alleviate adolescent and young adults (AYAs) anxiety surrounding ACP and increase social support and communication about end-of-life care preferences with family members and health care providers (HCPs). METHODS A total of 149 AYAs aged 18-39 years receiving cancer-directed therapy or treatment for another chronic medical illness were enrolled at seven US sites. Baseline data included prior ACP communication with family members and HCPs and measures of generalized anxiety, ACP anxiety, and social support. Participants critically reviewed each page of VMC and then completed three pages of the document. ACP anxiety was measured again immediately after the completion of VMC pages. One month later, participants repeated anxiety and social support measures and were asked if they shared what they had completed in VMC with a family member or HCP. RESULTS At baseline, 50.3% of participants reported that they previously had a conversation about EoL preferences with a family member; 19.5% with an HCP. One month later, 65.1% had subsequently shared what they wrote in VMC with a family member; 8.9% shared with an HCP. Most (88.6%) reported they would not have had this conversation if not participating in the study. No significant changes occurred in social support. There was an immediate drop in anxiety about EoL planning after reviewing VMC which persisted at 1 month. Generalized anxiety was also significantly lower 1 month after reviewing VMC. SIGNIFICANCE OF RESULTS Having a document specifically created for AYAs to guide ACP planning can decrease anxiety and increase communication with family members but not necessarily with HCPs. Future research should examine ways ACP can be introduced more consistently to this young population to allow their preferences for care to be heard, respected, and honored, particularly by their healthcare providers.
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24
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Sansom-Daly UM, Wiener L, Darlington AS, Poort H, Rosenberg AR, Weaver MS, Schulte F, Anazodo A, Phillips C, Sue L, Herbert AR, Mack JW, Lindsay T, Evans H, Wakefield CE. Thinking globally to improve care locally: A Delphi study protocol to achieve international clinical consensus on best-practice end-of-life communication with adolescents and young adults with cancer. PLoS One 2022; 17:e0270797. [PMID: 35802558 PMCID: PMC9269432 DOI: 10.1371/journal.pone.0270797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022] Open
Abstract
For the sizeable subset of adolescents and young adults whose cancer is incurable, developmentally appropriate end-of-life discussions are critical. Standards of care for adolescent and young adult end-of-life communication have been established, however, many health-professionals do not feel confident leading these conversations, leaving gaps in the implementation of best-practice end-of-life communication. We present a protocol for a Delphi study informing the development and implementation of clinician training to strengthen health-professionals’ capacity in end-of-life conversations. Our approach will inform training to address barriers to end-of-life communication with adolescents and young adults across Westernized Adolescent and Young Adult Cancer Global Accord countries. The Adolescent and Young Adult Cancer Global Accord team involves 26 investigators from Australia, New Zealand, the United States, Canada and the United Kingdom. Twenty-four consumers, including adolescents and young adults with cancer history and carers, informed study design. We describe methodology for a modified Delphi questionnaire. The questionnaire aims to determine optimal timing for end-of-life communication with adolescents and young adults, practice-related content needed in clinician training for end-of-life communication with adolescents and young adults, and desireability of evidence-based training models. Round 1 involves an expert panel of investigators identifying appropriate questionnaire items. Rounds 2 and 3 involve questionnaires of international multidisciplinary health-professionals, followed by further input by adolescents and young adults. A second stage of research will design health-professional training to support best-practice end-of-life communication. The outcomes of this iterative and participatory research will directly inform the implementation of best-practice end-of-life communication across Adolescent and Young Adult Cancer Global Accord countries. Barriers and training preferences identified will directly contribute to developing clinician-training resources. Our results will provide a framework to support further investigating end-of-life communication with adolescents and young adults across diverse countries. Our experiences also highlight effective methodology in undertaking highly collaborative global research.
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Affiliation(s)
- Ursula M. Sansom-Daly
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia
- Sydney Youth Cancer Service, Prince of Wales/Sydney Children’s Hospital, Randwick, New South Wales, Australia
- * E-mail:
| | - Lori Wiener
- Psychosocial Support and Research Program, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Anne-Sophie Darlington
- School of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom
| | - Hanneke Poort
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Abby R. Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America
- Palliative Care and Resilience Program, Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Meaghann S. Weaver
- Divisions of Palliative Care & Pediatric Hematology/Oncology, University of Nebraska Medical Center, Lincoln, Nebraska, United States of America
- National Center for Ethics in Health Care, Washington DC, Washington, United States of America
| | - Fiona Schulte
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hematology, Oncology and Transplant Program, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Antoinette Anazodo
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia
- Sydney Youth Cancer Service, Prince of Wales/Sydney Children’s Hospital, Randwick, New South Wales, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - Celeste Phillips
- School of Nursing, Indiana University, Indianapolis, Indiana, United States of America
| | - Louise Sue
- Adolescent and Young Adult Cancer Services Team, Canterbury District Health Board, Christchurch, New Zealand
| | - Anthony R. Herbert
- Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Centre for Children’s Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jennifer W. Mack
- Population Sciences for Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Toni Lindsay
- Chris O’Brien Lifehouse Cancer Centre, Camperdown, New South Wales, Australia
| | - Holly Evans
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia
| | - Claire E. Wakefield
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia
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25
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Bedoya SZ, Fry A, Gordon ML, Lyon ME, Thompkins J, Fasciano K, Malinowski P, Heath C, Sender L, Zabokrtsky K, Pao M, Wiener L. Adolescent and Young Adult Initiated Discussions of Advance Care Planning: Family Member, Friend and Health Care Provider Perspectives. Front Psychol 2022; 13:871042. [PMID: 35756319 PMCID: PMC9215331 DOI: 10.3389/fpsyg.2022.871042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aims End-of-life (EoL) discussions can be difficult for seriously ill adolescents and young adults (AYAs). Researchers aimed to determine whether completing Voicing My CHOiCES (VMC)-a research-informed advance care planning (ACP) guide-increased communication with family, friends, or health care providers (HCPs), and to evaluate the experience of those with whom VMC was shared. Methods Family, friends, or HCPs who the AYAs had shared their completed VMC with were administered structured interviews to assess their perception of the ACP discussion, changes in their relationship, conversation quality, and whether the discussion prompted changes in care. Open-ended responses underwent thematic analysis. Results One-month post-completion, 65.1% of AYA had shared VMC completion with a family member, 22.6% with a friend, and 8.9% with an HCP. Among a sample of respondents, family (47%) and friends (33%) reported a positive change in their relationship with the AYA. Participant descriptions of the experience fell into five themes: positive experience (47%), difficult experience (44%), appreciated a guide to facilitate discussion (35%), provided relief (21%), and created worry/anxiety (9%). Only 1 HCP noted a treatment change. Family (76%), friends (67%), and HCP (50%) did not think the AYA would have discussed EoL preferences without completing VMC. Conclusions VMC has potential to enhance communication about ACP between AYA and their family and friends, though less frequently with HCPs. Participants reported a positive change in their relationship with the AYA after discussing VMC, and described experiencing the conversation as favorable, even when also emotionally difficult.
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Affiliation(s)
- Sima Z. Bedoya
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Abigail Fry
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Mallorie L. Gordon
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | | | | | | | | | - Corey Heath
- Cook Children’s Medical Center, Fort Worth, TX, United States
| | - Leonard Sender
- Children’s Hospital Orange County, Orange, CA, United States
| | - Keri Zabokrtsky
- Children’s Hospital Orange County, Orange, CA, United States
| | - Maryland Pao
- National Institute of Mental Health, Bethesda, MD, United States
| | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
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26
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Brunetta J, Fahner J, Legemaat M, van den Bergh E, Krommenhoek K, Prinsze K, Kars M, Michiels E. Age-Appropriate Advance Care Planning in Children Diagnosed with a Life-Limiting Condition: A Systematic Review. CHILDREN 2022; 9:children9060830. [PMID: 35740767 PMCID: PMC9221719 DOI: 10.3390/children9060830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 12/05/2022]
Abstract
Pediatric advance care planning (pACP) is an important strategy to support patient-centered care. It is known to be difficult, yet paramount, to involve the child in pACP while adjusting treatment to age and the corresponding stage of development. This systematic review was aimed to evaluate the age appropriateness of pACP interventions by assessing their characteristics, content, and evidence. CINAHL, Embase and MEDLINE were searched from 1 January 1998 to 31 August 2020 in order to identify peer-reviewed articles containing strategies and tools to facilitate pACP in both children (0–18 years) with life-limiting conditions and their families. An assessment of quality was performed using Cochrane tools and COREQ. The full protocol is available as PROSPERO CRD42020152243. Thirty-one articles describing 18 unique pACP tools were included. Most tools were developed for adolescents and young adults. In most cases, the interventions tried to assess the child’s and family’s preferences concerning their current and future hopes, wishes, and goals of the care. This was aimed to enhance communication about these preferences between children, their families, and health-care providers and to improve engagement in pACP. The relevance of an age-appropriate approach was mentioned in most articles, but this was mainly implicit. Seven articles implemented age-appropriate elements. Six factors influencing age appropriateness were identified. Tools to support pACP integrated age-appropriate elements to a very limited extent. They mainly focused on adolescents. The involvement of children of all ages may need a more comprehensive approach.
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Affiliation(s)
- Julie Brunetta
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands; (J.B.); (M.K.)
| | - Jurrianne Fahner
- Division of Pediatrics, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
- Correspondence:
| | - Monique Legemaat
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.L.); (E.v.d.B.); (K.K.); (K.P.); (E.M.)
| | - Esther van den Bergh
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.L.); (E.v.d.B.); (K.K.); (K.P.); (E.M.)
| | - Koen Krommenhoek
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.L.); (E.v.d.B.); (K.K.); (K.P.); (E.M.)
| | - Kyra Prinsze
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.L.); (E.v.d.B.); (K.K.); (K.P.); (E.M.)
| | - Marijke Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands; (J.B.); (M.K.)
| | - Erna Michiels
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.L.); (E.v.d.B.); (K.K.); (K.P.); (E.M.)
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27
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Linebarger JS, Johnson V, Boss RD, Linebarger JS, Collura CA, Humphrey LM, Miller EG, Williams CSP, Rholl E, Ajayi T, Lord B, McCarty CL. Guidance for Pediatric End-of-Life Care. Pediatrics 2022; 149:186860. [PMID: 35490287 DOI: 10.1542/peds.2022-057011] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The final hours, days, and weeks in the life of a child or adolescent with serious illness are stressful for families, pediatricians, and other pediatric caregivers. This clinical report reviews essential elements of pediatric care for these patients and their families, establishing end-of-life care goals, anticipatory counseling about the dying process (expected signs or symptoms, code status, desired location of death), and engagement with palliative and hospice resources. This report also outlines postmortem tasks for the pediatric team, including staff debriefing and bereavement.
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Affiliation(s)
- Jennifer S Linebarger
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, Missouri
| | - Victoria Johnson
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Berman Institute of Bioethics, Baltimore, Maryland
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28
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Hughes B, O’Brien M, Flynn A, Knighting K. Views and experiences of young people, their parents/carers and healthcare professionals of the advance care planning process: A summary of the findings from a qualitative study. Palliat Med 2022; 36:841-854. [PMID: 35360999 PMCID: PMC9087310 DOI: 10.1177/02692163221083447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Advance care planning for young people is relatively new in the UK. There is a lack of understanding about the engagement of young people in their own planning process, optimal timing of discussions and the facilitators and barriers to the engagement of young people. AIM To explore the views and experiences of young people, their parents/carers and HCPs of the advance care planning process. DESIGN A qualitative study, using semi-structured interviews with young people, their parents/carers and healthcare professionals across four case series. Data were analysed using thematic analysis. PARTICIPANTS Fifteen participants were interviewed: young people (n = 2), parents/carers (n = 5) and healthcare professionals (n = 8). RESULTS Three themes were identified from the findings. Key findings related to barriers and facilitators of engaging young people in their own care planning were apparent in the following areas: misperception of terms; hierarchies of power in relationships; and a flexible and innovative organisational structure and culture. CONCLUSION Participants expressed a variety of views and experiences of advance care planning. Advance care planning was thought to be best initiated by a consultant when the young person is in their mid-teens, their condition is stable, and before they transition to adult care. Engagement was also considered to be facilitated by appropriate communication, developing relationships prior to initiating advance care planning, and written support for everyone involved in the process. These factors were supported by training and education for healthcare professionals and a flexible and innovative structure and cultures of organisations.
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Affiliation(s)
| | | | - Anita Flynn
- Edge Hill University, Ormskirk,
Lancashire, UK
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van Driessche A, Gilissen J, De Vleminck A, Kars M, Fahner J, van der Werff ten Bosch J, Deliens L, Cohen J, Beernaert K. The BOOST paediatric advance care planning intervention for adolescents with cancer and their parents: development, acceptability and feasibility. BMC Pediatr 2022; 22:210. [PMID: 35428281 PMCID: PMC9010242 DOI: 10.1186/s12887-022-03247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Although advance care planning (ACP) has been widely recommended to support patient and family engagement in understanding the patient’s values, preferences and goals of care, there are only a few models in paediatric oncology that capture ACP as a process of behaviour change. We aimed to develop and test the acceptability and feasibility of BOOST pACP (Benefits of Obtaining Ownership Systematically Together in paediatric Advance Care Planning) – an intervention to improve ACP in adolescents with cancer, their parents and paediatric oncologists. Methods Several methods informed the intervention development process: 1) Problem identification: interviews with 11 healthcare professionals working in paediatric oncology; 2) Identification of evidence: literature review of existing pACP tools and barriers and facilitators in performing pACP; 3) Logic model and 4) Intervention design: collaborative expert meetings with researchers and professionals in pACP; 5a) Acceptability test of the materials: interviews with nine healthcare professionals, four adolescents and young adults with cancer and six parents; 5b) Feasibility test of core intervention components with three families, including interviews about their experiences. Results The BOOST pACP intervention was iteratively developed and adapted, based on feedback from families, healthcare professionals, and pACP experts (e.g., components were changed, deleted, and added; formulation of themes and associated questions were amended to enhance acceptability). The core components of the BOOST pACP intervention include: four ACP conversation sessions with the adolescent and/or parent(s) provided by a trained facilitator, structured by interactive conversation cards covering different ACP themes, followed by a transfer of information from the intervention facilitator to the paediatric oncologist. Core intervention components were deemed feasible by all participating families. Conclusion The BOOST pACP intervention was developed by close involvement of both adolescent patients and their parents, healthcare professionals and pACP experts. The final intervention and supporting materials are considered appropriate and feasible. Its effectiveness in improving parent-adolescent communication on ACP themes is currently being tested in a multi-centre randomised controlled trial. Researchers aiming to develop a complex psychosocial intervention for a vulnerable target group could use the step-by-step approach described in this paper. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03247-9.
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Hansen K, Edwards LA, Yohannes K, Luong R, Lin A, Long J, Halpern-Felsher B, Cohen H, Kaufman BD. Advance Care Planning Preferences for Adolescents With Cardiac Disease. Pediatrics 2022; 149:184391. [PMID: 34984466 DOI: 10.1542/peds.2020-049902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adolescents with cardiac disease are at risk for life-changing complications and premature death. The importance of advance care planning (ACP) in adults with congenital heart disease and in pediatric patients with HIV and cancer has been demonstrated. ACP preferences of adolescents with heart disease have not been evaluated. We describe ACP preferences of adolescents with heart disease and compare with those of their caregivers. METHODS Outpatient adolescents aged 12 to 18 years with heart failure, cardiomyopathy, heart transplantation, or who were at risk for cardiomyopathy, as well as their caregivers, completed self-administered questionnaires which evaluated participants' opinions regarding content and timing of ACP discussions, preferences for end-of-life communication, and emotional responses to ACP. RESULTS Seventy-eight adolescents and 69 caregivers participated, forming 62 adolescent-caregiver dyads. Adolescents and caregivers reported that adolescent ACP discussions should occur early in the disease course (75% and 61%, respectively). Adolescents (92%) wanted to be told about terminal prognosis, whereas only 43% of caregivers wanted the doctor to tell their child this information. Most adolescents (72%) and caregivers (67%) anticipated that discussing ACP would make the adolescent feel relieved the medical team knew their wishes. Most caregivers (61%) believed that adolescents would feel stress associated with ACP discussions, whereas only 31% of adolescents anticipated this. CONCLUSIONS Adolescents and their caregivers agree that ACP should occur early in disease course. There are discrepancies regarding communication of prognosis and perceived adolescent stress related to ACP discussions. Facilitated conversations between patient, caregiver, and providers may align goals of care and communication preferences.
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Affiliation(s)
| | - Lindsay A Edwards
- Divisions of Cardiology.,Division of Cardiology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | | | | | - Amy Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jin Long
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Bonnie Halpern-Felsher
- Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Harvey Cohen
- Division of Hematology/Oncology, Lucile Packard Children's Hospital Stanford, Palo Alto, California
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Psychosocial Needs and Preferences for Care among Adolescent and Young Adult Cancer Patients (Ages 15–39): A Qualitative Study. Cancers (Basel) 2022; 14:cancers14030710. [PMID: 35158975 PMCID: PMC8833451 DOI: 10.3390/cancers14030710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022] Open
Abstract
Simple Summary Adolescents and young adults (AYAs) are a unique population: they are a diverse group between the ages of 15–39 years with distinct needs and experience numerous developmental milestones during this age range. Notably, AYAs have faced worse outcomes in cancer care, both with shorter survival and worse quality of life compared to children and older adults. Understanding AYAs’ psychosocial, communication and informational needs is crucial to addressing this disparity and improving cancer care delivery. By hearing directly from AYAs, we are able to capture nuances of their experiences and provide clinical recommendations to healthcare providers involved in the care of AYAs with cancer. This study specifically interviewed AYAs with cancer to understand their perspectives, identify needs and to develop recommendations for cancer care delivery and accommodations across the cancer experience. Abstract Adolescents and young adults (AYAs) require a multidisciplinary approach to cancer care due to their complex biopsychosocial situations and varied developmental maturity. Currently, age and diagnosis determine referral to pediatric or adult oncology, with differing treatment paradigms and service utilization patterns, contributing to suboptimal improvements in outcomes. Understanding the unique perspectives of AYAs is essential to designing patient-centered AYA services. Thus, we conducted six focus groups with AYAs (n = 25) treated by medical or pediatric oncologists to evaluate: (1) the unique experiences of cancer care as an AYA; (2) AYA-specific information needs and communication preferences; and (3) recommendations for service provision, delivery and accommodations for AYAs. Transcripts were analyzed using inductive thematic content analysis and identified six major themes to inform clinically-actionable recommendations and the development of a patient-reported outcome measure: (1) AYAs experience social isolation and loss of independence; (2) AYAs have an uncertain sense of the future and need conversations around survivorship and long-term and late effects; (3) AYAs desire greater control over discussions with their care team; (4) AYAs need additional navigational and social/caregiver supports; (5) AYAs prefer an inclusive AYA space in the hospital; and (6) LGBTQ+ patients experience distinct concerns as AYA cancer patients. These will form the basis for specific and tailored clinical recommendations to improve AYA cancer care delivery.
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Abstract
Purpose of Review To present new findings in order to aid in the provision of high-quality symptom management and psychosocial care for adolescents and young adults with advanced cancer at the end of life. Recent Findings Behavioral health providers support patients by teaching them symptom control skills, building legacies, and making meaning of their lives. Integration of cultural values is essential for comprehensive assessment and decision-making. Effective management of physiological symptoms and psychological distress begins with accurate communication about prognosis and goals of care that focus on patient preferences and priorities. Oncology teams promote quality of life and the successful management of fatigue, pain, decreased mobility, poor appetite, and dyspnea with the early inclusion of palliative care. Summary While provision of end-of-life care in a young person with cancer presents challenges, multidisciplinary teams can effectively accompany patients in this journey by prioritizing patient and family preferences to promote quality of life.
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von Blanckenburg P, Leppin N, Nagelschmidt K, Seifart C, Rief W. Matters of Life and Death: An Experimental Study Investigating Psychological Interventions to Encourage the Readiness for End-of-Life Conversations. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:243-254. [PMID: 33212438 DOI: 10.1159/000511199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/30/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Talking about death and dying is evoking discomfort in many persons, resulting in avoidance of this topic. However, end-of-life discussions can alleviate distress and uncertainties in both old and young adults, but only a minority uses this option in palliative care. Even in healthy populations, talking about death is often seen as alleviative and worthwhile, but rarely initiated. OBJECTIVE To investigate different psychological interventions (a) encouraging the readiness for end-of-life discussions and (b) changing death attitudes in healthy adults of different ages. METHODS 168 participants were randomized to four different interventions (IG1: value-based intervention with end-of-life perspective, IG2: motivation-based intervention with end-of-life perspective, IG3: combination of IG1 and IG2, CG: control group). Primary outcome was the readiness to engage in end-of-life topics. Secondary outcomes were fear of death, fear of dying and death acceptance. Assessments took place before, directly after the intervention and at 2 weeks of follow up. RESULTS IG2 and IG3 reported significantly more changes in the readiness to engage in end-of-life discussions than the CG (F[5.61, 307] = 4.83, p < 0.001, ηp2 = 0.081) directly after the intervention. The effect of IG3 remained stable at the follow-up. There were no significant effects of the interventions on end-of-life fears or death acceptance. Acceptability of the interventions was very high. CONCLUSIONS Short interventions can be useful to encourage end-of-life discussions and could be integrated in health care programs. The efficacy and effectiveness of these short interventions in palliative patients are currently examined.
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Affiliation(s)
- Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany,
| | - Nico Leppin
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Katharina Nagelschmidt
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Carola Seifart
- Institutional Review Board, Clinical Ethics, Philipps University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
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Labudde EJ, DeGroote NP, Ebelhar J, Massie AM, Allen KE, Castellino SM, Wasilewski-Masker K, Brock KE. Evaluating Palliative Opportunities Across the Age Spectrum in Children and Adolescent Patients with Cancer. J Adolesc Young Adult Oncol 2021; 11:402-409. [PMID: 34582272 DOI: 10.1089/jayao.2021.0081] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent patients with cancer experience unique stressors due to their developmental stage, with increased physical, emotional, and social distress. Palliative care (PC) serves an important role in pediatric cancer care. We examined "palliative opportunities," or events during a patient's cancer course where subspecialty PC would be warranted and compared opportunities between adolescents and younger patients. Methods: Patients from a single center, 0-18 years of age at cancer diagnosis, who died from January 1, 2012, to November 30, 2017, were included. In this secondary analysis, patients were divided into cohorts based on age at diagnosis: 0-12 and 13-18 years. Demographic, disease, and treatment data were collected. Descriptive statistics and modeling were performed. Number, type, and timing of palliative opportunities and PC consultation timing and reason were evaluated across cohorts. Results: Of the 296 patients included for analysis, 27.7% were 13-18 years (82/296) at diagnosis. Frequency of palliative opportunities did not differ by age (median 7.0 [interquartile range 4.0 and 10.0] in both cohorts). PC consultation occurred in 36.5% (108/296), with neither rate nor timing differing by age group. PC consultations in adolescents were more often for symptom management (p = 0.0001). Adolescent patients were less likely to have a do-not-resuscitate order placed before death (61.0%, 50/82) compared to younger patients (73.8%, 158/214, p = 0.03). Conclusion: Adolescent patients with cancer did not experience more palliative opportunities than younger patients in this cohort, although they often have challenging psychological, family, and social stressors that were not identified. Incorporating additional palliative opportunities could enhance identification of stress and symptoms in adolescents with cancer such that PC could be timed to meet their needs.
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Affiliation(s)
- Emily J Labudde
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Nicholas P DeGroote
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jonathan Ebelhar
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - A McCauley Massie
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristen E Allen
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA.,Division of Pediatric Palliative Care, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
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Rosenberg AR, Steiner J, Lau N, Fladeboe K, Toprak D, Gmuca S, O'Donnell MB, Smith K, Brown CE, Yi-Frazier JP. From Theory to Patient Care: A Model for the Development, Adaptation, and Testing of Psychosocial Interventions for Patients With Serious Illness. J Pain Symptom Manage 2021; 62:637-646. [PMID: 33677072 PMCID: PMC8418616 DOI: 10.1016/j.jpainsymman.2021.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
Psychosocial and supportive care interventions are a cornerstone of palliative care science, yet there is little published guidance regarding how to develop, test, adapt, and ultimately disseminate evidence-based interventions. Our objective was to describe the application of a single intervention-development model in multiple populations of patients with serious illness. Specifically, we use the "Promoting Resilience in Stress Management" (PRISM) intervention as an exemplar for how the Obesity Related Behavioral Intervention Trials (ORBIT) intervention-development model may be applied to: 1) create an initial palliative care intervention; 2) adapt an existing intervention for a new patient-population; 3) expand an existing intervention to include new content; and, 4) consider dissemination and implementation of a research-proven intervention. We began by identifying key psychological and social science theories and translating them a testable clinical hypothesis. Next, we conducted observational studies and randomized trials to design, refine, and standardize PRISM within unique patient-populations. We moved backwards in the ORBIT model when necessary to adapt or expand PRISM content and delivery-strategies to meet patient-reported needs. Finally, we began to explore PRISM's effectiveness using Dissemination and Implementation research methods. Key lessons include the need to ground intervention-development in evidence-based theory; involve patient, clinician, and other stakeholders at every phase of development; "meet patients where they are at" with flexible delivery strategies; invest in the time to find the right scientific premise and the right intervention content; and, perhaps most importantly, involve an interdisciplinary research team.
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Affiliation(s)
- Abby R Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Jill Steiner
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Nancy Lau
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Child Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kaitlyn Fladeboe
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Demet Toprak
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Sabrina Gmuca
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA; Division of Rheumatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Center for Pediatric Clinical Effectiveness and PolicyLab at Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maeve B O'Donnell
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kiska Smith
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA
| | - Crystal E Brown
- Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, WA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Science, Seattle Children's Research Institute, Seattle, WA, USA
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Fladeboe KM, O'Donnell MB, Barton KS, Bradford MC, Steineck A, Junkins CC, Yi-Frazier JP, Rosenberg AR. A novel combined resilience and advance care planning intervention for adolescents and young adults with advanced cancer: A feasibility and acceptability cohort study. Cancer 2021; 127:4504-4511. [PMID: 34358332 DOI: 10.1002/cncr.33830] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/03/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few evidence-based psychosocial programs have been tested among adolescents and young adults (AYAs) with advanced cancer (AC), and early advance care planning (ACP) in this population is rare. The authors aimed to determine the feasibility and acceptability of 1) delivering an established resilience-coaching program, and 2) integrating ACP into that program, among AYAs with AC. METHODS Eligible AYAs were 12 to 24 years old, diagnosed with advanced cancer (recurrent/refractory disease or a diagnosis associated with <50% survival) and fluent in English. The Promoting Resilience in Stress Management-Advanced Cancer (PRISM-AC) program included PRISM's standard sessions targeting stress-management, goal-setting, cognitive-restructuring, and meaning-making, delivered 1:1, 1 to 2 weeks apart, plus a new session involving elements of the AYA-specific Voicing My Choices ACP guide. Participants completed surveys at baseline and 12 weeks, and exit interviews following study completion. Feasibility was defined as ≥70% completion of 1) standard 4-session PRISM and 2) the new ACP session among those completing standard PRISM. Acceptability was defined qualitatively. Trajectories of patient-reported anxiety, depression, and hope were examined descriptively. RESULTS Of 50 eligible, approached AYAs, 26 (52%) enrolled and completed baseline surveys. The AYAs had a mean age of 16 years (SD = 2.7 years), and the majority were male (73%) and White/Caucasian (62%). Twenty-two AYAs (85%) completed standard PRISM, and of those, 18 (82%) completed the ACP session. Feedback was highly positive; 100% and 91% described the overall and ACP programs as valuable, respectively. Anxiety, depression, and hope were unchanged after the program. CONCLUSIONS Resilience coaching followed by integrated ACP is feasible and acceptable for AYAs with AC. Participating did not cause distress or decrease hope. LAY SUMMARY Advance care planning (ACP) among adolescents and young adults (AYAs) with advanced cancer can be difficult to introduce. We investigated whether it is feasible and acceptable to integrate ACP into an existing resilience-coaching program for AYAs. In this cohort study of 26 AYAs with advanced cancer, we found the Promoting Resilience in Stress Management-Advanced Cancer program to be feasible (≥70% intervention-completion) and highly acceptable (positive post-participation feedback, no evidence of participant-distress). We conclude that an intervention integrating resilience coaching and ACP is feasible and acceptable among AYAs with advanced cancer.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - Maeve B O'Donnell
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Krysta S Barton
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Miranda C Bradford
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Children's Core for Biomedical Statistics, Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Angela Steineck
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - Courtney C Junkins
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
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Mack JW, Fisher L, Kushi L, Chao CR, Vega B, Rodrigues G, Josephs I, Brock KE, Buchanan S, Casperson M, Cooper RM, Fasciano KM, Kolevska T, Lakin JR, Lefebvre A, Schwartz CM, Shalman DM, Wall CB, Wiener L, Altschuler A. Patient, Family, and Clinician Perspectives on End-of-Life Care Quality Domains and Candidate Indicators for Adolescents and Young Adults With Cancer. JAMA Netw Open 2021; 4:e2121888. [PMID: 34424305 PMCID: PMC8383130 DOI: 10.1001/jamanetworkopen.2021.21888] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/09/2021] [Indexed: 11/14/2022] Open
Abstract
Importance End-of-life care quality indicators specific to adolescents and young adults (AYAs) aged 12 to 39 years with cancer have not been developed. Objective To identify priority domains for end-of-life care from the perspectives of AYAs, family caregivers, and clinicians, and to propose candidate quality indicators reflecting priorities. Design, Setting, and Participants This qualitative study was conducted from December 6, 2018, to January 5, 2021, with no additional follow-up. In-depth interviews were conducted with patients, family caregivers, and clinicians and included a content analysis of resulting transcripts. A multidisciplinary advisory group translated priorities into proposed quality indicators. Interviews were conducted at the Dana-Farber Cancer Institute, Kaiser Permanente Northern California, Kaiser Permanente Southern California, and an AYA cancer support community (lacunaloft.org). Participants included 23 AYAs, 28 caregivers, and 29 clinicians. Exposure Stage IV or recurrent cancer. Main Outcomes and Measures Care priorities. Results Interviews were conducted with 23 patients (mean [SD] age, 29.3 [7.3] years; 12 men [52%]; 18 White participants [78%]), 28 family caregivers (23 women [82%]; 14 White participants [50%]), and 29 clinicians (20 women [69%]; 13 White participants [45%]). Caregivers included 22 parents (79%), 5 spouses or partners (18%), and 1 other family member (4%); the 29 clinicians included 15 physicians (52%), 6 nurses or nurse practitioners (21%), and 8 social workers or psychologists (28%). Interviews identified 7 end-of-life priority domains: attention to physical symptoms, attention to quality of life, psychosocial and spiritual care, communication and decision-making, relationships with clinicians, care and treatment, and independence. Themes were consistent across the AYA age range and participant type. Although some domains were represented in quality indicators developed for adults, unique domains were identified, as well as AYA-specific manifestations of existing domains. For example, quality of life included global quality of life; attainment of life goals, legacy, and meaning; support of personal relationships; and normalcy. Within communication and decision-making, domains included communication early in the disease course, addressing prognosis and what to expect at the end of life, and opportunity for AYAs to hold desired roles in decision-making. Care and treatment domains relevant to cancer therapy, use of life-prolonging measures, and location of death emphasized the need for preference sensitivity rather than a standard path. This finding differs from existing adult indicators that propose that late-life chemotherapy, intensive measures, and hospital death should be rare. Conclusions and Relevance The findings of this qualitative study suggest that AYAs with cancer have priorities for care at the end of life that are not fully encompassed in existing indicators for adults. Use of new indicators for this young population may better reflect patient- and family-centered experiences of quality care.
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Affiliation(s)
- Jennifer W. Mack
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lauren Fisher
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Larry Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Chun R. Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Brenda Vega
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gilda Rodrigues
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Katharine E. Brock
- Divisions of Pediatric Oncology and Palliative Care, Emory University and Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Susan Buchanan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Now with Agios Pharmaceuticals, Cambridge, Massachusetts
| | | | - Robert M. Cooper
- Department of Pediatric Oncology, Kaiser Permanente Southern California, Pasadena
| | - Karen M. Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tatjana Kolevska
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland
| | - Joshua R. Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna Lefebvre
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Corey M. Schwartz
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland
| | - Dov M. Shalman
- Department of Palliative Care, Kaiser Permanente Southern California, Pasadena
| | - Catherine B. Wall
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lori Wiener
- Psychosocial Support and Research Program, National Cancer Institute, Bethesda, Maryland
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland
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Sisk BA, Keenan MA, Blazin LJ, Kaye E, Baker JN, Mack JW, DuBois JM. "Don't be afraid to speak up": Communication advice from parents and clinicians of children with cancer. Pediatr Blood Cancer 2021; 68:e29052. [PMID: 33861026 PMCID: PMC8286806 DOI: 10.1002/pbc.29052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/02/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Parents and clinicians of children with cancer can provide advice to improve communication that reflects lessons learned through experience. We aimed to identify categories of communication advice offered to parents of children with cancer from clinicians and other parents. PROCEDURE (1) Semi-structured interviews with 80 parents of children with cancer at three sites; (2) single-item, open-ended survey administered following 10 focus groups with 58 pediatric oncology clinicians at two sites. We asked participants for communication advice to parents, and analyzed responses using semantic content analysis. RESULTS Parents provided five categories of communication advice to other parents. Advocacy involved asking questions, communicating concerns, and speaking up for the child. Support involved pursuing self-care, seeking and accepting help, and identifying supportive communities. Managing information involved taking and organizing notes, remaining open to difficult truths, and avoiding inaccurate information. Partnership involved establishing open lines of communication with clinicians, making the family's values and priorities known, and trusting the clinical team. Engaging and supporting the child involved, understanding and incorporating the child's preferences and values, and creating a loving environment. Clinicians' advice addressed similar categories, although only one clinician described engaging and supporting the child. Furthermore, parental advice expanded beyond interactions with the clinical team, whereas clinician advice focused more on the role of clinicians. CONCLUSIONS Parents and clinicians of children with cancer provided five categories of communication advice. With these data, clinicians, health care organizations, support groups, and patient advocates could offer experience-informed advice to parents who are seeking information and support.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan A Keenan
- Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lindsay J Blazin
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Erica Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer W Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - James M DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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39
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Weaver MS, Doyle B, Foglia M, Holk I, Potter L. Clinician Perspectives on Animated Video Vignettes to Support Advance Care Planning Communication for Veterans. J Palliat Med 2021; 24:1710-1713. [PMID: 34271841 DOI: 10.1089/jpm.2021.0255] [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: 11/12/2022] Open
Abstract
Background: Despite availability of educational resources and documentation methods for advance care planning (ACP), few video tools exist. Animation relevant to Veteran experiences may enhance clinical conversations by illustrating relatable scenarios. Objective: To explore clinician perspectives on four novel video vignettes created by the study group. Design: Online survey with attention to perceived appropriateness, usefulness, and uptake intention. Settings/Subjects: Virtual video presentation with feedback poll for Veterans Affairs clinicians. Measurements: Descriptive and univariant analyses of responses to questions extracted from the validated Video Engagement Scale and prior ACP assessments. Results: Thirty respondents rated video appropriateness and usefulness at a mean 4.8 (range 4-5). Videos were relatable, relevant, and motivating with 90% respondents reporting ready intention to use in clinical practice. Conclusions: Veteran-specific animated video vignettes are received affirmatively by Veteran Affairs clinicians. These videos have potential to foster early engaged discussions about ACP.
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Affiliation(s)
- Meaghann S Weaver
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, USA.,Divisions of Adult and Pediatric Palliative Care, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Beth Doyle
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, USA
| | - Marybeth Foglia
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, USA.,Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ian Holk
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, USA
| | - Lucy Potter
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, USA
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40
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Schwerzmann M, Goossens E, Gallego P, Kovacs AH, Moons P, Swan L, Tobler D, de Stoutz N, Gabriel H, Greutmann M, Roos-Hesselink JW, Sobanski PZ, Thomet C. Recommendations for advance care planning in adults with congenital heart disease: a position paper from the ESC Working Group of Adult Congenital Heart Disease, the Association of Cardiovascular Nursing and Allied Professions (ACNAP), the European Association for Palliative Care (EAPC), and the International Society for Adult Congenital Heart Disease (ISACHD). Eur Heart J 2021; 41:4200-4210. [PMID: 32862229 DOI: 10.1093/eurheartj/ehaa614] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/30/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023] Open
Abstract
Survival prospects in adults with congenital heart disease (CHD), although improved in recent decades, still remain below expectations for the general population. Patients and their loved ones benefit from preparation for both unexpected and predictable deaths, sometimes preceded by a prolonged period of declining health. Hence, advance care planning (ACP) is an integral part of comprehensive care for adults with CHD. This position paper summarizes evidence regarding benefits of and patients' preferences for ACP and provides practical advice regarding the implementation of ACP processes within clinical adult CHD practice. We suggest that ACP be delivered as a structured process across different stages, with content dependent upon the anticipated disease progression. We acknowledge potential barriers to initiate ACP discussions and emphasize the importance of a sensitive and situation-specific communication style. Conclusions presented in this article reflect agreed expert opinions and include both patient and provider perspectives.
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Affiliation(s)
- Markus Schwerzmann
- Center for Congenital Heart Disease, University Hospital Inselspital, Department of Cardiology, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, box 7001, 3000 Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Pastora Gallego
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n. 41013 Seville, Spain
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN-62 Portland, Oregon, USA
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, box 7001, 3000 Leuven, Belgium.,Institute of Health and Care Science, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Klipfrontein Road Mowbray, Cape Town 7700, South Africa
| | - Lorna Swan
- Division of Cardiology, Peter Munk Cardiac Centre; Toronto Congenital Cardiac Centre for Adults, University of Toronto, 585 University Avenue; Toronto ON M5G 2N2, Canada
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 44031 Basel, Switzerland
| | - Noémi de Stoutz
- European Society of Cardiology Patient Forum Representative, Member of "Cuore Matto" and Global ARCH, Dorfstrasse 64, 8126 Zumikon, Switzerland
| | - Harald Gabriel
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Matthias Greutmann
- Department of Cardiology, University Heart Center, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, Erasmus University, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Piotr Z Sobanski
- Palliative Care Unit and Competence Center, Department of Internal Medicine, Hospital Schwyz, Waldeggstrasse 10, 6430 Schwyz, Switzerland
| | - Corina Thomet
- Center for Congenital Heart Disease, University Hospital Inselspital, Department of Cardiology, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland.,Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, box 7001, 3000 Leuven, Belgium
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41
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Emerson ND, Bursch B. Ethical Issues in Providing End-of-Life Cancer Care for Transitional-Aged Youth. J Clin Psychol Med Settings 2021; 28:781-788. [PMID: 33598787 DOI: 10.1007/s10880-021-09764-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
The aim of the study is to examine the salient ethical factors that arise in caring for transitional-aged cancer patients at the end of life (EOL). This article reviews significant clinical, ethical, and legal considerations relevant to psychologists working in oncology. Transitional-aged youth (TAY, ages 16-24) with cancer face a number of challenges when navigating treatment options at the EOL. Changes in treatment roadmaps, lapses in effective provider-patient communication, disagreements with parents, and developmental and disease-based changes in capacity all become salient in palliative care. Psychologists should be aware that both physician and patient factors influence the types of treatments proposed as well as the extent of EOL discussions. Psychologists are urged to bear in mind the ethical principles of respect for people's rights and dignity and nonmaleficence to best aid families and multidisciplinary teams navigate this difficult time and promote quality of life and the patient's wishes.
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Affiliation(s)
- Natacha D Emerson
- UCLA Department of Psychiatry, David Geffen School of Medicine, 760 Westwood Plaza, UCLA Semel 48-241, Los Angeles, CA, 90024-1759, USA.
| | - Brenda Bursch
- UCLA Department of Psychiatry, David Geffen School of Medicine, 760 Westwood Plaza, UCLA Semel 48-241, Los Angeles, CA, 90024-1759, USA.,UCLA Department of Pediatrics, David Geffen School of Medicine, 760 Westwood Plaza, UCLA Semel 48-241, Los Angeles, CA, 90024-1759, USA
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42
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DeCourcey DD, Partin L, Revette A, Bernacki R, Wolfe J. Development of a Stakeholder Driven Serious Illness Communication Program for Advance Care Planning in Children, Adolescents, and Young Adults with Serious Illness. J Pediatr 2021; 229:247-258.e8. [PMID: 32949579 DOI: 10.1016/j.jpeds.2020.09.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/25/2020] [Accepted: 09/11/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To develop a generalizable advance care planning (ACP) intervention for children, adolescents, and young adults with serious illness using a multistage, stakeholder-driven approach. STUDY DESIGN We first convened an expert panel of multidisciplinary health care providers (HCPs), researchers, and parents to delineate key ACP intervention elements. We then adapted an existing adult guide for use in pediatrics and conducted focus groups and interviews with HCPs, parents, and seriously ill adolescents and young adults to contextualize perspectives on ACP communication and our Pediatric Serious Illness Communication Program (PediSICP). Using thematic analysis, we identified guide adaptations, preferred content, and barriers for Pedi-SICP implementation. Expert panelists then reviewed, amended and finalized intervention components. RESULTS Stakeholders (34 HCPs, 9 parents, and 7 seriously ill adolescents and young adults) participated in focus groups and interviews. Stakeholders validated and refined the guide and PediSICP intervention and identified barriers to PediSICP implementation, including the need for HCP training, competing demands, uncertainty regarding timing, and documentation of ACP discussions. CONCLUSIONS The finalized PediSICP intervention includes a structured HCP and family ACP communication occasion supported by a 3-part communication tool and bolstered by focused HCP training. We also identified strategies to ameliorate implementation barriers. Future research will determine the feasibility of the PediSICP and whether it improves care alignment with patient and family goals.
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Affiliation(s)
| | - Lindsay Partin
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Anna Revette
- Survey and Data Management Core, Dana Farber Cancer Institute, Boston, MA
| | - Rachelle Bernacki
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA
| | - Joanne Wolfe
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA
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43
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Palliative Care for Children with Lung Diseases. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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44
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Weaver MS. Communication as Compassion. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:80-82. [PMID: 33373570 DOI: 10.1080/15265161.2020.1850911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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45
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Upshaw NC, Roche A, Gleditsch K, Connelly E, Wasilewski-Masker K, Brock KE. Palliative care considerations and practices for adolescents and young adults with cancer. Pediatr Blood Cancer 2021; 68:e28781. [PMID: 33089627 DOI: 10.1002/pbc.28781] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Abstract
The definition of adolescents and young adults (AYAs) in oncology varies with upper limits up to age 39. Younger AYAs, ages 12-24 years, are often cared for within pediatrics. In caring for AYAs with cancer, there are unique considerations that become even more important to recognize, acknowledge, and address in AYAs with life-threatening cancer receiving palliative care. This review highlights important factors such as psychosocial development, cultural considerations, and support structure, which should be considered when providing palliative care to AYAs with cancer during the various stages of care: introduction of palliative care; symptom management; advanced care planning (ACP); end-of-life (EOL) care; and bereavement.
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Affiliation(s)
- Naadira C Upshaw
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Anna Roche
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Katrina Gleditsch
- Division of Hospice and Palliative Medicine, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina
| | - Erin Connelly
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia.,Division of Pediatric Palliative Care, Emory University School of Medicine, Atlanta, Georgia
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46
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Murray H, Pettitt N, Tomas J. Advance Care Planning for Adolescents and Young Adults with Cancer: A Retrospective Case Note Audit from a Regional Specialist Center in the United Kingdom. J Adolesc Young Adult Oncol 2020; 10:493-496. [PMID: 33347382 DOI: 10.1089/jayao.2020.0149] [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] [Indexed: 11/12/2022] Open
Abstract
The extent of Advance Care Planning (ACP) among Adolescent and Young Adult (AYA) cancer patients is not well characterized. This retrospective case note audit scrutinized the records of all AYA patients (aged 16-25 years) known to a regional specialist center in the United Kingdom, and who died between 2013 and 2019, for evidence of ACP. Eighty-four patients were included. ACP was identified for 67% of patients. Sixty-four percent expressed a preferred place of death; actual place of death reflected this in 65% of cases. Creation of a bespoke document may help to standardize ACP and improve end-of-life care.
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Affiliation(s)
- Hazel Murray
- Medcial Student, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Nicola Pettitt
- Nurse Consultant, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Jon Tomas
- Consultant in Palliative Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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47
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Steiner JM, Dhami A, Brown CE, Stout KK, Curtis JR, Engelberg RA, Kirkpatrick JN. Barriers and Facilitators of Palliative Care and Advance Care Planning in Adults With Congenital Heart Disease. Am J Cardiol 2020; 135:128-134. [PMID: 32866444 DOI: 10.1016/j.amjcard.2020.08.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023]
Abstract
Palliative care has potential to improve quality of life and goal-concordant care for patients with adult congenital heart disease (ACHD). However, it is rarely employed prior to critical illness because the best methods for implementation are not well-defined. We qualitatively evaluated ACHD patients' understanding of and opinions regarding palliative care and advance care planning (ACP) to better define the needs of this population. We conducted a thematic analysis of 25 semistructured interviews with patients with ACHD in which we assessed participants' perspectives on the need for, and barriers and facilitators to, the use of palliative care and ACP. In a group of participants with ACHD (mean age 38, 48% male) classified as simple (24%), moderate (32%), or complex (44%), we identified 4 major themes: (1) using knowledge to combat future uncertainties; (2) unfamiliarity with and limited exposure to palliative care and ACP; (3) facilitators and barriers to engaging in palliative care and ACP; and (4) importance of timing and presentation of ACP discussions. In conclusion, participants expressed a desire for knowledge about ACHD progression and treatment. They supported routine incorporation of palliative care and ACP and identified related facilitators and barriers to doing so. Importantly, timing and format of these discussions must be individualized using shared decision-making between clinicians, patients, and their families.
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48
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Giordano F, Rutigliano C, Muggeo P, Fusaro T, Santoro N. Ettore's song: The hero who had the courage to fight Achilles. J Health Psychol 2020; 26:5-11. [PMID: 33106044 DOI: 10.1177/1359105320968144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
End-of-life accompaniment requires even greater care of the patient and their family by the multi-disciplinary team, which requires a clear, wellorganized interdisciplinary and interprofessional approach. Musictherapy (MT) is often use as a complementary approach to improve a person's quality of life by helping to relieve symptoms, addressing psychological needs, offering support and comfort, facilitating communication, and meeting spiritual needs.Through songwriting, Ettore, a teenager was able to make choices and act on his own will. Songwriting represented a channel for effective and powerful communication and expression. The song became the means by which the relationship with the team was maintained and deepened; it became something tangible, a product with its own consistency, a further bond that unites Ettore to his family to this day.
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49
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Coombs S, Aouad P, Jaaniste T. Factors Associated With the Location of Expected Pediatric Deaths in the Palliative Care Context. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:850-867. [PMID: 32938305 DOI: 10.1177/0030222820959941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early planning and knowing which factors to consider when planning the location of death (LOD) of a palliative child, may help minimize the burden of hasty decision-making in the future, and may provide families with a sense of control. The current paper reviewed which factors were associated with pediatric LOD and further considered some emerging factors that should are important to better facilitate integrative planning. Three overarching areas of consideration related to pediatric LOD planning were identified including health service factors, familial factors and patient factors. Multiple sub-factor considerations are presented. Further, the paper presents a conceptual model of the factors found to be related to pediatric LOD planning. The limitations that exist with rigorously and empirically studying pediatric LOD preferences are apparent from the dearth of knowledge seen in the field. However, future studies should continue to examine such factors more closely to better understand the nuanced implications.
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Affiliation(s)
- Sandra Coombs
- Departments of Pain and Palliative Care, Sydney Children's Hospital - Randwick, Sydney, Australia
| | - Phillip Aouad
- Departments of Pain and Palliative Care, Sydney Children's Hospital - Randwick, Sydney, Australia
- Department of Pain, Sydney Children's Hospital - Randwick, Sydney, Australia
| | - Tiina Jaaniste
- Departments of Pain and Palliative Care, Sydney Children's Hospital - Randwick, Sydney, Australia
- Department of Pain, Sydney Children's Hospital - Randwick, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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50
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Weaver MS, Wiener L, Jacobs S, Bell CJ, Madrigal V, Mooney-Doyle K, Lyon ME. Weaver et al's Response to Morrison: Advance Directives/Care Planning: Clear, Simple, and Wrong (DOI: 10.1089/jpm.2020.0272). J Palliat Med 2020; 24:8-10. [PMID: 32865470 DOI: 10.1089/jpm.2020.0486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Meaghann S Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Shana Jacobs
- Division of Oncology, Children's National Medical Center, Washington, DC, USA
| | - Cynthia J Bell
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Vanessa Madrigal
- Pediatric Critical Care and Pediatric Ethics Program, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's National Health System, Washington, DC, USA
| | - Kim Mooney-Doyle
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Maureen E Lyon
- Children's National Hospital/Center for Translational Science and George Washington School of Medicine and Health Sciences, Washington, DC, USA
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