1
|
Newman AR, Kenney AE, Witkowski E, Karst J, Lerret S, Davies WH, Rothschild CB. Palliative Care Interventions Among Adolescents and Young Adults with Serious Illness: A Scoping Review. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2023; 11:262-273. [PMID: 37753528 PMCID: PMC10519447 DOI: 10.1037/cpp0000486] [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] [Indexed: 09/28/2023]
Abstract
Objective To map the range of multidisciplinary palliative care interventions that are available to adolescents and young adults (AYAs) with serious illness. Methods Scoping review methodology as outlined by Arksey and O'Malley. Results Twenty-two articles describing nine specific AYA-focused, multidisciplinary palliative care interventions were included in this review. Interventions focused on supporting advance care planning (ACP), facilitating treatment decision making, managing pain, and promoting resilience, psychosocial well-being, and quality of life. Interventions were delivered face-to-face and via different eHealth platforms and were targeted to AYAs with cancer, HIV/AIDS, and cystic fibrosis in both inpatient and outpatient settings. Conclusions Few evidence-based multidisciplinary palliative care interventions have documented benefit for AYAs with serious illness. The limited work that has been done demonstrates that AYAs are open to engaging in palliative care interventions and suggests that individual members of the multidisciplinary team can implement these different interventions to support enhanced patient outcomes.
Collapse
Affiliation(s)
- Amy R. Newman
- Marquette University College of Nursing
- Children’s Wisconsin, Department of Nursing Research & Evidence-Based Practice
| | | | | | - Jeffrey Karst
- Department of Pediatrics, Medical College of Wisconsin
| | - Stacee Lerret
- Department of Pediatrics, Medical College of Wisconsin
| | | | | |
Collapse
|
2
|
Chen YC, Huang HP, Tung TH, Lee MY, Beaton RD, Lin YC, Jane SW. The decisional balance, attitudes, and practice behaviors, its predicting factors, and related experiences of advance care planning in Taiwanese patients with advanced cancer. BMC Palliat Care 2022; 21:189. [PMID: 36324101 PMCID: PMC9628122 DOI: 10.1186/s12904-022-01073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 08/12/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background
Patients with advanced cancer are prone to experience burdensome physical, psychological, and financial consequences. Healthcare providers may not fully appreciate advanced cancer patients’ medical care autonomy, such as at that emboded by Advance Care Planning (ACP), and by doing so may compromise their quality of end-of-life (EOL). Hence, it is essential for healthcare providers to effectively assess and communicate with patients’ regarding their medical decisions before their patients are incapacitated by their disease progression. The purpose of this investigation was to describe the decisional balance, attitudes, and practice behaviors of ACP and its predictors of ACP-related experiences in Taiwanese patients with advanced cancer. Methods
This cross-sectional, descriptive study employed a mixed-methodsquantitative and qualitative design with a sample of 166 patients that were purposely recruited from in-patient oncology units at a regional teaching hospital in southern Taiwan. Study data consisted of patient replies to a 34-item self-report tool, Decisional Balance, Attitudes, Practice Behaviors of ACP (DAP-ACP) and 4 semi-structured questions. Result
Findings indicated that, in general, study participants exhibited favorable ACP-decisional balance and positive ACP-attitudes & practice behaviors. The results also indicated that gender, educational level, and cancer diagnosis were associated with significant differences on the “ACP-decisional balance” and “ACP-attitudes” scales. In addition, our findings documented that the participants’ gender and educational level were significant predictors of both ACP-decisional balance and ACP-attitudes. Furthermore the participants’ ACP-practice behaviors were predicted by ACP-decisional balance, but not with their ACP-attitudes. The qualitative analysis of the semi-structured questions identified six themes in responses to current medical decision making (e.g., compliance with physician instructions, family engagement in treatment decision-making); and eight themes pertaining to future ACP-related concerns were identified (e.g., family conflict, effectiveness of time-limited trials). Conclusion
To promote patients’ engagement in ACP, the healthcare professional need to assess and advocate patients’ concerns or attitudes regarding ACP in a timely manner. In addition, factors or concerns that might influence patients’ responses to ACP derived from both the quantitative and qualitative findings of this current study need to be considered especially in initiating the dialogue regarding ACP with patients with advanced cancer. Trial registration No. CYCH 2,019,072, Date of registration 5 Dec 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01073-5.
Collapse
Affiliation(s)
- Yueh-Chun Chen
- Department of Nursing, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Hsiang-Ping Huang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Ming-Yang Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Randal D Beaton
- Psychosocial & Community Health and Health Services, Schools of Nursing and Public Health, University of Washington, Seattle, USA
| | - Yung-Chang Lin
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Ko, Taiwan
| | - Sui-Whi Jane
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Ko, Taiwan. .,Dean of Academic Affairs, Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1st Rd., Gui-Shan Dist, 33303, Tao-Yuan City, Taiwan.
| |
Collapse
|
3
|
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.
Collapse
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.)
| |
Collapse
|
4
|
Thomas T, Tan M, Ahmed Y, Grigorenko EL. A Systematic Review and Meta-Analysis of Interventions for Orphans and Vulnerable Children Affected by HIV/AIDS Worldwide. Ann Behav Med 2021; 54:853-866. [PMID: 32525205 DOI: 10.1093/abm/kaaa022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Worldwide, there are more than 13.3 million orphans and vulnerable children affected by Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) (HIV OVC), defined as individuals below the age of 18 who have lost one or both parents to HIV/AIDS or have been made vulnerable by HIV/AIDS; they are at risk for negative psychosocial and cognitive outcomes. PURPOSE This meta-analysis aimed to examine the scientific literature on available interventions for HIV OVC, with a focus on community-based interventions (CBI). METHODS Systematic electronic searches were conducted from four databases between October 2016 and April 2017 to identify articles investigating the effectiveness of interventions for HIV OVC. Effect sizes were calculated for each article which provided enough information and data points for analyses. RESULTS Seventy-four articles were reviewed, including psychosocial interventions (d = 0.30), cognitive interventions (d = 0.14), social protection interventions (d = 0.36), and community-based interventions (CBI; d = 0.36). Study-specific effect sizes varied widely, ranging from -1.09 to 2.26, that is, from a negative effect to an impressively large positive one, but the majority of studies registered small to medium effects (the overall effect size for all studies was 0.32, SE = 0.03, 95% CI: 0.26-0.37). Social protection interventions had the highest positive outcomes whereas CBI tended to have the fewest significant positive outcomes, with some outcomes worsening instead of improving. CONCLUSIONS Overall, interventions provided to OVC have potential for improving cognitive, psychosocial, and risk-behavior outcomes. Social protection interventions and CBI had the highest effect sizes, but CBI had positive effects on fewer outcomes and demonstrated some negative effects. CBI warrant scrutiny for improvement, as they represent an important form of culturally embedded services with potentially long-term benefits to OVC, yet appear to be differentially effective. Successful components of other types of intervention were identified, including cash grants, mentorship, and family therapy. In addition, more research is needed that attends to which interventions may be more effective for specific populations, or that studies cost-effectiveness.
Collapse
Affiliation(s)
- Tina Thomas
- Department of Psychology, University of Houston, Houston, TX
| | - Mei Tan
- Department of Psychology, University of Houston, Houston, TX
| | - Yusra Ahmed
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX
| | - Elena L Grigorenko
- Department of Psychology, University of Houston, Houston, TX.,Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX.,Molecular and Human Genetics, Baylor College of Medicine, Houston, TX.,Moscow State University for Psychology and Education, Moscow, Russian Federation
| |
Collapse
|
5
|
Wu LM, Huang IC, Su HL, Lee SL. Interventions to Support Adolescents With Cancer in Decision-Making: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs 2021; 18:339-349. [PMID: 34291849 DOI: 10.1111/wvn.12522] [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] [Accepted: 12/19/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adolescents have autonomous views and participatory rights. There is increasing support for involving adolescents with cancer in the healthcare decision-making process. AIMS The purpose of this study was to synthesize current knowledge to identify major components and outcomes of interventions to enhance shared decision-making (SDM) by adolescents with cancer during and after treatment. METHODS Six electronic databases (PubMed, CINHAL, MEDLINE, Cochrane, EBSCO, and Web of Science) were searched from their inceptions to February 2020. Eligibility criteria were intervention studies, studies of interventions to support adolescents with cancer involved in SDM, and studies of patients diagnosed with cancer between 10 and 18 years of age. Data extraction and quality appraisal were conducted by using a standardized data extraction form. Quality appraisal was based on the Cochrane Risk of Bias Tool. RESULTS Of 331 citations, five studies with a total of 648 participants aged between 13 and 21 years met inclusion criteria. Interventions included structured sessions held one to three times per week. SDM engagement strategies incorporated weekly assignments, live action videos, brochures, Five Wishes© advance directives, and follow-up counseling. Treatment preference congruence in adolescent and parent dyads was higher in intervention groups. Meta-analysis was performed on two studies and demonstrated statistically significant improvements in decision quality at 6 months (z = 3.37, p = .001; 95% CI = .174-.657) and 12 months (z = 3.17, p = .002; 95% CI = .150-.633) after SDM interventions in adolescent cancer survivors. No adverse events among patients were found, although anxiety scores increased in families in an intervention group. LINKING EVIDENCE TO ACTION This review identified essential components of SDM interventions. Our findings may guide the future design of interventions to support high-quality decision-making by adolescents with cancer. Coaching can educate adolescent cancer survivors on quality decision-making methods and can improve the quality of consequent decisions. More research is needed to determine outcomes of SDM interventions.
Collapse
Affiliation(s)
- Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - I-Chin Huang
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hsiu-Lan Su
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Li Lee
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| |
Collapse
|
6
|
Lin CJ, Cheng YI, Garvie PA, D’Angelo LJ, Wang J, Lyon ME. The Effect of FAmily-CEntered (FACE ®) Pediatric Advanced Care Planning Intervention on Family Anxiety: A Randomized Controlled Clinical Trial for Adolescents With HIV and Their Families. JOURNAL OF FAMILY NURSING 2020; 26:315-326. [PMID: 33283612 PMCID: PMC8015181 DOI: 10.1177/1074840720964093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Clinicians fear pediatric advance care planning (pACP) for adolescents is too distressing for families. Multisite longitudinal randomized controlled trial of adolescents with HIV tested the effect of FAmily-CEntered (FACE®) pACP intervention on families' anxiety and depression. One hundred five adolescent/family dyads were randomized to FACE® (n = 54 dyads) or control (n = 51 dyads). Families were 90% African American, 37% HIV-positive, and 22% less than high school educated. Families reported lower anxiety 3 months post-FACE® intervention than control (β = -4.71, 95% confidence interval [CI] = [-8.20, -1.23], p = .008). Male family members were less anxious than female family members (β = -4.55, 95% CI = [-6.96, -2.138], p ≤ .001). Family members living with HIV reported greater depressive symptoms than HIV-uninfected families (β = 3.32, 95% CI = [0.254, 6.38], p = .034). Clinicians can be assured this structured, facilitated FACE® pACP model minimized family anxiety without increasing depressive symptoms. Adolescent/family dyads should be invited to have access to, and provision of, evidence-based pACP as part of patient-centered/family-supported care in the HIV continuum of care.
Collapse
Affiliation(s)
| | - Yao I. Cheng
- Children’s National Hospital & Center for Translational Research, Washington, DC, USA
| | | | | | - Jichuan Wang
- Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, DC, USA
| | - Maureen E. Lyon
- Children’s National Hospital & Center for Translational Research, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, DC, USA
- Children’s National Research Institute, Washington, DC, USA
| | | |
Collapse
|
7
|
Beernaert K. 'Survey of paediatricians found them to be involved in advance care planning': Are we there yet? Acta Paediatr 2020; 109:874-876. [PMID: 31917869 DOI: 10.1111/apa.15138] [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: 10/25/2022]
Affiliation(s)
- Kim Beernaert
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel Ghent Belgium
| |
Collapse
|
8
|
Hein K, Knochel K, Zaimovic V, Reimann D, Monz A, Heitkamp N, Borasio GD, Führer M. Identifying key elements for paediatric advance care planning with parents, healthcare providers and stakeholders: A qualitative study. Palliat Med 2020; 34:300-308. [PMID: 31985331 PMCID: PMC7074656 DOI: 10.1177/0269216319900317] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although international guidelines recommend discussions about goals of care and treatment options for children with severe and life-limiting conditions, there are still few structured models of paediatric advance care planning. AIM The study aimed at identifying key components of paediatric advance care planning through direct discussions with all involved parties. DESIGN The study had a qualitative design with a participatory approach. Participants constituted an advisory board and took part in two transdisciplinary workshops. Data were collected in discussion and dialogue groups and analysed using content analysis. SETTING/PARTICIPANTS We included bereaved parents, health care providers and stakeholders of care networks. RESULTS Key elements were discussions, documentation, implementation, timing and participation of children and adolescents. Parents engage in discussions with facilitators and persons of trust to reach a decision. Documentation constitutes the focus of professionals, who endorse brief recommendations for procedures in case of emergencies, supplemented by larger advance directives. Implementation hindrances include emotional barriers of stakeholders, disagreements between parents and professionals and difficulties with emergency services. Discussion timing should take into account parental readiness. The intervention should be repeated at regular intervals, considering emerging needs and increasing awareness of families over time. Involving children and adolescents in advance care planning remains a challenge. CONCLUSION A paediatric advance care planning intervention should take into account potential pitfalls and barriers including issues related to timing, potential conflicts between parents and professionals, ambiguity towards written advance directives, the role of non-medical carers for paediatric advance care planning implementation, the need to involve the child and the necessity of an iterative process.
Collapse
Affiliation(s)
- Kerstin Hein
- Center for Pediatric Palliative Care, University Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Kathrin Knochel
- Center for Pediatric Palliative Care, University Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Vedrana Zaimovic
- Center for Pediatric Palliative Care, University Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Daniel Reimann
- Center for Pediatric Palliative Care, University Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Anna Monz
- Center for Pediatric Palliative Care, University Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Nari Heitkamp
- Center for Pediatric Palliative Care, University Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Gian Domenico Borasio
- Palliative Care Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Monika Führer
- Center for Pediatric Palliative Care, University Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Germany
| |
Collapse
|
9
|
Weaver MS, Mooney-Doyle K, Kelly KP, Montgomery K, Newman AR, Fortney CA, Bell CJ, Spruit JL, Kurtz Uveges M, Wiener L, Schmidt CM, Madrigal VN, Hinds PS. The Benefits and Burdens of Pediatric Palliative Care and End-of-Life Research: A Systematic Review. J Palliat Med 2019; 22:915-926. [PMID: 30835596 DOI: 10.1089/jpm.2018.0483] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study is to report the benefits and burdens of palliative research participation on children, siblings, parents, clinicians, and researchers. Background: Pediatric palliative care requires research to mature the science and improve interventions. A tension exists between the desire to enhance palliative and end-of-life care for children and their families and the need to protect these potentially vulnerable populations from untoward burdens. Methods: Systematic review followed PRISMA guidelines with prepared protocol registered as PROSPERO #CRD42018087304. MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and The Cochrane Library were searched (2000-2017). English-language studies depicting the benefits or burdens of palliative care or end-of-life research participation on either pediatric patients and/or their family members, clinicians, or study teams were eligible for inclusion. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results: Twenty-four studies met final inclusion criteria. The benefit or burden of palliative care research participation was reported for the child in 6 papers; siblings in 2; parents in 19; clinicians in 3; and researchers in 5 papers. Benefits were more heavily emphasized by patients and family members, whereas burdens were more prominently emphasized by researchers and clinicians. No paper utilized a validated benefit/burden scale. Discussion: The lack of published exploration into the benefits and burdens of those asked to take part in pediatric palliative care research and those conducting the research is striking. There is a need for implementation of a validated benefit/burden instrument or interview measure as part of pediatric palliative and end-of-life research design and reporting.
Collapse
Affiliation(s)
- Meaghann S Weaver
- 1Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Kim Mooney-Doyle
- 2Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Katherine Patterson Kelly
- 3Department of Nursing Science, Professional Practice, and Quality Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kathleen Montgomery
- 4Department of Nursing, American Family Children's Hospital, Madison, Wisconsin
| | - Amy R Newman
- 5College of Nursing, University of Utah, Salt Lake City, Utah.,6Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Christine A Fortney
- 7Martha S. Pitzer Center for Women, Children & Youth, College of Nursing, Ohio State University, Columbus, Ohio
| | - Cynthia J Bell
- 8College of Nursing, Wayne State University, Detroit, Michigan
| | | | - Melissa Kurtz Uveges
- 9Center for Bioethics, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lori Wiener
- 10National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Cynthia M Schmidt
- 11McGoogan Library of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Vanessa N Madrigal
- 12Division of Critical Care Medicine, Department of Pediatrics, Children's National Health Systems, George Washington University, Washington, DC
| | - Pamela S Hinds
- 13Department of Nursing Science, Professional Practice & Quality, Children's National Health System, George Washington University, Washington, DC.,14Department of Pediatrics, George Washington University, Washington, DC
| |
Collapse
|
10
|
Fahner JC, Beunders AJ, van der Heide A, Rietjens JA, Vanderschuren MM, van Delden JJ, Kars MC. Interventions Guiding Advance Care Planning Conversations: A Systematic Review. J Am Med Dir Assoc 2019; 20:227-248. [DOI: 10.1016/j.jamda.2018.09.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 12/14/2022]
|
11
|
Lyon ME, Garvie PA, D'Angelo LJ, Dallas RH, Briggs L, Flynn PM, Garcia A, Cheng YI, Wang J. Advance Care Planning and HIV Symptoms in Adolescence. Pediatrics 2018; 142:e20173869. [PMID: 30341154 PMCID: PMC6317555 DOI: 10.1542/peds.2017-3869] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To determine the effect of family-centered pediatric advance care planning (FACE pACP) on HIV-specific symptoms. METHODS In this single-blinded, randomized controlled trial conducted at 6 US hospital-based HIV clinics, 105 adolescent-family dyads, randomly assigned from July 2011 to June 2014, received 3 weekly sessions in either the FACE pACP arm ([1] pediatric advance care planning survey, [2] Respecting Choices interview, and [3] 5 Wishes directive) or the control arm ([1] developmental history, [2] safety tips, and [3] nutrition and exercise tips). The General Health Assessment for Children measured patient-reported HIV-specific symptoms. Latent class analyses clustered individual patients based on symptom patterns. Path analysis examined the mediating role of dyadic treatment congruence with respect to the intervention effect on symptom patterns. RESULTS Patients were a mean age of 17.8 years old, 54% male, and 93% African American. Latent class analysis identified 2 latent HIV-symptom classes at 12 months: higher symptoms and suffering (27%) and lower symptoms and suffering (73%). FACE pACP had a positive effect on dyadic treatment congruence (β = .65; 95% CI: 0.04 to 1.28), and higher treatment congruence had a negative effect on symptoms and suffering (β = -1.14; 95% CI: -2.55 to -0.24). Therefore, FACE pACP decreased the likelihood of symptoms and suffering through better dyadic treatment congruence (β = -.69; 95% CI: -2.14 to -0.006). Higher religiousness (β = 2.19; 95% CI: 0.22 to 4.70) predicted symptoms and suffering. CONCLUSIONS FACE pACP increased and maintained agreement about goals of care longitudinally, which lowered adolescents' physical symptoms and suffering, suggesting that early pACP is worthwhile.
Collapse
Affiliation(s)
- Maureen E Lyon
- Divisions of Adolescent and Young Adult Medicine and
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Patricia A Garvie
- Research Department, Children's Diagnostic and Treatment Center, Fort Lauderdale, Florida
| | - Lawrence J D'Angelo
- Divisions of Adolescent and Young Adult Medicine and
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Ronald H Dallas
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Linda Briggs
- Respecting Choices, Coalition to Transform Advanced Care Innovations, Washington, District of Columbia; and
| | - Patricia M Flynn
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ana Garcia
- Department of Pediatrics, Division of Infectious Disease and Immunology, Batchelor Children's Research Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Yao I Cheng
- Biostatistics and Study Methodology, Center for Translational Science, Children's Research Institute, Children's National, Washington, District of Columbia
| | - Jichuan Wang
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
- Biostatistics and Study Methodology, Center for Translational Science, Children's Research Institute, Children's National, Washington, District of Columbia
| |
Collapse
|
12
|
Popejoy E, Pollock K, Almack K, Manning JC, Johnston B. Decision-making and future planning for children with life-limiting conditions: a qualitative systematic review and thematic synthesis. Child Care Health Dev 2017; 43:627-644. [PMID: 28402040 DOI: 10.1111/cch.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 02/24/2017] [Accepted: 03/13/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND In the last decade, the number of children with life-limiting and life-threatening conditions in England has almost doubled, and it is estimated that worldwide, there are 1.2 million children with palliative care needs. Families and professionals caring for children with life-limiting conditions are likely to face a number of difficult treatment decisions and develop plans for future care over the course of the child's life, but little is known about the process by which these decisions and plans are made. METHODS The purpose of this review is to synthesize findings from qualitative research that has investigated decision-making and future planning for children with life-limiting conditions. A systematic search of six online databases was conducted and identified 887 papers for review; five papers were selected for inclusion, using predefined criteria. Reference list searching and contacting authors identified a further four papers for inclusion. RESULTS Results sections of the papers were coded and synthesized into themes. Nineteen descriptive themes were identified, and these were further synthesized into four analytical themes. Analytical themes were 'decision factors', 'family factors', 'relational factors' and 'system factors'. CONCLUSIONS Review findings indicate that decision-making and future planning is difficult and needs to be individualized for each family. However, deficits in understanding the dynamic, relational and contextual aspects of decision-making remain and require further research.
Collapse
Affiliation(s)
- E Popejoy
- University of Nottingham School of Health Sciences, Nottingham, UK
| | - K Pollock
- Nottingham Children's Hospital, Nottingham, UK
| | - K Almack
- University of Nottingham School of Health Sciences, Nottingham, UK
| | - J C Manning
- University of Nottingham School of Health Sciences, Nottingham, UK
| | - B Johnston
- University of Glasgow School of Medicine, Glasgow, UK
| |
Collapse
|
13
|
Pediatric advance care planning (pACP) for teens with cancer and their families: Design of a dyadic, longitudinal RCCT. Contemp Clin Trials 2017; 62:121-129. [PMID: 28844985 DOI: 10.1016/j.cct.2017.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 12/30/2022]
Abstract
Cancer is the leading cause of disease-related death for adolescents and young adults (AYAs) in the United States. Parents of AYAs with life-threatening illnesses have expressed the desire to talk to their children about end of life (EOL) care, yet, like caregivers of adult patients, struggle to initiate this conversation. Building Evidence for Effective Palliative/End of Life Care for Teens with Cancer is a longitudinal, randomized, controlled, single-blinded clinical trial aimed at evaluating the efficacy of FAmily CEntered disease-specific advance care planning (ACP) for teens with cancer (FACE-TC). A total of 130 dyads (260 subjects) composed of AYAs 14-20years old with cancer and their family decision maker (≥18years old) will be recruited from pediatric oncology programs at Akron Children's Hospital and St. Jude Children's Research Hospital. Dyads will be randomized to either the FACE-TC intervention or Treatment as Usual (TAU) control. FACE-TC intervention dyads will complete three 60-minute ACP sessions held at weekly intervals. Follow-up data will be collected at 3, 6, 12, and 18months post-intervention by a blinded research assistant (RA). The effects of FACE-TC on patient-family congruence in treatment preferences, quality of life (QOL), and advance directive completion will be analyzed. FACE-TC is an evidenced-based and patient-centered intervention that considers QOL and EOL care according to the AYA's representation of illness. The family is involved in the ACP process to facilitate shared decision making, increase understanding of the AYA's preferences, and make a commitment to honor the AYA's wishes.
Collapse
|
14
|
Dallas RH, Kimmel A, Wilkins ML, Rana S, Garcia A, Cheng YI, Wang J, Lyon ME. Acceptability of Family-Centered Advanced Care Planning for Adolescents With HIV. Pediatrics 2016; 138:peds.2016-1854. [PMID: 27940700 PMCID: PMC5127070 DOI: 10.1542/peds.2016-1854] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Small pilot studies support the appropriateness of engaging adolescents with chronic or life-limiting illnesses in pediatric advance care planning (pACP). We do not yet know if pACP is acceptable, feasible, and worthwhile, even if emotionally intense, in a fully powered randomized controlled trial. METHODS We conducted a prospective 2-arm randomized controlled trial at 6 US urban hospitals. Adolescent/family member dyads were randomized to receive the 1-session-a-week 3-session FAmily-CEntered Advance Care Planning (FACE) pACP intervention (1, ACP Survey; 2, Goals of Care Conversation/Treatment Preferences; 3, Completion of Advance Directive) or active comparator (1, Developmental History; 2, Safety Tips; 3, Nutrition/Exercise). The Satisfaction Questionnaire was administered to participants independently after each session by a blinded research assistant. RESULTS We enrolled 53% of eligible participants and intervened with 97 adolescent/family dyads. Adolescents ranged in age from 14 to 21 years; 54% were male individuals; 93% African American; and 73% perinatally infected. Attendance was 99% for all 3 sessions in each arm. At session 3, FACE adolescents and family dyad members, respectively, found the session useful (98%, 98%) and helpful (98%, 100%), despite feelings of sadness (25%, 17%). FACE adolescents' improvement in the total subscale A score (useful, helpful, like a load off my mind, satisfied, something I needed to do, courageous, worthwhile) was better than control adolescents at session 3 (β = 1.16, P = .02). There were no adverse events. CONCLUSIONS FACE enabled worthwhile conversations, while simultaneously eliciting intense emotions. No participants withdrew, 99% of those enrolled completed each session, and there were no adverse events, evidence of pACP's feasibility, acceptability, and safety.
Collapse
Affiliation(s)
- Ronald H. Dallas
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Allison Kimmel
- Division of Adolescent and Young Adult Medicine, Center for Translational Science/Children’s Research Institute, Children’s National, Washington, District of Columbia
| | - Megan L. Wilkins
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sohail Rana
- Howard University College of Medicine, Washington, District of Columbia
| | - Ana Garcia
- The University of Miami Miller School of Medicine, Miami, Florida; and
| | - Yao I. Cheng
- Division of Adolescent and Young Adult Medicine, Center for Translational Science/Children’s Research Institute, Children’s National, Washington, District of Columbia
| | - Jichuan Wang
- Division of Adolescent and Young Adult Medicine, Center for Translational Science/Children’s Research Institute, Children’s National, Washington, District of Columbia;,The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Maureen E. Lyon
- Division of Adolescent and Young Adult Medicine, Center for Translational Science/Children’s Research Institute, Children’s National, Washington, District of Columbia;,The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | |
Collapse
|
15
|
Rhodes RL, Nazir F, Lopez S, Xuan L, Nijhawan AE, Alexander-Scott NE, Halm EA. Use and Predictors of End-of-Life Care Among HIV Patients in a Safety Net Health System. J Pain Symptom Manage 2016; 51:120-5. [PMID: 26384554 PMCID: PMC4763921 DOI: 10.1016/j.jpainsymman.2015.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/19/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022]
Abstract
CONTEXT Although highly active antiretroviral therapy has improved survival among many HIV patients, there are still those with advanced illness and limited access to care who may benefit from palliative care and hospice. OBJECTIVES To examine completion of advance directives, use of palliative care, and enrollment in hospice among HIV patients who receive care at an urban safety net hospital. METHODS This was a retrospective cohort study of HIV patients in a large, urban safety net hospital in 2010. Physicians abstracted data from the electronic medical record on patient and clinical factors and end-of-life care use. Logistic regression examined predictors of hospice use. RESULTS Overall, 367 HIV patients identified electronically by International Classification of Disease (ICD)-9 code were hospitalized in 2010. The mean age was 42 years, and 57% were African American. Although 28% died, only 6% of the sample received palliative care consultation, and 6% of the sample enrolled in hospice. Those who received hospice had lower albumin levels (adjusted odds ratio [AOR] 4.53, 95% CI 1.19-17.34) had received palliative care (AOR 9.73, 95% CI 2.10-45.09) and completed an advance directive (AOR 16.33, 95% CI 4.23-61.68). Of those patients who received hospice, the mean time to death after enrollment was 11 days. CONCLUSION Among an urban cohort of HIV patients, the rates of advance directive completion, palliative care use, and hospice use were low. Despite advancements in the treatment of HIV, many patients with advanced illness may benefit from palliative care and hospice services. Advances should be made in identifying those patients earlier in their disease trajectories.
Collapse
Affiliation(s)
- Ramona L Rhodes
- Division of Geriatric Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
| | - Fiza Nazir
- Division of Geriatric Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sonya Lopez
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Lei Xuan
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ank E Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole E Alexander-Scott
- Division of Infectious Diseases, Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ethan A Halm
- Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
16
|
Kimmel AL, Wang J, Scott RK, Briggs L, Lyon ME. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers. Contemp Clin Trials 2015; 43:172-8. [PMID: 26044463 DOI: 10.1016/j.cct.2015.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 01/14/2023]
Abstract
Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.
Collapse
Affiliation(s)
- Allison L Kimmel
- Center for Translational Science, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, USA.
| | - Jichuan Wang
- Center for Translational Science, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, USA; The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC, USA.
| | - Rachel K Scott
- MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, USA.
| | - Linda Briggs
- Gunderson Lutheran Medical Foundation, Inc., 1900 South Avenue, La Crosse, WI, USA.
| | - Maureen E Lyon
- Center for Translational Science, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, USA; The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC, USA.
| |
Collapse
|
17
|
Lotz JD, Jox RJ, Borasio GD, Führer M. Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study. Palliat Med 2015; 29:212-22. [PMID: 25389347 PMCID: PMC4359209 DOI: 10.1177/0269216314552091] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pediatric advance care planning differs from the adult setting in several aspects, including patients' diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals' perspective. AIM We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. DESIGN This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. SETTING/PARTICIPANTS We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. RESULTS Perceived problems with pediatric advance care planning relate to professionals' discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor's advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. CONCLUSION Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers.
Collapse
Affiliation(s)
- Julia D Lotz
- Coordination Center for Pediatric Palliative Care, University Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Ralf J Jox
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Gian Domenico Borasio
- Service de Soins Palliatifs, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Monika Führer
- Coordination Center for Pediatric Palliative Care, University Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| |
Collapse
|
18
|
Lyon ME, Garvie P, He J, Malow R, McCarter R, D'Angelo LJ. Spiritual well-being among HIV-infected adolescents and their families. JOURNAL OF RELIGION AND HEALTH 2014; 53:637-53. [PMID: 23104266 PMCID: PMC3568454 DOI: 10.1007/s10943-012-9657-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Congruence in spirituality between HIV+ adolescent (n = 40)/family (n = 40) dyads and psychological adjustment and quality of life were assessed, using the Spiritual Well-Being Scale of the Functional Assessment of Chronic Illness Therapy, Beck Depression Inventory-II, Beck Anxiety Inventory and Pediatric Quality of Life Inventory at baseline and 3-month post-intervention. Adolescents were 60 % female and 92 % African American. Congruence in spirituality between adolescent/surrogate dyads remained unchanged at 3 months. High congruence existed for "having a reason for living"; rejection of "life lacks meaning/purpose" and "HIV is a punishment from God." Adolescents were less likely to forgive the harm others caused them than their families.
Collapse
Affiliation(s)
- Maureen E Lyon
- Center for Translational Research, Children's Research Institute, Children's National Medical Center, Room M7658, 111 Michigan Avenue, N.W., Washington, DC, 20010-2970, USA,
| | | | | | | | | | | |
Collapse
|
19
|
Duckworth KE, Forti AM, Russell GB, Naik S, Hurd DD, McQuellon RP. Hematopoietic stem cell transplant candidate and designated proxy distress levels prior to hematopoietic stem cell transplantation. Am J Hosp Palliat Care 2013; 31:853-6. [PMID: 24142596 DOI: 10.1177/1049909113508217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem cell transplantation (HCT) is associated with a high risk of morbidity, making advance care planning (ACP) essential. The purpose of this study was to assess and compare proxy and HCT candidate distress levels (Distress Thermometer) before (T1) and after (T2) ACP question completion. 79 participants (40 HCT candidates, 39 proxies) rated their distress. The T1, T2 mean distress scores (SD) for HCT candidates were 3.13(2.27), 2.96(2.10); 43% and 38% endorsed clinically significant distress (≥4). Proxies reported 4.21(2.48), 4.33 (2.46); 62% endorsed significant distress at T1, T2. The majority of proxies endorsed distress levels that were clinically significant and comparatively higher (T1 (p = 0.047) and T2 (p = 0.009)) than their paired HCT recipients. Responding to questions about ACP did not increase overall distress ratings.
Collapse
Affiliation(s)
- Katharine E Duckworth
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Allison M Forti
- Counseling Department, Wake Forest University, Winston-Salem, NC, USA
| | - Gregory B Russell
- Department of Biostatistical Sciences, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Seema Naik
- Texas Transplant Institute, San Antonio, TX, USA
| | - David D Hurd
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Richard P McQuellon
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| |
Collapse
|
20
|
Garvie PA, He J, Wang J, D'Angelo LJ, Lyon ME. An exploratory survey of end-of-life attitudes, beliefs, and experiences of adolescents with HIV/AIDS and their families. J Pain Symptom Manage 2012; 44:373-85.e29. [PMID: 22771129 PMCID: PMC3432673 DOI: 10.1016/j.jpainsymman.2011.09.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 09/06/2011] [Accepted: 09/15/2011] [Indexed: 11/17/2022]
Abstract
CONTEXT For youths with life-limiting conditions, little is known regarding families' understanding of their adolescent's wishes for end-of-life (EOL) care. OBJECTIVES To examine congruence in HIV positive adolescents and their families' thoughts about death and dying. METHODS The Lyon Advance Care Planning Survey-Adolescent and Surrogate versions were administered within a randomized controlled trial. Participants (n=48) were medically stable adolescents aged 14-21 years with HIV/AIDS and their families. Congruence was measured by intraclass correlation coefficients (ICCs) for continuous variables and by kappa for ordinal or dichotomous responses. RESULTS Adolescent participants were as follows: mean age 16.6 years (range 14-21); 37.5% males; 92% African American; 38% CD4 count <200; and viral load mean=32,079 copies/mL (range <400-91,863 copies/mL). Adolescent/family dyads agreed that it is important to complete an advance directive to let loved ones know their wishes (21/24 dyads), yet no dyads agreed an advance directive had been completed. Dyads endorsed incongruent thoughts about the adolescent being afraid of dying in pain (64%; congruent afraid=8 dyads, kappa=-0.0769) and being off life support machines (congruent important=9 dyads, ICC=-0.133, 95% confidence interval = -0.540, 0.302, P=0.721). Families' knowledge of teens' preferences for the timing of EOL conversations (early vs. late in course of illness) was poor (kappa=-0.1186). Adolescents (90%) wanted to talk about EOL issues before they entered the dying phase. CONCLUSION Although important areas of congruence emerged, equally important areas, such as the timing of these conversations and adolescents' EOL needs and wishes, are not known by their families. Families need help initiating conversations to assure that their adolescents' EOL wishes are known to them.
Collapse
|
21
|
Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle (FACE): design and methods. Contemp Clin Trials 2012; 33:1033-43. [PMID: 22664645 DOI: 10.1016/j.cct.2012.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 04/26/2012] [Accepted: 05/13/2012] [Indexed: 12/25/2022]
Abstract
As life expectancy increases for adolescents ever diagnosed with AIDS due to treatment advances, the optimum timing of advance care planning is unclear. Left unprepared for end-of-life (EOL) decisions, families may encounter miscommunication and disagreements, resulting in families being charged with neglect, court battles and even legislative intervention. Advanced care planning (ACP) is a valuable tool rarely used with adolescents. The Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle study is a two-arm, randomized controlled trial assessing the effectiveness of a disease specific FAmily CEntered (FACE) advanced care planning intervention model among adolescents diagnosed with AIDS, aimed at relieving psychological, spiritual, and physical suffering, while maximizing quality of life through facilitated conversations about ACP. Participants will include 130 eligible dyads (adolescent and family decision-maker) from four urban cities in the United States, randomized to either the FACE intervention or a Healthy Living Control. Three 60-minute sessions will be conducted at weekly intervals. The dyads will be assessed at baseline as well as 3-, 6-, 12-, and 18-month post-intervention. The primary outcome measures will be in congruence with EOL treatment preferences, decisional conflict, and quality of communication. The mediating and moderating effects of threat appraisal, HAART adherence, and spiritual struggle on the relationships among FACE and quality of life and hospitalization/dialysis use will also be assessed. This study will be the first longitudinal study of an AIDS-specific model of ACP with adolescents. If successful, this intervention could quickly translate into clinical practice.
Collapse
|
22
|
Lyon ME, Garvie PA, Kao E, Briggs L, He J, Malow R, D’Angelo LJ, McCarter R. Spirituality in HIV-infected adolescents and their families: FAmily CEntered (FACE) Advance Care Planning and medication adherence. J Adolesc Health 2011; 48:633-6. [PMID: 21575826 PMCID: PMC3096935 DOI: 10.1016/j.jadohealth.2010.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 09/10/2010] [Indexed: 01/01/2023]
Abstract
PURPOSE To explore the effect of spirituality and religious beliefs on FAmily CEntered (FACE) Advance Care Planning and medication adherence among human immunodeficiency virus (HIV) positive adolescents and their surrogate decision-makers. METHODS A sample of HIV-positive adolescents (n = 40) and their surrogates, aged ≥ 21 years, (n = 40), was randomized to an active Healthy Living Control group or the FACE Advance Care Planning intervention, guided by transactional stress and coping theory. Adolescents' spirituality and their belief that HIV is a punishment from God were assessed at baseline and 3 months after the intervention, using the Functional Assessment of Chronic Illness Therapy-Spiritual Well Being Scale, Expanded, Version 4. RESULTS Control adolescents increased faith and meaning/purpose more than FACE adolescents (p = .02). At baseline, more behaviorally infected adolescents (16%) believed that HIV was a punishment from God as compared with those who were infected perinatally (8%). Adolescents endorsing that HIV was a punishment scored lower on spirituality (p = .05) and adherence to Highly Active Antiretroviral Therapy (HAART) (p = .04). Surrogates were more spiritual than adolescents (p ≤ .0001). CONCLUSION Providing family support in a friendly, facilitated environment enhanced spirituality among adolescents. Facilitated family conversations had an especially positive effect on medication adherence and spiritual beliefs among behaviorally infected adolescents.
Collapse
Affiliation(s)
- Maureen E. Lyon
- Children’s National Medical Center & George Washington School of Medicine and Health Sciences, Washington, District of Columbia, Children’s Research Institute, Washington, District of Columbia
| | | | - Ellin Kao
- Children’s National Medical Center & George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Linda Briggs
- Gundersen Lutheran Medical Foundation, Inc., Madison, Wisconsin
| | - Jianping He
- Children’s Research Institute, Washington, District of Columbia
| | - Robert Malow
- Florida International University, Miami, Florida
| | - Lawrence J. D’Angelo
- Children’s National Medical Center & George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Robert McCarter
- Children’s Research Institute, Washington, District of Columbia
| |
Collapse
|