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Snaman JM, Kaye EC, Spraker-Perlman H, Levine D, Clark L, Wilcox R, Barnett B, Sykes A, Lu Z, Cunningham MJ, Baker JN. Incorporating Bereaved Parents as Faculty Facilitators and Educators in Teaching Principles of Palliative and End-of-Life Care. Am J Hosp Palliat Care 2018; 35:1518-1525. [PMID: 30012005 DOI: 10.1177/1049909118786875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Education and training for interdisciplinary pediatric providers requires training in principles of palliative and end-of-life (EOL) care. The experiences of bereaved parents can inform and enhance palliative care educational curricula in uniquely powerful and valuable ways. The objective of this study is to present an innovative palliative care educational program facilitated by trained bereaved parents who serve as volunteer educators in local and national palliative care educational forums and to describe how incorporation of bereaved parents in these educational forums affects participant comfort with communication and management of children at the EOL. METHODS: Parent educators underwent both general and session-specific training and participated in debriefings following each session. Survey tools were developed or adapted to determine how bereaved parent educators affected participant experiences in 3 different educational forums. Pre- and postsession surveys with incorporation of retrospective preprogram assessment items to control for response shift were used in the evaluation of institutional seminars on pediatric palliative and EOL care and role-play-based communication training sessions. Results from feedback surveys sent to attendees were used to appraise the participants' experience at the international oncology symposium. RESULTS: Involvement of trained parent educators across diverse, interdisciplinary educational forums improved attendee comfort in communicating with, and caring for, patients and families with serious illness. Importantly, parent educators also derive benefit from involvement in educational sessions with interdisciplinary clinicians. CONCLUSIONS: Integration of bereaved parents into palliative and EOL care education is an innovative and effective model that benefits both interdisciplinary clinicians and bereaved parents.
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Affiliation(s)
- Jennifer M Snaman
- 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Erica C Kaye
- 2 Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Holly Spraker-Perlman
- 2 Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deena Levine
- 2 Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa Clark
- 2 Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Robin Wilcox
- 2 Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Brittany Barnett
- 3 Department of Volunteer Services, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - April Sykes
- 4 Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zhaohua Lu
- 4 Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melody J Cunningham
- 5 Division of Palliative Care, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Justin N Baker
- 2 Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Griffith R, Davies K, Lavender V. The characteristics and experiences of anticipatory mourning in caregivers of teenagers and young adults. Int J Palliat Nurs 2015; 21:527-33. [PMID: 26619236 DOI: 10.12968/ijpn.2015.21.11.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reports a systematic review of literature undertaken to identify characteristics and experiences of anticipatory mourning in caregivers of teenagers and young adults with life-limiting or life-threatening conditions. A comprehensive literature search was conducted using the key words 'anticipatory', 'mourning', 'grief', and synonyms. This review focused on six studies that met inclusion criteria and reported characteristics of anticipatory mourning in caregivers of teenagers and young adults. Characteristics and experiences were sorted into four main themes: symptoms; a sense of loss; caregiver behaviour; and the unique experience of caring for, or losing, a teenager or young adult. The review suggests that there are characteristics and experiences of anticipatory mourning that are unique to caregivers of this age group. The review also suggests that consideration of anticipatory mourning is important in offering holistic care to young adults and their caregivers, and points to the need for further research in this area.
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Affiliation(s)
| | - Kerry Davies
- Research Co-ordinator, at Helen and Douglas House Hospice, Oxford
| | - Verna Lavender
- Senior Lecturer in Cancer Care, Faculty of Health and Life Sciences, Oxford Brookes University
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Ng F, Crawford GB, Chur-Hansen A. Treatment approaches of palliative medicine specialists for depression in the palliative care setting: findings from a qualitative, in-depth interview study. BMJ Support Palliat Care 2015; 6:186-93. [PMID: 25573668 DOI: 10.1136/bmjspcare-2014-000719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 12/19/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Treatment of depression in the palliative care setting is complicated by varied treatment preferences, a small body of research, and unique challenges associated with the end-of-life. Little is known about the treatment practices of medical practitioners in this setting. OBJECTIVE This study aimed to investigate and characterise the treatment approaches of palliative medicine specialists for depression. DESIGN Semistructured, in-depth interviews were conducted to explore explanatory models of depression from palliative medicine specialists, including a focus on treatment. Verbatim interview transcripts were analysed for themes. SETTING/PARTICIPANTS Palliative medicine specialists practising in Australia were recruited and purposively sampled. Nine participants were interviewed to reach data saturation. RESULTS Five themes were identified in relation to treatment of depression: (1) guiding principles of treatment; (2) treatment approaches; (3) factors underpinning treatment decisions; (4) difficulties arising in treatment; and (5) interdisciplinary roles. Participants described five distinct treatment approaches, consisting of biological orientation, psychosocial orientation, combination approach, undifferentiated approach and ambivalence. Treatment decisions were contingent on patient, depression, clinician and sociocultural factors. Difficulties included discomfort with treating depression, being inadequately equipped and confronting therapeutic limitations. Treating depression was considered to require multidisciplinary team effort. CONCLUSIONS Palliative medicine specialists' treatment approaches are linked to their concepts of and causal explanations for depression. Future treatment guidelines could aim to consider specific varieties of depression, be more differentiated in treatment modality and type, and consider decision-shaping factors. Continuing mental health education and the incorporation of psychiatry and psychology into palliative care services may have enduring benefits.
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Affiliation(s)
- Felicity Ng
- Discipline of Psychiatry, School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia Consultation-Liaison Psychiatry, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale, South Australia, Australia
| | - Gregory B Crawford
- Discipline of Medicine, School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia Central Adelaide Palliative Care Service, Central Adelaide Local Health Network, Woodville, South Australia, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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New Patient-Centered Care Standards from the Commission on Cancer: Opportunities and Challenges. ACTA ACUST UNITED AC 2012; 10:107-11. [DOI: 10.1016/j.suponc.2011.12.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 12/15/2011] [Accepted: 12/20/2011] [Indexed: 11/18/2022]
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Abstract
Children with life-threatening illnesses and their families may face physical, emotional, psychosocial, and spiritual challenges throughout the children's course of illness. Pediatric palliative care is designed to meet such challenges. Given the psychosocial and emotional needs of children and their families it is clear that psychiatrists can, and do, play a role in delivering pediatric palliative care. In this article the partnership between pediatric palliative care and psychiatry is explored. The authors present an overview of pediatric palliative care followed by a summary of some of the roles for psychiatry. Two innovative pediatric palliative care programs that psychiatrists may or may not be aware of are described. Finally, some challenges that are faced in further developing this partnership and suggestions for future research are discussed.
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Kramer BJ, Kavanaugh M, Trentham-Dietz A, Walsh M, Yonker JA. Complicated grief symptoms in caregivers of persons with lung cancer: the role of family conflict, intrapsychic strains, and hospice utilization. OMEGA-JOURNAL OF DEATH AND DYING 2011; 62:201-20. [PMID: 21495532 PMCID: PMC3265356 DOI: 10.2190/om.62.3.a] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Guided by a stress process conceptual model, this study examines social and psychological determinants of complicated grief symptoms focusing on family conflict, intrapsychic strains, and the potential moderating effect of care quality and hospice utilization. Relying on data from 152 spouse and adult child lung cancer caregiver survey respondents, drawn from an ancillary study of the Assessment of Cancer CarE and SatiSfaction (ACCESS) in Wisconsin, hierarchical multiple regression analysis was used to examine determinants of complicated grief. After controlling for contextual factors and time since death, complicated grief symptoms were higher among caregivers with less education, among families with lower prior conflict but higher conflict at the end-of-life, who had family members who had difficulty accepting the illness, and who were caring for patients with greater fear of death. Additionally, hospice utilization moderated the effect of fear of death on complicated grief. Findings suggest that family conflict, intrapsychic strains, and hospice utilization may help to explain the variability found in complicated grief symptoms among bereaved caregivers. Implications for enhancing complicated grief assessment tools and preventative interventions across the continuum of cancer care are highlighted.
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Affiliation(s)
- Betty J Kramer
- University of Wisconsin-Madison, School of Social Work, Madison, WI 53706, USA.
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Affiliation(s)
- Heather Kendall
- Heather Kendall is an assistant professor of nursing at Missouri Western State University in St Joseph, Missouri. She is also a staff nurse in the ICU at Heartland Regional Medical Center in St Joseph
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Knapp C, Madden V, Button D, Brown R, Hastie B. Partnerships between pediatric palliative care and psychiatry. Child Adolesc Psychiatr Clin N Am 2010; 19:423-37, xi. [PMID: 20478508 DOI: 10.1016/j.chc.2010.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children with life-threatening illnesses and their families may face physical, emotional, psychosocial, and spiritual challenges throughout the children's course of illness. Pediatric palliative care is designed to meet such challenges. Given the psychosocial and emotional needs of children and their families it is clear that psychiatrists can, and do, play a role in delivering pediatric palliative care. In this article the partnership between pediatric palliative care and psychiatry is explored. The authors present an overview of pediatric palliative care followed by a summary of some of the roles for psychiatry. Two innovative pediatric palliative care programs that psychiatrists may or may not be aware of are described. Finally, some challenges that are faced in further developing this partnership and suggestions for future research are discussed.
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Affiliation(s)
- Caprice Knapp
- Departments of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL 32610, USA.
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Knapp C, Quinn GP, Murphy D, Brown R, Madden V. Adolescents With Life-Threatening Illnesses. Am J Hosp Palliat Care 2010; 27:139-44. [DOI: 10.1177/1049909109358310] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adolescents have unique physical and psychosocial needs. Adolescents want to gain autonomy, yet they must still rely on their parents for support. These unique needs are further complicated by a life-threatening illness. Adolescents with life-threatening illnesses must rely on their parents, due to legal aspects of decision making, and they also face potential loss of peer interaction as they spend more time in hospitals and away from their friends. Adolescents may also be concerned with fertility, reproduction, and sexuality, issues that are often not addressed in palliative care programs. To meet the unique needs of adolescents, specific palliative care programs may need to be developed.
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Affiliation(s)
- Caprice Knapp
- University of Florida, College of Medicine, Gainesville, FL, USA,
| | | | - Devin Murphy
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Rebecca Brown
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Vanessa Madden
- University of Florida, College of Medicine, Gainesville, FL, USA
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