Telling young children with leukemia their diagnosis: the flower garden as analogy

Effects of Message Framing on Patients' Perceptions and Willingness to Change to a Biosimilar in a Hypothetical Drug Switch

OBJECTIVE

Patients often hold negative perceptions toward biosimilars that can create barriers to their uptake. Physicians also report uncertainty in how best to explain biosimilars. The aim of this study was to measure the effect of differently framed explanations on patients' perceptions of and willingness to change to a biosimilar in a hypothetical drug switch.

METHODS

Ninety-six patients with rheumatic diseases taking an originator biologic were randomized to receive 1 of 4 biosimilar explanations: positive framing with and without an analogy, and negative framing with and without an analogy. Willingness to switch to a biosimilar, perceptions about biosimilars, and the effectiveness of the explanation were measured after the information delivery.

RESULTS

Positive framing led to more participants being willing to switch (67%) than negative framing (46%). Framing significantly predicted willingness to switch to a biosimilar, with participants in the positive framing group being 2.36 times more willing to switch (P = 0.041). The positive framing group also reported significantly greater perceived efficacy of biosimilars (P = 0.046) and thought the explanation was more convincing (P = 0.030). The analogy did not enhance willingness to switch or increase understanding (P > 0.05).

CONCLUSION

Positive framing can improve perceptions of and willingness to switch to a biosimilar in patients currently taking biologic treatments.

The role of nature in cancer patients' lives: a systematic review and qualitative meta-synthesis

Background

A systematic review and meta-synthesis was conducted to identify, compare and synthesize the published qualitative literature contributing to our understanding of the role of nature in cancer patients’ lives.

Method

An electronic search of Medline, CINAHL, PsycINFO and Cochrane Databases was conducted to identify qualitative studies focused on cancer patients’ nature experiences published between January 1985 and May 2015. Records were assessed according to pre-defined inclusion criteria. Data were extracted on study characteristics and evaluated using the COREQ guidelines for comprehensive quality reporting. Qualitative data from ‘results’ and ‘findings’ sections were entered into data management software NVivo in order to identify recurring themes and facilitate interpretation across studies.

Results

From 11 eligible publications, seven inter-related core themes with descriptive themes were identified as follows: connecting with what is valued; being elsewhere, seeing and feeling differently; exploration, inner and outer excursions; home and safe; symbolism, understanding and communicating differently; benefitting from old and new physical activities; and, enriching aesthetic experiences.

Conclusions

Nature provides patients with unburdened physical and psychic space invested with personal significance. Findings propose nature’s role as a “secure base” offering patients a familiar and nurturing context from which new perspectives can emerge and caring connections can be made with themselves, others, the past, and the future. As such, nature supported patients to navigate the clinical and personal consequences of cancer. Comprehensive representation of cancer patients’ nature experiences identified patient values and care opportunities embedded in clinical and personal environments, which may be considered for future research and care service development.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3366-6) contains supplementary material, which is available to authorized users.

Interventions for improving communication with children and adolescents about their cancer

BACKGROUND

Communication with children and adolescents with cancer about their disease and treatment and the implications of these is an important aspect of good quality care. It is often poorly performed in practice. Various interventions have been developed that aim to enhance communication involving children or adolescents with cancer.

OBJECTIVES

To assess the effects of interventions for improving communication with children and/or adolescents about their cancer, its treatment and their implications, updating the 2003 version of this review.

SEARCH STRATEGY

In April 2006 we updated searches of the following sources: CENTRAL (The Cochrane Library, issue 1 2006); MEDLINE (Ovid), (2003 to March week 5 2006); EMBASE (Ovid) (2003 to 2006 week 13); PsycINFO (Ovid) (2003 to March week 5 2006); CINAHL (Ovid) (2003 to March week 5 2006); ERIC (CSA) (earliest to 2006); Sociological Abstracts (CSA) (earliest to 2006); Dissertation Abstracts: (2002 to 6 April 2006).In 2003 we conducted searches of CENTRAL; MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, Sociological Abstracts and Dissertation Abstracts.For the initial (2001) publication of this review we also searched the following databases: PsycLIT; Cancerlit; Sociofile; Health Management Information Consortium; ASSIA; LISA; PAIS; Information Science Abstracts; JICST; Pascal; Linguistics and Language Behavior Abstracts; Mental Health Abstracts; AMED; MANTIS.We also searched the bibliographies of studies assessed for inclusion, and contacted experts in the field.

SELECTION CRITERIA

Randomised and non-randomised controlled trials, and before and after studies, evaluating the effects of interventions for improving communication with children and/or adolescents about their cancer, treatment and related issues.

DATA COLLECTION AND ANALYSIS

Data relating to the interventions, populations and outcomes studied and the design and methodological quality of included studies were extracted by one review author and checked by another review author. We present a narrative summary of the results.

MAIN RESULTS

One new study met the criteria for inclusion; in total we have included ten studies involving 438 participants. Studies were diverse in terms of the interventions evaluated, study designs used, types of people who participated and the outcomes measured.One study of a computer-assisted education programme reported improvements in knowledge and understanding about blood counts and cancer symptoms. One study of a CD-ROM about leukaemia reported an improvement in children's feelings of control over their health. One study of art therapy as support for children during painful procedures reported an increase in positive, collaborative behaviour. Two out of two studies of school reintegration programs reported improvements in some aspects of psychosocial wellbeing (one in anxiety and one in depression), social wellbeing (two in social competence and one in social support) and behavioural problems; and one reported improvements in physical competence. One newly-identified study of a multifaceted interactive intervention reported a reduction in distress (as measured by heart rate) related to radiation therapy.Two studies of group therapy, one of planned play and story telling, and one of a self-care coping intervention, found no significant effects on the psychological or clinical outcomes measured.

AUTHORS' CONCLUSIONS

Interventions to enhance communication involving children and adolescents with cancer have not been widely or rigorously assessed. The weak evidence that exists suggests that some children and adolescents with cancer may derive some benefit from specific information-giving programs, from support before and during particular procedures, and from interventions that aim to facilitate their reintegration into school and social activities. More research is needed to investigate the effects of these and other related interventions.

Paediatric palliative care: challenges and emerging ideas

Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-threatening conditions and their families. To achieve this goal, the individuals working in this field need to: clearly define the population served; better understand the needs of children with life-threatening conditions and their families; develop an approach that will be appropriate across different communities; provide care that responds adequately to suffering; advance strategies that support caregivers and health-care providers; and promote needed change by cultivating educational programmes. Despite these challenges, advances in paediatric palliative care have been achieved in a short period of time; we expect far greater progress as the field becomes more formalised and research networks are established.

Audiotaping communication of the diagnosis of childhood leukemia: parents' evaluation

PURPOSE

To evaluate how parents viewed the authors' practice of audiotaping the initial communication of the leukemia diagnosis and of the complete program of care, including the prognosis.

METHODS

From January 1997 through December 1998, at the end of the formal communication interview, parents were asked to evaluate the audiotaping by filling out a questionnaire concerning the procedure.

RESULTS

Sixty-three parents of children with leukemia participated.

CONCLUSIONS

The authors' use of audiotapes was strongly supported by the parents as a supplementary intervention and has become a routine procedure.

Interventions for improving communication with children and adolescents about their cancer

BACKGROUND

Communication with children and adolescents with cancer about their disease and treatment and the implications of these is an important aspect of good quality care. It is often poorly performed in practice. Various interventions have been developed that aim to enhance communication involving children or adolescents with cancer.

OBJECTIVES

To examine the effects of interventions to enhance communication with children and/or adolescents about their cancer, its treatment and their implications.

SEARCH STRATEGY

We searched the following sources: Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, Issue 1 2003; MEDLINE (1966 to January week 2 2003); EMBASE (1985 to 2003 week 4); CINAHL (1982 to December week 4 2002); Dissertation Abstracts (1861 to January 2003); ERIC (1966 to January 2003); PsycINFO (1985 to January week 4 2003); Sociological Abstracts (1963 to January 2003).For the initial (2001) publication of this review we also searched the following databases: PsycLIT; Cancerlit;; Sociofile; Health Management Information Consortium; ASSIA; LISA; PAIS; Information Science Abstracts; JICST; Pascal; Linguistics and Language Behavior Abstracts; Mental Health Abstracts; AMED; MANTIS. We also searched the bibliographies of studies assessed for inclusion, and contacted experts in the field.

SELECTION CRITERIA

Randomised and non-randomised controlled trials and before and after studies that evaluated the effects of interventions to enhance communication with children and/or adolescents about their cancer, treatment and related issues.

DATA COLLECTION AND ANALYSIS

Data relating to the interventions, populations and outcomes studied and the design and methodological quality of included studies were extracted by one reviewer and checked by another reviewer. A narrative summary of the results is presented.

MAIN RESULTS

Nine studies met the criteria for inclusion. They were diverse in terms of the interventions evaluated, study designs used, types of people who participated and the outcomes measured. One study of a computer-assisted education programme reported improvements in knowledge and understanding about blood counts and cancer symptoms. One study of a CD-ROM about leukemia reported an improvement in children's feelings of control over their health. One study of art therapy as support for children during painful procedures reported an increase in positive, collaborative behaviour. Two out of two studies of school reintegration programs reported improvements in some aspects of psychosocial wellbeing (one in anxiety and one in depression), social wellbeing (two in social competence and one in social support) and behavioural problems; and one reported improvements in physical competence.

REVIEWER'S CONCLUSIONS

Interventions to enhance communication involving children and adolescents with cancer have not been widely or rigorously assessed. The weak evidence that exists suggests that some children and adolescents with cancer may derive some benefit from specific information-giving programs and from interventions that aim to facilitate their reintegration into school and social activities. More research is needed to investigate the effects of these and other related interventions.

The needs of children and adolescents with cancer for information and social support

Research has indicated that information and social support may have helped children and adolescents with cancer to cope with their illness and lead normal lives. However, recent researchers have reported that youths with cancer express a clear interest in receiving more information and social support. This study reviewed research on information and social support for children and adolescents with cancer to understand their needs. Young patients with cancer showed high uncertainty about cancer. Besides, adolescents with cancer were more in conflict with their parents than healthy youths. Discussions on future plans or death are difficult for young people with cancer. They also are frequently absent from school over time. Moreover, they want to make healthy friends. To fulfill the needs of these youths, nurses should be aware not only of individualized information and social support, but also of these factors from an ecologic perspective. Further qualitative research is required to identify the needs of youths with cancer and resolve these issues.

Does illness experience influence the recall of medical information?

Recall of a storyboard description of an unfamiliar illness was assessed in 66 healthy children and 40 children with chronic illness (cystic fibrosis or asthma). A significant interaction between verbal intelligence quotient and illness experience (p < 0.001) suggested that more able sick children may be resistant to learning new medical information.

SIOP Working Committee on psychosocial issues in pediatric oncology: guidelines for communication of the diagnosis

This is the fourth official document of the SIOP Working Committee on psychosocial issues in pediatric oncology constituted in 1991. This document develops another topic discussed and approved by the SIOP Committee: "communication of the diagnosis" is addressed to the pediatric oncology community as guidelines that could be followed. The highly stressful nature of the diagnostic period must be acknowledged, and communication involving the staff and all family members should cover both medical and psychosocial issues. A well-planned and extensive initial session should be followed by continuing discussions. The goal is a knowledgeable family that can talk openly with its members and with the staff.

Information about diagnosis and prognosis related to anxiety and depression in children with cancer aged 8-16 years

The aim of this study was to test the hypothesis that being openly informed about the diagnosis and prognosis benefits the emotional well-being of children with cancer. A stratified sample of 56 children with cancer aged 8-16 years and their parents participated. The parents were interviewed about the information they had given to their child. Self-report questionnaires were administered to the children measuring anxiety and depression. Children who received open information about their diagnosis and prognosis at the initial stage of the disease showed significantly less anxiety and depression. Our findings suggest that parents should be advised to inform their child with cancer openly and soon after the initial diagnosis. Physicians should offer help to the parents in dealing with the difficult task of confronting the child with the diagnosis, prognosis and treatment.