Fathers' Experiences of Caring for a Child with a Chronic Illness: A Systematic Review

Effects of Family Caregiver-Nurse Communication on Family Management and Family Caregiver Uncertainty Regarding the Care of Children With Long-Term Ventilator Dependence

Nurses caring for hospitalized children with long-term ventilator dependence (LTVD) assess family management capability and teach new skills through communication with family caregivers. This theoretically-based quantitative, descriptive study aimed to determine the communication behaviors associated with family caregiver uncertainty and management of the child with LTVD's care after discharge. One hundred families and 48 nurses enrolled. Family caregiver-nurse conversations were recorded and transcripts coded for communication behaviors. Family management and uncertainty data were gathered during hospitalization and after discharge. Data analysis included correlations and linear mixed models. Family caregivers and nurses used advocating and negotiating roles communication behaviors least frequently; however, these communication behaviors were associated with the most aspects in terms of uncertainty about the child's condition and ease of management of the child's care after discharge to home. Nurses should assess family caregiver ease in managing care, provide support, and engage in collaborative problem-solving through respectful communication.

Fathers' impact on outcomes in the treatment of eating disorders: A scoping review

OBJECTIVE

Male caregivers' participation in eating disorder (ED) treatment for their affected children is less consistent than female caregivers', with unclear effects. To clarify the impact, this scoping review examined literature on male caregiver involvement in ED treatment, focusing on its impact on fathers, treatment processes, and their affected children.

METHODS

A search encompassing English and French peer-reviewed articles from 1990 to 2022 was conducted. Studies distinguishing between mothers and fathers, addressing Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases ED diagnoses, and involving active interventions were included. From 1651 initially identified articles, 251 were retained after abstract and title review, and 45 met all criteria.

RESULTS

Documented outcomes indicated fathers' engagement in ED treatment improved their well-being and family functioning, but these gains were not consistently tied to treatment outcomes. Father attendance, improved caregiving skills, and their expectations of treatment correlated with better outcomes for their affected child.

CONCLUSIONS

Father involvement in ED treatment remains under-explored. This review emphasises fathers' positive impact while highlighting the need to better understand the link with overall patient outcomes. We call for proactive exploration of how to surmount barriers to fathers' involvement and ensure that paternal contributions are optimised in ED treatment alongside those of female caregivers.

Quality of Life in Children With Chronic Health Conditions and Its Contribution to Unmet Supportive Care Needs of Families

BACKGROUND

While theoretical models have established the bidirectional relationship between health and wellbeing of parents and children with chronic health conditions (CHCs), previous work has predominantly emphasised the impact of parent functioning on child outcomes. This study examines how quality of life (QoL) domains in children with CHCs are associated with unmet supportive care needs (SCN) of their parents and explores whether these associations vary by health condition.

METHOD

Parents of children with congenital heart disease (CHD), type 1 diabetes (T1D) and cancer diagnosed before the age of 12 years and receiving treatment within the last 5 years were eligible. Parents recruited through charity organisations and social media platforms completed a secure, online survey via Qualtrics. The PedsQL examined child QoL across four dimensions: physical, emotional, social and school functioning. A 34-item survey assessed parents' unmet SCN in the previous month across six need domains (e.g., care and informational). Linear regressions examined associations between child QoL and unmet SCN domains and moderation analyses determined whether associations varied as a function of CHC.

RESULTS

The study included 186 parents (age range 25-56 years) of children diagnosed with various CHCs (52% CHD; 27% T1D, 21% cancer). The child's emotional functioning was inversely related to all unmet SCN domains, social functioning was inversely related to three domains (physical and social; support; financial), school functioning was inversely related to two domains (physical and social; care), and child's physical functioning was not associated with any SCN domains. Only the association between child school functioning and unmet care needs was significantly moderated by CHC type (p < 0.05).

CONCLUSION

Poorer emotional functioning in children with a CHC is a key factor in determining parents unmet SCN. Larger studies are required to replicate these findings and inform design of interventions addressing QoL and unmet SCN in families of children with common CHCs.

Pediatric epilepsy representations among children/adolescents and parents: The role of age, gender, and clinical variables

According to the common-sense model of self-regulation, illness representations influence treatment adherence and, thus, health status. As pediatric epilepsy management is usually shared between children/adolescents and parents, we aimed to assess and compare illness representations of both groups. Additionally, the role of gender and clinical variables in pediatric epilepsy representations was explored. One hundred and seventy-three dyads of Portuguese children/adolescents with epilepsy and parents were assessed with the Brief Illness Perception Questionnaire. Pediatric epilepsy was perceived as a moderate threat. Although epilepsy symptoms and consequences were mainly perceived as low, the emotional impact of the illness was moderate to high. Compared to children/adolescents, parents presented higher understanding of epilepsy, higher concern, and more intense emotional responses to the illness. Adolescents understood the illness better than children. Gender did not relate to illness representations among children/adolescents or parents. Epilepsy severity and control were the clinical variables most strongly associated with illness representations. Pediatric epilepsy representations should be routinely assessed separately for children/adolescents and parents, particularly following changes in epilepsy severity. When pediatric illness representations are found to be incongruent with medical information, such beliefs should be challenged, preferably with a tailored approach.

Challenges and coping strategies among caregivers of children with cancer receiving care at a national referral hospital in Kenya

BACKGROUND

The number of children diagnosed with cancer is expected to increase by 2050. The caring aspect of these children is usually left to members of the family, more so the mothers. Caregivers are usually faced with various challenges, such as financial issues, social stigma, and emotional and psychological issues. Caregivers use various coping strategies to manage the challenges they experience in the caring process, which can be positive or negative coping strategies.

OBJECTIVE

To explore the challenges and coping strategies of caregivers of children with cancer receiving care at a national referral hospital in Kenya.

METHODS

This study employed a descriptive phenomenological approach to explore the challenges and coping strategies of caregivers of children with cancer receiving treatment at a national referral hospital in Kenya. Purposive and snowball sampling techniques were used to select 44 participants for five focus group discussions (FGDs) conducted between October and December 2023. The data were analysed via inductive thematic analysis.

RESULTS

Four themes arose from the challenges experienced, which included psychological, financial, treatment-related, and social/family-related issues. These eleven subthemes included stress, depression, lack of transport, lack of food, loss of employment, treatment delays, and marital issues, among others. Two themes related to coping strategies were positive adaptation and denial, which were highlighted as negative coping strategies. Positive coping included praying, crying, talking to people, and seeking help.

CONCLUSION

Caregivers of children with cancer undergo various challenges and apply various coping strategies to try and adapt to their new normal. Reinforcing positive coping strategies and helping caregivers utilize other coping strategies, such as the use of support groups, could help them better care for their children.

"I won't ever feel normal": experience reported through photovoice by children with chronic kidney disease

BACKGROUND

Much of the global chronic kidney disease burden is experienced in low- and middle-income countries. Children living with chronic kidney disease (CKD) face medical and social challenges, and they need support at the individual and family levels. This study aimed to explore children's experiences living with kidney replacement therapy (KRT) who attend the largest pediatric nephrology department in Guatemala.

METHODS

This qualitative study used photovoice and asked children to take pictures that represented what is like to live with CKD. Each child and their caregiver underwent an interview where the photos were used to elicit and facilitate discussion. The interviews were recorded, transcribed, and then analyzed using thematic analysis.

RESULTS

Eight children and their mothers participated in the study. Three themes were identified: interactions with the health system, changing and difficult family dynamics, and strains on social interactions. Children face social challenges including self-isolation and alienation. The family dynamics and familial structures often are forced to change, inducing stress. This is all exacerbated by the difficulties that arise in navigating the Guatemalan health system.

CONCLUSIONS

Photovoice techniques are a feasible way to understand the experiences of children and their families who face CKD. The disease affects all aspects of life and recognizing this while advising and administering care can help provide a comprehensive level of care. Health systems need to make efforts aimed at improving the quality of care as well as the multidisciplinary support available to children and their families.

A Systematic Review of Methods and Practice for Integrating Maternal, Fetal, and Child Health Outcomes, and Family Spillover Effects into Cost-Utility Analyses

BACKGROUND

Maternal-perinatal interventions delivered during pregnancy or childbirth have unique characteristics that impact the health-related quality of life (HRQoL) of the mother, fetus, and newborn child. However, maternal-perinatal cost-utility analyses (CUAs) often only consider either maternal or child health outcomes. Challenges include, but are not limited to, measuring fetal, newborn, and infant health outcomes, and assessing their impact on maternal HRQoL. It is also important to recognize the impact of maternal-perinatal health on family members' HRQoL (i.e., family spillover effects) and to incorporate these effects in maternal-perinatal CUAs.

OBJECTIVE

The aim was to systematically review the methods used to include health outcomes of pregnant women, fetuses, and children and to incorporate family spillover effects in maternal-perinatal CUAs.

METHODS

A literature search was conducted in Medline, Embase, EconLit, Cochrane Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Network of Agencies for Health Technology Assessment (INAHTA), and the Pediatric Economic Database Evaluation (PEDE) databases from inception to 2020 to identify maternal-perinatal CUAs that included health outcomes for pregnant women, fetuses, and/or children. The search was updated to December 2022 using PEDE. Data describing how the health outcomes of mothers, fetuses, and children were measured, incorporated, and reported along with the data on family spillover effects were extracted.

RESULTS

Out of 174 maternal-perinatal CUAs identified, 62 considered the health outcomes of pregnant women, and children. Among the 54 quality-adjusted life year (QALY)-based CUAs, 12 included fetal health outcomes, the impact of fetal loss on mothers' HRQoL, and the impact of neonatal demise on mothers' HRQoL. Four studies considered fetal health outcomes and the effects of fetal loss on mothers' HRQoL. One study included fetal health outcomes and the impact of neonatal demise on maternal HRQoL. Furthermore, six studies considered the impact of neonatal demise on maternal HRQoL, while four included fetal health outcomes. One study included the impact of fetal loss on maternal HRQoL. The remaining 26 only included the health outcomes of pregnant women and children. Among the eight disability-adjusted life year (DALY)-based CUAs, two measured fetal health outcomes. Out of 174 studies, only one study included family spillover effects. The most common measurement approach was to measure the health outcomes of pregnant women and children separately. Various approaches were used to assess fetal losses in terms of QALYs or DALYs and their impact on HRQoL of mothers. The most common integration approach was to sum the QALYs or DALYs for pregnant women and children. Most studies reported combined QALYs and incremental QALYs, or DALYs and incremental DALYs, at the family level for pregnant women and children.

CONCLUSIONS

Approximately one-third of maternal-perinatal CUAs included the health outcomes of pregnant women, fetuses, and/or children. Future CUAs of maternal-perinatal interventions, conducted from a societal perspective, should aim to incorporate health outcomes for mothers, fetuses, and children when appropriate. The various approaches used within these CUAs highlight the need for standardized measurement and integration methods, potentially leading to rigorous and standardized inclusion practices, providing higher-quality evidence to better inform decision-makers about the costs and benefits of maternal-perinatal interventions. Health Technology Assessment agencies may consider providing guidance for interventions affecting future lives in future updates.

Pediatric renal caregiver burden scale: Psychometric properties of the Turkish version

BACKGROUND AND PURPOSE

As treatment increasingly shifts from hospital settings to home environments, the burden on caregivers of chronic kidney disease patients has the potential to increase further. It is essential to assess the experience and burdens of caregivers of children with chronic kidney disease to identify caregivers' needs and provide targeted interventions when necessary. Hence, this study aimed to assess the psychometric properties of the Turkish version of the Pediatric Renal Caregiver Burden Scale (PR-CBS).

METHODS

This methodological study involved 215 parents with children aged 5-18 and was conducted between December 5, 2021, and August 15, 2022. The Content Validity Index, Explanatory and Confirmatory Factor Analyses, Cronbach's alpha, Test-retest reliability, and item-total score correlation were used in the data analysis. The Turkish version of PR-CBS test-retest reliability analysis was performed with 30 parents after four weeks.

RESULTS

PR-CBS consists of 20 items and five sub-dimensions (illness worries, impact on self, impact on child, responsibility, institutional burden). The Turkish version of the PR-CBS and its five dimensions demonstrated satisfactory internal consistency and reliability. The construct validity of the Turkish version of the PR-CBS was confirmed by Explanatory Factor Analyses and was validated with Confirmatory Factor Analysis.

CONCLUSIONS

PR-CBS is a valid and reliable tool to assess the burden of caregivers of children with chronic kidney disease in Turkish society.

IMPLICATIONS FOR PRACTICE

By assessing the care burden of families, pediatric nurses can enhance the opportunity to provide quality care and support to caregivers and their patients.

Family management structural model for children with atopic dermatitis

PURPOSE

To construct a structural model of family management for children with atopic dermatitis.

DESIGN AND METHODS

In this cross-sectional study, data were collected using a structured questionnaire. Participants included primary caregivers of children aged 2-12 years who had received a medical diagnosis of atopic dermatitis and had been experiencing the condition for over three months. We used SPSS/WIN 26.0 to analyze the variables and AMOS 23.0 for structural equation modeling.

RESULTS

Family functioning resilience, social support, and family coping had significant direct effects on family management. Illness severity, illness duration, and family life difficulty indirectly influenced family management, demonstrating significant total effects. The severity and duration of atopic dermatitis, family life difficulty, family functioning resilience, social support, and family coping explained 78.9% of the model.

CONCLUSIONS

The final model was suitable for predicting family management for children with atopic dermatitis. By confirming mediating effects, this study contributes to enhancing family management through nursing interventions. These findings offer valuable insights for developing family-centered nursing strategies to improve family management for children with atopic dermatitis.

PRACTICE IMPLICATIONS

Nursing interventions targeting the alleviation of family management challenges and enhancement of family functioning resilience, social support, and family coping are pivotal for improving the well-being of children with atopic dermatitis. Furthermore, tailored intervention development must take into account not only the severity and illness duration of atopic dermatitis in children but also the characteristics of the family. Improving family nursing through such tailored interventions can help enhance children's health and quality of life.

Elements of fatherhood involved in the gestational period: a scoping review

OBJECTIVE

To identify in the literature and summarize the elements and characteristics of fatherhood involved during pregnancy.

METHOD

Scoping review that used PRISMA-ScR guide to report this review. Searches were carried out in PubMed, CINAHL, PsycInfo, LILACS and Scopus. Google search engines and public health agency websites assisted in searches of gray literature and Rayyan in screening studies.

RESULTS

A total of 406 articles were identified, of which 16 made up the final sample. Five elements make up an involved fatherhood: feeling like a father, being a provider and protector, being a partner and participant in pregnancy, participating in prenatal appointments and feeling prepared to take care of a baby.

CONCLUSION

Fathers want to be involved in prenatal care, but feel excluded from this process. Public policies that encourage paternal involvement and healthcare professional training to better welcome and promote paternal involvement are of paramount importance.

The comparative study of chronically ill and healthy children and adolescents in the light of their general mental health

Children's hospitalisation is difficult for the family and the immediate environment. In these cases, the provision of psychological support is particularly important. Chronically ill children who are regularly hospitalised are in a particularly difficult situation, often feeling vulnerable. Our research aims to explore and analyse in detail the psychological state, attitudes and mental health of chronically ill children and to compare patient groups (children receiving care in pulmonology, gastroenterology, onco-haematology and rehabilitation) to understand the interacting factors, which may be of great importance for quality patient care and for measures to improve patient care in the future. We studied chronically ill children (N = 107) aged 10 to 18 years (M = 14.3; SD = 2.0), cared for by the Department of Paediatric Rehabilitation, Paediatric Psychiatry and Psychosomatics of the University of Debrecen Clinical Centre, the second largest paediatric institution in Hungary. In our survey, sociodemographic questions, the Connor-Davidson Resilience Scale, the Satisfaction With Life Scale, the Cantril Ladder, the Non-Productive Thoughts Questionnaire, the Problematic Internet Use Questionnaire, the Drawing version of Pictorial Representation of Illness Self-Measure (PRISM-D), the Beck Depression Inventory-Shortened Scale, the Illness Intrusiveness Ratings Scale, the Spielberger State-Trait Anxiety Questionnaire-Child Version and the Strength and Difficulty Questionnaire were applied. One-way analysis of variance (ANOVA) was used to examine differences between groups, and Pearson rank correlation analysis was used to measure the relationships between individual variables. The results show significant differences between patient groups in terms of resilience, depression, nonproductive thoughts, problematic internet use, anxiety and coping, but no consistent pattern in the development of scores. In addition, for some psychological correlates, the role of sociodemographic background also showed significant results. The practical utility of our study is that using questionnaire methods to map patient satisfaction, compliance, and patient attitudes will provide regarding the factors that influence the mental health status of children living with chronic illnesses. In the light of this, additional methods and tools can be included to improve the quality of healthcare and to develop a set of procedures that will serve the intended purpose.

Exploring fathers' experiences of caring for a child with complex care needs through ethnography and arts-based methodologies

BACKGROUND

Although the number of children living with complex care needs (CCN) is increasing worldwide, there is limited data on the experience of fathers caring for children with CCN. This paper reports on findings specific to fathers' experiences of caring for their child with CCN and highlights recommendations provided for parents of children with CCN, service providers, and policymakers. The findings emerged from a larger study designed to examine how Canadian families of children with CCN participate in society.

METHODS

We used the qualitative research approach of ethnography and arts-based methodologies (ecomaps and photovoice) as well as purposive and snowball sampling techniques. Four parents were engaged as advisors and twenty-nine fathers participated in interviews (all were married or in a relationship; age range of 28 to 55 years). In line with an ethnographic approach, data analysis involved several iterative steps including comparing data from the first, second, and third set of interviews and refining themes.

RESULTS

One overarching theme, striving to be there for the child with CCN, was identified. Five supporting themes further exemplified how fathers strived to be there for their child: 1) contributing to the parental team through various roles; 2) building accessibility through adaptation; 3) engaging in activities with the child; 4) expressing admiration and pride in their children; and 5) meaning making. Recommendations for parents included making and nurturing connections and asking for help while recommendations for healthcare and social service providers included communicating authentically with families and listening to parents. Fathers also indicated that leadership and funding for programs of families of children with CCN should be priorities for policymakers.

CONCLUSIONS

In addition to documenting fathers' active involvement in their child's care and development, our findings provide new insights into how fathers make participation in everyday life accessible and inclusive for their children. Study findings also point to 1) priority areas for policymakers (e.g., accessible physical environments); 2) factors that are critical for fostering collaborative care teams with fathers; and 3) the need for complex care teams in the adult health care system. Implications for those providing psychosocial support for these families are noted as well as knowledge gaps worthy of future exploration such as the role of diversity or intersectionality in fathering children with CCN.

Psychosocial issues and coping strategies in families affected by long-chain fatty acid oxidation disorders

Long-chain fatty acid oxidation disorders (lcFAODs) are associated with a high disease burden due to both the risk of metabolic decompensation as well as chronic, partly irreversible complications in some. Little research has been performed on the impact of these disorders on the daily life of parents and caregivers. We performed a web-based questionnaire study among parents/caregivers of patients affected with lcFAODs. The questionnaire focused on challenges at different ages of the child, on disease management issues, schooling, family and social life as well as the parental job situation, and their overall attitude toward the disease and the future life of their child. Data were collected from parents/caregivers of 63 patients (87 respondents, 63% mothers, 36% fathers) with lcFAODs (median age of patients 8.0 years, range 0-25 years, long-chain 3-hydrocyacyl-CoA dehydrogenase deficiency 40%, mitochondrial trifunctional protein deficiency 14%, very long-chain acyl-CoA dehydrogenase deficiency 41%, carnitine palmitoyltransferase 2 deficiency 5%). The overall disease burden of parents was considered highest during infancy and decreased with increasing age of their child. More than one third of parents were afraid that their child's disease might have an impact on his/her career choice and adult life. Negative effects of the child's disease on the job situation and career development were more commonly reported by mothers compared to fathers. Although the majority of parents considered their child's metabolic disorder a severe disease, most parents had a positive attitude toward their child's disease and seemed to cope well with their situation.

Toxic Stress as a Potential Factor Inducing Negative Emotions in Parents of Newborns and Infants with Cyanotic Congenital Heart Disease

BACKGROUND

Parents who have a newborn with a congenital heart defect experience negative emotions, which may determine the emotional state of their children.

METHODS

The study group included 154 parents of newborns and infants with cyanotic congenital heart disease, before cardiac surgery and after the procedure. HADS m and PSS-10 questionnaires were used to assess parental anxiety, depression, aggression, and the level of stress.

RESULTS

High levels of depression, anxiety, total HADS and stress were diagnosed in a large group of parents, regardless of the stage of cardiac surgery treatment. A high level of stress was associated with a higher prevalence of emotional disturbance both in the total HADS (overall) and in all its individual domains. Anxiety and depression were more common in mothers. A high level of stress was a significant predictor of anxiety and depression in parents.

CONCLUSIONS

A high level of stress was a significant predictor of anxiety and depression in parents of infants with congenital heart disease. The parents' psychological condition is one of many potential determinants over the course of their child's treatment and recovery.

Unmet supportive care needs in families of children with chronic health conditions: an Australian cross-sectional study

BACKGROUND

The aim of this study was to identify similarities and differences in the unmet supportive care needs (USCN) of families of children with major chronic health conditions (CHCs) using a universal need assessment tool.

METHODS

A cross-sectional online survey involving parents of children with congenital heart disease (CHD), type 1 diabetes mellitus (T1D), cancer, and asthma diagnosed within the last 5 years recruited via social media and support organizations. Thirty-four items assessing the USCN across six domains (care needs, physical and social needs, informational needs, support needs, financial needs, child-related emotional needs) were responded to on a 4-point Likert scale [no need (1) to high need (4)]. Descriptive statistics identified the level of need, and linear regressions identified factors associated with higher need domain scores. Due to small numbers, the asthma group was excluded from comparisons across CHCs.

RESULTS

One hundred and ninety-four parents completed the survey (CHD: n = 97, T1D: n = 50, cancer: n = 39, and asthma: n = 8). Parents of children with cancer were most likely to report at least one USCN (92%), followed by parents of children with T1D (62%). The five most commonly reported USCN across CHCs were drawn from four domains: child-related emotional, support, care, and financial. Three need items were included in the top five needs for all conditions. A higher USCN was associated with a greater frequency of hospital visits and the absence of parental support.

CONCLUSIONS

Using a universal need assessment tool, this is one of the first studies to characterize USCN in families of children diagnosed with common CHCs. While proportions endorsing different needs varied across conditions, the most endorsed needs were similar across the illness groups. This suggests that support programs or services could be shared across different CHCs. Video Abstract.