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Scott HM, Coombes L, Braybrook D, Harðardóttir D, Roach A, Bristowe K, Bluebond-Langner M, Fraser LK, Downing J, Farsides B, Murtagh FEM, Ellis-Smith C, Harding R. What are the anticipated benefits, risks, barriers and facilitators to implementing person-centred outcome measures into routine care for children and young people with life-limiting and life-threatening conditions? A qualitative interview study with key stakeholders. Palliat Med 2024; 38:471-484. [PMID: 38481003 PMCID: PMC11025304 DOI: 10.1177/02692163241234797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND There is a growing evidence-base underpinning implementation of person-centred outcome measures into adult palliative care. However evidence on how best to achieve this with children facing life-threatening and life-limiting conditions is limited. AIM To identify the anticipated benefits, risks, barriers and facilitators to implementing person-centred outcome measures for children with life-limiting and life-threatening conditions. DESIGN Cross-sectional qualitative semi-structured interview study with key stakeholders analysed using Framework analysis informed by the adapted-Consolidated Framework for Implementation Research. SETTING/PARTICIPANTS A total of n = 26 children with life-limiting or life-threatening conditions, n = 40 parents/carers, n = 13 siblings and n = 15 health and social care professionals recruited from six hospitals and three children's hospices and n = 12 Commissioners of health services. RESULTS All participants were supportive of future implementation of person-centred outcome measures into care. Anticipated benefits included: better understanding of patient and family priorities, improved communication and collaborative working between professionals and families and standardisation in data collection and reporting. Anticipated risks included increased workload for staff and measures not being used as intended. Implementation barriers included: acceptability and usability of outcome measures by children; burden and capacity of parents/carers regarding completion; privacy concerns; and language barriers. Implementation facilitators included designing measures using language that is meaningful to children and families, ensuring potential benefits of person-centred outcome measures are communicated to encourage 'buy-in' and administering measures with known and trusted professional. CONCLUSIONS Implementation of person-centred outcome measures offer potential benefits for children with life-limiting and life-threatening conditions. Eight recommendations are made to maximise benefits and minimise risks in implementation.
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Affiliation(s)
- Hannah May Scott
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Lucy Coombes
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Debbie Braybrook
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Daney Harðardóttir
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Anna Roach
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
- University College London, London, UK
| | - Katherine Bristowe
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Myra Bluebond-Langner
- University College London, Louis Dundas Centre for Children’s Palliative Care, London, UK
- Rutgers University, Camden, NJ, USA
| | - Lorna K Fraser
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Julia Downing
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
- International Children’s Palliative Care Network, Kampala, Uganda
| | - Bobbie Farsides
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Fliss EM Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Clare Ellis-Smith
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Richard Harding
- King’s College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
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Coats H, Doyon K, Isaacson MJ, Tay D, Rosa WE, Mayahara M, Kates J, Frechman E, Wright PM, Boyden JY, Broden EG, Hinds PS, James R, Keller S, Thrane SE, Mooney-Doyle K, Sullivan SS, Xu J, Tanner J, Natal M. The 2023-2026 Hospice and Palliative Nurses Association Research Agenda. J Hosp Palliat Nurs 2023; 25:55-74. [PMID: 36843048 DOI: 10.1097/njh.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The Hospice and Palliative Nursing Association established the triannual research agenda to ( a ) provide focus for researchers to conduct meaningful scientific and quality improvement initiatives and inform evidence-based practice, ( b ) guide organizational funding, and ( c ) illustrate to other stakeholders the importance of nursing research foci. HPNA Research Agendas are developed to give direction for future research to continue advancing expert care in serious illness and ensure equitable delivery of hospice and palliative care.
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3
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Bradford N, Slater P, Fielden P, Condon P, Skrabal Ross X, Douglas M, Radford C, Carter A, Walker R, Badat A, Edwards R, Spencer B, Herbert A. Care at Your Fingertips: Codesign, Development, and Evaluation of the Oncology Hub App for Remote Symptom Management in Pediatric Oncology. JCO Clin Cancer Inform 2023; 7:e2200134. [PMID: 36706346 DOI: 10.1200/cci.22.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To codesign, develop, and evaluate a smartphone app that includes patient-reported measures of symptoms and real-time advice in children's cancer. METHODS The Oncology Hub is a comprehensive approach to symptom management that includes a suite of codesigned tools and resources including clinical algorithms to determine the level of concern, symptom management advice, and resources for families of children with cancer. The evaluation involved Think Aloud interviews with parent and adolescent patients to complete tasks in the app as well as a User Experience questionnaire (score range, 0-120) and qualitative feedback. The accuracy of algorithms was determined by repeated testing of inputs and outputs over 4 weeks. RESULTS Design and wireframes were iteratively refined through consultation with parents and adolescents confirming the final design. Beta testing evaluation was then completed by 25 participants including two adolescents. Across all participants, 84% of tasks were easy to navigate, and the Oncology Hub demonstrated high usability, usefulness, and acceptability with participants' scores ranging between 90 and 120 (mean = 112.2, standard deviation = 9.43). Qualitative feedback was positive. Testing of algorithms identified inconsistencies in understanding between clinical research and coding teams; refinements were made until the expected response notifications were returned with 100% accuracy. CONCLUSION Technology offers new ways to think about how clinicians and families communicate and share information to harness the best of community and hospital services. Understanding how information is exchanged using health apps, and how this affects clinical workflow is critical to successful implementation, and optimizing symptom assessment and management in children with cancer.
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Affiliation(s)
- Natalie Bradford
- Queensland University of Technology, Brisbane, Australia.,Children's Health Queensland, South Brisbane, Australia
| | | | | | - Paula Condon
- Children's Health Queensland, South Brisbane, Australia
| | | | | | | | - Amanda Carter
- Children's Health Queensland, South Brisbane, Australia
| | - Rick Walker
- Children's Health Queensland, South Brisbane, Australia
| | - Ashraf Badat
- Children's Health Queensland, South Brisbane, Australia
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Raybin JL, Zhou W, Pan Z, Jankowski C. Quality of Life Outcomes With Creative Arts Therapy in Children With Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:155-167. [PMID: 35467438 DOI: 10.1177/27527530211055988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Introduction: Children with cancer experience distress and decreased quality of life (QOL). Creative arts therapy (CAT) is a therapeutic modality which may improve QOL. This study examined the relationship between CAT and QOL in children and adolescents with cancer. Secondary aims explored relationships between CAT and emotional reactions, resilience, and posture (to investigate future potential as an objective biomarker of QOL). Methods: Children aged 3-18 years undergoing cancer treatments and a parent proxy completed the PedsQL3.0 Cancer Module, Faces Scale for emotional reactions, Resilience Scale in adolescents (>12 years), and an inclinometer to measure thoracic kyphosis before and after CAT. CAT exposure (number of sessions) was recorded. Results: Ninety-eight children with cancer (mean age 7.8 years, range 3-17) and parent proxy were enrolled. Of the 83 participants included in the final analysis, 18 received no CAT, 32 received low dose, and 33 received high dose CAT. A significant improvement in QOL was seen with high dose CAT in (slope change, p = .015), but the overall time by group interaction was not significant. Slope change response patterns suggested that CAT led to improved posture as compared to no CAT (time by group interaction, p = .044). Discussion: CAT may be an effective intervention to improve QOL in this population. Because initial evidence suggests that posture also improves with CAT, further investigation of posture as a potential objective biomarker of QOL is supported. Further study with a randomized controlled trial is warranted.
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Affiliation(s)
- Jennifer L Raybin
- Pediatric Palliative Care, Center for Cancer and Blood Disorders, Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Wenru Zhou
- Colorado School of Public Health-Biostatistics and Informatics, CO, USA
| | - Zhaoxing Pan
- Department of Pediatrics, Anschutz School of Medicine, 129263University of Colorado, CO, USA
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5
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Archer S, Cheung NH, Williams I, Darzi A. The impact of digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care: A systematic review and narrative synthesis. Palliat Med 2021; 35:2017-2023. [PMID: 34159851 PMCID: PMC8641035 DOI: 10.1177/02692163211026523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Digital health interventions are becoming increasingly important and may be particularly relevant for paediatric palliative care. In line with the aims of palliative care, digital health interventions should aim to maintain, if not improve, psychological wellbeing. However, the extent to which the psychological outcomes of digital health interventions are assessed is currently unknown. AIM To identify and synthesise the literature exploring the impact of all digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care. DESIGN Systematic review and narrative synthesis. DATA SOURCES MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and the Midwives Information & Resource Service were searched on the 27th July 2020, in addition to the first five pages of Google Scholar. To be included in the review, papers must have contained: quantitative or qualitative data on psychosocial outcomes, data from patients aged 0-18 receiving palliative care or their families, a digital health intervention, and been written in English. RESULTS Three studies were included in the review. All looked at the psychological impact of telehealth interventions. Papers demonstrated fair or good quality reporting but had small sample sizes and varied designs. CONCLUSIONS Despite the design and development of digital health interventions that span the technological landscape, little research has assessed their psychosocial impact in the paediatric palliative care community. Whilst the evidence base around the role of these interventions continues to grow, their impact on children and their families must not be overlooked.
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Affiliation(s)
- Stephanie Archer
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | | | - Ivor Williams
- Helix Centre, Imperial College London, St Mary’s Hospital, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
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6
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Juárez-Villegas LE, Altamirano-Bustamante MM, Zapata-Tarrés MM. Decision-Making at End-of-Life for Children With Cancer: A Systematic Review and Meta-Bioethical Analysis. Front Oncol 2021; 11:739092. [PMID: 34722289 PMCID: PMC8554195 DOI: 10.3389/fonc.2021.739092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Evidence shows that medical education includes a variety of basic and clinical skills. Ethical and human values are not typically considered in medical school curricula, and this is evident in medical practice in certain scenarios such as decision-making at pediatric cancer patients' end of life. Methods This study explores a bioethical approach to address complex decision-making at the end of life in children and adolescents with cancer. We are a cross-functional group of scientists from several academic disciplines who conducted a systematic review of the literature using our newly developed meta-bioethical analysis and synthesis of findings. The search was carried out in five databases, resulting in 10 research papers. Following quality screening, seven articles were ultimately selected for further analysis. Results Our focus is on the state of the art to better understand the bioethical deliberation at the end of life in pediatric oncology. Here, we report a systematic review that includes (i) classification of the screened articles by the type of decision-making they use, ii) the system values that are at the core of the decision-making at the end of life, and iii) bioethical and ethical discernment queries. We conclude with a discussion regarding the best practices of ethical discernment and decision-making at the end of life.This study highlights the need to develop more research to better understand the influence and origin of these multidimensional factors determining critical decisions that define the quality of life of patients in a highly sensitive moment. Conclusion We conclude that personal aspects of the physician define their actions more than knowledge or organized structure. It is thus necessary that pediatric oncologists receive ethics and humanistic education.
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Affiliation(s)
- Luis Enrique Juárez-Villegas
- Department of Hematology-Oncology, Hospital Infantil de Mexico Federico Gómez, Mexico City, Mexico.,Master and Doctorate Program in Medical and Health Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Myriam M Altamirano-Bustamante
- Master and Doctorate Program in Medical and Health Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Metabolic Diseases Research Unit, Cross-functional Bioethics Group, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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7
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Participatory Design of an Electronic Cross-Facility Health Record (ECHR) System for Pediatric Palliative Care: A Think-Aloud Study. CHILDREN-BASEL 2021; 8:children8100839. [PMID: 34682105 PMCID: PMC8534759 DOI: 10.3390/children8100839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/15/2023]
Abstract
Background: Pediatric palliative care (PPC) patients experience years of multisectoral and professional care. An electronic cross-facility health record (ECHR) system can support the immediate exchange of information among PPC professionals. Based on a needs assessment, a prototype ECHR system was developed. Methods: To evaluate potential users’ perspective regarding the system, a qualitative observational study was conducted consisting of a concurrent think-aloud session and a semi-structured qualitative interview. Results: Twenty PPC professionals (nurses, physicians) from specialized outpatient PPC teams, a PPC unit, and medical offices rated the ECHR system as a helpful tool to improve the exchange and collection of information, communication between PPC professionals, and treatment planning. From the user’s point of view, the basic logic of the ECHR system should be further adapted to improve the interaction of data remirrored from patient records of outpatient and inpatient care with those entered via the system. The users wished for further functions (text search) and content (information on therapies). Some content, such as the treatment process, needs to be further adapted. Conclusion: The developed ECHR system needs to be more specific in some features by offering all available information; while for other features, be less specific to offer a quick overview. The ability to share information promptly and automatically was seen as a tremendous improvement to the quality of care for PPC patients.
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8
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Bradford N, Condon P, Pitt E, Tyack Z, Alexander K. Optimising symptom management in children with cancer using a novel mobile phone application: protocol for a controlled hybrid effectiveness implementation trial (RESPONSE). BMC Health Serv Res 2021; 21:942. [PMID: 34503489 PMCID: PMC8427146 DOI: 10.1186/s12913-021-06943-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/26/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Intense and aggressive treatment regimens for most children's cancer have achieved vast improvements in survival but are also responsible for both a high number and burden of symptoms. The use of Patient Reported Outcome Measures (PROMs) demonstrates a range of benefits for improved symptom management in adults with cancer. There are, however, multiple barriers to integrating PROMs into routine care in children and adolescents with cancer. This study aims to evaluate: (1) the effectiveness of electronic PROMs to generate stratified alerts, symptom management recommendations and graphical summaries (the RESPONSE system) to improve health outcomes and (2) the implementation of the RESPONSE system by assessing feasibility, acceptability, satisfaction, and sustainability. METHODS A pragmatic hybrid II effectiveness-implementation controlled trial, using mixed methods, will be undertaken, advancing both knowledge of the effectiveness of the intervention and implementation factors. One-hundred and sixty children with cancer receiving active treatment will be recruited 1:1 to a non-randomised study involving two groups with an equal number of participants in each group. The intervention group (n = 80) will be prospectively recruited to receive the RESPONSE system intervention over eight weeks, versus the historical matched control group (n = 80) who will complete the ePROMs without access to the RESPONSE system. The primary outcome of the effectiveness trial is change between groups in total symptom burden. Secondary outcomes include child health-related quality-of-life and implementation outcomes. Trial data will be analysed using linear mixed-effects models. Formative implementation evaluation is informed by CFIR and ERIC frameworks and implementation outcomes will be mapped to the RE-AIM framework and include interviews, field notes, as well as administrative data to evaluate feasibility, acceptability, satisfaction and sustainability. TRIAL REGISTRATION NUMBER ACTRN12621001084875 . Retrospectively Registered 16 August 2021.
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Affiliation(s)
- Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia.
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 62 Graham St, South Brisbane, QLD, 4101, Brisbane, Australia.
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia.
| | - Paula Condon
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 62 Graham St, South Brisbane, QLD, 4101, Brisbane, Australia
| | - Erin Pitt
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
| | - Zephanie Tyack
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
| | - Kimberly Alexander
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
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9
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Vaughn J, Shah N, Docherty SL, Yang Q, Shaw RJ. Symptom Monitoring in Children With Life-Threatening Illness: A Feasibility Study Using mHealth. ANS Adv Nurs Sci 2021; 44:268-278. [PMID: 33624987 PMCID: PMC8368073 DOI: 10.1097/ans.0000000000000359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children with life-threatening illness (C-LTI) experience considerable symptom distress. Mobile technology may offer opportunities to better obtain symptom data that will lead to better symptom management. A mixed-methods study was conducted to explore the feasibility of monitoring and visualizing symptoms using 2 mobile health devices in C-LTI. Participants engaged with the Apple Watch 56% and recorded in the study app 63% of their study days. Our findings showed feasibility of using mobile technology for monitoring symptoms and further explored opportunities to visualize these data showing symptom occurrences, patterns, and trajectories in C-LTI.
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Affiliation(s)
- Jacqueline Vaughn
- University of North Carolina School of Nursing, Chapel Hill (Dr Vaughn); Department of Hematology, Duke University School of Medicine, Durham, North Carolina (Dr Shah); and Duke University School of Nursing, Durham, North Carolina (Drs Docherty, Yang, and Shaw)
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10
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Adaptation and evaluation of a child-friendly patient reported outcome measure for use in Australia. Collegian 2021. [DOI: 10.1016/j.colegn.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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11
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Vaughn J, Shah N, Jonassaint J, Harris N, Docherty S, Shaw R. User-Centered App Design for Acutely Ill Children and Adolescents. J Pediatr Oncol Nurs 2020; 37:359-367. [PMID: 32646317 DOI: 10.1177/1043454220938341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background and Objectives: The high level of acceptance and consistent use of smartphones by children and adolescents present new opportunities to monitor and collect health data. For acutely ill children and adolescents, collecting symptom data via smartphone applications (apps) provides patient-reported data that can be collected daily and offers the potential to provide a more comprehensive picture of the symptom experience. The purpose of this study was to employ user-centered design principles and medical professional input in order to obtain feedback and insight into redesigning our Technology Recordings for better Understanding Blood and Marrow Transplant (TRU-PBMT) app. This redesigned app will be used for children and adolescents with cancer or undergoing blood and marrow transplantation. Method: We interviewed six pediatric blood and marrow transplant patients (ages 10-17 years) who had pilot tested the app, and we surveyed 30 pediatric oncology clinicians. Results: Interview feedback from previous app users and survey feedback from clinicians guided the app redesign. We incorporated suggestions to make the app more engaging, meaningful, personal, and motivating in order to increase symptom reporting. We added emojis to the symptom tracker, a mood scale, and personalized symptom graphs. Conclusion: Leveraging mobile health technologies may be a useful and acceptable approach to obtain symptom data; however, design and software development needs to be evidenced-based and informed by user needs. Our approach using patient and clinician feedback was valuable in the redesign of the TRU-PBMT app and will contribute to symptom research for acutely ill children and adolescents.
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Affiliation(s)
| | | | - Jude Jonassaint
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Ryan Shaw
- Duke University School of Nursing, Durham, NC, USA
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12
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Marcus M, Xiong D, Wang Y, Maida CA, Hays RD, Coulter ID, Spolsky VW, Lee SY, Shen J, Crall JJ, Liu H. Development of toolkits for detecting dental caries and caries experience among children using self-report and parent report. Community Dent Oral Epidemiol 2019; 47:520-527. [PMID: 31576591 DOI: 10.1111/cdoe.12494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 07/31/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To develop child- and parent-reported toolkits for active caries and caries experience in children and adolescents, ages 8-17. METHODS A sample of 398 child/parent dyads recruited from 12 dental practices in Los Angeles County completed a computer-assisted survey that assessed oral health perceptions. In addition, children received a dental examination that identified the presence or absence of active caries and caries experience. A Multiple Adaptive Regression Splines model was used to identify a subset of survey items associated with active caries and caries experience. The splines and coefficients were refined by generalized cross-validation. Sensitivity and specificity for both dependent variables were evaluated. RESULTS Eleven child self-reported items were identified that had sensitivity of 0.82 and specificity of 0.45 relative to active caries. Twelve parent-reported items had a sensitivity of 0.86 and specificity of 0.50. Seven child self-reported items had a sensitivity of 0.86 and specificity of 0.34, and 11 parent-reported items had a sensitivity of 0.86 and specificity of 0.47 for caries experience. CONCLUSIONS The survey items identified here are useful in distinguishing children with and without active caries and with and without caries experience. This research presents a path towards using children's and their parents' reports about oral health to screen for clinically determined caries and caries exposure. The items identified in this study can be useful when clinical information is unavailable.
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Affiliation(s)
- Marvin Marcus
- Division of Public Health and Community Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California
| | - Di Xiong
- Division of Public Health and Community Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California.,Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Yan Wang
- Division of Public Health and Community Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California.,Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Carl A Maida
- Division of Public Health and Community Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California.,Division of Oral Biology and Medicine, School of Dentistry, University of California Los Angeles, Los Angeles, California
| | - Ron D Hays
- Division of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.,RAND Corporation, Santa Monica, California
| | - Ian D Coulter
- Division of Public Health and Community Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California.,RAND Corporation, Santa Monica, California
| | - Vladimir W Spolsky
- Division of Public Health and Community Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California
| | - Steve Y Lee
- Section of Restorative Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California
| | - Jie Shen
- Division of Public Health and Community Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California
| | - James J Crall
- Division of Public Health and Community Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California
| | - Honghu Liu
- Division of Public Health and Community Dentistry, School of Dentistry, University of California Los Angeles, Los Angeles, California.,Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.,Division of General Internal Medicine and Health Services Research, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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13
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Romo RD, Carpenter JG, Buck H, Lindley LC, Xu J, Owen JA, Sullivan SS, Bakitas M, Dionne-Odom JN, Zubkoff L, Matzo M. HPNA 2019-2022 Research Agenda: Development and Rationale. J Hosp Palliat Nurs 2019; 21:E17-E23. [PMID: 31166302 PMCID: PMC6776462 DOI: 10.1097/njh.0000000000000580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Building on the strong work of previous research agendas (2009-2012, 2012-2015, 2015-2018), the Hospice and Palliative Nurses Association Research Advisory Council developed the 2019-2022 Research Agenda in consultation with Hospice and Palliative Nurses Association (HPNA) membership and assessment of major trends in palliative nursing. The HPNA Research Advisory Council identified 5 priority areas and asked subject experts in each area to summarize the state of the science, identify critical gaps, and provide recommendations for future research. This document expands the executive summary published on the HPNA website (www.advancingexpertcare.org/hpna/) and provides supporting evidence for the 2019-2022 recommendations. The 5 priority areas are as follows: (1) pediatric hospice and palliative nursing research; (2) family caregiving; (3) interprofessional education and collaborative practice; (4) big data science, precision health, and nursing informatics; and (5) implementation science.
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Affiliation(s)
- Rafael D Romo
- Rafael D. Romo, PhD, RN, PHN, is assistant professor of Nursing, University of Virginia School of Nursing, Charlottesville. Joan G. Carpenter, PhD, CRNP, ACHPN, FPCN, is research associate, University of Pennsylvania School of Nursing, and health science specialist, Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, Pennsylvania. Harleah Buck, PhD, RN, FPCN, FAHA, FAAN, is associate professor and coordinator of Chronic Illness Initiatives, University of Southern Florida, Tampa. Lisa C. Lindley, PhD, RN, FPCN, is associate professor, College of Nursing, University of Tennessee, Knoxville. Jiayun Xu, PhD, RN, is assistant professor, College of Health and Human Sciences, Purdue University School of Nursing, West Lafayette, Indiana. John A. Owen, EdD, MSc, is associate director, Center for Academic Strategic Partnerships for Interprofessional Research and Education (ASPIRE), University of Virginia School of Nursing, Charlottesville. Suzanne S. Sullivan, PhD, MBA, RN, CHPN, is assistant professor, University at Buffalo State University of New York School of Nursing. Marie Bakitas, DNSc, CRNP, NP-C, AOCN, ACHPN, FAAN, is professor and Marie L. O'Koren Endowed Chair in Nursing, University of Alabama at Birmingham School of Nursing. J. Nicholas Dionne-Odom, PhD, MSN, MA, RN, FPCN, is assistant professor of nursing, University of Alabama at Birmingham School of Nursing. Lisa Zubkoff, PhD, is assistant professor of psychiatry, Dartmouth University Geisel School of Medicine and the Dartmouth Institute, Hanover, New Hampshire. Marianne Matzo, PhD, RN, APRN-CNP, AOCNP, AHPCN, FPCN, FAAN, is director of research, Hospice and Palliative Nurses Association, Pittsburgh, PA
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Silva-Rodrigues FM, Hinds PS, Nascimento LC. The Theory of Unpleasant Symptoms in Pediatric Oncology Nursing: A Conceptual and Empirical Fit? J Pediatr Oncol Nurs 2019; 36:436-447. [PMID: 31027449 DOI: 10.1177/1043454219844225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Symptom management knowledge is a priority for pediatric oncology nursing research. Theories and models can frame the studies of symptoms experienced during childhood cancer. This article describes and analyzes the middle-range theory, theory of unpleasant symptoms (TOUS), for its conceptual and empirical fit with pediatric oncology nursing based on its current use in adult oncology research and its limited use to date in pediatric oncology. Searches in PubMed and CINAHL databases using the keywords theory of unpleasant symptoms and cancer and covering the time period 2000 to 2017 yielded 103 abstracts for review. Twenty published reports met eligibility criteria for review; only one included pediatric oncology patients. No study to date has tested all the components of the TOUS in pediatrics. The TOUS component of performance appears to be underaddressed across completed studies that instead include a focus on patient-reported quality of life rather than on perceived behavioral or performance indicators concurrent with the subjective symptom reports. Additionally, the influence of family, essential in pediatric oncology, is absent in the majority of studies guided by the TOUS. The TOUS is a structurally complicated framework that would be a conceptual fit for pediatric oncology if family influence and perceived function were included. Studies across this population and guided by the TOUS are needed, although testing all the theorized linkages in the TOUS would likely require a large sample size of patients and, thereby, multisite approaches given that cancer is a rare disease in childhood.
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Affiliation(s)
| | - Pamela S Hinds
- Children's National Health System, Washington, DC, USA.,George Washington University, Washington, DC, USA
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15
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Rico-Mena P, Palacios-Ceña D, Martino-Alba R, Chocarro-Gonzalez L, Güeita-Rodríguez J. The impact of home-based physical rehabilitation program on parents' experience with children in palliative care: a qualitative study. Eur J Phys Rehabil Med 2019; 55:494-504. [PMID: 30781934 DOI: 10.23736/s1973-9087.19.05474-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pediatric palliative care programs aim to improve the quality of life of children with severe life-threatening illnesses, and that of their families. Although rehabilitation and physical therapy provides a valuable tool for the control of symptoms, it has been poorly researched to date. Since the family represents such a fundamental support in these cases, it is important to deepen our understanding regarding the value of implementing rehabilitation programs from the parents' perspective. AIM The aim of this paper was to explore parents' experiences regarding the implementation of a physical rehabilitation program in pediatric palliative care. DESIGN A qualitative methodology was chosen. SETTING The unit of pediatric palliative care at the Hospital Niño Jesús (Madrid, Spain). POPULATION The inclusion criteria were: 1) parents of children, irrespective of their diagnosis; 2) integrated within the program of palliative care at the time of study; 3) aged between 0-18 years; 4) must be receiving Home-Based Rehabilitation Program by the Pediatric Palliative Care team. Fourteen parents were included. METHODS Purposeful sampling method was implemented. Data collection consisted of unstructured and semi-structured interviews. A thematic analysis was performed to interpret transcripts. Guidelines for conducting qualitative studies established by the Consolidated Criteria for Reporting Qualitative Research were followed. RESULTS Three main themes were identified: 1) the meaning of physical rehabilitation to parents; 2) physical rehabilitation as an opportunity for patients to stay in their home environment; and 3) home-based physical rehabilitation as part of the families' social environment. CONCLUSIONS The main needs of a home physical rehabilitation program are to decrease pain and suffering, together with improving family education and training. CLINICAL REHABILITATION IMPACT The experience of rehabilitation programs at home is essential in order to improve both the quality of life and the quality of care of affected children and parents.
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Affiliation(s)
- Patricia Rico-Mena
- Department of Physiotherapy, Podology and Dance, European University of Madrid, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Rey Juan Carlos University, Madrid, Spain - .,Group of Humanities and Qualitative Research in Health Science of Univesidad Rey Juan Carlos (Hum&QRinHS), Madrid, Spain
| | - Ricardo Martino-Alba
- Unit of Pediatric Palliative Care, Niño Jesús Pediatric University Hospital, Madrid, Spain
| | | | - Javier Güeita-Rodríguez
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Rey Juan Carlos University, Madrid, Spain.,Group of Humanities and Qualitative Research in Health Science of Univesidad Rey Juan Carlos (Hum&QRinHS), Madrid, Spain
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Delivering Pediatric Palliative Care: From Denial, Palliphobia, Pallilalia to Palliactive. CHILDREN-BASEL 2018; 5:children5090120. [PMID: 30200370 PMCID: PMC6162556 DOI: 10.3390/children5090120] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022]
Abstract
Among the over 21 million children with life-limiting conditions worldwide that would benefit annually from a pediatric palliative care (PPC) approach, more than eight million would need specialized PPC services. In the United States alone, more than 42,000 children die every year, half of them infants younger than one year. Advanced interdisciplinary pediatric palliative care for children with serious illnesses is now an expected standard of pediatric medicine. Unfortunately, in many institutions there remain significant barriers to achieving optimal care related to lack of formal education, reimbursement issues, the emotional impact of caring for a dying child, and most importantly, the lack of interdisciplinary PPC teams with sufficient staffing and funding. Data reveals the majority of distressing symptoms in children with serious illness (such as pain, dyspnea and nausea/vomiting) were not addressed during their end-of-life period, and when treated, therapy was commonly ineffective. Whenever possible, treatment should focus on continued efforts to control the underlying illness. At the same time, children and their families should have access to interdisciplinary care aimed at promoting optimal physical, psychological and spiritual wellbeing. Persistent myths and misconceptions have led to inadequate symptom control in children with life-limiting diseases. Pediatric Palliative Care advocates the provision of comfort care, pain, and symptom management concurrently with disease-directed treatments. Families no longer have to opt for one over the other. They can pursue both, and include integrative care to maximize the child's quality of life. Since most of the sickest children with serious illness are being taken care of in a hospital, every children's hospital is now expected to offer an interdisciplinary palliative care service as the standard of care. This article addresses common myths and misconceptions which may pose clinical obstacles to effective PPC delivery and discusses the four typical stages of pediatric palliative care program implementation.
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