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Persaud N, Brearley S, Walshe C. The Lived Experiences of Hospice Healthcare Workers Caring for Adolescents and Young Adults With Advanced Cancer: An Interpretative Phenomenological Analysis. J Palliat Care 2024:8258597241277725. [PMID: 39212046 DOI: 10.1177/08258597241277725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Objective: To understand the lived experience of healthcare workers who provide palliative care to adolescents and young adults living with advanced cancer. Methods: Interpretative phenomenological analysis was the design of this study. Hospice healthcare workers from four pediatric hospices across Canada were recruited through purposive sampling. Semistructured in-person interviews were conducted. Results: Eighteen hospice healthcare workers participated. Two superordinate themes were identified. First, balancing on the tightrope of uncertainty wherein hospice healthcare workers strive to do their best while aiming to take the path of least regret. This theme was underscored by a notion of doing for the adolescents and young adults. Second, acting as a proxy revolves around the importance of fostering relationships with adolescents and young adults through honesty and transparency. The cycle of protection between adolescents and young adults, families, and healthcare providers was emphasized. Conclusions: An action-focused orientation when supporting adolescents and young adults was shared by the healthcare workers. The need to do for adolescents and young adults and the need to protect not only the people they care for but also themselves. More exploration is needed on how healthcare workers who care for adolescents and young adults can be supported while better understanding coping mechanisms.
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Affiliation(s)
| | - Sarah Brearley
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- Division of Health Research, International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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Broden EG, McCarthy S, Snaman JM. Partnering With Parents to Dismantle "Good-Death" Narratives. JAMA Pediatr 2024; 178:431-432. [PMID: 38466276 DOI: 10.1001/jamapediatrics.2024.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This Viewpoint dismantles the notion of a “good death” in pediatrics using quotes from bereaved parents and provides actionable alternatives to improve quality end-of-life care for dying children and their families.
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Affiliation(s)
- Elizabeth G Broden
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Yale Schools of Medicine and Public Health, Yale University, New Haven, Connecticut
| | - Sarah McCarthy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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Kammin V, Fraser L, Flemming K, Hackett J. Experiences of music therapy in paediatric palliative care from multiple stakeholder perspectives: A systematic review and qualitative evidence synthesis. Palliat Med 2024; 38:364-378. [PMID: 38450624 PMCID: PMC10955799 DOI: 10.1177/02692163241230664] [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: 03/08/2024]
Abstract
BACKGROUND Children and young people with life-limiting conditions and their families need physical and emotional support to manage the challenges of their lives. There is a lack of synthesised qualitative research about how music therapy is experienced by children, young people and their families supported by paediatric palliative care services. AIM To systematically identify and synthesise qualitative research on experiences of music therapy in paediatric palliative care from stakeholder perspectives. DESIGN A Qualitative Evidence Synthesis was conducted using Thematic Synthesis. The review protocol was registered in PROSPERO (registration number: CRD42021251025). DATA SOURCES Searches were conducted with no dates imposed via the electronic databases PsycINFO, MEDLINE, EMBASE, AMED and CINAHL in April 2021 and updated in April 2022. Studies were appraised for quality using the Critical Appraisal Skills Programme tool (CASP). RESULTS A total of 148 studies were found, 5 studies met the eligibility criteria reporting the experiences of 14 mothers, 24 family members and 4 staff members in paediatric palliative care. There were five overarching themes: emotional and physical reprieve, opportunity for normalised experiences, thriving despite life limited condition, enhance family wellbeing and therapeutic relationship central to outcomes. CONCLUSION Music therapy provides unique benefits for this paediatric population particularly in supporting child and family wellbeing. The therapeutic relationship, interpersonal skills of the therapist and experience in paediatric palliative care are perceived as central to these positive outcomes.
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Affiliation(s)
- Victoria Kammin
- The Paediatric Palliative Care Research Group, Department of Health Sciences, University of York, York, UK
| | - Lorna Fraser
- The Paediatric Palliative Care Research Group, Department of Health Sciences, University of York, York, UK
| | - Kate Flemming
- The Paediatric Palliative Care Research Group, Department of Health Sciences, University of York, York, UK
| | - Julia Hackett
- The Paediatric Palliative Care Research Group, Department of Health Sciences, University of York, York, UK
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Abstract
In this narrative medicine essay, a pediatric oncologist grapples with the emotions of loss and guilt while attending the memorial service of her 8-year-old patient.
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Affiliation(s)
- Mallory R Taylor
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
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Barton KS, Steineck A, Walsh CA, Lau N, O’Donnell MB, Rosenberg AR. "I won't get to live my life the way I planned it": A qualitative analysis of the experiences of adolescents and young adults with advanced cancer. Pediatr Blood Cancer 2023; 70:e30554. [PMID: 37438862 PMCID: PMC10566371 DOI: 10.1002/pbc.30554] [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] [Received: 04/21/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Individuals with advanced cancer face complex challenges, including prognostic uncertainty and evolving goals of care. Despite the unique psychosocial support needs of adolescents and young adults (AYAs), few studies have specifically examined AYA perspectives of and experiences with advanced cancer. The objective of this study was to describe the experience, needs, and perspectives of pediatric AYAs with advanced cancer. PROCEDURE We invited English-speaking AYAs (age 14-25 years) who were receiving treatment for advanced cancer at our single tertiary pediatric cancer center to participate in semi-structured interviews. We used directed content analysis for codebook development and then applied in-depth thematic network analysis to describe their perspectives and experiences with advanced cancer. RESULTS A total of 32 AYAs (86% of approached) completed interviews. A slight majority were male (59%) and non-Hispanic White (56%). Most were diagnosed with leukemia/lymphoma, had recurrent disease (84%), and were a mean 53 months from initial diagnosis. Organizing themes of "not being able to beat this," "not wanting to miss out," and "living each day" generated the global theme "do I have a future?" "Making tough medical decisions," "adjusting life/plans/perspectives," and "decisions about dying" were organized into the global theme "those decisions … were really hard." "Feeling like there is no one to talk to," "being away from family and friends," and "feeling like a burden" generated the global theme "I felt very alone." CONCLUSIONS Pediatric AYAs with advanced cancer describe unique challenges. Psychological support interventions are needed to empower AYAs to navigate difficult decisions and to cope with isolation.
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Affiliation(s)
- Krysta S. Barton
- Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Angela Steineck
- MACC Fund Center for Cancer and Blood Disorders, Department of Pediatrics, Medical College of Wisconsin; Milwaukee, WI, USA
| | - Casey A. Walsh
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA, USA
| | - Nancy Lau
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Maeve B. O’Donnell
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Abby R. Rosenberg
- Department of Psychosocial Oncology & Palliative Care; Dana-Farber Cancer Institute; Boston, MA, USA
- Department of Pediatrics, Boston Children’s Hospital; Boston, MA, USA
- Department of Pediatrics, Harvard Medical School; Boston, MA, USA
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Cuviello A, Ang N, Morgan K, Baker JN, Anghelescu DL. Palliative Sedation Therapy Practice Comparison - A Survey of Pediatric Palliative Care and Pain Management Specialists. Am J Hosp Palliat Care 2023; 40:977-986. [PMID: 36475873 DOI: 10.1177/10499091221138298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Context: Palliative sedation therapy (PST) can relieve suffering at end-of-life (EOL) in children with intolerable and refractory symptoms. However, updated and consistent guidance on PST practices are imperative. Objectives: We investigate current variations in clinical practice and PST implementation among pediatric palliative care (PPC) and pain management (PM) specialists. Methods: We distributed an IRB-exempt electronic anonymous survey via email through the Society of Pediatric Pain Medicine, and the American Academy of Hospice and Palliative Medicine. Survey responses were collated and descriptively reported. Results: Of 83 survey responses, the majority (75%) represented large academic children's hospitals. The distribution between PPC and pediatric pain management specialists' responses was 60% and 40%, respectively. Most respondents reported having designated pain management and/or palliative care teams (70% and 90%, respectively). Approximately half (48%) reported following an institutional PST protocol, most not requiring formal ethics consult (69%). Only 54% of respondents noted that the Do Not Resuscitate (DNR) order was required prior to PST initiation. PST was primarily utilized for children with oncologic diagnoses (76%). The primary and secondary medications of choice for PST implementation were reported to be opioids (39%) and benzodiazepines (36%) by pain management specialists, and benzodiazepines (52%) and barbiturates (28%) by palliative care specialists. Conclusions: Our study highlights the variability in the practice and implementation of PST. Further educational efforts are key for establishing PST practices and efficient protocol development.
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Affiliation(s)
| | - Nicholas Ang
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kyle Morgan
- University of Tennessee Health Science Center, Memphis, TN, USA
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Rico-Mena P, Güeita-Rodríguez J, Martino-Alba R, Castel-Sánchez M, Palacios-Ceña D. The Emotional Experience of Caring for Children in Pediatric Palliative Care: A Qualitative Study among a Home-Based Interdisciplinary Care Team. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040700. [PMID: 37189949 DOI: 10.3390/children10040700] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
The healthcare providers caring for children with life-threatening illnesses experience considerable compassion fatigue. The purpose of this study was to describe the feelings and emotions of professionals working in an interdisciplinary pediatric palliative home care team. A qualitative case study was conducted, comprising 18 participants. A purposeful sampling technique approach was used including the home-based interdisciplinary pediatric palliative team. Data were collected via semi-structured interviews and researchers' field notes. A thematic analysis was performed. Two themes emerged: (a) changing life for the better, which described how professionals value life more and helping children and families provides compassion satisfaction, which is comforting and explains their dedication to care; (b) adverse effects of work highlighted the emotional burden of caring for children with life-limiting or life-threatening illnesses, which can affect their job satisfaction and may lead to burnout, showing how experiencing in-hospital child deaths with suffering leads professionals to develop an interest in specializing in pediatric palliative care. Our study provides information on possible causes of emotional distress in professionals caring for children with life-threatening illnesses and highlights strategies that can help them to reduce their distress.
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Affiliation(s)
- Patricia Rico-Mena
- Physical Therapy and Health Sciences Research Group, Faculty of Sport Sciences, Department of Physiotherapy, Chiropody and Dance, Universidad Europea de Madrid, 28670 Madrid, Spain
- International Doctorate School, Rey Juan Carlos University, 28008 Madrid, Spain
| | - Javier Güeita-Rodríguez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science, Rey Juan Carlos University, 28922 Alcorcón, Spain
| | - Ricardo Martino-Alba
- Pediatric Palliative Care Unit, Hospital Universitario Infantil Niño Jesús, 28009 Madrid, Spain
| | - Marina Castel-Sánchez
- Physical Therapy and Health Sciences Research Group, Faculty of Sport Sciences, Department of Physiotherapy, Chiropody and Dance, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science, Rey Juan Carlos University, 28922 Alcorcón, Spain
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Bourque C, Dumont E, Martisella M, Daoust L, Cantin S, Levasseur MC, de Steur Q, Duval M, Marquis MA, Sultan S. L’expérience à long terme des parents endeuillés en oncologie pédiatrique : une étude rétrospective de 2 à 18 ans après le décès d’un enfant. PSYCHO-ONCOLOGIE 2023. [DOI: 10.3166/pson-2022-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Objectifs : Cette étude rétrospective et transversale vise à comprendre l’expérience à long terme des parents endeuillés en oncologie pédiatrique et les différences du deuil parental en fonction du genre.
Matériel et méthodes : Un questionnaire multisectionnel coconstruit avec des cliniciens et intervenants en suivi de deuil a été tenu en ligne en 2018 et 2019. Les participants au sondage étaient des parents dont l’enfant était décédé au service d’hématologie-oncologie du CHU Sainte-Justine 2 à 18 ans auparavant. Des sections spécifiques sur les réactions, les changements et les souvenirs ont fait l’objet d’analyses descriptives.
Résultats : Les réponses de 48 parents ont été analysées. Les résultats indiquent que les mères ont tendance à modifier certaines de leurs activités sociales, alors que les pères cherchent plutôt à retrouver leurs habitudes. Les réactions initialement fortes des parents s’atténuent au fil du temps sans disparaître, en particulier la tristesse et les troubles du sommeil. Les parents ont des souvenirs apaisants des interactions et des soins reçus des intervenants en milieux clinique et communautaire même plusieurs années après le décès de leur enfant.
Conclusion : L’offre de soutien psychosocial communautaire et professionnel à long terme est pertinente, de même aux besoins des couples et aux besoins individuels des parents en fonction du genre.
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Steineck A, Lau N, Fladeboe KM, Walsh CA, Rosenberg AR, Yi-Frazier JP, Barton KS. Seeking virtual support: Digital technology use in adolescent and young adults with advanced cancer. Pediatr Blood Cancer 2022; 69:e29938. [PMID: 36069542 PMCID: PMC10324622 DOI: 10.1002/pbc.29938] [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] [Received: 04/12/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND A cancer diagnosis, especially advanced cancer, interferes with adolescent/young adult (AYA) peer relationships. AYAs increasingly use digital technologies (i.e., social media, video games) as a social instrument; little is known about the role of digital technologies in the AYA cancer experience. The objective of this analysis was to describe the use and impact of digital technologies among AYAs with advanced cancer. PROCEDURE As part of the "Exploring the Concept of a 'Good Death'" study, semi-structured interviews were conducted with 32 English-speaking AYAs (14-25 years) with advanced cancer (relapsed/refractory disease, estimated survival <50%). Interviews were audio recorded, deidentified, and transcribed verbatim. Questions focused on communication and sources of psychosocial support. Directed content analysis was used for codebook creation. Three reviewers completed transcript coding and reconciled discrepancies. Thematic analysis identified hierarchical themes. The present analysis focused on the specific theme of "digital technologies as a support mechanism." RESULTS When asked about sources of support, social media and multiplayer online games were most often recognized by AYAs. Three themes emerged regarding the role of digital technologies: distraction, maintaining existing peer support, and connecting with peers with cancer. Two AYAs acknowledged negative consequences of social media. CONCLUSIONS AYAs with advanced cancer cite digital technologies as a mechanism for maintaining and seeking peer support. Digital technologies may be leveraged to provide psychosocial support for AYAs with advanced cancer.
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Affiliation(s)
- Angela Steineck
- Seattle Children’s Hospital, Cancer and Blood Disorders Center; Seattle, WA
- Seattle Children’s Research Institute, Center for Clinical and Translational Research, Palliative Care and Resilience Lab; Seattle, WA
- University of Washington School of Medicine, Department of Pediatrics; Seattle, WA
- MACC Fund Center for Cancer and Blood Disorders, Department of Pediatrics, Medical College of Wisconsin; Milwaukee, WI, USA
| | - Nancy Lau
- Seattle Children’s Research Institute, Center for Clinical and Translational Research, Palliative Care and Resilience Lab; Seattle, WA
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Kaitlyn M. Fladeboe
- Seattle Children’s Research Institute, Center for Clinical and Translational Research, Palliative Care and Resilience Lab; Seattle, WA
- University of Washington School of Medicine, Department of Pediatrics; Seattle, WA
| | - Casey A. Walsh
- Seattle Children’s Research Institute, Center for Clinical and Translational Research, Palliative Care and Resilience Lab; Seattle, WA
- University of Washington, Department of Health Services, Seattle, WA
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | - Abby R. Rosenberg
- Seattle Children’s Hospital, Cancer and Blood Disorders Center; Seattle, WA
- Seattle Children’s Research Institute, Center for Clinical and Translational Research, Palliative Care and Resilience Lab; Seattle, WA
- University of Washington School of Medicine, Department of Pediatrics; Seattle, WA
| | - Joyce P. Yi-Frazier
- Seattle Children’s Research Institute, Center for Clinical and Translational Research, Palliative Care and Resilience Lab; Seattle, WA
| | - Krysta S. Barton
- Seattle Children’s Research Institute, Center for Clinical and Translational Research, Palliative Care and Resilience Lab; Seattle, WA
- Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Seattle Children’s Research Institute, Seattle, WA
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Gagnon M, Kunyk D. Beyond technology, drips, and machines: Moral distress in PICU nurses caring for end-of-life patients. Nurs Inq 2021; 29:e12437. [PMID: 34157180 DOI: 10.1111/nin.12437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Moral distress is an experience of profound moral compromise with deeply impactful and potentially long-term consequences to the individual. Critical care areas are fraught with ethical issues, and end-of-life care has been associated with numerous incidences of moral distress among nurses. One such area where the dichotomy of life and death seems to be at its sharpest is in the pediatric intensive care unit. The purpose of this study was to understand the moral distress experiences of pediatric intensive care nurses when caring for pediatric patients at the end of life. A secondary analysis was undertaken of seven transcripts from registered nurses across six Canadian pediatric intensive care units and produced three themes: under prioritization of child patient dignity, burden of insider knowledge, and environmental constraints on nursing roles and responsibilities. When caring for patients at the end of life, nurses experienced moral distress when a dignified death was not realized. Furthermore, despite interprofessional collaboration efforts in Canada, the concept of silo mentality persists and contributes to moral distress. Organizational involvement is needed to address moral distress in pediatric intensive care nurses both to achieve a dignified death for child patients and in addressing silo mentality.
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Affiliation(s)
- Michelle Gagnon
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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