The implementation and strategy of triadic communication in pediatric oncology: a scoping review

Triad child-parent-professional communication is considered a priority in evaluating and optimizing therapeutic alliance in pediatric oncology. This scoping review aimed to map the existing evidence in implementation, influencing factors, and strategies of triadic communication in pediatric oncology. Using Arksey and O'Malley's framework, we searched 5 databases and grey literature until June 15th, 2024. Two researchers selected studies and extracted data independently. The PAGER framework was employed to summarize the implications of existing research to inform future research and practice. A total of 24 articles were included. Healthcare professionals usually initiate triadic communication. Communication topics rarely focused on prognosis, emotions, and end-of-life care. The triad child-parent-professional exhibited similarities in language, emotional, and decision-making communication preferences but differed regarding skills and information preferences. The roles of the triad parts were unclear, especially nurses' role, responsibilities, and contributions were seldom specified. Factors influencing the implementation spanned individual, organizational, and socio-cultural levels. Five types including 21 specific suggested strategies were identified to facilitate implementation, yet few strategies were adopted by patients and caregivers, and limited effectiveness studies have evaluated specific strategies. Overall, while triadic communication has received considerable attention in the world, its practical implementation in real-world settings remains largely underdeveloped. IMPACT: Our research has mapped the global trajectories of triadic communication between child-parent-professional throughout the cancer journey. A precise delineation of roles and responsibilities within the triadic communication framework in pediatric oncology is crucial for augmenting collaborative efforts and achieving optimal coordination among stakeholders. Healthcare professionals could partner with families to comprehend individual communication preferences, cultivating a collaborative relationship that honors each participant's needs and enhances informed decision-making. The findings equip healthcare professionals with a range of strategies to navigate communication with children with cancer and their parents.

Analysing multimodal data that have been collected using photovoice as a research method

BACKGROUND

Creative arts practice can enhance the depth and quality of mental health research by capturing and foregrounding participants' lived experience. Creative methods are emotionally activating and promote multiple perspectives, tolerating ambiguities and uncertainties, which are shared and even celebrated.

KEY ARGUMENTS

Methods such as photovoice use imagery to elucidate narratives that are not easily captured by more traditional interview-based research techniques. However, the use of creative methods and participatory research remains novel as there is little guidance of how to navigate conceptual, practical, and analytical challenges.

CONCLUSION

This paper considers these challenges, and puts forward practical and theory informed recommendations, using as study of photovoice methods for investigating ethnic inequalities in the use of the mental health act (Co-Pact) as a case study.

Problems, Stressors and Needs of Children and Adolescents with Cancer

BACKGROUND

Cancer diseases in children and adolescents are considered to be one of the most serious health problems in the world. It is estimated that about 151,435 cases are diagnosed in children annually. Children with cancer experience many comorbid symptoms related to diagnosis and treatment that can profoundly affect their lives. They experience physical and emotional suffering, which affects their well-being and physical fitness, influencing the prognosis and deteriorating their physical, mental and social functioning. Given the limited data, an attempt was made to assess the problems of the biopsychosocial sphere of need and stressors among children and adolescents treated for cancer. Accurate symptom assessment is essential to ensure high-quality care and effective treatment.

PATIENTS AND METHODS

The qualitative study was conducted in pediatric oncology of hospitals in Poland. Children diagnosed with cancer were invited to participate in the study to assess their problems, stressors and needs.

RESULTS

The study included 520 people, where female sex constituted 48% and male 52%. The mean age of the children is 13.2 SD = 2.5. Negative experiences related to the disease are experienced by 82% of children. Among the surveyed children, the most experienced were anxiety (61%). The conducted research shows that as many as 69% of all respondents experienced states that indicate severe depression. The most common somatic problems reported by children were pain (58%). The most dominant areas of life that had a negative impact was body image (85%).

CONCLUSIONS

Children and adolescents diagnosed with neoplastic disease experience many problems and stressors in every sphere of life, which undoubtedly affects a high level of unmet needs. The main category of needs concerning the challenges faced by children with cancer was psychological and care problems. In the youth group, the needs were mainly related to education and social support.

Two decades of childhood cancer care in Cameroon: 2000-2020

BACKGROUND

Before the year 2000, there was no dedicated childhood cancer service in Cameroon. The aim of this study was to investigate the progress made with pediatric oncology care in Cameroon from 2000 to 2020.

METHOD

A literature search was conducted for published articles on childhood cancer in Cameroon and relevant documents, and conference abstracts were reviewed. The articles were analyzed under the themes: awareness, diagnosis, epidemiology, treatment, outcome, advocacy, partnerships, traditional and complementary medicine, palliative care, and capacity building.

RESULTS

Low awareness on childhood cancer was addressed with education activities targeting the general population and health care professionals. Cancer diagnosis was achieved with cytology, histology, and simple imaging. Management for common and curable cancers was implemented with use of modified treatment regimens for low- and middle-income settings. Nutritional support was shown to mitigate the effects of malnutrition on treatment toxicity, and support was provided for transportation and accommodation. There was good collaboration between the pediatric oncology professionals nationally and twinning with international partners. Capacity building activities led to the availability of three pediatric oncologists and pediatric oncology-trained nurses. Advocacy nationally led to the support of the Ministry of Health with pediatric oncology-specific priority actions in the latest national cancer control plan.

CONCLUSION

Childhood cancer should receive the necessary attention of health care policymakers in Cameroon. With continued commitment of government, nongovernmental organizations, charities, childhood cancer specialists, patient and parent groups, there should be an improved future for children with cancer in Cameroon.

Health-Related Quality of Life among Cancer Survivors Depending on the Occupational Status

The study aimed to identify and compare the factors affecting health-related quality of life (HRQoL) depending on the occupational status of cancer survivors. This study was a secondary data analysis from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2014 to 2018. Hierarchical multivariate linear regression was used to investigate the factors affecting the HRQoL of each group. Non-working cancer survivors had significantly lower HRQoL than working cancer survivors (p < 0.001). A hierarchical multiple regression model showed that demographic, health-related, and psychological characteristics explained 62.0% of non-working cancer survivors' HRQoL (F = 4.29, p < 0.001). Among the input variables, health-related characteristics were the most influential factors (ΔR² = 0.274, F = 9.84, p < 0.001). For working cancer survivors, health-related characteristics were the only variable that was statistically associated with HRQoL (F = 5.556, p < 0.001). It is important to enhance physical activities and manage the chronic disease to improve the HRQoL of working cancer survivors. Further, managing health-related characteristics, including depressive symptoms and suicidal ideation, is necessary for non-working cancer survivors. Regarding working survivors, psychological factors such as depressive symptoms and suicidal tendencies did not affect HRQoL. Therefore, an early and effective return to work program should be developed for the improvement of their HRQoL.

Pediatric cancer communication in low- and middle-income countries: A scoping review

The burden of global childhood cancer lies in low- and middle-income countries (LMICs). Communication is essential to pediatric cancer care, and the National Cancer Institute (NCI) has defined 6 functions of communication between patients, family members, and providers, including 1) fostering healing relationships, 2) responding to emotions, 3) exchanging information, 4) making decisions, 5) managing uncertainty, and 6) enabling self-management. Nevertheless, communication needs and practices in LMICs remain incompletely understood. For this review, the Web of Science, Scopus, PubMed, and Turning Research Into Practice databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews. Searching identified 2988 articles, with 11 added through snowballing. Forty articles met the inclusion criteria. Two reviewers extracted data on study characteristics, communication functions, enablers, barriers, and additional major themes. This review included work from 17 countries. Most studies (85%) used qualitative methodology; the number of participants ranged from 7 to 304. All 6 of the NCI-defined communication functions were identified in included studies, with rates ranging from 100% of studies for information exchange to 28% of studies for decision making. Communication barriers included cancer misconceptions, stigma, and hierarchy between parents and providers. Provider training and community education facilitated communication. Additional themes included disclosure to children, family dynamics, and the multidisciplinary health care team. In conclusion, all 6 of the communication functions defined by the NCI were applied by pediatric cancer researchers in LMICs. Additional barriers, enablers, and communication themes noted in LMICs deserve further exploration, and a relative paucity of research in comparison with high-income countries highlights the need for further work.