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Ritter J, Allen S, Cohen PD, Fajardo AF, Marx K, Loggetto P, Auste C, Lewis H, de Sá Rodrigues KE, Hussain S, Omotola A, Bolous NS, Thirumurthy H, Essue BM, Steliarova-Foucher E, Huang IC, Meheus F, Bhakta N. Financial hardship in families of children or adolescents with cancer: a systematic literature review. Lancet Oncol 2023; 24:e364-e375. [PMID: 37657477 PMCID: PMC10775706 DOI: 10.1016/s1470-2045(23)00320-0] [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] [Received: 04/11/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/03/2023]
Abstract
Financial hardship in childhood cancer contributes to poor health outcomes and global disparities in survival, but the extent of the financial burden on families is not yet fully understood. We systematically reviewed financial hardship prevalence and individual components characterising financial hardship across six domains (medical, non-medical, and indirect costs, financial strategies, psychosocial responses, and behavioural responses) and compared characteristics across country income levels using an established theory of human needs. We included 123 studies with data spanning 47 countries. Extensive heterogeneity in study methodologies and measures resulted in incomparable prevalence estimates and limited analysis. Components characterising financial hardship spanned the six domains and showed variation across country income contexts, yet a synthesis of existing literature cannot establish whether these are true differences in characterisation or burden. Our findings emphasise a crucial need to implement a data-driven methodological framework with validated measures to inform effective policies and interventions to address financial hardship in childhood cancer.
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Affiliation(s)
- Julie Ritter
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | | | - Kelsey Marx
- Prometheus Federal Services, Washington, DC, USA
| | - Patrícia Loggetto
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Hedley Lewis
- CHOC Childhood Cancer Foundation South Africa, Rivonia, South Africa
| | | | | | - Ayomide Omotola
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | | | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Filip Meheus
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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Chiwanga FS, Woodford J, Masika GM, Richards DA, Savi V, von Essen L. An mHealth Intervention to Improve Guardians' Adherence to Children's Follow-Up Care for Acute Lymphoblastic Leukemia in Tanzania (GuardiansCan Project): Protocol for a Development and Feasibility Study. JMIR Res Protoc 2023; 12:e48799. [PMID: 37403706 PMCID: PMC10433028 DOI: 10.2196/48799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/13/2023] [Accepted: 07/05/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Cancer is a leading cause of death during childhood and in low- and middle-income countries survival rates can be as low as 20%. A leading reason for low childhood cancer survival rates in low- and middle-income countries such as Tanzania is treatment abandonment. Contributing factors include poor communication between health care providers and children's guardians, insufficient cancer knowledge, and psychological distress. OBJECTIVE Our aim is to respond to Tanzanian guardians' poor adherence to children's follow-up care after treatment for acute lymphoblastic leukemia with the help of mobile health (mHealth) technology. Our goal is to increase guardians' adherence to children's medications and follow-up visits and to decrease their psychological distress. METHODS Following the Medical Research Council framework for developing and evaluating complex interventions, we will undertake the GuardiansCan project in an iterative phased approach to develop an mHealth intervention for subsequent testing. Public contribution activities will be implemented throughout via the establishment of a Guardians Advisory Board consisting of guardians of children with acute lymphoblastic leukemia. We will examine the acceptability, feasibility, and perceived impact of Guardians Advisory Board activities via an impact log and semistructured interviews (study I). In phase 1 (intervention development) we will explore guardians' needs and preferences for the provision of follow-up care reminders, information, and emotional support using focus group discussions and photovoice (study II). We will then co-design the mHealth intervention with guardians, health care professionals, and technology experts using participatory action research (study III). In phase 2 (feasibility), we will examine clinical, methodological, and procedural uncertainties associated with the intervention and study procedures to prepare for the design and conduct of a future definitive randomized controlled trial using a single-arm pre-post mixed methods feasibility study (study IV). RESULTS Data collection for the GuardiansCan project is anticipated to take 3 years. We plan to commence study I by recruiting Guardians Advisory Board members in the autumn of 2023. CONCLUSIONS By systematically following the intervention development and feasibility phases of the Medical Research Council Framework, and working alongside an advisory board of guardians, we intend to develop an acceptable, culturally appropriate, feasible, and relevant mHealth intervention with the potential to increase guardians' adherence to children's follow-up care after treatment of acute lymphoblastic leukemia, leading to a positive impact on children's health and chances to survive, and reducing distress for guardians. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48799.
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Affiliation(s)
- Faraja S Chiwanga
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
- Directorate of Medical Services, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Joanne Woodford
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
| | - Golden M Masika
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
- Department of Clinical Nursing, University of Dodoma, Dodoma, United Republic of Tanzania
| | - David A Richards
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Victor Savi
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
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Chironda G, Jarvis MA, Brysiewicz P. Family-Focused Nursing Research in WHO Afro-Region Member States: A Scoping Review. JOURNAL OF FAMILY NURSING 2023; 29:136-154. [PMID: 36433834 PMCID: PMC10160405 DOI: 10.1177/10748407221132018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Although family nursing research has become an important focus for over the past 20 years, the evolution and extent of family nursing research in the World Health Organization (WHO) Afro-regions is less explored. The purpose of this scoping review was to map the evidence of family-focused nursing research using the Joanna Briggs Institute Scoping Review methodology. A systematic electronic search of articles was carried out for the period January 1, 2000 to December 31, 2020. The review process culminated in 85 articles, evidencing an increase in publications particularly in 2019 (n = 12). Eighteen countries were involved, with the Southern African region contributing 52% of the studies. Family members were predominantly described as parents, siblings, and children, with the most focused area of study being family experiences (n = 52). The majority of studies (n = 59) used qualitative methodologies. Despite the recent increase in family-focused nursing research in the WHO Afro-regions, further qualitative research, including more complex methodologies and interventions are still required to build contextualized evidence-based family-focused nursing.
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Alghamdi S, Alqurashi A, Almarbae N, Fadul Y, Alharbi M, Bashammakh R. Experience of Parents with Children Undergoing Chemotherapy. SAGE Open Nurs 2023; 9:23779608231207233. [PMID: 37920748 PMCID: PMC10619346 DOI: 10.1177/23779608231207233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/22/2023] [Accepted: 09/23/2023] [Indexed: 11/04/2023] Open
Abstract
Background The care of a child receiving chemotherapy has a significant impact on the parents and family structure, which has been explored in depth in a few studies in Saudi Arabia. The purpose of this study is to further explore the lived experiences of Saudi Arabian parents in caring for their children receiving chemotherapy. Methodology A qualitative descriptive design was used in this study with a sample of 17 parents of children receiving chemotherapy. The participants were recruited using the snow-balling technique throughout the community, as well as from the University Hospital, Pediatric Oncology Department. The data were collected via in-person and virtual methods using semi-structured, open-ended interviews and analyzed using thematic analysis. Results The findings of the study were placed into two main themes: family experience and stages of disease. Family experiences include the parents and siblings' experiences. The stages of disease include three sub-themes: the pre-diagnosis phase, diagnosis phase, and treatment phase. Conclusion The cancer journey had a huge impact on the parents and siblings. The study revealed important findings related to the experiences during the stages of diseases and lived experiences of parents and siblings including psychological, physiological, social, and financial impacts.
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Affiliation(s)
- Salmah Alghamdi
- Maternity and Childhood Nursing Department, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Afnan Alqurashi
- Medical Surgical Nursing Department, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nura Almarbae
- Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yara Fadul
- Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maha Alharbi
- Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reham Bashammakh
- Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
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Wang R. Application of Augmented Reality Technology in Children's Picture Books Based on Educational Psychology. Front Psychol 2022; 13:782958. [PMID: 35185721 PMCID: PMC8850626 DOI: 10.3389/fpsyg.2022.782958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
To cultivate children's imagination, observation, thinking ability, and aesthetic consciousness, the questionnaire survey is adopted to analyze the design strategies and principles of children's picture books based on augmented reality (AR). Primarily, the related concepts and theories are expounded for the research content. Children in preschool aged 4-5 years are invited as primary participants in this work, and the psychological characteristics of the invited children are analyzed in depth. Then, a study is carried out on the existing AR children's picture books. The problems existing in the design of AR children's picture books are found, and then, related solutions are put forward based on the results of the questionnaire survey. Besides, a design is made on the strategies and interactive design principles of AR children's picture books on mobile terminals that are more in line with the needs of children. The results show that 41.07% of parents do not understand AR technology, and 37.5% of preschool children indicate that they do not operate mobile devices independently. However, they need the assistance of parents to use this kind of picture book. A total of 44.64% of parents believe that the main problem of AR picture books in the current market is the lack of interesting interaction. Given the above problems, five principles are proposed for the design of AR children's picture books based on mobile terminals, namely, easy operation principle, interesting principle, guiding principle, timely feedback principle, and safety principle. A set of universally applicable design methods are proposed for AR children's picture books based on mobile terminals, which provides certain theoretical guidance for the development of related types of products.
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Affiliation(s)
- Rui Wang
- College of Art and Design, Beijing Polytechnic, Beijing, China
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Concerns and Needs of Support Among Guardians of Children on Cancer Treatment in Dar es Salaam: A Qualitative Study. Cancer Nurs 2021; 43:E342-E348. [PMID: 31107702 DOI: 10.1097/ncc.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cancer in children in Tanzania is a concerning health issue, yet there is a shortage of information about the experiences of the guardians of children who receive cancer treatment. OBJECTIVE To explore concerns and needs of support among guardians of children on cancer treatment in Dar es Salaam, Tanzania. METHOD Using a qualitative design, 3 focus group discussions were held with 22 guardians of children aged 9 to 17 years. Guardians were recruited from Muhimbili National Hospital, Dar es Salaam, where their children were receiving cancer treatment. Data were analyzed using thematic content analysis. RESULTS Guardians experienced several issues during the initial stages of their child's cancer treatment, including the process of seeking a diagnosis, and experiences with care at the peripheral (regional) hospitals and national hospital. They also shared what they felt would lessen their difficult experiences. Seven themes emerged in this study: financial concerns, emotional concerns, barriers to cancer care, need for improved cancer care, need for information, need for tangible support, and gratitude and hope. CONCLUSION Guardians of children with cancer experience challenges during initial stages when seeking a diagnosis and have concerns and needs related to cancer care and treatment. IMPLICATIONS FOR PRACTICE Improvements are needed regarding care at regional hospitals, the cancer diagnosis, and the recognition of early signs of cancer and quick referral to diagnostic centers, compassionate caring behaviors by healthcare workers, budgetary support from the government to meet the medication supply demands, and meeting stakeholders' support needs.
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