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Baxter MA, Denholm M, Kingdon SJ, Kathirgamakarthigeyan S, Parikh S, Shakir R, Johnson R, Martin H, Walton M, Yao W, Swan A, Samuelson C, Ren X, Cooper A, Gray HL, Clifton S, Ball J, Gullick G, Anderson M, Dodd L, Hayhurst H, Salama M, Shotton R, Britton F, Christodoulou T, Abdul-Hamid A, Eichholz A, Evans RM, Wallroth P, Gibson F, Poole K, Rowe M, Harris J. CAnceR IN PreGnancy (CARING) - a retrospective study of cancer diagnosed during pregnancy in the United Kingdom. Br J Cancer 2024; 130:1261-1268. [PMID: 38383704 PMCID: PMC11014900 DOI: 10.1038/s41416-024-02605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population. METHODS In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020). RESULTS Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%. CONCLUSIONS This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.
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Affiliation(s)
- M A Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK.
| | - M Denholm
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
| | - S J Kingdon
- Exeter Oncology Centre, Royal Devon University Hospitals NHS Trust, Exeter, UK
| | | | - S Parikh
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Shakir
- Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Johnson
- Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Martin
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, Cambridge University, Cambridge, UK
| | - M Walton
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - W Yao
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - C Samuelson
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - X Ren
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - A Cooper
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - H-L Gray
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - S Clifton
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - J Ball
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - G Gullick
- Oncology Department, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - M Anderson
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - L Dodd
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - H Hayhurst
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - M Salama
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Shotton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - F Britton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - T Christodoulou
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A Abdul-Hamid
- Department of Oncology, Royal Surrey County Hospital NHS Trust, Surrey, UK
| | - A Eichholz
- Department of Oncology, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - R M Evans
- South West Wales Cancer Centre, Swansea Bay NHS Trust, Swansea, UK
| | | | - F Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Poole
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, Belmont, Sutton, Surrey, UK
| | - M Rowe
- Sunrise Oncology Centre, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - J Harris
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Livermore P, Kupiec K, Wedderburn LR, Knight A, Solebo AL, Shafran R, Robert G, Sebire NJ, Gibson F. Designing, Developing, and Testing a Chatbot for Parents and Caregivers of Children and Young People With Rheumatological Conditions (the IMPACT Study): Protocol for a Co-Designed Proof-of-Concept Study. JMIR Res Protoc 2024; 13:e57238. [PMID: 38568725 PMCID: PMC11024752 DOI: 10.2196/57238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Pediatric rheumatology is a term that encompasses over 80 conditions affecting different organs and systems. Children and young people with rheumatological chronic conditions are known to have high levels of mental health problems and therefore are at risk of poor health outcomes. Clinical psychologists can help children and young people manage the daily difficulties of living with one of these conditions; however, there are insufficient pediatric psychologists in the United Kingdom. We urgently need to consider other ways of providing early, essential support to improve their current well-being. One way of doing this is to empower parents and caregivers to have more of the answers that their children and young people need to support them further between their hospital appointments. OBJECTIVE The objective of this co-designed proof-of-concept study is to design, develop, and test a chatbot intervention to support parents and caregivers of children and young people with rheumatological conditions. METHODS This study will explore the needs and views of children and young people with rheumatological conditions, their siblings, parents, and caregivers, as well as health care professionals working in pediatric rheumatology. We will ask approximately 100 participants in focus groups where they think the gaps are in current clinical care and what ideas they have for improving upon them. Creative experience-based co-design workshops will then decide upon top priorities to develop further while informing the appearance, functionality, and practical delivery of a chatbot intervention. Upon completion of a minimum viable product, approximately 100 parents and caregivers will user-test the chatbot intervention in an iterative sprint methodology to determine its worth as a mechanism for support for parents. RESULTS A total of 73 children, young people, parents, caregivers, and health care professionals have so far been enrolled in the study, which began in November 2023. The anticipated completion date of the study is April 2026. The data analysis is expected to be completed in January 2026, with the results being published in April 2026. CONCLUSIONS This study will provide evidence on the accessibility, acceptability, and usability of a chatbot intervention for parents and caregivers of children and young people with rheumatological conditions. If proven useful, it could lead to a future efficacy trial of one of the first chatbot interventions to provide targeted and user-suggested support for parents and caregivers of children with chronic health conditions in health care services. This study is unique in that it will detail the needs and wants of children, young people, siblings, parents, and caregivers to improve the current support given to families living with pediatric rheumatological conditions. It will be conducted across the whole of the United Kingdom for all pediatric rheumatological conditions at all stages of the disease trajectory. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57238.
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Affiliation(s)
- Polly Livermore
- Rheumatology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children, London, United Kingdom
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, United Kingdom
| | - Klaudia Kupiec
- Rheumatology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Lucy R Wedderburn
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children, London, United Kingdom
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, United Kingdom
| | - Andrea Knight
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
- Neurosciences and Mental Health Program, SickKids Research Institute, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ameenat L Solebo
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Opthamology Department, Great Ormond Street Children's Hospital NHS Foundation Trust, London, United Kingdom
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - N J Sebire
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Surrey, United Kingdom
- Director of Research - Nursing and Allied Health, Great Ormond Street Children's Hospital, London, United Kingdom
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Evans C, Shepherd L, Bryan G, Fulbright H, Crowther S, Wakeling S, Stewart A, Stewart C, Chisholm J, Gibson F, Phillips B, Morgan JE. A systematic review of early phase studies for children and young people with relapsed and refractory rhabdomyosarcoma: The REFoRMS-SR project. Int J Cancer 2024; 154:1235-1260. [PMID: 38071594 DOI: 10.1002/ijc.34808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 02/07/2024]
Abstract
Rhabdomyosarcoma is the commonest soft tissue sarcoma in children. Around one-third of children with rhabdomyosarcoma experience relapse or have refractory disease, which is associated with a poor prognosis. This systematic review of early phase studies in pediatric relapsed/refractory rhabdomyosarcoma was conducted to inform future research and provide accurate information to families and clinicians making difficult treatment choices. Nine databases and five trial registries were searched in June 2021. Early phase studies of interventions for disease control in patients under 18 years old with relapsed/refractory rhabdomyosarcoma were eligible. No language/geographic restrictions were applied. Studies conducted after 2000 were included. Survival outcomes, response rates, quality of life and adverse event data were extracted. Screening, data extraction and quality assessment (Downs and Black Checklist) were conducted by two researchers. Owing to heterogeneity in the included studies, narrative synthesis was conducted. Of 16,965 records screened, 129 published studies including over 1100 relapsed/refractory rhabdomyosarcoma patients were eligible. Most studies evaluated systemic therapies. Where reported, 70% of studies reported a median progression-free survival ≤6 months. Objective response rate was 21.6%. Adverse events were mostly hematological. One-hundred and seven trial registry records of 99 studies were also eligible, 63 of which report they are currently recruiting. Study quality was limited by poor and inconsistent reporting. Outcomes for children with relapsed/refractory rhabdomyosarcoma who enroll on early phase studies are poor. Improving reporting quality and consistency would facilitate the synthesis of early phase studies in relapsed/refractory rhabdomyosarcoma (PROSPERO registration: CRD42021266254).
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Affiliation(s)
- Connor Evans
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lucy Shepherd
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Gemma Bryan
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Helen Fulbright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | | | | | | | - Julia Chisholm
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Great Ormond Street Hospital, London, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jessica E Morgan
- Centre for Reviews and Dissemination, University of York, York, UK
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Oulton K, Williams A, Gibson F. Acceptability of a novel device to improve child patient experience during venepuncture for blood sampling: Intervention with 'MyShield'. J Child Health Care 2024; 28:53-68. [PMID: 35544716 DOI: 10.1177/13674935221098297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to explore the acceptability of a novel device ('MyShield'): a device used for distraction during clinical procedures. It is a cardboard cuff, designed to fit around the arm, either above the elbow or around the wrist and used to hide the procedure from view. This device was tested in practice, to establish acceptability to children, parents and clinical staff. Fifty-eight children tried 'MyShield' during a venepuncture procedure. Feedback from 54 children, 58 parents/carers and 16 clinical staff was collected using surveys and interviews. In 24 cases, observational data were also collected. A large majority of children (94%, n = 51) and parents (96%, n = 56) reported a positive experience when using 'MyShield'; saying they would likely use it again. Potential of 'MyShield' in promoting parent/clinician interaction with the child was highlighted. Data suggests that 'MyShield' may be a useful device for children undergoing venepuncture, when used in conjunction with standard care, and subject to individual preferences and choice. Further work is required to establish mechanism of action and whether use of 'MyShield' has any impact across a range of short- and long-term outcome measures relating to patient experience and effectiveness.
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London, UK
| | | | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London, UK
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
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5
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Vázquez-Vázquez A, Smith A, Gibson F, Roberts H, Mathews G, Ward JL, Viner RM, Nicholls D, Cornaglia F, Roland D, Phillips K, Hudson LD. Admissions to paediatric medical wards with a primary mental health diagnosis: a systematic review of the literature. Arch Dis Child 2024:archdischild-2023-326593. [PMID: 38373777 DOI: 10.1136/archdischild-2023-326593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To systematically review the literature describing children and young people (CYP) admissions to paediatric general wards because of primary mental health (MH) reasons, particularly in MH crisis. DESIGN PubMed, Embase, PsycINFO, Web of Science and Google Scholar were searched, with no restriction on country or language. We addressed five search questions to inform: trends and/or the number of admissions, the risk factors for adverse care, the experiences of CYP, families/carers and healthcare professionals (HCPs) and the evidence of interventions aimed at improving the care during admissions.Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality assessment. This review was registered with PROSPERO (CRD42022350655). RESULTS Thirty-two studies met the inclusion criteria. Eighteen addressed trends and/or numbers/proportions of admissions, 12 provided data about the views/experiences of HCPs, two provided data about CYP's experiences and four explored improving care. We were unable to identify studies examining risk factors for harm during admissions, but studies did report the length of stay in general paediatric/adult settings while waiting for specialised care, which could be considered a risk factor while caring for this group. CONCLUSIONS MH admissions to children's wards are a long-standing issue and are increasing. CYP will continue to need to be admitted in crisis, with paediatric wards a common location while waiting for assessment. For services to be delivered effectively and for CYP and their families/carers to feel supported and HCPs to feel confident, we need to facilitate more integrated physical and MH pathways of care. PROSPERO REGISTRATION NUMBER CRD42022350655.
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Affiliation(s)
- Adriana Vázquez-Vázquez
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Abigail Smith
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Faith Gibson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- University of Surrey, Guildford, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Helen Roberts
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Gabrielle Mathews
- CYP Transformation Team, NHS England and NHS Improvement London, London, UK
| | - Joseph Lloyd Ward
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
| | | | - Damian Roland
- SAPPHIRE Group, Population Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Kirsty Phillips
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lee D Hudson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
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Taylor RM, Whelan JS, Barber JA, Alvarez-Galvez J, Feltbower RG, Gibson F, Stark DP, Fern LA. The Impact of Specialist Care on Teenage and Young Adult Patient-Reported Outcomes in England: A BRIGHTLIGHT Study. J Adolesc Young Adult Oncol 2024. [PMID: 38285524 DOI: 10.1089/jayao.2023.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Purpose: In England, health care policy promotes specialized age-appropriate cancer services for teenagers and young adults (TYA), for those aged 13-24 years at diagnosis. Specialist Principal Treatment Centers (PTCs) provide enhanced age-specific care for TYA, although many still receive all or some of their care in adult or children's cancer services. Our aim was to determine the patient-reported outcomes associated with TYA-PTC based care. Methods: We conducted a multicenter cohort study, recruiting 1114 TYA aged 13-24 years at diagnosis. Data collection involved a bespoke survey at 6,12,18, 24, and 36 months after diagnosis. Confounder adjusted analyses of perceived social support, illness perception, anxiety and depression, and health status, compared patients receiving NO-TYA-PTC care with those receiving ALL-TYA-PTC and SOME-TYA-PTC care. Results: Eight hundred and thirty completed the first survey. There was no difference in perceived social support, anxiety, or depression between the three categories of care. Significantly higher illness perception was observed in the ALL-TYA-PTC and SOME-TYA-PTC group compared to the NO-TYA-PTC group, (adjusted difference in mean (ADM) score on Brief Illness Perception scale 2.28 (95% confidence intervals [CI] 0.48-4.09) and 2.93 [1.27-4.59], respectively, p = 0.002). Similarly, health status was significantly better in the NO-TYA-PTC (ALL-TYA-PTC: ADM -0.011 [95%CI -0.046 to 0.024] and SOME-TYA-PTC: -0.054 [-0.086 to -0.023]; p = 0.006). Conclusion: The reason for the difference in perceived health status is unclear. TYA who accessed a TYA-PTC (all or some care) had higher perceived illness. This may reflect greater education and promotion of self-care by health care professionals in TYA units.
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Affiliation(s)
- Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Julie A Barber
- Department of Statistical Science, University College London, London, United Kingdom
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Faith Gibson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Dan P Stark
- Leeds Institute of Medical Research at St James's, Leeds, United Kingdom
| | - Lorna A Fern
- Cancer Clinical Trials Unit, University Hospitals London, London, United Kingdom
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Hudson LD, Ward J, Vázquez-Vázquez A, Settle K, Cornaglia F, Gibson F, Phillips K, Mathews G, Roberts H, Roland D, Nicholls DE, Elphinstone H, Viner R. Mental Health Admissions to Paediatric Wards Study (MAPS): a protocol for the analysis of Hospital Episode Statistics (HES) data. BMJ Paediatr Open 2024; 8:e002352. [PMID: 38286521 DOI: 10.1136/bmjpo-2023-002352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/25/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to an MH crisis, and there have been longstanding concerns about the quality of care to support these patients in this setting. Mental Health Admissions to Paediatric Wards Study aims to generate a theory of change (ToC) model to improve the quality of care for CYP admitted to acute paediatric services after presenting in a MH crisis. METHODS AND ANALYSIS We will undertake a national (England), sequential, mixed methods study to inform a ToC framework alongside a stakeholder group consisting of patients, families/carers and healthcare professionals (HCPs). Our study consists of four work packages (WP) undertaken over 30 months. WP1 is limited to using national routine administrative data to identify and characterise trends in MH admissions in acute paediatric wards in England between 2015- 2022. ETHICS AND DISSEMINATION WP1 received ethical approval (Ref 23/NW/0192). We will publish the overall synthesis of data and the final ToC to improve care of CYP with MH crisis admitted to general acute paediatric settings. As coproducers of the ToC, we will work with our stakeholder group to ensure wide dissemination of findings. Potential impacts will be on service development, new models of care, training and workforce planning.
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Affiliation(s)
- Lee Duncan Hudson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Joseph Ward
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Adriana Vázquez-Vázquez
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kate Settle
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Faith Gibson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
- University of Surrey, Guildford, UK
| | - Kirsty Phillips
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Gabrielle Mathews
- CYP Transformation Team, NHS England and NHS Improvement London, London, UK
| | - Helen Roberts
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Damian Roland
- SAPPHIRE Group, Population Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | | | - Holly Elphinstone
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Russell Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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8
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Hudson LD, Vázquez-Vázquez A, Gibson F, Phillips K, Mathews G, Roberts H, Cornaglia F, Roland D, Ward J, Nicholls DE, Elphinstone H, Viner R. Mental Health Admissions to Paediatric Wards Study (MAPS): protocol of a prospective study of mental health admissions to paediatric wards in England using surveillance and qualitative methods. BMJ Paediatr Open 2024; 8:e002186. [PMID: 38272539 PMCID: PMC10824001 DOI: 10.1136/bmjpo-2023-002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to an MH crisis, and there have been longstanding concerns about the quality of care to support these patients in this setting. MAPS aims to generate a Theory of Change (ToC) model to improve the quality of care for CYP admitted to acute paediatric services after presenting with an MH crisis. Here, we describe work packages (WPs) 2 and 3 of the study, which have been granted ethics approval. METHODS AND ANALYSIS We will undertake a national (England), sequential, mixed-methods study to inform a ToC framework alongside a stakeholder group consisting of patients, families/carers and healthcare professionals (HCPs). Our study consists of four WPs undertaken over 30 months. WP2 is limited to working with stakeholders to develop a data collection instrument and then use this in a prospective study of MH admissions over 6 months in 15 purposively recruited acute paediatric wards across England. WP3 consists of gathering the views of CYP, their families/carers and HCPs during admissions using semistructured interviews. ETHICS AND DISSEMINATION WP2 and WP3 received ethical approval (ref: 23/LO/0349). We will publish the overall synthesis of data and the final ToC to improve care of CYP with MH crisis admitted to general acute paediatric settings. As co-producers of the ToC, we will work with our stakeholder group to ensure wide dissemination of findings. Potential impacts will be upon service development, new models of care, training and workforce planning. PROSPERO REGISTRATION NUMBER CRD42022350655.
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Affiliation(s)
- Lee Duncan Hudson
- University College London Great Ormond Street Institute of Child Health, London, UK
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Adriana Vázquez-Vázquez
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Faith Gibson
- University College London Great Ormond Street Institute of Child Health, London, UK
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Kirsty Phillips
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Gabrielle Mathews
- CYP Transformation Team, NHS England and NHS Improvement London, London, UK
| | - Helen Roberts
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Damian Roland
- SAPPHIRE Group, Population Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Joseph Ward
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Holly Elphinstone
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Russell Viner
- University College London Great Ormond Street Institute of Child Health, London, UK
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Sipanoun P, Aldiss S, Porter L, Morgan S, Powell E, Gibson F. Transition of young people from children's into adults' services: what works for whom and in what circumstances - protocol for a realist synthesis. BMJ Open 2024; 14:e076649. [PMID: 38176872 PMCID: PMC10773364 DOI: 10.1136/bmjopen-2023-076649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The process of transitioning young people from children's or adolescents' health services into adults' services is a crucial time in the lives and health of young people and has been reported to be disjointed rather than a process of preparation in which they are involved. Such transitions not only fail to meet the needs of young people and families at this time of significant change, but they may also result in a deterioration in health, or disengagement with services, which can have deleterious long-term consequences. Despite the wealth of literature on this topic, there has yet to be a focus on what works for whom, in what circumstances, how and why, in relation to all young people transitioning from children's into adults' services, which this realist synthesis aims to address. METHODS AND ANALYSIS This realist synthesis will be undertaken in six stages: (1) the scope of the review will be defined; (2) initial programme theories (IPTs) developed; (3) evidence searched; (4) selection and appraisal; (5) data extraction and synthesis; and (6) finally, refine/confirm programme theory. A theory-driven, iterative approach using the 'On Your Own Feet Ahead' theoretical framework, will be combined with an evidence search including a review of national transition policy documents, supplemented by citation tracking, snowballing and stakeholder feedback to develop IPTs. Searches of EMBASE, EMCARE, Medline, CINAHL, Cochrane Library, Web of Science, Scopus, APA PsycINFO and AMED will be conducted from 2014 to present, supplemented with grey literature, free-text searching (title, abstract and keywords) and citation tracking. Data selection will be based on relevance and rigour and extracted and synthesised iteratively with the aim of identifying and exploring causal links between contexts, mechanisms and outcomes. Results will be reported according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards Quality and Publication Standards. ETHICS AND DISSEMINATION This realist synthesis forms part of the National Transition Evaluation Study, which has received ethical and regulatory approval (IRAS ID: 313576). Results will be disseminated through peer-review publication, conference presentations and working with healthcare organisations, stakeholder groups and charities. TRIAL REGISTRATION NUMBER NCT05867745. PROSPERO REGISTRATION NUMBER CRD42023388985.
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Affiliation(s)
- Pippa Sipanoun
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital, London, UK
- UCL Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Louise Porter
- The Burdett National Transition Nursing Network, England
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sue Morgan
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Powell
- The Burdett National Transition Nursing Network, England
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital, London, UK
- UCL Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, London, UK
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10
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Oulton K, Gibson F, Kenten C, Russell J, Carr L, Hassiotis A, Kelly P, Kerry S, Tuffrey-Wijne I, Whiting M, Wray J. Being a child with intellectual disabilities in hospital: The need for an individualised approach to care. J Appl Res Intellect Disabil 2024; 37:e13153. [PMID: 37792824 DOI: 10.1111/jar.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND There is limited qualitative research focussed specifically on what it is like for children and young people with intellectual disabilities coming into hospital, with much of the evidence-base being about those with Autism Spectrum Condition or adults with intellectual disabilities. AIM To share rich detail of the emotional and physical impact on children and young people with intellectual disabilities of attending hospital, from their own and their parent's perspective. METHODS Talking Mats interviews, sticker survey and photography with children and young people with intellectual disabilities, and in-depth interviews, hospital diaries and photography with their parents. RESULTS AND CONCLUSIONS The multiple and compounding layers of complexity surrounding hospital care of children and young people with intellectual disabilities resulted in challenges associated with loss of familiarity and routine, undergoing procedures, managing sensory overload, managing pain and having a lack of safety awareness. An individualised approach to their care is needed.
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Affiliation(s)
- Kate Oulton
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Charlotte Kenten
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Jessica Russell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucinda Carr
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Angela Hassiotis
- UCL Division of Psychiatry, University College London, London, UK
| | - Paula Kelly
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sam Kerry
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Mark Whiting
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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11
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Aldiss S, Hollis R, Phillips B, Ball-Gamble A, Brownsdon A, Chisholm J, Crowther S, Dommett R, Gower J, Hall NJ, Hartley H, Hatton J, Henry L, Langton L, Maddock K, Malik S, McEvoy K, Morgan JE, Morris H, Parke S, Picton S, Reed-Berendt R, Saunders D, Stewart A, Tarplee-Morris W, Walsh A, Watkins A, Weller D, Gibson F. Research priorities for children's cancer: a James Lind Alliance Priority Setting Partnership in the UK. BMJ Open 2023; 13:e077387. [PMID: 38128939 DOI: 10.1136/bmjopen-2023-077387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES To engage children who have experienced cancer, childhood cancer survivors, their families and professionals to systematically identify and prioritise research questions about childhood cancer to inform the future research agenda. DESIGN James Lind Alliance Priority Setting Partnership. SETTING UK health service and community. METHODS A steering group oversaw the initiative. Potential research questions were collected in an online survey, then checked to ensure they were unanswered. Shortlisting via a second online survey identified the highest priority questions. A parallel process with children was undertaken. A final consensus workshop was held to determine the Top 10 priorities. PARTICIPANTS Children and survivors of childhood cancer, diagnosed before age 16, their families, friends and professionals who work with this population. RESULTS Four hundred and eighty-eight people submitted 1299 potential questions. These were refined into 108 unique questions; 4 were already answered and 3 were under active study, therefore, removed. Three hundred and twenty-seven respondents completed the shortlisting survey. Seventy-one children submitted questions in the children's surveys, eight children attended a workshop to prioritise these questions. The Top 5 questions from children were taken to the final workshop where 23 questions in total were discussed by 25 participants (young adults, carers and professionals). The top priority was 'can we find effective and kinder (less burdensome, more tolerable, with fewer short and long-term effects) treatments for children with cancer, including relapsed cancer?' CONCLUSIONS We have identified research priorities for children's cancer from the perspectives of children, survivors, their families and the professionals who care for them. Questions reflect the breadth of the cancer experience, including diagnosis, relapse, hospital experience, support during/after treatment and the long-term impact of cancer. These should inform funding of future research as they are the questions that matter most to the people who could benefit from research.
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Affiliation(s)
- Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Bob Phillips
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Hull-York Medical School and Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Alex Brownsdon
- Patient Representative on the Children's Cancer Priority Setting Partnership Steering Group, London, UK
| | - Julia Chisholm
- The Royal Marsden NHS Foundation Trust, Sutton, UK
- Institute of Cancer Research Sutton, Sutton, UK
| | - Scott Crowther
- Parent Representative on the Children's Cancer Priority Setting Partnership Steering Group, Coventry, UK
| | | | - Jonathan Gower
- James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, Southampton, UK
| | - Nigel J Hall
- Southampton Children's Hospital, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Helen Hartley
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jenni Hatton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Louise Henry
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Loveday Langton
- Parent Representative on the Children's Cancer Priority Setting Partnership Steering Group, London, UK
| | | | | | - Keeley McEvoy
- Medical Needs Teaching Service, Leeds Children's Hospital, Leeds, UK
| | - Jessica Elizabeth Morgan
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Helen Morris
- Children, Teenage and Young Adult Cancer Operational Delivery Network, South West, Bristol, UK
| | - Simon Parke
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Rosa Reed-Berendt
- Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dan Saunders
- The Christie NHS Foundation Trust, Manchester, UK
| | - Andy Stewart
- Parent Representative on the Children's Cancer Priority Setting Partnership Steering Group, Perth, UK
| | | | - Amy Walsh
- Parent Representative on the Children's Cancer Priority Setting Partnership Steering Group, Keswick, UK
| | - Anna Watkins
- Parent Representative on the Children's Cancer Priority Setting Partnership Steering Group, London, UK
| | - David Weller
- The University of Edinburgh, Edinburgh Medical School, Edinburgh, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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12
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Aldiss S, Hart-Spencer P, Langton L, Malik S, McEvoy K, Morgan JE, Reed-Berendt R, Hollis R, Phillips B, Gibson F. What matters to you? Engaging with children in the James Lind Alliance Children's Cancer Priority Setting Partnership. Res Involv Engagem 2023; 9:110. [PMID: 38037183 PMCID: PMC10688066 DOI: 10.1186/s40900-023-00518-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Previous priority setting exercises have sought to involve children, but in the final reporting, it is evident that few children had been engaged through the process. A primary aim in the Children's Cancer Priority Setting Partnership was to find out from children what they want research to focus on. We report on our experience to inform methods of engagement with children in future James Lind Alliance Priority Setting Partnerships and similar exercises. METHODS We followed the James Lind Alliance process, collecting and shortlisting questions via online surveys with adult survivors of childhood cancer, carers, and professionals, and holding a final workshop. Alongside this, a parallel process to collect and prioritise questions from children was undertaken. We created animations for parents/carers to explain the project and surveys to children, gathered questions via online surveys and held a workshop with children to identify their priorities. RESULTS Sixty-one children and young people with cancer and 10 siblings, aged 3-21 years, submitted 252 potential questions/topics via the surveys. Submissions were refined into 24 summary questions. These questions were discussed at a workshop with eight children; they also added more questions on topics of importance to them. Workshop participants prioritised the Top 5 questions; top priority was, 'How can we make being in hospital a better experience for children and young people? (like having better food, internet, toys, and open visiting so other family members can be more involved in the child's care)'. The Top 5 also included cancer prevention, treatments closer to home, early diagnosis, and emotional support. These questions were taken to the final workshop at which the Top 10 priorities were decided, all five children's priorities were reflected in the final Top 10. CONCLUSIONS We have demonstrated that it is possible to successfully involve children directly in setting priorities for future research. Future priority setting exercises on topics relevant to children, should seek to include their views. The Children's Cancer Top 10 priorities reflect the voices of children and should inform the funding of future research.
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Affiliation(s)
- Susie Aldiss
- School of Health Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Surrey Research Park, Guildford, GU2 7YH, UK.
| | | | - Loveday Langton
- Children's Cancer Priority Setting Partnership Steering Group, London, UK
| | | | - Keeley McEvoy
- Medical Needs Teaching Service, Leeds Children's Hospital, Leeds, UK
| | - Jessica E Morgan
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Rosa Reed-Berendt
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | | | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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13
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Peat G, Delaney SA, Gibson F, Fraser LK, Brierley J. Shared decision-making experiences in child long-term ventilation: a systematic review. Eur Respir Rev 2023; 32:230098. [PMID: 37611948 PMCID: PMC10445106 DOI: 10.1183/16000617.0098-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/23/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Recent decades have seen an increase in children receiving long-term ventilation. To ensure that long-term ventilation decisions incorporate the perspectives of stakeholders, it is vital that empirical evidence is gathered to substantiate frameworks and guidance on shared decision-making for long-term ventilation. This systematic review and qualitative evidence synthesis aimed to clarify what shared decision-making constitutes in relation to long-term ventilation initiation for children and young people (<21 years). METHODS A systematic review of qualitative research was undertaken. Searches were conducted in MEDLINE, Embase, CINAHL, PsycINFO and Web of Science. RESULTS Findings from 13 studies were included representative of 363 caregivers and 143 healthcare professional experiences. Components that support shared decision-making included acknowledging the unique positionality of caregivers and ensuring caregivers were informed about the implications of long-term ventilation. Beneficial qualities of engagement between stakeholders included honest, clear and timely dialogue using lay, tactful and sensitive language. CONCLUSION Our findings clarify components and approaches supportive of shared decision-making in discussions about long-term ventilation. This review therefore provides a valuable resource to implement shared decision-making practices in the context of long-term ventilation decisions for children and young people.
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Affiliation(s)
- George Peat
- Department of Health Sciences, University of York, York, UK
- Collaborative Paediatric Palliative Care Research Network
| | | | - Faith Gibson
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Lorna K Fraser
- Collaborative Paediatric Palliative Care Research Network
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Kings College, London, UK
| | - Joe Brierley
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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14
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Patel P, Robinson PD, van der Torre P, Tomlinson D, Seelisch J, Oberoi S, Morgan JE, Hinds PS, Götte M, Gibson F, Duong N, Davis H, Culos-Reed SN, Cataudella D, Miranda V, Dupuis LL, Sung L. Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update. EClinicalMedicine 2023; 63:102147. [PMID: 37609066 PMCID: PMC10440444 DOI: 10.1016/j.eclinm.2023.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
Objective was to update a clinical practice guideline (CPG) for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients. We reconvened a multi-disciplinary and multi-national panel. While the previous 2018 CPG evaluated adult and pediatric randomized controlled trials (RCTs) to manage fatigue, this 2023 update revised previous recommendations based only on pediatric RCTs. Twenty RCTs were included in the updated systematic review. Physical activity significantly reduced fatigue (standardized mean difference -0.44, 95% confidence interval -0.64 to -0.24; n = 8 RCTs). Using the 2018 recommendations as a basis, the panel continued to make strong recommendations to use physical activity, and to offer relaxation, mindfulness or both, to manage fatigue in pediatric patients. Cognitive or cognitive behavioral therapies may be offered. Pharmacological approaches should not be routinely used. The panel made a new good practice statement to routinely assess for fatigue, ideally using a validated scale.
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Affiliation(s)
- Priya Patel
- Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
| | - Paula D. Robinson
- Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada
| | - Patrick van der Torre
- Sport and Exercise Center, Princess Máxima Center for Pediatric Oncology, Utrecht 3584CS, the Netherlands
| | - Deborah Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
| | - Jennifer Seelisch
- Division of Hematology/Oncology, Children’s Hospital London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, Max Rady College of Medicine, CancerCare Manitoba, University of Manitoba, 675 McDermot Ave, Winnipeg, MB R3E 0V9, Canada
| | - Jessica E. Morgan
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
- Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds LS1 3EX, UK
| | - Pamela S. Hinds
- Department of Nursing Science, Professional Practice, and Quality, Children's National Health System, Washington, DC, USA
- Department of Pediatrics, George Washington University, 111 Michigan Ave NW, Washington, DC 20010, USA
| | - Miriam Götte
- University Hospital Essen, West German Cancer Center, Hufelandstraße 55, Essen 45147, Germany
| | - Faith Gibson
- Centre for Outcomes and Experiences Research in Children's Health, Illness, and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- School of Health Sciences, University of Surrey, 388 Stag Hill, Guildford GU2 7XH, UK
| | | | | | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - Danielle Cataudella
- Department of Pediatric Psychology, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
| | - Vanessa Miranda
- Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
| | - L. Lee Dupuis
- Department of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
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Molassiotis A, Yorke J, McCarthy AL, Wengstrom Y, Gibson F, Abu-Odah H. The Evolution of Worldwide Nurse-Led Cancer Research in the Last 2 Decades (2004-2022): A Bibliometric Mapping and Visual Analysis. Cancer Nurs 2023:00002820-990000000-00164. [PMID: 37552219 DOI: 10.1097/ncc.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Research led by nurses has evolved rapidly over the last 2 decades globally. Assessing the work that has been conducted so far can help the specialty to strategically shape future directions of nurse-led cancer research. OBJECTIVE The aim of this study was to provide a comprehensive, up-to-date synthesis of all nurse-led cancer research published articles over 20 years. METHODS A bibliometric analysis was used. Three databases were used to retrieve nurse-led cancer research publications for the period from January 1, 2004, to March 11, 2022. RESULTS A total of 7043 original articles were retrieved. A significant increase in nurse-led cancer research over the past 2 decades was evident. The United States and United Kingdom were the most productive countries in terms of the number of published articles. Minimal international collaboration was observed among low- or middle-income countries versus high-income countries. Breast cancer, palliative care, and quality of life received the most attention in nurse-led cancer research, followed by education, pain, and communication. Very few publications addressed cancer prevention, breaking bad news, and cancer rehabilitation. CONCLUSION Areas to consider in the future include more international collaborations on commonly agreed research agendas, capacity building to allow more research beyond the few countries that dominate the publications, and more focus on low- or middle-income countries. IMPLICATIONS FOR PRACTICE The findings of this study provide direction for future research led by cancer nurses and the areas that warrant further investigation.
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Affiliation(s)
- Alex Molassiotis
- Author Affiliations: School of Nursing, The Hong Kong Polytechnic University (Drs Molassiotis and Abu-Odah), Hong Kong SAR; Health and Social Care Research Centre, University of Derby (Dr Molassiotis), United Kingdom; School of Health Sciences, University of Manchester (Dr Yorke), United Kingdom; The Christie NHS Foundation Trust (Dr Yorke); School of Nursing, Midwifery & Social Work, University of Queensland (Dr McCarthy), Brisbane, Australia; Division of Neurobiology, Care Sciences & Society, Karolinska Institute, Karolinska Comprehensive Cancer Center, Karolinska University Hospital (Dr Wengstrom), Stockholm, Sweden; and School of Health Sciences, University of Surrey (Dr Gibson); and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust (Dr Gibson), London, United Kingdom
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Serjeant GR, Serjeant BE, Mason KP, Gibson F, Gardner RA, Warren L, Reid M, Happich M, Kulozik AE. The beta thalassaemia trait in Jamaica. J Community Genet 2023; 14:355-360. [PMID: 37391652 PMCID: PMC10444720 DOI: 10.1007/s12687-023-00657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/25/2023] [Indexed: 07/02/2023] Open
Abstract
The objective of this study was to review the prevalence and features of the beta thalassaemia trait in Jamaican populations. Screening of 221,306 newborns over the last 46 years has given an indication of the distribution and prevalence of beta thalassaemia genes, and screening of 16,612 senior school students in Manchester parish, central Jamaica, has provided their haematological features. The prevalence of the beta thalassaemia trait predicted from double heterozygotes was 0.8% of 100,000 babies in Kingston, 0.9% of 121,306 newborns in southwest Jamaica, and 0.9% of school students in Manchester. Mild beta+ thalassaemia variants (-88 C>T, -29 A>G, -90 C>T, polyA T>C) accounted for 75% of Kingston newborns, 76% of newborns in southwest Jamaica, and 89% of Manchester students. Severe beta+ thalassaemia variants were uncommon. Betao thalassaemia variants occurred in 43 patients and resulted from 11 different variants of which the IVSII-849 A>G accounted for 25 (58%) subjects. Red cell indices in IVSII-781 C>G did not differ significantly from HbAA, and this is probably a harmless polymorphism rather than a form of beta+ thalassaemia; the removal of 6 cases in school screening had a minimal effect on the frequency of the beta thalassaemia trait. Red cell indices in the beta+ and betao thalassaemia traits followed established patterns, although both were associated with increased HbF levels. The benign nature of beta+ thalassaemia genes in Jamaica means that cases of sickle cell-beta+ thalassaemia are likely to be overlooked, and important clinical questions such as the role of pneumococcal prophylaxis remain to be answered.
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Affiliation(s)
- G R Serjeant
- Sickle Cell Trust, 14 Milverton Cres, Kingston 6, Jamaica.
| | - B E Serjeant
- Sickle Cell Trust, 14 Milverton Cres, Kingston 6, Jamaica
| | - K P Mason
- Sickle Cell Trust, 14 Milverton Cres, Kingston 6, Jamaica
| | - F Gibson
- Sickle Cell Trust, 14 Milverton Cres, Kingston 6, Jamaica
| | - R-A Gardner
- Sickle Cell Trust, 14 Milverton Cres, Kingston 6, Jamaica
| | - L Warren
- Sickle Cell Trust, 14 Milverton Cres, Kingston 6, Jamaica
| | - M Reid
- Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
| | - M Happich
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Heidelberg, Germany
| | - A E Kulozik
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Heidelberg, Germany
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Aldiss S, Gibson F, Vindrola-Padros C, Wray J, Kelly P. 'They could not see our eyes, they cannot see our faces, they do not know who we are and that is hard': a qualitative interview study with staff caring for children and families in a UK specialist children's hospital during the COVID-19 pandemic. BMJ Open 2023; 13:e070048. [PMID: 37316313 DOI: 10.1136/bmjopen-2022-070048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Despite lower rates of illness, morbidity and mortality associated with SARS-CoV-2 infection in children during the COVID-19 pandemic, their health and well-being has been significantly impacted. Emerging evidence indicates that this includes experiences of hospital-based care for them and their families. As part of a series of multisite research studies to undertake a rapid appraisal of perceptions of hospital staff, working during the pandemic, our study focused on clinical and non-clinical staff perceptions of the impact of COVID-19 on aspects of care delivery, preparedness and staffing specific to a specialist children's hospital. DESIGN Qualitative study using a qualitative rapid appraisal design. Hospital staff participated in a telephone interview. We used a semistructured interview guide, and recorded and transcribed all interviews. Rapid Research Evaluation and Appraisal Lab Rapid Assessment Procedure sheets were used to share data; team-based analysis was facilitated using a framework approach. SETTING Specialist children's hospital in London, UK. PARTICIPANTS Thirty-six staff representing a range of roles within the hospital: 19 (53%) nurses, 7 (19%) medical staff and 10 (28%) other staff groups (including radiographers, managers, play staff, schoolteachers, domestic and portering staff and social workers). RESULTS Three overarching themes relating to staff perceptions of the impact on children and families were identified, each containing subthemes: (1) same hospital but different for everyone, (2) families paid the price and (3) the digital world. They illustrated that providing care and treatment for children and families changed profoundly during the pandemic, particularly during lockdown periods. Adaptations to deliver clinical care, play, schooling and other therapies online were rapidly put into action; however, benefits were not universal or always inclusive. CONCLUSIONS The disruption to a central principle of children's hospital care-the presence and involvement of families-was of critical concern to staff, suggesting a need for the specific impact of COVID-19 on children's services to be accounted for.
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Affiliation(s)
- Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Cecilia Vindrola-Padros
- Rapid Research Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paula Kelly
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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18
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Harris J, Ream E, Armes J, Gibson F, Marcu A, Parsons CT, Robinson A, Varghese S, Poole K. What do we know about the psychosocial issues associated with cancer during pregnancy? A scoping review and gap analysis. BMJ Open 2023; 13:e063283. [PMID: 36868601 PMCID: PMC9990617 DOI: 10.1136/bmjopen-2022-063283] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES There is a global increase in the number of women diagnosed with cancer during their pregnancy and a nascent evidence base to guide their supportive care. The purposes of this study were to (1) map research on the psychosocial issues affecting women and their partners on diagnosis and treatment for cancer during pregnancy; (2) determine available supportive care or educational interventions; and (3) identify knowledge gaps for future research and development. DESIGN Scoping review. SEARCH STRATEGY Six databases were searched (Scopus, CINAHL, PsycINFO, Medline, Intermid, Maternal and Infant Health) to retrieve primary research (January 1995 to November 2021) investigating women and/or their partner's decision-making and their psychosocial outcomes during and after pregnancy. DATA EXTRACTION AND SYNTHESIS Sociodemographic, gestational and disease characteristics of participants and psychosocial issues identified were extracted. Leventhal's self-regulatory model of illness provided a framework for mapping study findings enabling evidence synthesis and gap analysis. RESULTS Twelve studies were included, conducted in eight countries in six continents. Most women (70% of 217) were diagnosed with breast cancer during pregnancy. Reporting of sociodemographic, psychiatric, obstetric and oncological characteristics that are important in assessing psychosocial outcomes was inconsistent. None of the studies had a longitudinal design and no supportive care or educational interventions were identified. The gap analysis highlighted the lack of evidence about pathways to diagnosis, impact of late effects and how internal/social resources may affect outcomes. CONCLUSIONS Research has focused on women with gestational breast cancer. Little is known about those diagnosed with other cancers. We encourage future study designs to capture data on sociodemographic, obstetric, oncological and psychiatric characteristics and adopt a longitudinal approach to explore the longer term psychosocial impact on women and their families. Future research should include outcomes that are meaningful for women (and their partners) and draw on international collaboration to accelerate progress in this field.
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Affiliation(s)
- Jenny Harris
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Emma Ream
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Foundation Trust (GOSH), London, UK
| | - Afrodita Marcu
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Catherine Treena Parsons
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ann Robinson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sherin Varghese
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karen Poole
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, Sutton, UK
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19
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Morgan S, Gibson F, Aldiss S, Porter L. Effective transition of young people with long-term conditions into adult services. Nurs Child Young People 2023; 35:34-42. [PMID: 35989553 DOI: 10.7748/ncyp.2022.e1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 01/07/2023]
Abstract
Healthcare transition involves the purposeful and planned process of preparing, empowering and supporting young people with long-term conditions and their families when they are moving from child to adult services. Transition is a series of events that provides the young person with the knowledge and skills they require to be able to function in adult services. Until recently little has been done to address the perceived barriers and challenges involved in transition. In this article, the authors discuss the challenges associated with effective transition and describe their experience of implementing a healthcare transition pathway using a quality improvement model.
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Affiliation(s)
- Sue Morgan
- hosted by Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, England and Great Ormond Street Hospital for Children NHS Foundation Trust, London, England
| | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, England
| | - Louise Porter
- hosted by Leeds Teaching Hospitals NHS Trust, Leeds, England
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20
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Martins A, Aldiss S, Taylor RM, Gibson F. Care coordination, consistency and continuity: the case of the key worker role in children’s cancer care. Int J Qual Stud Health Well-being 2022; 17:2092958. [PMID: 35757984 PMCID: PMC9246033 DOI: 10.1080/17482631.2022.2092958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose The overall aim was to evaluate the key worker role across principal treatment centres for children with cancer in England, Wales and Scotland. Methods Mixed-methods case study gathering data from multiple perspectives using questionnaires, interviews, focus groups and reports/performance documents over a two-year period. Framework approach was adopted to analyse transcripts and documentary data. Results Participants included: 22 nurse specialist key workers, 103 parents, 85 professionals and 10 children/young people. Qualitative and quantitative data were woven together, to best illuminate key worker services. Four main models of care were described as well as the context of care and process of care. Key working effectiveness centred around three pillars: care coordination; expert knowledge, experience and expertise; relationship. These were essential to improved family experience, emotional wellbeing, and delivery of individualized care closer to home. Conclusions The role is complex and diverse, responding to local needs. Certain conditions, (e.g., high caseload) placed limits on enacting the three pillars, diminishing the positive experience of families. When they worked well, key workers reduced the fragmented nature of services and families placed great value on keeping the same key worker from diagnosis into long-term care. Retaining these roles, where already in place, or including, if not, we would recommend, factoring into budgets to sustain and expand such roles.
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Affiliation(s)
- Ana Martins
- UCLH Cancer Clinical Trials Unit, University College London Hospitals, London, UK
| | - Susie Aldiss
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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21
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Pearson H H, Bryan G, Kayum C, Gibson F, Darlington AS. Parent values and preferences underpinning treatment decision-making in poor-prognosis childhood cancer: a scoping review. BMC Pediatr 2022; 22:595. [PMID: 36229792 PMCID: PMC9563461 DOI: 10.1186/s12887-022-03635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Parents of children who are diagnosed with a poor-prognosis cancer want to be involved in making treatment-related decisions for their child. They often make repeated decisions depending on their child’s response to treatment and can experience decisional regret as a consequence. Understanding parent values and preferences when making treatment-related decisions may help enhance discussions with healthcare professionals and identify additional ways of providing support to this parent population. Objectives To explore parent values and preferences underpinning treatment decision-making for children receiving cancer-directed therapy for a poor prognosis cancer. Methods A scoping review of research literature and systematic reviews from qualitative, quantitative, and mixed methods studies was conducted following Joanna Briggs Institute methodology. Articles which included parents of a child who received cancer-directed therapy for a poor-prognosis childhood cancer, under the age of eighteen years were considered. Four electronic databases were searched (CINAHL, Medline, PsychINFO, Web of Science Core Collections). Reference and citation lists of all included full-text articles were also searched. Summative content analysis was used to synthesise findings and develop themes. Results Twelve articles were included. Parent decision-making was affected by underpinning factors: hope for a cure, fear of their child dying and uncertainty. Influencing factors: opinions of others, child’s wishes, and faith and religion had the potential to inform decision-making processes. Parents valued having enough time, being a good parent and being involved in decision-making. Preferences within these values varied resulting in the potential for conflict and ‘trade-offs’ in making decisions. Conclusions Parent decision-making in poor-prognosis childhood cancer is complex and extends beyond values and preferences. Underpinning factors and values are consistent through the decision-making process with influencing factors and preferences varying between parents. Preferences can conflict when parents want to continue cancer-directed therapy whilst maintaining their child’s quality of life or can change depending on a parents’ cognitive state as they realise cure might be unlikely.
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Affiliation(s)
- Helen Pearson H
- School of Health Sciences, University of Southampton, Southampton, UK. .,The Oak Centre for Children and Young People, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, Surrey, UK.
| | - Gemma Bryan
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Catherine Kayum
- Member of the Parent and Carer Group, Patient Public Involvement, London, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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22
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Henry L, Aldiss S, Gibson F, Pugh G, Stevens M. Nutritional assessment and dietetic resource for children and young people with cancer in the United Kingdom. Pediatr Blood Cancer 2022; 69:e29743. [PMID: 35484958 DOI: 10.1002/pbc.29743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Both under- and overnutrition may have adverse impact on outcome of cancer in children and teenagers/young adults (CTYA). Previous studies confirm that screening for nutritional risk and detection of nutritional abnormality is inconsistently undertaken in practice. METHODS We undertook a survey of dietetic resource and nutritional assessment in CTYA principal treatment centres (PTC) in the United Kingdom. Responses were received from 95% children's and 69% TYA PTC. RESULTS Only 13/18 (72%) children's PTC, and one of 11 (9%) TYA PTC, met national standards for dietetic resource; one of 18 (6%) paediatric and six of 11(54%) TYA PTC had no such resource. While resources were greater in larger paediatric PTC, who were also most likely to undertake stem cell transplantation, resources in TYA PTC were too low to assess relationship to centre size. Most centres focused resources on inpatient care and <50% considered staffing adequate; 82% used nutritional screening tools but without consistency in the tool used. Weight and height were the principal method for assessment, but with inconsistency in the frequency of measurement and use in different clinical settings. Measures derived from weight and height, including body mass index (BMI), were inconsistently utilised. The use of arm anthropometry was rare despite evidence that use increases recognition of undernutrition. Detailed nutritional assessment was infrequently attempted. CONCLUSION Barriers to adequate nutritional assessment and treatment for all patients include resource limitations (particularly TYA), training for staff, and uncertainty about detailed assessment of nutritional status. There is a need to harmonise screening and assessment of nutritional status in CTYA with cancer.
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Affiliation(s)
- Louise Henry
- Department of Nutrition and Dietetics, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Susie Aldiss
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Gemma Pugh
- National Child Cancer Network, Te Aho o Te Kahu Cancer Control Agency, Wellington, New Zealand
| | - Michael Stevens
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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- https://cancerandnutrition.nihr.ac.uk
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23
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Airdrie J, Geagan C, Davies N, Powers K, Wright I, Borrill H, Gibson F, Clifford S, Lowis S, Bailey S, Limond J, Owen R, Grundy R, Lemon J, Hayes L, Malins S, Thomas S. QOL-34. The relationship between Psychological Flexibility, Quality-of-Life and psychological health in young people who have experienced a brain tumour. Neuro Oncol 2022. [PMCID: PMC9164668 DOI: 10.1093/neuonc/noac079.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite increasing survival rates in young people who have experienced a brain tumour, this patient group have the poorest reported quality-of-life (QoL) of all cancer survivors. QoL is defined as an individual’s perception of their position in life in relation to their goals, expectations and standards. QoL can be influenced by physical functioning but one of its strongest predictors is psychological health. A concept that has a large impact on psychological health is Psychological Flexibility (PF). PF refers to the ability to recognise and adapt to situations, shift cognitive and behavioural repertoires which are impacting negatively on personal and social functioning and commit to behaviours that are in line with strongly held values. Studies have demonstrated a relationship between PF and QoL in other patient populations such as chronic pain and breast cancer survivors. In this study we explored the relationship between PF and QoL at baseline in a sample of young people enrolled in a randomised controlled trial of Acceptance and Commitment Therapy (ACT) for young people who have experienced a brain tumour. We found that higher PF was associated with higher QoL in both 11-15 year olds (R2 = .69, p < .05) and 16 – 24 year olds (R2 = .29, p < .01). We also found higher PF was associated with lower levels of mental health difficulties (R2s ≥ .24, ps < .01) which was also associated with higher levels of QoL (R2 = .49 , p < .01). The results suggest assessing and providing support to increase PF is important for young people who have experienced a brain tumour. It highlights that interventions found to increase PF, such as ACT, could be helpful in improving psychological health in this population.
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Affiliation(s)
- Jac Airdrie
- University Hospitals Bristol and Weston , Bristol , United Kingdom
| | - Chloe Geagan
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust , Newcastle , United Kingdom
| | - Nicholas Davies
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Katie Powers
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Ingram Wright
- University Hospitals Bristol and Weston , Bristol , United Kingdom
- University of Bristol , Bristol , United Kingdom
| | - Heather Borrill
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust , Newcastle , United Kingdom
| | - Faith Gibson
- University of Surrey , Surrey , United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) , London , United Kingdom
| | | | - Stephen Lowis
- University Hospitals Bristol and Weston , Bristol , United Kingdom
- University of Bristol , Bristol , United Kingdom
| | - Simon Bailey
- University of Newcastle , Newcastle , United Kingdom
| | | | - Ray Owen
- Wye Valley NHS Trust , Hereford , United Kingdom
| | - Richard Grundy
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
- Children’s Brain Tumour Research Centre, University of Nottingham , Nottingham , United Kingdom
| | - James Lemon
- NHS Dumfries and Galloway , Dumfries , United Kingdom
| | | | - Sam Malins
- Children’s Brain Tumour Research Centre, University of Nottingham , Nottingham , United Kingdom
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Sophie Thomas
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
- Children’s Brain Tumour Research Centre, University of Nottingham , Nottingham , United Kingdom
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24
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Powers K, Airdrie J, Thomas S, Gibson F, Geagan C, Davies N, Malins S. QOL-26. Exploring the experience of young people receiving remotely delivered Acceptance and Commitment Therapy following treatment for a brain tumour. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Despite high survival rates of children and young people diagnosed with a brain tumour, survival is often associated with poor psychological, physical, and social outcomes. Acceptance and Commitment Therapy (ACT) is an evidence-based psychological intervention shown to improve psychological and physical outcomes in adults and children with chronic disease, including cancer. The ACT Now study investigates the feasibility of ACT delivered remotely with young people who have experienced a brain tumour. This study aims to describe participant experience whilst better understanding the impact of therapy and capturing the barriers and facilitators to engagement. Participants of the ACT Now study were invited to take part in a semi-structured interview with questions covering experience of study initiation, receipt of ACT, remote delivery and overall impact of ACT. Ten participants who had previously undergone treatment for a brain tumour have been interviewed to date. Interviews were transcribed verbatim and coded into broad themes. We found that pre-therapy mood and altruism served as motivation for interviewees’ involvement in the study. Interviewees reported hoping to learn coping techniques to navigate fluctuating moods and the pressures of young adult life. Despite the technology used for remote delivery occasionally malfunctioning, interviewees reported increased ability to access therapy via this method. However, an overall preference for face-to-face therapy delivery was reported with interviewees describing that they felt communication might have been easier in person. The therapeutic relationship and the therapists’ flexible schedules were seen as facilitators to session attendance. Barriers to attendance were scarcely reported but included scheduling conflicts due to work or school. ACT was highly regarded amongst interviewees and provided an opportunity for them to learn about themselves and how they can live in accordance with their personal values. Interviewees benefitted from ACT psychologically, physically, and socially and reported an overall positive experience of study involvement.
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Affiliation(s)
- Katie Powers
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Jac Airdrie
- University Hospitals Bristol and Weston NHS Foundation Trust , Bristol , United Kingdom
| | - Sophie Thomas
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
- Children’s Brain Tumour Research Centre, University of Nottingham , Nottingham , United Kingdom
| | - Faith Gibson
- School of Health Sciences, University of Surrey , Surrey , United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust , London , United Kingdom
| | - Chloe Geagan
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Nic Davies
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Sam Malins
- Institute of Mental Health, University of Nottingham Innovation Park , Nottingham , United Kingdom
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25
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Forster AS, Herbert A, Koo MM, Taylor RM, Gibson F, Whelan JS, Lyratzopoulos G, Fern LA. Associations between diagnostic time intervals and health-related quality of life, clinical anxiety and depression in adolescents and young adults with cancer: cross-sectional analysis of the BRIGHTLIGHT cohort. Br J Cancer 2022; 126:1725-1734. [PMID: 35190694 PMCID: PMC9174449 DOI: 10.1038/s41416-022-01698-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/06/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The association of diagnostic intervals and outcomes is poorly understood in adolescents and young adults with cancer (AYA). We investigated associations between diagnostic intervals and health-related quality of life (HRQoL), anxiety and depression in a large AYA cohort. METHODS Participants aged 12-24 completed interviews post-diagnosis, providing data on diagnostic experiences and the patient-reported outcomes (PROs) HRQoL, anxiety and depression. Demographic and cancer information were obtained from clinical and national records. Six diagnostic intervals were considered. Relationships between intervals and PROs were examined using regression models. RESULTS Eight hundred and thirty participants completed interviews. In adjusted models, across 28 of 30 associations, longer intervals were associated with poorer PROs. Patient intervals (symptom onset to first seeing a GP) of ≥1 month were associated with greater depression (adjusted odds ratio (aOR):1.7, 95% Confidence Interval (CI):1.1-2.5) compared to <1 month. ≥3 pre-referral GP consultations were associated with greater anxiety (aOR:1.6, CI:1.1-2.3) compared to 1-2 consultations. Symptom onset to first oncology appointment intervals of ≥2 months was associated with impaired HRQoL (aOR:1.8, CI:1.2-2.5) compared to <2 months. CONCLUSIONS Prolonged diagnostic intervals in AYA are associated with an increased risk of impaired HRQoL, anxiety and depression. Identifying and delivering interventions for this high-risk group is a priority.
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Affiliation(s)
- Alice S Forster
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Annie Herbert
- Medical Research Council, Integrative Epidemiology Unit at University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, University of Bristol, Bristol, BS8 2BN, UK
| | - Minjoung Monica Koo
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7YH, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Jeremy S Whelan
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Lorna A Fern
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK.
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26
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Lea S, Taylor R, Gibson F. Developing, Nurturing, and Sustaining an Adolescent and Young Adult-Centered Culture of Care. Qual Health Res 2022; 32:956-969. [PMID: 35356832 DOI: 10.1177/10497323221084910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Adolescents and young adults have unique needs which differ from those of children or adults. In the United Kingdom, we have dedicated services, which are diverse in how they are managed and delivered. A multiple-case study was conducted in young people's cancer services in four geographical regions of England. Data collection included: semi-structured interviews with healthcare professionals (n = 41) and young people (n = 29); and observation (total = 120 hours). Thematic analysis was used to synthesize and interpret five emerging themes describing the way a culture of adolescent and young adult-specific care developed. To develop a cultural attitude which embraced and promoted core values, leadership was needed, as well as high patient volume accessing a service. Time was essential, an adolescent and young adult-centered culture of care does not happen overnight, it needs time and dedicated staff to evolve, but once in place, services have a significant impact on the experience of care.
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Affiliation(s)
- Sarah Lea
- 8964University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel Taylor
- 8964University College London Hospitals NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey
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27
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Hudson LD, Chapman S, Street KN, Nicholls D, Roland D, Dubicka B, Gibson F, Mathews G, Viner RM. Increased admissions to paediatric wards with a primary mental health diagnosis: results of a survey of a network of eating disorder paediatricians in England. Arch Dis Child 2022; 107:309-310. [PMID: 34521633 DOI: 10.1136/archdischild-2021-322700] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Lee D Hudson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health Library, London, UK .,Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Simon Chapman
- Child Health, South London and Maudsley NHS Foundation Trust, London, UK.,Child and Adolescent Eating Disorders, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London, London, UK
| | - Damian Roland
- Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Bernadka Dubicka
- The Cove, Lancashire Care NHS Foundation Trust, Preston, UK.,Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, UK
| | - Faith Gibson
- Great Ormond Street Hospital For Children NHS Trust, London, UK.,University of Surrey, Guildford, UK
| | - Gabrielle Mathews
- CYP Transformation Team, NHS England and NHS Improvement London, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health Library, London, UK
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Serjeant GR, Serjeant BE, Mason KP, Gibson F, Osmond C, Thein SL, Happich M, Kulozik AE. The haematology of Jamaicans: red cell indices in HbAA, HbAS, HbAC, and HbA-HPFH genotypes. J Community Genet 2022; 13:229-234. [PMID: 35018573 DOI: 10.1007/s12687-021-00575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
Based in the parish of Manchester in central Jamaica, the Manchester Project offered free detection of haemoglobin genotype to senior classes in 15 secondary schools between 2008 and 2013. Restricting the database to 15,103 students aged 15.0-19.9 years provided an opportunity to examine the red cell characteristics of the different haemoglobin genotypes, including normal (HbAA) in 85.0%, the sickle cell trait (HbAS) in 9.7%, HbC trait (HbAC) in 3.5% and hereditary persistence of foetal haemoglobin (HbA-HPFH) in 0.4%. Compared to the normal HbAA phenotype, HbAS had significantly increased mean cell haemoglobin concentration (MCHC), red cell count (RBC), and red cell distribution width (RDW) and decreased mean cell volume (MCV) and mean cell haemoglobin (MCH), these differences being even more marked in HbAC. Compared to HbAA, the HbA-HPFH had significantly increased RDW, but there were no consistent differences in other red cell indices, and there were no significant differences in haematological indices between the two common deletion HPFH variants, HPFH-1 and HPFH-2. Although these changes are unlikely to be clinically significant, they contribute to an understanding of the haematological spectrum of the common haemoglobin genotypes in peoples of African origin.
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Affiliation(s)
- G R Serjeant
- Sickle Cell Trust, 14 Milverton Cres, Kingston, Jamaica.
| | - B E Serjeant
- Sickle Cell Trust, 14 Milverton Cres, Kingston, Jamaica
| | - K P Mason
- Sickle Cell Trust, 14 Milverton Cres, Kingston, Jamaica
| | - F Gibson
- Sickle Cell Trust, 14 Milverton Cres, Kingston, Jamaica
| | - C Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England
| | - S L Thein
- Sickle Cell Branch, National Heart, Lung and Blood Institutes National Institutes of Health, Bethesda, MD, USA
| | - M Happich
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Heidelberg, Germany
| | - A E Kulozik
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Heidelberg, Germany
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Sipanoun P, Oulton K, Gibson F, Wray J. A systematic review of the experiences and perceptions of users of an electronic patient record system in a pediatric hospital setting. Int J Med Inform 2022; 160:104691. [DOI: 10.1016/j.ijmedinf.2022.104691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 01/06/2023]
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Cockle-Hearne J, Aldiss S, Gibson F, Milne S, Todd J, Ream E. Support interventions provided during palliative care to families with dependent children when a parent has terminal illness: a scoping review protocol. JBI Evid Synth 2021; 19:3163-3173. [PMID: 34100829 DOI: 10.11124/jbies-20-00472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review is to identify and map support interventions provided during palliative care to families with dependent children when a parent has a terminal illness. INTRODUCTION For dependent children, losing a parent through terminal illness can be one of the most traumatic experiences they will face. Without age-appropriate information and support, parental death can lead to unresolved grief, post-traumatic stress, and longer-term negative social, emotional, educational, and behavioral consequences. Support from health care professionals is provided, but challenges within hospice and community palliative care mean the needs of dependent children may not be addressed. Greater emphasis is often placed on children's and families' bereavement needs as opposed to their pre-bereavement needs. The status of pre-bereavement support in palliative care for these families has not been documented. INCLUSION CRITERIA We will include studies of support interventions provided to families with dependent children when a parent has a terminal illness that are delivered during palliative care and in settings including, but not limited to, hospices, hospitals, and the community (including family and care homes). Empirical, peer-reviewed studies based on qualitative, quantitative, or mixed methods data, and gray literature, reporting any stage of intervention development will be included. METHODS This review will follow the JBI approach for scoping reviews. Multiple database searches will be conducted. Two authors will independently review full-text articles and extract data. Interventions will be mapped in terms of characteristics, evaluation methods, and implementation challenges. Data will be presented in tables, diagrammatic form, and narrative summary.
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Affiliation(s)
| | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK.,Centre for Outcomes and Experience Research in Children's Health Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Shannon Milne
- Research Department, Princess Alice Hospice, Esher, UK
| | - Jennifer Todd
- Research Department, Princess Alice Hospice, Esher, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
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31
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Taylor RM, Fern LA, Barber J, Gibson F, Lea S, Patel N, Morris S, Alvarez-Galvez J, Feltbower R, Hooker L, Martins A, Stark D, Raine R, Whelan JS. Specialist cancer services for teenagers and young adults in England: BRIGHTLIGHT research programme. Programme Grants Appl Res 2021. [DOI: 10.3310/pgfar09120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
When cancer occurs in teenagers and young adults, the impact is far beyond the physical disease and treatment burden. The effect on psychological, social, educational and other normal development can be profound. In addition, outcomes including improvements in survival and participation in clinical trials are poorer than in younger children and older adults with similar cancers. These unique circumstances have driven the development of care models specifically for teenagers and young adults with cancer, often focused on a dedicated purpose-designed patient environments supported by a multidisciplinary team with expertise in the needs of teenagers and young adults. In England, this is commissioned by NHS England and delivered through 13 principal treatment centres. There is a lack of evaluation that identifies the key components of specialist care for teenagers and young adults, and any improvement in outcomes and costs associated with it.
Objective
To determine whether or not specialist services for teenagers and young adults with cancer add value.
Design
A series of multiple-methods studies centred on a prospective longitudinal cohort of teenagers and young adults who were newly diagnosed with cancer.
Settings
Multiple settings, including an international Delphi study of health-care professionals, qualitative observation in specialist services for teenagers and young adults, and NHS trusts.
Participants
A total of 158 international teenage and young adult experts, 42 health-care professionals from across England, 1143 teenagers and young adults, and 518 caregivers.
Main outcome measures
The main outcomes were specific to each project: key areas of competence for the Delphi survey; culture of teenagers and young adults care in the case study; and unmet needs from the caregiver survey. The primary outcome for the cohort participants was quality of life and the cost to the NHS and patients in the health economic evaluation.
Data sources
Multiple sources were used, including responses from health-care professionals through a Delphi survey and face-to-face interviews, interview data from teenagers and young adults, the BRIGHTLIGHT survey to collect patient-reported data, patient-completed cost records, hospital clinical records, routinely collected NHS data and responses from primary caregivers.
Results
Competencies associated with specialist care for teenagers and young adults were identified from a Delphi study. The key to developing a culture of teenage and young adult care was time and commitment. An exposure variable, the teenagers and young adults Cancer Specialism Scale, was derived, allowing categorisation of patients to three groups, which were defined by the time spent in a principal treatment centre: SOME (some care in a principal treatment centre for teenagers and young adults, and the rest of their care in either a children’s or an adult cancer unit), ALL (all care in a principal treatment centre for teenagers and young adults) or NONE (no care in a principal treatment centre for teenagers and young adults). The cohort study showed that the NONE group was associated with superior quality of life, survival and health status from 6 months to 3 years after diagnosis. The ALL group was associated with faster rates of quality-of-life improvement from 6 months to 3 years after diagnosis. The SOME group was associated with poorer quality of life and slower improvement in quality of life over time. Economic analysis revealed that NHS costs and travel costs were similar between the NONE and ALL groups. The ALL group had greater out-of-pocket expenses, and the SOME group was associated with greater NHS costs and greater expense for patients. However, if caregivers had access to a principal treatment centre for teenagers and young adults (i.e. in the ALL or SOME groups), then they had fewer unmet support and information needs.
Limitations
Our definition of exposure to specialist care using Hospital Episode Statistics-determined time spent in hospital was insufficient to capture the detail of episodes or account for the variation in specialist services. Quality of life was measured first at 6 months, but an earlier measure may have shown different baselines.
Conclusions
We could not determine the added value of specialist cancer care for teenagers and young adults as defined using the teenage and young adult Cancer Specialism Scale and using quality of life as a primary end point. A group of patients (i.e. those defined as the SOME group) appeared to be less advantaged across a range of outcomes. There was variation in the extent to which principal treatment centres for teenagers and young adults were established, and the case study indicated that the culture of teenagers and young adults care required time to develop and embed. It will therefore be important to establish whether or not the evolution in services since 2012–14, when the cohort was recruited, improves quality of life and other patient-reported and clinical outcomes.
Future work
A determination of whether or not the SOME group has similar or improved quality of life and other patient-reported and clinical outcomes in current teenage and young adult service delivery is essential if principal treatment centres for teenagers and young adults are being commissioned to provide ‘joint care’ models with other providers.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- National Cancer Research Institute, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nishma Patel
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain
| | - Richard Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dan Stark
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
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Livermore P, Gibson F, Mulligan K, Wedderburn LR, McCann LJ, Gray S. Mapping the current psychology provision for children and young people with juvenile dermatomyositis. Rheumatol Adv Pract 2021; 5:rkab062. [PMID: 34671713 PMCID: PMC8522803 DOI: 10.1093/rap/rkab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Juvenile Dermatomyositis (JDM) is a rare, chronic autoimmune condition of
childhood, with known psychosocial implications. In this study, we sought to
establish current psychological support for children and young people across
the UK with rheumatic conditions, with a specific focus on those with
JDM. Methods Electronic surveys were distributed to the 15 centres that belong to the JDM
Research Group in the UK, collecting responses from health-care
professionals in the fields of medicine, nursing and psychology. Results One hundred per cent of professionals from medicine and nursing replied from
all 15 centres. Of these, 7 (47%) did not have a named psychologist
as part of their rheumatology team, despite the majority [13 (87%)]
having >200 paediatric rheumatology patients. Of the remaining
centres, hospital psychology provision varied considerably. When rating
their service, only 3 (8%) of 40 professionals scored their service
as five (where one is poor and five is excellent); there were wide
discrepancies in these scores. Many challenges were discussed, including
limited psychology provision, lack of time and difficulties in offering
support across large geographical areas. Conclusion Many of the challenges discussed are applicable to other centres worldwide.
Suggestions have been proposed that might help to improve the situation for
children and young people with rheumatic conditions, including JDM. Based on
these findings, we suggest that rheumatology teams maximize use of these
data to advocate and work toward more comprehensive psychology provision and
support in their individual centres.
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Affiliation(s)
- Polly Livermore
- Rheumatology Department, University College London Great Ormond Street Institute of Child Health.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust.,NIHR Biomedical Research Centre at Great Ormond Street Hospital.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust.,School of Health Sciences, University of Surrey, Guildford
| | - Kathleen Mulligan
- Centre of Health Services Research, University of London.,East London NHS Foundation Trust, London
| | - Lucy R Wedderburn
- Rheumatology Department, University College London Great Ormond Street Institute of Child Health.,NIHR Biomedical Research Centre at Great Ormond Street Hospital.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London
| | - Liza J McCann
- Rheumatology Department, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Suzanne Gray
- Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Aldiss S, Gibson F, Geoghegan S, Jewitt A, Elliott TK, Williams A, Wray J, Oulton K. 'We don't know what tomorrow will bring': Parents' experiences of caring for a child with an undiagnosed genetic condition. Child Care Health Dev 2021; 47:588-596. [PMID: 33709393 DOI: 10.1111/cch.12866] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/21/2020] [Accepted: 02/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Families and healthcare professionals caring for a sick or disabled child without a definitive diagnosis face unique challenges, particularly in relation to managing uncertainty, access to healthcare and coordination of care. There has been little research exploring the impact this has on families, their support needs or their experience of health services. METHODS This qualitative interview study included interviews with 14 mothers of children with undiagnosed genetic conditions. Transcripts were analysed using thematic analysis. RESULTS Four themes emerged, uncovering overlapping patterns in the data: (1) living with complexity amidst uncertainty-'We don't know what tomorrow will bring'; (2) parental role-'I do everything I can'; (3) parental role-'Not coping is not an option'; and (4) support needs-'There's lots of help that just isn't out there'. CONCLUSIONS The results clearly demonstrate the stresses faced when caring for a child with an undiagnosed genetic condition. Some themes are shared with the experience of other families caring for children with complex needs. However, parents were doing all they could for their child in the context of a life of uncertainty, with the absence of a clear diagnosis clearly causing additional stress that impacted on the whole family. Impact on their emotional and physical well-being was evident; they described times of feeling stressed, worried and anxious. They were confused due to being overloaded with information and frustrated by a lack of care coordination. Parents did not appear to prioritize their own well-being and held back their emotions to protect themselves and others. As a result, they had many unmet needs, particularly relating to emotional support.
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Affiliation(s)
- Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sophie Geoghegan
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anna Jewitt
- Clinical Genetics Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tara Kerr Elliott
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anna Williams
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Evans J, Gardiner B, Green D, Gibson F, O'Connor G, Lanigan J. Systematic review of gastrostomy complications and outcomes in pediatric cancer and bone marrow transplant. Nutr Clin Pract 2021; 36:1185-1197. [PMID: 34245471 DOI: 10.1002/ncp.10724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Nutrition support is essential in children with cancer, including those undergoing bone marrow transplant (BMT), to reduce the risk of malnutrition and associated deleterious outcomes. Enteral nutrition is more commonly provided via nasogastric than gastrostomy tubes because of safety concerns with the latter in immunocompromised children. This systematic review investigated the incidence and type of complications and outcomes in pediatric cancer patients fed by gastrostomy. METHODS Databases were searched for randomized and observational studies investigating the use of any gastrostomy device in children aged <18 years with any cancer diagnosis, including those undergoing BMT. Five cohort and 11 case series studies were included. Owing to clinical heterogeneity, meta-analyses were not performed. RESULTS Quality of evidence varied, with five studies judged at serious risk of bias and poor quality; however, the remaining 11 were considered to range from moderate to good quality. Across studies, 54.6% of children developed one or more complications, of which 76.6% were classified as minor, 23.4% major. The most frequent complications included inflammation (52% of episodes), infection (42.1%), leakage (22.3%), and granuloma (21%). Evidence regarding infection rates in cancer/BMT patients compared with other disease states was inconclusive. Gastrostomy feeding was associated with improvement or stabilization of nutrition status in 77%-92.7% of children. CONCLUSION Gastrostomy feeding in this population is relatively safe and effective in stabilizing or improving nutrition status throughout treatment. Complications are frequent but mostly minor. Placement requires careful consideration of the complications, benefits, nutrition risk and status at diagnosis, and quality of life.
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Affiliation(s)
- James Evans
- Dietetics Department, Great Ormond Street Hospital for Children, London, UK.,University College London Great Ormond Street Institute of Child Health, London, UK
| | - Breeana Gardiner
- Dietetics Department, Great Ormond Street Hospital for Children, London, UK
| | - Dan Green
- Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, London, UK
| | - Graeme O'Connor
- Dietetics Department, Great Ormond Street Hospital for Children, London, UK.,University College London Great Ormond Street Institute of Child Health, London, UK
| | - Julie Lanigan
- University College London Great Ormond Street Institute of Child Health, London, UK
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Gibson F, Fern LA, Phillips B, Gravestock H, Malik S, Callaghan A, Dyker K, Groszmann M, Hamrang L, Hough R, McGeachy D, Morgan S, Smith S, Upadhyaya S, Veitch H, Williamson M, Whelan J, Aldiss S. Reporting the whole story: Analysis of the 'out-of-scope' questions from the James Lind Alliance Teenage and Young Adult Cancer Priority Setting Partnership Survey. Health Expect 2021; 24:1593-1606. [PMID: 34247435 PMCID: PMC8483195 DOI: 10.1111/hex.13276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/17/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objective We conducted a UK‐wide survey to identify the top 10 research questions for young people's cancer. We conducted secondary analysis of questions submitted, which were ‘out‐of‐scope’ of the original survey aim. We sought to disseminate these questions, to inform practice, policy and the development of potential interventions to support young people with cancer. Design James Lind Alliance Priority Setting Partnership. Participants Young people aged 13‐24 with a current/previous cancer diagnosis, their families/friends/partners and professionals who work with this population. Methods Eight hundred and fifty‐five potential research questions were submitted, and 326 were classified as ‘out‐of‐scope’. These questions, along with 49 ‘free‐text’ comments, were analysed using thematic analysis. Results The 375 out‐of‐scope questions and comments were submitted by: 68 young people, 81 family members/partners/friends and 42 professionals. Ten overarching themes were identified: diagnostic experience; communication; coordination of care; information needs and lack of information; service provision; long‐term effects and aftercare support; family support; financial impact; end‐of life care; and research methods and current research. Conclusions The need to tailor services, information and communication is a striking thread evidenced across the ‘out‐of‐scope’ questions. Gaps in information highlight implications for practice in revisiting information needs throughout the cancer trajectory. We must advocate for specialist care for young people and promote the research priorities and these findings to funding bodies, charities, young people and health and social care policymakers, in order to generate an evidence base to inform effective interventions across the cancer trajectory and improve outcomes. Patient/public contributions Patients and carers were equal stakeholders throughout.
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Affiliation(s)
- Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,School of Health Sciences, University of Surrey, Guildford, UK
| | - Lorna A Fern
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK.,Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds, UK
| | - Helen Gravestock
- Policy, Influencing and Voice, Young Lives vs Cancer, London, UK
| | - Sonia Malik
- Policy and Influencing, Young Lives vs Cancer, London, UK
| | - Amy Callaghan
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, Glasgow, UK
| | - Karen Dyker
- Clinical Oncology Department, Clinical Oncology Department, St James's University Hospital, Leeds, UK
| | - Mike Groszmann
- Psychological Medicine Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Leila Hamrang
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, Manchester, UK
| | - Rachael Hough
- Department of Adolescent Haematology, Children and Young People's Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Demi McGeachy
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, Glasgow, UK
| | - Sue Morgan
- Teenage and Young Adult Cancer Service, Ward L33, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sheela Upadhyaya
- Trials and Studies Coordinating Centre, The James Lind Alliance, National Institute for Health Research Evaluation, University of Southampton, Southampton, UK
| | | | - Max Williamson
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, London, UK
| | - Jeremy Whelan
- Division of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
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36
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Bryan G, Kelly P, Chesters H, Franklin J, Griffiths H, Langton L, Langton L, Wakefield CE, Gibson F. Access to and experience of education for children and adolescents with cancer: a scoping review protocol. Syst Rev 2021; 10:167. [PMID: 34099059 PMCID: PMC8182947 DOI: 10.1186/s13643-021-01723-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer diagnosis in childhood or adolescence impacts significantly on school attendance, experience and educational outcomes. While there is longstanding recognition in clinical practice that these effects span the whole illness trajectory and continue beyond treatment completion, further clarity is required on the specific barriers and facilitators to education during cancer treatment and beyond, as well as on the experiences of children and adolescents across the full range of education settings (hospital, home, virtual, original school of enrolment), in order to determine which interventions are successful in improving access and experience from their perspective. The aim of this review is to identify what is known from the existing literature about access to and experience of education for children and adolescents with cancer during and post treatment. METHODS We have planned a scoping literature review searching the following databases from inception onwards: MEDLINE (Ovid), Embase and Embase Classic, Web of Science Core Collection, Education Resources Index, Sociological Abstracts, APA PsycINFO, SCOPUS, CINAHL Plus, Emcare and The Cochrane Library. In addition, DARE, conference abstracts, key journals, and institutional websites will be searched. Arksey and O'Malley's six-step process will be followed, including a consultation exercise. Studies, reports and policies from any country providing care and treatment for children and adolescents with cancer published in English will be considered eligible for inclusion. Two reviewers will independently screen all citations, full-text articles and abstract data. A narrative summary of findings will be conducted. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods. DISCUSSION This is a timely examination given the increased incidence of childhood cancer, more intensive treatment regimens and improved survival rates for childhood cancer. The inclusion of a substantive consultation exercise with families and professionals will provide an important opportunity to examine the scoping review outputs. Findings will assist the childhood cancer community in developing a comprehensive evidence-based understanding of a significant associated bio-psychosocial impact of cancer diagnosis and treatment and will form the first step towards developing effective interventions and policies to mitigate identified detrimental effects. SYSTEMATIC REVIEW REGISTRATION Open Science Framework (osf/io/yc4wt).
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Affiliation(s)
- Gemma Bryan
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, GU2 7XH, Surrey, UK.,Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, UK
| | - Paula Kelly
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, 37 Queen Square, London, UK.
| | - Heather Chesters
- Great Ormond Street Institute of Child Health Library, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, UK
| | - Jayne Franklin
- The Children's Hospital School at Great Ormond Street Hospital & UCH, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Helen Griffiths
- Clinical Health Psychology Psychological Medicine, Oxford University Hospitals NHS Foundation Trust, Children's Psychological Medicine, John Radcliffe Hospital, Oxford, UK
| | | | | | - Claire E Wakefield
- School of Women's and Children's Health, UNSW MEDICINE, UNSW, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, GU2 7XH, Surrey, UK.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, 37 Queen Square, London, UK
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Malins S, Owen R, Wright I, Borrill H, Limond J, Gibson F, Grundy RG, Bailey S, Clifford SC, Lowis S, Lemon J, Hayes L, Thomas S. Acceptance and commitment therapy for young brain tumour survivors: study protocol for an acceptability and feasibility trial. BMJ Open 2021; 11:e051091. [PMID: 34078638 PMCID: PMC8173289 DOI: 10.1136/bmjopen-2021-051091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Survivors of childhood brain tumours have the poorest health-related quality of life of all cancer survivors due to the multiple physical and psychological sequelae of brain tumours and their treatment. Remotely delivered acceptance and commitment therapy (ACT) may be a suitable and accessible psychological intervention to support young people who have survived brain tumours. This study aims to assess the feasibility and acceptability of remotely delivered ACT to improve quality of life among these young survivors. METHODS AND ANALYSIS This study is a two-arm, parallel group, randomised controlled trial comparing ACT with waitlist control at 12-week follow-up as the primary endpoint. Seventy-two participants will be recruited, who are aged 11-24 and have completed brain tumour treatment. Participants will be randomised to receive 12 weeks of ACT either immediately or after a 12-week wait. The DNA-v model of ACT will be employed, which is a developmentally appropriate model for young people. Feasibility will be assessed using the proportion of those showing interest who consent to the trial and complete the intervention. Acceptability will be assessed using participant evaluations of the intervention, alongside qualitative interviews and treatment diaries analysed thematically. A range of clinical outcome measures will also assess physical and mental health, everyday functioning, quality of life and service usage at 12-week follow-up. The durability of treatment effects will be assessed by further follow-up assessments at 24 weeks, 36 weeks and 48 weeks. ETHICS AND DISSEMINATION Ethical approval was given by East Midlands, Nottingham 1 Research Ethics Committee (Reference: 20/EM/0237). Study results will be disseminated in peer-reviewed journals, through public events and relevant third sector organisations. TRIAL REGISTRATION ISRCTN10903290; NCT04722237.
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Affiliation(s)
- Sam Malins
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Ray Owen
- Wye Valley NHS Trust, Hereford, UK
| | - Ingram Wright
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Heather Borrill
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jenny Limond
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Faith Gibson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Simon Bailey
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Steven C Clifford
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Lowis
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Louise Hayes
- DNA-v International, Melbourne, Victoria, Australia
| | - Sophie Thomas
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Oulton K, Wray J, Kelly P, Khair K, Sell D, Gibson F. Culture, cognisance, capacity and capability: The interrelationship of individual and organisational factors in developing a research hospital. J Clin Nurs 2021; 31:362-377. [PMID: 34046965 DOI: 10.1111/jocn.15867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Abstract
AIM To share our experience of implementing a programme of interventions aimed at building research capacity and capability of nurses and allied health professionals in a specialist children's hospital. BACKGROUND Clinicians at the forefront of care are well positioned to lead on research to improve outcomes and experiences of patients but some professional groups continue to be underrepresented. Inequities persist alongside robust national infrastructures to support Clinical Academic Careers for non-medical health professionals, further highlighting the need to address local infrastructure and leadership to successfully build research capacity. DESIGN An evolving programme of inquiry and analysis was established in one organisation, this included targeted interventions to mitigate barriers and enable research capacity and capability. METHODS An all-staff survey was conducted in 2015 to understand the existing research culture. Interventions were put in place, evaluated through a second survey (2018), and focus group interviews with staff who had accessed interventions. RESULTS Respondents demonstrated high levels of interest and commitment to research at the individual level which were not always harnessed at the organisational level. Inequities between professional groups existed in terms of training, time to undertake research and opportunities and outputs. Follow-up revealed continuing structural barriers at an organisational level, however at an individual level, interventions were reflected in >30 fellowship awards; major concerns were reported about sustaining these research ambitions. CONCLUSIONS Success in building a research-active clinical workforce is multifactorial and all professional groups report increasing challenges to undertake research alongside clinical responsibilities. Individuals report concerns about the depth and pace of cultural change to sustain Clinical Academic Careers and build a truly organisation-wide research hospital ethos to benefit patients. RELEVANCE TO CLINICAL PRACTICE The achievements of individual nurses and allied health professionals indicate that with supportive infrastructure, capacity, cognisance and capability are not insurmountable barriers for determined clinicians. We use the standards for reporting organisational case studies to report our findings (Rodgers et al., 2016 Health Services and Delivery Research, 4 and 1).
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paula Kelly
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kate Khair
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Haemnet, London, UK
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,School of Health Sciences, University of Surrey, Guildford, Surrey, UK
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Abstract
INTRODUCTION Parents of a child with cancer want to be involved in making treatment decisions for their child. Underpinning and informing these decisions are parents' individual values and preferences. Parents of a child who has a poor prognosis cancer and who subsequently dies can experience decisional regret. To support parents, and potentially reduce decisional regret, identifying the values and preferences of parents who are making these treatment decisions may enhance the support that can be provided by healthcare professionals. An increased understanding will support future work in this area and identify research gaps that could strengthen support strategies in clinical practice. The aim of this scoping review is to explore parent values and preferences underpinning treatment decision making when their child is receiving cancer-directed therapy for a poor prognosis cancer. METHODS AND ANALYSIS The Joanna Briggs Institute scoping review methodology will be followed. An initial database search of CINHAL and MEDLINE will be conducted to analyse the keywords using subject headings and Medical Subject Headings terms. Articles will be initially screened on title and abstract. The reference and citation lists of the full-text articles to be included will be searched using Web of Science. Articles will be independently reviewed by two reviewers and any discrepancies discussed with a third reviewer. Data extracted will be presented in tabular, diagrams and descriptive summaries. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review. This review will inform further research with parents to understand their values and preferences when making repeated treatment decisions when their child has a poor prognosis cancer. All outputs will be disseminated through peer-reviewed publications and conference presentations.This scoping review is registered on the Open Science Framework (https://osf.io/n7j9f).
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Affiliation(s)
- Helen Pearson
- Royal Marsden NHS Foundation Trust, London, UK
- Faculty of Medicine Health and Life Sciences, University of Southampton, Southampton, UK
| | - Faith Gibson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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Oulton K, Gibson F, Williams A, Geoghegan S, Aldiss S, Wray J. Supporting families of children with an undiagnosed genetic condition: Using co-design to ensure the right person is in the right post doing the right job. Child Care Health Dev 2021; 47:300-310. [PMID: 33305423 DOI: 10.1111/cch.12838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/21/2020] [Accepted: 11/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Families and professionals caring for a child without a definitive diagnosis face unique challenges, particularly in relation to managing uncertainty; access to healthcare; obtaining relevant information and support; and trying to navigate a healthcare system that is often fragmented. We used co-design to inform the establishment of the first UK specialist nursing post dedicated to working with children with undiagnosed genetic conditions and their families. OBJECTIVES (1) To understand what families and hospital staff want from the service; (2) To understand how the post should be operationalized in practice; (3) To develop the job description and person specification for the postholder. METHODS A range of approaches were used to collect data: interviews (nine parents and 10 hospital staff); a focus group (three parents); a creative workshop (six patients and siblings); and an online forum (81 parents). Data were analyzed using framework and thematic analysis. The strands of data were brought together and reviewed as a whole to formulate the postholder's job description and person specification. RESULTS Stakeholders identified nine key elements to the role which were incorporated into the job description: practical support; point of contact; community liaison; signposting to other services; care coordination; supporting families; advocacy; raising awareness; and emotional support. CONCLUSIONS Highlighted in this paper are the practical aspects of engaging and involving all relevant stakeholders in the process of co-designing a new post and subsequent staff recruitment. The flexibility employed in the setting and methods of data collection were instrumental in ensuring that the views of a diverse range of participants were ascertained. A major consideration is the resources required to undertake co-design, in terms of time and finances. We believe that the resources required for the co-design are offset by the advantages of having the right person in the right post, doing the right job.
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,School of Health Sciences, University of Surrey, Guildford, UK
| | - Anna Williams
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sophie Geoghegan
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Fern LA, Taylor RM, Barber J, Alvarez-Galvez J, Feltbower R, Lea S, Martins A, Morris S, Hooker L, Gibson F, Raine R, Stark DP, Whelan J. Processes of care and survival associated with treatment in specialist teenage and young adult cancer centres: results from the BRIGHTLIGHT cohort study. BMJ Open 2021; 11:e044854. [PMID: 33827838 PMCID: PMC8031022 DOI: 10.1136/bmjopen-2020-044854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Survival gains in teenagers and young adults (TYA) are reported to be lower than children and adults for some cancers. Place of care is implicated, influencing access to specialist TYA professionals and research.Consequently, age-appropriate specialist cancer care is advocated for TYA although systematic investigation of associated outcomes is lacking. In England, age-appropriate care is delivered through 13 Principal Treatment Centres (TYA-PTC). BRIGHTLIGHT is the national evaluation of TYA cancer services to examine outcomes associated with differing places and levels of care. We aimed to examine the association between exposure to TYA-PTC care, survival and documentation of clinical processes of care. DESIGN Prospective cohort study. SETTING 109 National Health Service (NHS) hospitals across England. PARTICIPANTS 1114 TYA, aged 13-24, newly diagnosed with cancer between 2012 and 2014. INTERVENTION Participants were assigned a TYA-PTC category dependent on the proportion of care delivered in a TYA-PTC in the first year after diagnosis: all care in a TYA-PTC (ALL-TYA-PTC, n=270), no care in a TYA-PTC (NO-TYA-PTC, n=359), and some care in a TYA-PTC with additional care in a children's/adult unit (SOME-TYA-PTC, n=419). PRIMARY OUTCOME Data were collected on documented processes indicative of age-appropriate care using clinical report forms, and survival through linkage to NHS databases. RESULTS TYA receiving NO-TYA-PTC care were less likely to have documentation of molecular diagnosis, be reviewed by a children's or TYA multidisciplinary team, be assessed by supportive care services or have a fertility discussion. There was no significant difference in survival according to category of care. There was weak evidence that the association between care category and survival differed by age (p=0.08) with higher HRs for those over 19 receiving ALL or SOME-TYA-PTC compared with NO-TYA-PTC. CONCLUSION TYA-PTC care was associated with better documentation of clinical processes associated with age-appropriate care but not improved survival.
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Affiliation(s)
- Lorna A Fern
- Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cadiz, Spain
| | | | - Sarah Lea
- Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Martins
- Cancer Clinical Trials, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Morris
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Faith Gibson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Rosalind Raine
- Institute of Epidemiology & Health, University College London, London, UK
| | - Dan P Stark
- Leeds Insitute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Jeremy Whelan
- Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
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Lea S, Gibson F, Taylor RM. "Holistic Competence": How Is it Developed, Shared, and Shaped by Health Care Professionals Caring for Adolescents and Young Adults with Cancer? J Adolesc Young Adult Oncol 2021; 10:503-511. [PMID: 33691496 DOI: 10.1089/jayao.2020.0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose: In England, specialist cancer services for adolescents and young adults (young people) aged 15-24 are provided in 13 specialist units, with additional care provided in child and adult cancer units in the region. As a result of specialization, health care professionals (HCPs) have refined their competence, to deliver holistic care that has become central to the culture of young people's cancer care. We sought to understand and describe how HCPs developed this competence. Methods: We conducted a multiple case study in four regions across England in 24 hospitals. Data were collected through observation of clinical areas, shadowing members of the multidisciplinary team, and semistructured interviews with young people. Data were analyzed thematically and triangulated to draw meaning applicable to a range of contexts. Results: Young people (n = 29) and HCP (n = 41) across 24 different care settings were interviewed. Holistic competence enabled HCPs to deliver care that considered the age-specific needs of young people, including social, emotional, and psychological needs, in accordance with their life stage and psychosocial development. Development of holistic competence was facilitated by the following four factors: the environment, the experience continuum, enthusiasm, and education. Conclusion: The four factors facilitating holistic competence were interlinked. Working in a specialist/dedicated environment for young people increased HCPs' exposure to young people. This enabled them to become experienced in young people's cancer care, supported through education and training. Without frequent exposure to young people, HCPs were less able to achieve holistic competence, the impact of which was acutely felt by young people.
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Affiliation(s)
- Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Taylor RM, Fern LA, Barber J, Alvarez-Galvez J, Feltbower R, Lea S, Martins A, Morris S, Hooker L, Gibson F, Raine R, Stark DP, Whelan J. Longitudinal cohort study of the impact of specialist cancer services for teenagers and young adults on quality of life: outcomes from the BRIGHTLIGHT study. BMJ Open 2020; 10:e038471. [PMID: 33243793 PMCID: PMC7692812 DOI: 10.1136/bmjopen-2020-038471] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES In England, healthcare policy advocates specialised age-appropriate services for teenagers and young adults (TYA), those aged 13 to 24 years at diagnosis. Specialist Principal Treatment Centres (PTC) provide enhanced TYA age-specific care, although many still receive care in adult or children's cancer services. We present the first prospective structured analysis of quality of life (QOL) associated with the amount of care received in a TYA-PTC DESIGN: Longitudinal cohort study. SETTING Hospitals delivering inpatient cancer care in England. PARTICIPANTS 1114 young people aged 13 to 24 years newly diagnosed with cancer. INTERVENTION Exposure to the TYA-PTC defined as patients receiving NO-TYA-PTC care with those receiving ALL-TYA-PTC and SOME-TYA-PTC care. PRIMARY OUTCOME Quality of life measured at five time points: 6, 12, 18, 24 and 36 months after diagnosis. RESULTS Group mean total QOL improved over time for all patients, but for those receiving NO-TYA-PTC was an average of 5.63 points higher (95% CI 2.77 to 8.49) than in young people receiving SOME-TYA-PTC care, and 4·17 points higher (95% CI 1.07 to 7.28) compared with ALL-TYA-PTC care. Differences were greatest 6 months after diagnosis, reduced over time and did not meet the 8-point level that is proposed to be clinically significant. Young people receiving NO-TYA-PTC care were more likely to have been offered a choice of place of care, be older, from more deprived areas, in work and have less severe disease. However, analyses adjusting for confounding factors did not explain the differences between TYA groups. CONCLUSIONS Receipt of some or all care in a TYA-PTC was associated with lower QOL shortly after cancer diagnosis. The NO-TYA-PTC group had higher QOL 3 years after diagnosis, however those receiving all or some care in a TYA-PTC experienced more rapid QOL improvements. Receipt of some care in a TYA-PTC requires further study.
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Affiliation(s)
- Rachel M Taylor
- Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Barber
- Department of Statistical Science, University College, London, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cadiz, Spain
| | | | - Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Dan P Stark
- Leeds Insitute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Jeremy Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
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Koo MM, Lyratzopoulos G, Herbert A, Abel GA, Taylor RM, Barber JA, Gibson F, Whelan J, Fern LA. Association of Self-reported Presenting Symptoms With Timeliness of Help-Seeking Among Adolescents and Young Adults With Cancer in the BRIGHTLIGHT Study. JAMA Netw Open 2020; 3:e2015437. [PMID: 32880648 PMCID: PMC7489839 DOI: 10.1001/jamanetworkopen.2020.15437] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/20/2020] [Indexed: 01/01/2023] Open
Abstract
Importance Evidence regarding the presenting symptoms of cancer in adolescents and young adults can support the development of early diagnosis interventions. Objective To examine common presenting symptoms in adolescents and young adults aged 12 to 24 years who subsequently received a diagnosis of cancer and potential variation in time to help-seeking by presenting symptom. Design, Setting, and Participants This multicenter study is a cross-sectional analysis of the BRIGHTLIGHT cohort study, which was conducted across hospitals in England. Participants included adolescents and young adults aged 12 to 24 years with cancer. Information on 17 prespecified presenting symptoms and the interval between symptom onset and help-seeking (the patient interval) was collected through structured face-to-face interviews and was linked to national cancer registry data. Data analysis was performed from January 2018 to August 2019. Exposures Self-reported presenting symptoms. Main Outcomes and Measures The main outcomes were frequencies of presenting symptoms and associated symptom signatures by cancer group and the proportion of patients with each presenting symptom whose patient interval was longer than 1 month. Results The study population consisted of 803 adolescents and young adults with valid symptom information (443 male [55%]; 509 [63%] aged 19-24 years; 705 [88%] White). The number of symptoms varied by cancer group: for example, 88 patients with leukemia (86%) presented with 2 or more symptoms, whereas only 9 patients with melanoma (31%) presented with multiple symptoms. In total, 352 unique symptom combinations were reported, with the 10 most frequent combinations accounting for 304 patients (38%). Lump or swelling was reported by more than one-half the patients (419 patients [52%; 95% CI, 49%-56%]). Other common presenting symptoms across all cancers were extreme tiredness (308 patients [38%; 95% CI, 35%-42%]), unexplained pain (281 patients [35%; 95% CI, 32%-38%]), night sweats (192 patients [24%; 95% CI, 21%-27%]), lymphadenopathy (191 patients [24%; 95% CI, 21%-27%]), and weight loss (190 patients [24%; 95% CI, 21%-27%]). The relative frequencies of presenting symptoms also varied by cancer group; some symptoms (such as lump or swelling) were highly prevalent across several cancer groups (seen in >50% of patients with lymphomas, germ cell cancers, carcinomas, bone tumors, and soft-tissue sarcomas). More than 1 in 4 patients (27%) reported a patient interval longer than 1 month; this varied from 6% (1 patient) for fits and seizures to 43% (18 patients) for recurrent infections. Conclusions and Relevance Adolescents and young adults with cancer present with a broad spectrum of symptoms, some of which are shared across cancer types. These findings point to discordant presenting symptom prevalence estimates when information is obtained from patient report vs health records and indicate the need for further symptom epidemiology research in this population.
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Affiliation(s)
- Minjoung M. Koo
- Epidemiology of Cancer and Healthcare Outcomes Research Group, Department of Behavioural Sciences and Health, University College London, London, United Kingdom
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer and Healthcare Outcomes Research Group, Department of Behavioural Sciences and Health, University College London, London, United Kingdom
| | - Annie Herbert
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Gary A. Abel
- University of Exeter Medical School, St Luke’s Campus, Exeter, United Kingdom
| | - Rachel M. Taylor
- Centre for Nurse, Midwife, and Allied Health Professional-led Research, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Julie A. Barber
- Department of Statistical Science, University College London, London, United Kingdom
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Jeremy Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lorna A. Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Taylor RM, Lobel B, Thompson K, Onashile A, Croasdale M, Hall N, Gibson F, Martins A, Wright D, Morgan S, Whelan JS, Fern LA. BRIGHTLIGHT researchers as 'dramaturgs': creating There is a Light from complex research data. Res Involv Engagem 2020; 6:48. [PMID: 32789023 PMCID: PMC7418195 DOI: 10.1186/s40900-020-00222-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND BRIGHTLIGHT is a national evaluation of cancer services for young people aged 13-24 years in England. It is a mixed methods study with six interlinked studies aiming to answer the question: do specialist cancer services for teenagers and young adults add value? http://www.brightlightstudy.com/. Young people have been integral to study development and management, working as co-researchers, consultants and collaborators throughout. We aimed to share results in a way that was meaningful to young people, the public, and multidisciplinary professionals. This paper reports the development of 'There is a Light: BRIGHTLIGHT', a theatrical interpretation of study results by young people, and offers insight into the impact on the cast, researchers and audiences. METHODS The BRIGHTLIGHT team collaborated with Contact Young Company, a youth theatre group in Manchester. Twenty members of Contact Young Company and four young people with cancer worked together over an eight-week period during which BRIGHTLIGHT results were shared along with explanations of cancer, healthcare policy and models of care in interactive workshops. Through their interpretation, the cast developed the script for the performance. The impact of the process and performance on the cast was evaluated through video diaries. The research team completed reflective diaries and audiences completed a survey. RESULTS 'There is a Light' contained five acts and lasted just over an hour. It played 11 performances in six cities in the United Kingdom, to approximately 1377 people. After nine performances, a 30-min talk-back between members of the cast, creative team, an expert healthcare professional, and the audience was conducted, which was attended by at least half the audience. Analysis of cast diaries identified six themes: initial anxieties; personal development; connections; cancer in young people; personal impact; interacting with professionals. The cast developed strong trusting relationships with the team. Professionals stated they felt part of the process rather than sitting on the periphery sharing results. Both professional and lay audiences described the performance as meaningful and understandable. Feedback was particularly positive from those who had experienced cancer themselves. CONCLUSIONS Using theatre to present research enabled BRIGHTLIGHT results to be accessible to a larger, more diverse audience.
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Affiliation(s)
- Rachel M. Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Brian Lobel
- Rose Bruford College, Sidcup, UK
- The Royal Central School of Speech and Drama, London, UK
| | | | | | | | | | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, Kate Granger Building, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Wright
- Top Floor Palatine Treatment Centre, The Christie Hospital, Manchester, UK
| | - Sue Morgan
- Teenage and Young Adult Cancer Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jeremy S. Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A. Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
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Gibson F, Hanly A, Kuang K, Kalin J, Wu M, Cole P, Alani R. 660 Dual HDAC and LSD1 inhibition as a novel strategy to overcome BRAF inhibitor resistance. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jones F, Whitehouse A, Dopson A, Palaghias N, Aldiss S, Gibson F, Shawe J. Reducing unintentional injuries in under fives: Development and testing of a mobile phone app. Child Care Health Dev 2020; 46:203-212. [PMID: 31782175 DOI: 10.1111/cch.12729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Unintentional injuries are a leading cause of preventable death and a major cause of ill health and disability in children under 5 years of age. A health promotion mobile phone application, "Grow up Safely" (GUS), was developed to support parents and carers in reducing unintentional injuries in this population of children. METHODS A prototype of the mobile application was developed to deliver health education on unintentional injury prevention linked to stages of child development. In order to explore the usability of the app and refine its content, three focus groups were conducted with 15 mothers. Data were analysed using thematic analysis. RESULTS The majority of participants reported previous use of health apps, mainly related to pregnancy and recommended by health professionals. The app was considered user-friendly and easy to navigate. Participants in two focus groups found the app informative and offered new information, and they would consider using it. Participants in the "young mum's" group considered the advice to be "common sense" but found the language too complex. All participants commented that further development of push-out notifications and endorsement by a reputable source would increase their engagement with the app. CONCLUSION The GUS mobile phone app, aimed at reducing unintentional injuries in children under five, was supported by mothers as a health promotion app. They would consider downloading it, particularly if recommended by a health professional or endorsed by a reputable organization. Further development is planned with push-out notifications and wider feasibility testing to engage targeted groups, such as young mothers, fathers, and other carers.
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Affiliation(s)
- Felicity Jones
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Ali Whitehouse
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Amy Dopson
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jill Shawe
- Institute of Health and Community, University of Plymouth, Plymouth, UK
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Chung JOK, Lam KKW, Ho KY, Cheung AT, Ho LK, Xei VW, Gibson F, Li WHC. Psychometric evaluation of the traditional Chinese version of the resilience Scale-14 and assessment of resilience in Hong Kong adolescents. Health Qual Life Outcomes 2020; 18:33. [PMID: 32075647 PMCID: PMC7031896 DOI: 10.1186/s12955-020-01285-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background A reliable and valid instrument that accurately measures resilience is crucial for the development of interventions to enhance the resilience of adolescents and promote their positive mental well-being. However, there is a lack of adolescent resilience assessment tools with good psychometric properties suitable for use with Hong Kong participants. This study aimed to evaluate the psychometric properties of the traditional Chinese version of the Resilience Scale-14. Methods Between October 2017 and January 2018, a stratified random sample of 1816 Grade 7 (aged 11–15 years) students from all 18 districts of Hong Kong were invited to participate in the study. Subjects were asked to respond to the traditional Chinese version of the Resilience Scale-14, the Center for Epidemiologic Studies Depression Scale for children, and Rosenberg’s Self-Esteem Scale. The psychometric properties, including the internal consistency, content validity, convergent and discriminant validity, exploratory and confirmatory factor analyses, and test–retest reliability of the Resilience Scale-14 were assessed. Results The translated scale demonstrated good internal consistency and test–retest reliability, excellent content validity, and appropriate convergent and discriminant validity. The results of the confirmatory factor analysis supported the two-factor structure of the traditional Chinese version of the Resilience Scale-14. Conclusions Results suggest that the translated scale is a reliable and valid tool to assess the resilience of young Hong Kong Chinese adolescents. Healthcare professionals could use the newly translated scale to assess resilience levels among Hong Kong adolescents and develop interventions that can help them combat mental health problems and lead healthier lives. Trial registration Clinicaltrials.gov ID NCT03538145 (retrospectively registered on May 15, 2018).
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Affiliation(s)
- Joyce Oi Kwan Chung
- School of Nursing, University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Katherine Ka Wai Lam
- School of Nursing, University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Ka Yan Ho
- School of Nursing, University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Ankie Tan Cheung
- School of Nursing, University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Long Kwan Ho
- School of Nursing, University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Viveka Wei Xei
- School of Nursing, University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
| | - William Ho Cheung Li
- School of Nursing, University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
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Oulton K, Sell D, Gibson F. Hospitalized children with intellectual disability: Parents as partners in their care. J Appl Res Intellect Disabil 2020; 33:917-926. [PMID: 32072753 DOI: 10.1111/jar.12713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 01/11/2020] [Accepted: 01/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited evidence exists of what hospital care is like for parents of children and young people (CYP) with intellectual disability (ID). Effective collaboration is often missing, with parents lacking trust in professionals, with feelings of being expected to care and consequently unable to leave their child. This paper focuses on what parents want from their relationship with healthcare professionals. METHOD An ethnographic approach was used, including in-depth interviews and informal discussions with nine parents of CYP with intellectual disability. Researcher voice poems are interspersed with quotations to illustrate key findings. RESULTS Parents described the need for a genuine partnership with professionals. They identified seven elements that ideally characterize this partnership: Preparation, Accessibility, Reliability, Trust, Negotiation, Expertise and Respect (PARTNER). CONCLUSION Children and young people with intellectual disability and their parents are frequent users of healthcare services. Getting it right from the outset is important to establish their trust in the system.
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Livermore P, Wedderburn LR, Gibson F. You give me a name that I can’t say, but I have to explain what it is every day: the power of poetry to share stories from young people with a rare disease. Journal of Poetry Therapy 2019. [DOI: 10.1080/08893675.2020.1694210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- P. Livermore
- Infection, Immunity and Inflammation Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
| | - L. R. Wedderburn
- Infection, Immunity and Inflammation Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
| | - F. Gibson
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- School of Health Sciences, University of Surrey, Guildford, UK
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