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Vo HH, Wilfond BS, Ding Y, Henderson CM, Raisanen JC, Ashwal G, Thomas A, Jabre NA, Shipman KJ, Schrooten A, Shaffer J, Boss RD. Family-Reflections.com: Creating a parent-to-parent web-based tool regarding pediatric home ventilation. Patient Educ Couns 2023; 114:107855. [PMID: 37348312 DOI: 10.1016/j.pec.2023.107855] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/23/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The decision to initiate pediatric mechanical ventilation via tracheostomy ("home ventilation") is complex and parents often desire information from other parents who have faced this decision. However, parent-to-parent communication is challenging as it is difficult to connect new families to experienced families in ways that optimize informed, balanced decision-making. OBJECTIVE Create a parent-to-parent web-based tool to support decision-making about pediatric home ventilation. PATIENT INVOLVEMENT The tool was created based on interviews and feedback from parents. METHODS We interviewed parents who previously chose for, or against, home ventilation for their child. Interview themes and family comments guided website development. Viewer feedback was solicited via an embedded survey in the tool. RESULTS We created 6 composite character families to communicate 6 themes about home ventilation: 1) Considering treatment options, 2) Talking with medical team, 3) Impact on life at home, 4) Impact on relationships, 5) Experience for the child, and 6) If the child's life is short. Nine families who reviewed the draft tool felt it would have helped with their decision about home ventilation. Specifically, it supported families in thinking through what was "most important about their child's breathing problems" (7 of 9 parents) and feeling "more at peace with the decision" (8 of 9 parents). Between 6/1/20-12/31/22, nearly 5500 viewers have accessed the tool and 56 viewers completed the survey (including 13 families and 39 clinicians). Feedback from experienced families and clinicians reported the tool taught them something new. DISCUSSION This novel parent-to-parent tool shows promise for expanding access to balanced, family-centered information about pediatric home ventilation. PRACTICAL VALUE The diverse stories and decisions let parents access multiple family perspectives. The tool's focus is on family-centric information that parents reported was usually missing from clinician counseling. FUNDING This work was supported by the National Palliative Care Research Center.
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Affiliation(s)
- Holly Hoa Vo
- Pediatrics, University of Washington School of Medicine, 1900 Ninth Avenue, Seattle 98101, USA; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 Ninth Ave, Seattle 98101, USA.
| | - Benjamin S Wilfond
- Pediatrics, University of Washington School of Medicine, 1900 Ninth Avenue, Seattle 98101, USA; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 Ninth Ave, Seattle 98101, USA
| | - Yuanyuan Ding
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD 21205, USA
| | - Carrie M Henderson
- Pediatrics, University of Mississippi Medical Center, 2500 N. State Street, Jackson 39216, USA; Center for Bioethics and Medical Humanities, 2500 N. State Street, Jackson 39216, USA
| | - Jessica C Raisanen
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA
| | - Gary Ashwal
- Booster Shot Media, 1450 2nd Street, Suite 342, Santa Monica, CA 90401, USA
| | - Alex Thomas
- Booster Shot Media, 1450 2nd Street, Suite 342, Santa Monica, CA 90401, USA
| | - Nicholas A Jabre
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA; Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Kelly J Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 Ninth Ave, Seattle 98101, USA
| | | | | | - Renee D Boss
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA; Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Shipman KJ, Mercer AH, Raisanen JC, Jabre NA, Vo HH, Miles A, Shepard J, Henderson CM, Boss RD, Wilfond BS. "What Would Give Her the Best Life?": Understanding Why Families Decline Pediatric Home Ventilation. J Palliat Med 2023. [PMID: 36662553 DOI: 10.1089/jpm.2022.0426] [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: 01/21/2023] Open
Abstract
Background: Families who must decide about pediatric home ventilation rely on the clinicians who counsel them for guidance. Most studies about pediatric home ventilation decisions focus on families who opt for this intervention, leaving much unknown about the families who decline. Objective: To describe the rationales of families who decline home ventilation. Design: Semi-structured interview study. Setting/Subjects: We interviewed 16 families in hospitals across 3 U.S. states, identified by their clinicians as previously deciding to not pursue home ventilation via tracheostomy within the past five years. Measurements: Targeted content and narrative analyses were used to understand family intentions and reasons for declining. Results: The clinical and social context varied among the 16 families in this study. Families' intentions in saying "no" fell into two categories: (1) definitive "No": Families who stood firm on in their decision and (2) contingent "No": Families who may consider this in the future. Families described four reasons why their child did not receive home ventilation: (1) concern about medical impacts, (2) concern about physical and/or communication restrictions, (3) concern that there would be no clear health benefit, and (4) concern about no clear meaningful life. Most families mentioned all four reasons, but concern about no clear meaningful life predominated. Conclusions: Though these families did not see home ventilation as an appropriate option, each reported a complex interplay of intentions behind and reasons for declining. Clinicians who counsel families about home ventilation could share the reasons that families commonly decline this intervention to facilitate a balanced discussion.
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Affiliation(s)
- Kelly J Shipman
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, Washington, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Amanda H Mercer
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | | | - Nicholas A Jabre
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.,Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Holly Hoa Vo
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alison Miles
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Shepard
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Carrie M Henderson
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Center for Bioethics and Medical Humanities, Jackson, Mississippi, USA
| | - Renee D Boss
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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Bogetz JF, Munjapara V, Henderson CM, Raisanen JC, Jabre NA, Shipman KJ, Wilfond BS, Boss RD. Home mechanical ventilation for children with severe neurological impairment: Parents' perspectives on clinician counselling. Dev Med Child Neurol 2022; 64:840-846. [PMID: 35080259 DOI: 10.1111/dmcn.15151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
AIM To retrospectively explore the perspectives of parents of children with severe neurological impairment (SNI), such as those with severe cerebral palsy, epilepsy syndromes, and structural brain differences, on clinician counseling regarding home mechanical ventilation (HMV). METHOD Inductive thematic analysis was performed on data from telephone interviews with parents who chose for and against HMV for their child with SNI at three academic children's hospitals across the USA. RESULTS Twenty-six parents/legal guardians of 24 children were interviewed. Fourteen children had static encephalopathy, 11 received HMV, and 20 were alive at the time of parent interviews. Themes included how HMV related to the child's prognosis, risk of death, and integration with goals of care. Although clinicians voiced uncertainty about how HMV would impact their child, parents felt this was coupled with prescriptive/intimidating examples about the child's end of life and judgments about the child's quality of life. INTERPRETATION While prognositc uncertainty exists, this study suggests that parents of children with SNI seek clinician counseling about HMV that considers their goals of care and views on their child's quality of life.
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Affiliation(s)
- Jori F Bogetz
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA.,Palliative Care Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Vasu Munjapara
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carrie M Henderson
- Center for Bioethics and Medical Humanities, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Division of Critical Care Medicine, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jessica C Raisanen
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas A Jabre
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly J Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA.,Palliative Care Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA.,Palliative Care Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Renee D Boss
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jabre NA, Raisanen JC, Shipman KJ, Henderson CM, Boss RD, Wilfond BS. Parent perspectives on facilitating decision-making around pediatric home ventilation. Pediatr Pulmonol 2022; 57:567-575. [PMID: 34738745 DOI: 10.1002/ppul.25749] [Citation(s) in RCA: 2] [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: 08/13/2021] [Revised: 10/07/2021] [Accepted: 11/02/2021] [Indexed: 11/07/2022]
Abstract
RATIONALE Deciding about pediatric home ventilation is exceptionally challenging for parents. Understanding the decision-making needs of parents who made different choices for their children could inform clinician counseling that better supports parents' diverse values and goals. OBJECTIVES To determine how clinicians can meet the decisional needs of parents considering home ventilation using a balanced sample of families who chose for or against intervention. METHODS We conducted semi-structured interviews of parents who chose for or against home ventilation for their child within the previous 5 years. Parents were recruited from three academic centers across the United States. Interviews focused on parent-clinician communication during decision-making and how clinicians made the process easier or more difficult. Qualitative analysis was used to generate themes and identify key results. RESULTS Thirty-eight parents were interviewed; 20 chose for and 18 chose against home ventilation. Five themes described their perspectives on how clinicians can facilitate high-quality decision-making: demonstrating dedication to families, effectively managing the medical team, introducing the concept of home ventilation with intention, facilitating meaningful conversation about the treatment options, and supporting and respecting the family's decision. CONCLUSIONS High-quality decision-making around home ventilation depends on individual clinician actions and the complex operations of large academic settings. Strong working relationships with parents, collaborative alliances with colleagues, and appropriate delivery of key content can help meet the needs of parents considering invasive breathing supports for their children.
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Affiliation(s)
- Nicholas A Jabre
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.,Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Kelly J Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Carrie M Henderson
- Department of Pediatric Critical Care Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA
| | - Renee D Boss
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.,Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA.,Divisions of Bioethics & Palliative Care and Pulmonary & Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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Henderson CM, Raisanen JC, Shipman KJ, Jabre NA, Wilfond BS, Boss RD. Life with pediatric home ventilation: Expectations versus experience. Pediatr Pulmonol 2021; 56:3366-3373. [PMID: 34310864 DOI: 10.1002/ppul.25577] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 04/06/2021] [Revised: 06/22/2021] [Accepted: 07/11/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To explore the family experience of home ventilation through a comparison of anticipated home life changes with subsequent experiences. STUDY DESIGN Guided interviews with parents across three states who chose home ventilation for their child within the last 5 years. PATIENT-SUBJECT SELECTION Purposive sampling of parents who chose home ventilation for their child within the last 5 years. METHODS Interviews were transcribed for qualitative analysis and analyzed for thematic saturation and prevalence of codes. RESULTS Twenty families were interviewed. Families generally reported not considering potential home life changes when facing the decision about home ventilation; instead, they worried most about medical management. These concerns reversed in importance later. Families learned medical management quickly but felt largely unprepared for the extensive changes to their home life, including isolation, altered relationships with extended family and community, effects on siblings, financial strain, and need for physical changes to their house. Families had not anticipated how much they would be affected by home healthcare as a new part of their life. CONCLUSIONS The priorities that families consider during decisions about pediatric home ventilation may not be aligned with the actual home experience of this technology. Given that the success of home ventilation largely rests with the family's care, family expectations for home life adaptations must be augmented, as should postdischarge supports for families with complex home care experiences.
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Affiliation(s)
- Carrie M Henderson
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Center for Bioethics and Medical Humanities, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Kelly J Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Nicholas A Jabre
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Renee D Boss
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Raisanen JC, Ruth A, Donohue PK, Detwiler K, Fratantoni K, Huff SM, Boss RD. Paying for Pediatric Home Health Care: How Families of Children With Medical Complexity Navigate Gaps in Coverage. Fam Community Health 2021; 44:184-193. [PMID: 33927166 DOI: 10.1097/fch.0000000000000300] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Limited private and public financing of home health care for children with medical complexity can have harmful and costly consequences. Little is known of how parents and professionals in the United States navigate coverage for these services or how payer restrictions are shaping service quality. Qualitative interviews were conducted with families and professionals (eg, prescribers, providers, administrators of pediatric home health care [PHHC]) caring for children with medical complexity. Interview transcripts were analyzed using inductive thematic analysis. In total, 47 families and 45 professionals from across 31 states and the District of Columbia had experiences with the full range of PHHC services. Participants detailed the need to patch together multiple insurances and payment programs to cover a child's home health needs. They described nontransparent eligibility determinations that do not reflect the diagnostic uncertainty and static functional status that is common for many children. Coverage denials are common, leaving gaps in care that can potentiate downstream cost escalation. Evidence-based health care reform must ensure that children get the PHHC needed to maintain function and reduce the need for hospital-based services. Recommendations are offered to improve PHHC financing and care for the most medically vulnerable children and their families.
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Affiliation(s)
- Jessica C Raisanen
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland (Mss Raisanen and Ruth and Dr Boss); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Ruth and Dr Donohue); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Donohue and Boss); Division of General and Community Pediatrics, Children's National Hospital, Washington, District of Columbia (Ms Detwiler and Dr Fratantoni) and Johns Hopkins Home Health Group, Baltimore, Maryland (Ms Huff). Ms Detwiler is the parent of a child with medical complexity
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Aziz KB, Boss RD, Yarborough CC, Raisanen JC, Neubauer K, Donohue PK. Intensity of Vasopressor Therapy and In-Hospital Mortality for Infants and Children: An Opportunity for Counseling Families. J Pain Symptom Manage 2021; 61:763-769. [PMID: 32942009 DOI: 10.1016/j.jpainsymman.2020.09.016] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022]
Abstract
CONTEXT Most pediatric deaths occur in an intensive care unit, and treatment specific predictors of mortality could help clinicians and families make informed decisions. OBJECTIVE To investigate whether the intensity of vasopressor therapy for pediatric patients, regardless of diagnosis, predicts in-hospital mortality. METHODS Single-center, retrospective medical chart review of children aged 0-17 who were admitted between 2005 and 2015 at a pediatric tertiary care center in the U.S. and received any vasopressor medication-dopamine, dobutamine, epinephrine, vasopressin, norepinephrine, or hydrocortisone. RESULTS During the 10-year period, 1654 patients received at least one vasopressor medication during a hospitalization. Median age at the time of hospitalization was three months, and the median duration of hospitalization was 23 days; 8% of patients had two to five hospitalizations in which they received vasopressors. There were 176 total patients who died while receiving vasopressors; most (93%) died during their first hospitalization. The most common diagnosis was sepsis (34%), followed by congenital heart disease (17%). Dopamine was the most commonly prescribed first-line vasopressor (70%), and hydrocortisone was the most commonly prescribed second-line vasopressor (49%) for all pediatric patients. The incidence of mortality rose sequentially with escalating vasopressor support, increasing from under 10% with the first vasopressor to 48% at the maximum number of agents. The odds of death almost doubled with the addition of each new vasopressor. CONCLUSIONS The intensity of vasopressor therapy for pediatric patients, regardless of diagnosis, is associated with in-hospital mortality; vasopressor escalation should trigger intensive palliative care supports.
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Affiliation(s)
- Khyzer B Aziz
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Renee D Boss
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
| | | | | | - Kathryn Neubauer
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pamela K Donohue
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Boss RD, Henderson CM, Raisanen JC, Jabre NA, Shipman K, Wilfond BS. Family Experiences Deciding For and Against Pediatric Home Ventilation. J Pediatr 2021; 229:223-231. [PMID: 33068566 DOI: 10.1016/j.jpeds.2020.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/30/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To understand what considerations drive family decisions for, and against, pediatric home ventilation. STUDY DESIGN Qualitative interviews with parents of children who faced a decision about home ventilation in the previous 5 years at 3 geographically dispersed institutions. RESULTS In total, 38 families (42 parents) were interviewed; 20 families opted for pediatric home ventilation, and 18 families opted against. Approximately one-quarter of children had isolated chronic lung disease; the remainder had medical complexity that was expected to remain static or decline. Parent perspectives about home ventilation generally reflected whether the child was early, or later, in their disease trajectory. Early on, parents often interpreted prognostic uncertainty as hope and saw home ventilation as a tool permitting time for improvement. For families of children later in their disease course, often already with home technology and home nursing, home ventilation held less possibility for meaningful improvement. Nearly all families experienced the decision as very emotionally distressing. Reflecting back, most families described feeling satisfied with whatever decision they made. CONCLUSIONS The 2 principal groups of families in our cohort-those with children whose respiratory insufficiency might improve, and those with children facing chronic decline-warrant targeted counseling approaches about initiating home ventilation. The distressing nature of this decision should be anticipated and family supports reinforced.
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Affiliation(s)
- Renee D Boss
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - Carrie M Henderson
- University of Mississippi Medical Center, Jackson, MS; Center for Bioethics and Medical Humanities, Jackson, MS
| | | | - Nicholas A Jabre
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - Kelly Shipman
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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Cuviello A, Raisanen JC, Donohue PK, Wiener L, Boss RD. Initiating Palliative Care Referrals in Pediatric Oncology. J Pain Symptom Manage 2021; 61:81-89.e1. [PMID: 32711123 PMCID: PMC9116129 DOI: 10.1016/j.jpainsymman.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/18/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 01/16/2023]
Abstract
CONTEXT Early palliative care (PC) has been shown to improve the quality of life of children with cancer, yet referral practices by pediatric oncology providers remains inconsistent and few patients receive a formal PC consult. OBJECTIVES We sought to describe patient characteristics used by oncologists for PC referral and identify ways to improve PC integration into the care for children with cancer. METHODS This mixed-methods study used semistructured audiotaped interviews to explore the patient or disease characteristics used by pediatric oncology providers to trigger PC referral. Conventional content analysis was applied to interview transcripts. RESULTS About 77 participants with diverse experience were interviewed. More than 75% of participants reported that PC was consulted too late and cited communication and systems issues as the top barriers. Most participants (85%) stated that a screening tool would be helpful to standardize referral practices to PC. Characteristics such as poor prognosis (88%), symptom management (86%), comorbidities (65%), and psychosocial needs (65%) were commonly reported triggers that should initiate PC consultation. However, when presented with case scenarios that included these characteristics, participants did not consistently identify the PC triggers. Nearly 50% of participants stated they had received some formalized PC training; however, only one-third of these participants noted completing a PC rotation. CONCLUSION Our findings suggest that pediatric oncologists are committed to improving the integration of PC for their patients and that standardization of referral practices, through the use of a screening tool, would be of benefit. Additional PC education might reinforce pediatric oncologists' recognition of PC triggers.
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Affiliation(s)
- Andrea Cuviello
- St Jude Children's Research Hospital, Memphis, Tennessee, USA.
| | | | | | - Lori Wiener
- National Institutes of Health, Bethesda, Maryland, USA
| | - Renee D Boss
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA; Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Ruth AR, Boss RD, Donohue PK, Shapiro MC, Raisanen JC, Henderson CM. Living in the Hospital: The Vulnerability of Children with Chronic Critical Illness. The Journal of Clinical Ethics 2020. [DOI: 10.1086/jce2020314340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Barone S, Boss RD, Raisanen JC, Shepard J, Donohue PK. Our life at home: Photos from families inform discharge planning for medically complex children. Birth 2020; 47:278-289. [PMID: 32808396 DOI: 10.1111/birt.12499] [Citation(s) in RCA: 6] [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: 04/27/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infants with medical complexity are increasingly cared for at home, creating unique challenges for their caregivers. The sickest of these are those with chronic critical illness (CCI). These infants' medical fragility and resource-intensive needs puts them at increased risk for suboptimal transitions from hospital- to home-based care. It is unclear whether, and if so, to what extent clinicians gather and use knowledge of a family's home context during discharge planning. METHODS This study is a pilot of a novel program, using Photovoice methodology, which aims to record and reflect the experience of caring for a child with CCI at home from caregivers' perspectives and to provide direct feedback to inpatient discharging clinicians, with the goal of increasing awareness of (a) the importance of home context and (b) current discharge limitations. RESULTS Through photographs, parents described the importance of developing new routines, learning how to be a family, the impact of medical technology on nearly all aspects of everyday life, the critical role played by clinicians during the transition home, and feelings of social stigma and isolation. Clinicians, in turn, learned about gaps in discharge planning and the value of making families part of the decision-making team. They also found meaning in seeing the children they had cared for doing well at home, which subsequently bolstered enthusiasm for their job. CONCLUSIONS Findings from this pilot study highlight the importance of understanding the lived experience of families caring for medically complex children at home and suggest that this knowledge can be used to address gaps in the transition home.
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Affiliation(s)
| | - Renee D Boss
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | | | | | - Pamela K Donohue
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cuviello A, Raisanen JC, Donohue PK, Wiener L, Boss RD. Defining the Boundaries of Palliative Care in Pediatric Oncology. J Pain Symptom Manage 2020; 59:1033-1042.e1. [PMID: 31838131 PMCID: PMC8979408 DOI: 10.1016/j.jpainsymman.2019.11.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 05/17/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
Abstract
CONTEXT Although palliative care (PC) continues to be integrated into pediatric oncological care, only a minority of patients with cancer receive a formal PC consult. OBJECTIVES We sought to describe oncologists' current understanding of PC and how primary PC is provided for children with cancer. METHODS This mixed-methods study explored pediatric oncology providers' definitions of PC and self-reported PC practices through semistructured audiotaped interviews. Conventional content analysis was applied to interview transcripts. RESULTS Seventy-seven participants with diverse training backgrounds (30 attending physicians, 21 nurses, 18 fellows, five nurse practitioners, and two child life specialists) completed an interview. Approximately 75% provided a modern definition of PC (e.g., not limited to end-of-life care); all participants acknowledged primary PC skills as part of their daily clinical activities. However, participants expressed wide variation in the comfort and time spent performing primary PC tasks (i.e., symptom management, addressing mental health and psychosocial needs) and over half reported that patients' PC needs are not adequately met. In addition, some reported confusion about the benefits of PC consultation, despite acknowledging that PC needs to be better integrated into the care of pediatric oncology patients. CONCLUSION Our findings demonstrate that although most pediatric oncologists accept a modern definition of PC in theory, how to integrate PC into pediatric oncology practice is less understood. Formalized training and standardization of practice surrounding identification of PC needs in patients who may require secondary or tertiary PC services may help to overcome current barriers for PC integration in pediatric oncology.
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Affiliation(s)
- Andrea Cuviello
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA; National Institutes of Health, Bethesda, Maryland, USA.
| | | | | | - Lori Wiener
- National Institutes of Health, Bethesda, Maryland, USA
| | - Renee D Boss
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
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13
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Seltzer RR, Raisanen JC, da Silva T, Donohue PK, Williams EP, Shepard J, Boss RD. Medical Decision-Making in Foster Care: Considerations for the Care of Children With Medical Complexity. Acad Pediatr 2020; 20:333-340. [PMID: 31809809 DOI: 10.1016/j.acap.2019.11.018] [Citation(s) in RCA: 8] [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: 06/03/2019] [Revised: 11/22/2019] [Accepted: 11/28/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore how medical decision-making for children with medical complexity (CMC) occurs in the context of foster care (FC). METHODS Together with a medical FC agency, we identified 15 CMC in medical FC and recruited eligible care team members (biological and foster parents, medical FC nurses, caseworkers in medical FC/child welfare, and pediatricians) for each child. Semistructured interviews were conducted, and conventional content analysis was applied to transcripts. RESULTS Fifty-eight interviews were completed with 2-5 care team members/child. Serious decision-making related to surgeries and medical technology was common. Themes regarding medical decision-making for CMC in FC emerged: 1) Protocol: decision-making authority is dictated by court order and seriousness of decision, 2) Process: decision-making is dispersed among many team members, 3) Representing the child's interests: the majority of respondents stated that the foster parent represents the child's best interests, while the child welfare agency should have legal decision-making authority, and 4) Perceived barriers: serious medical decision-making authority is often given to individuals who spend little time with the child. CONCLUSIONS Medical decisions for CMC can have uncertain risk/benefit ratios. For CMC in FC, many individuals have roles in these nuanced decisions; those with ultimate decision-making authority may have minimal interaction with the child. Pediatricians can assist by clarifying who has legal decision-making authority, facilitating team communication to promote truly informed consent, and serving as a resource to decision-makers. Further research should explore how to adapt the traditional model of shared decision-making to meet the needs of this population.
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Affiliation(s)
- Rebecca R Seltzer
- Johns Hopkins University School of Medicine (RR Seltzer, PK Donohue, J Shepard, RD Boss), Baltimore, Md; Berman Institute of Bioethics (RR Seltzer, JC Raisanen, RD Boss), Baltimore, Md.
| | - Jessica C Raisanen
- Berman Institute of Bioethics (RR Seltzer, JC Raisanen, RD Boss), Baltimore, Md
| | - Trisha da Silva
- Johns Hopkins Bloomberg School of Public Health (T da Silva, PK Donohue), Baltimore, Md
| | - Pamela K Donohue
- Johns Hopkins University School of Medicine (RR Seltzer, PK Donohue, J Shepard, RD Boss), Baltimore, Md; Johns Hopkins Bloomberg School of Public Health (T da Silva, PK Donohue), Baltimore, Md
| | - Erin P Williams
- Columbia University Vagelos College of Physicians and Surgeons (EP Williams), New York, NY
| | - Jennifer Shepard
- Johns Hopkins University School of Medicine (RR Seltzer, PK Donohue, J Shepard, RD Boss), Baltimore, Md
| | - Renee D Boss
- Johns Hopkins University School of Medicine (RR Seltzer, PK Donohue, J Shepard, RD Boss), Baltimore, Md; Berman Institute of Bioethics (RR Seltzer, JC Raisanen, RD Boss), Baltimore, Md
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14
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Boss RD, Raisanen JC, Detwiler K, Fratantoni K, Huff SM, Neubauer K, Donohue PK. Lived Experience of Pediatric Home Health Care Among Families of Children With Medical Complexity. Clin Pediatr (Phila) 2020; 59:178-187. [PMID: 31849237 DOI: 10.1177/0009922819894006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 11/17/2022]
Abstract
Background. For children with complex medical conditions, pediatric home health care is a chronic need. It is a clinical service delivered entirely outside of clinical settings, granting families unparalleled expertise regarding service quality. Methods. Telephone interviews with parents whose children have extensive experiences with home health care. Results: Five themes emerged: (1) benefits of home health care include child survival and family stability; (2) family life is inextricable from home health care schedules, staffing, and services; (3) home health care gaps threaten family physical, mental, and financial well-being; (4) Out-of-pocket costs are common; and (5) families must fight for services as their children's medical conditions evolve. Conclusions. Families understand better than prescribers, providers, or policy makers what is working, and what is not, with home health care. Family expertise should be the foundation for training other families, clinicians, and home health care agencies, and should be a central component of policy and advocacy in this area.
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Affiliation(s)
- Renee D Boss
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | | | | | | | - Susan M Huff
- Johns Hopkins Home Health Group, Baltimore, MD, USA
| | - Kathryn Neubauer
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Pamela K Donohue
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Ruth AR, Boss RD, Donohue PK, Shapiro MC, Raisanen JC, Henderson CM. Living in the Hospital: The Vulnerability of Children with Chronic Critical Illness. J Clin Ethics 2020; 31:340-352. [PMID: 33259339] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of family life, and the intensive utilization of resources-combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay. In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to make clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital.
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Affiliation(s)
- Alexandra R Ruth
- Johns Hopkins Bloomberg School of Public Health in Baltimore, MD USA.
| | - Renee D Boss
- Johns Hopkins Berman Institute of Bioethics and Division of Neonatal-Perinatal Medicine, Division of Neonatology, Johns Hopkins School of Medicine, Baltimore, MD USA.
| | - Pamela K Donohue
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family, and Reproductive Health; Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA.
| | - Miriam C Shapiro
- University of Minnesota School of Medicine, Department of Pediatrics; University of Minnesota Masonic Children's Hospital, Minneapolis, MN USA. mshapiro @umn.edu
| | - Jessica C Raisanen
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD USA. jraisan1 @jhu.edu
| | - Carrie M Henderson
- University of Mississippi Medical Center, Center for Bioethics and Medical Humanities, and Division of Pediatric Critical Care, Jackson, MS USA.
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16
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Seltzer RR, Raisanen JC, Williams EP, Da Silva T, Donohue PK, Boss RD. Exploring Medical Foster Care as a Placement Option for Children With Medical Complexity. Hosp Pediatr 2019; 9:697-706. [PMID: 31427371 DOI: 10.1542/hpeds.2018-0229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Medical foster care (MFC) offers a family-home setting for children with medical complexity (CMC) who cannot be cared for by their parents. We explored MFC as a placement option for CMC via in-depth interviews with the individuals providing and monitoring care. METHODS In collaboration with an MFC agency, we recruited care team members for 15 CMC. Semistructured interviews were audiotaped and transcribed. Descriptive analyses were performed on care team composition and roles, the placement process, and child medical, placement, and quality of life (QoL) characteristics. Foster parents completed child QoL questionnaires. Conventional content analysis was applied to participant suggestions for MFC improvements. RESULTS Fifty-eight interviews were conducted; a median of 4 care team members interviewed per child. An extensive network of individuals and systems are involved in providing care. Each child received care from multiple subspecialists (median = 5). Most children were technology dependent (87%), developmentally delayed (87%), and entered MFC from the hospital (73%) because of medical neglect (86%). Nearly half were in care for >2 years. Changes in placement and/or care team were common. QoL scoring showed impairments in multiple domains, whereas respondent interviews described positive aspects of QoL. Participants provided suggestions to improve care within MFC. CONCLUSIONS MFC is a promising placement option for CMC. Because many CMC are entering MFC directly from the hospital and require ongoing care from pediatric subspecialists, pediatricians should be familiar with MFC, the placement process, and the various systems and individuals involved. Pediatricians can play important roles in ensuring that children in MFC receive coordinated and high-quality care.
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Affiliation(s)
- Rebecca R Seltzer
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland;
- Berman Institute of Bioethics, Baltimore, Maryland
| | | | - Erin P Williams
- College of Physicians and Surgeons, Columbia University, New York, New York; and
| | - Trisha Da Silva
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Berman Institute of Bioethics, Baltimore, Maryland
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17
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Fratantoni K, Raisanen JC, Boss RD, Miller J, Detwiler K, Huff SM, Neubauer K, Donohue PK. The Pediatric Home Health Care Process: Perspectives of Prescribers, Providers, and Recipients. Pediatrics 2019; 144:peds.2019-0897. [PMID: 31467245 DOI: 10.1542/peds.2019-0897] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with medical complexity (CMC) often require pediatric home health care (PHHC) to meet their daily intensive care needs. Pediatricians are central to planning, implementing, and maintaining quality PHHC for CMC, yet a comprehensive road map for this process is lacking. With this national study, we aim to fill that gap. METHODS Semistructured interviews were conducted with parents and professionals from the 10 US Health Resources and Services Administration regions. Parents were recruited via advocacy groups for families of CMC; professionals with experience with PHHC for CMC were identified by using purposive and snowball sampling. Interview transcripts were qualitatively analyzed for themes. RESULTS A comprehensive process of prescribing, providing, and maintaining PHHC requires 5 steps: identifying needs, investigating options, developing plans of care, initiating services, and navigating evolving needs. The success of the PHHC process is built on knowledge, anticipation, and early identification of needs; communication; care-coordination infrastructure; skilled home health providers; and the parent-provider relationship. CONCLUSIONS Many CMC require PHHC to live safely outside of the hospital. Although the PHHC process involves multiple steps and participants, pediatricians' understanding of the process is the foundation of PHHC success. Fostering interagency relationships, increasing longitudinal care coordination, and investing in the PHHC infrastructure may reduce the burden placed on families and CMC as they navigate the complex process of PHHC.
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Affiliation(s)
- Karen Fratantoni
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia
| | | | - Renee D Boss
- Berman Institute of Bioethics, Baltimore, Maryland.,Department of Pediatrics, Johns Hopkins University School of Medicine and
| | - Jennifer Miller
- Department of Pediatrics, Johns Hopkins University School of Medicine and
| | - Kathryn Detwiler
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia
| | - Susan M Huff
- Johns Hopkins Home Health Group, Baltimore, Maryland
| | - Kathryn Neubauer
- Department of Pediatrics, Johns Hopkins University School of Medicine and
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins University School of Medicine and .,Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
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18
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Chadwick SB, Raisanen JC, Goldey KL, van Anders S. Strategizing to Make Pornography Worthwhile: A Qualitative Exploration of Women's Agentic Engagement with Sexual Media. Arch Sex Behav 2018; 47:1853-1868. [PMID: 29497916 DOI: 10.1007/s10508-018-1174-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 02/03/2018] [Accepted: 02/12/2018] [Indexed: 05/25/2023]
Abstract
Women often expect to encounter negative, problematic content when they consume pornography, yet many women use and enjoy pornography anyway. Some research has centered content type (e.g., sexist/violent vs. nonsexist/women-focused) as a key determinant of women's pornography experiences, but this precludes the notion that women are active, engaged consumers of pornography and minimizes women's role in shaping their own experiences. In the present study, we explored how a sample of sexually diverse women in the U.S. (aged 18-64; N = 73) worked toward positive experiences with pornography via active negotiation with negative content, using a secondary analysis of focus group data on women's sexual pleasure. We found that, although women often experienced pornography as risky, many women used it anyway and actively employed strategies to increase the likelihood of having a positive experience. Women's strategies were similar across sexual identity and age groups, but the heteronormative, youth-oriented portrayals of sexuality in mainstream pornography presented unique concerns for heterosexual, queer, and older women. Results have implications for how women can be conceptualized as active, rather than passive, consumers of pornography as well as for how women's agency might influence women's arousal responses to sexually explicit stimuli in research.
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Affiliation(s)
- Sara B Chadwick
- Departments of Psychology and Women's Studies, University of Michigan, Ann Arbor, MI, USA
| | - Jessica C Raisanen
- Departments of Psychology and Women's Studies, University of Michigan, Ann Arbor, MI, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Katherine L Goldey
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology and Behavioral Neuroscience, St. Edward's University, Austin, TX, USA
| | - Sari van Anders
- Departments of Psychology and Women's Studies, Program in Neuroscience, Science, Technology, and Society Program, Reproductive Sciences Program, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA.
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19
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Raisanen JC, Chadwick SB, Michalak N, van Anders SM. Average Associations Between Sexual Desire, Testosterone, and Stress in Women and Men Over Time. Arch Sex Behav 2018; 47:1613-1631. [PMID: 29845444 DOI: 10.1007/s10508-018-1231-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/01/2017] [Accepted: 05/08/2018] [Indexed: 05/10/2023]
Abstract
Sexual desire and testosterone are widely assumed to be directly and positively linked to each other despite the lack of supporting empirical evidence. The literature that does exist is mixed, which may result from a conflation of solitary and dyadic desire, and the exclusion of contextual variables, like stress, known to be relevant. Here, we use the Steroid/Peptide Theory of Social Bonds as a framework for examining how testosterone, solitary and partnered desire, and stress are linked over time. To do so, we collected saliva samples (for testosterone and cortisol) and measured desire as well as other variables via questionnaires over nine monthly sessions in 78 women and 79 men. Linear mixed models showed that testosterone negatively predicted partnered desire in women but not men. Stress moderated associations between testosterone and solitary desire in both women and men, but differently: At lower levels of stress, higher average testosterone corresponded to higher average solitary desire for men, but lower solitary desire on average for women. Similarly, for partnered desire, higher perceived stress predicted lower desire for women, but higher desire for men. We conclude by discussing the ways that these results both counter presumptions about testosterone and desire but fit with the existing literature and theory, and highlight the empirical importance of stress and gender norms.
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Affiliation(s)
- Jessica C Raisanen
- Departments of Psychology and Women's Studies, University of Michigan, Ann Arbor, MI, USA
| | - Sara B Chadwick
- Departments of Psychology and Women's Studies, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Michalak
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Sari M van Anders
- Departments of Psychology and Women's Studies, Program in Neuroscience, Reproductive Sciences Program; Science, Technology and Society Program; Biosocial Methods Collaborative, University of Michigan, Ann Arbor, MI, USA.
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON, K7L 3N6, Canada.
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20
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Muñoz-Blanco S, Raisanen JC, Donohue PK, Boss RD. Enhancing Pediatric Palliative Care for Latino Children and Their Families: A Review of the Literature and Recommendations for Research and Practice in the United States. Children (Basel) 2017; 5:children5010002. [PMID: 29271924 PMCID: PMC5789284 DOI: 10.3390/children5010002] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
As the demand for pediatric palliative care (PC) increases, data suggest that Latino children are less likely to receive services than non-Latino children. Evidence on how to best provide PC to Latino children is sparse. We conducted a narrative review of literature related to PC for Latino children and their families in the United States. In the United States, Latinos face multiple barriers that affect their receipt of PC, including poverty, lack of access to health insurance, language barriers, discrimination, and cultural differences. Pediatric PC research and clinical initiatives that target the needs of Latino families are sparse, underfunded, but essential. Education of providers on Latino cultural values is necessary. Additionally, advocacy efforts with a focus on equitable care and policy reform are essential to improving the health of this vulnerable population.
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Affiliation(s)
- Sara Muñoz-Blanco
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Jessica C Raisanen
- Clinical Ethics, Johns Hopkins Berman Institute of Bioethics, Baltimore, MD 21205, USA.
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
- Clinical Ethics, Johns Hopkins Berman Institute of Bioethics, Baltimore, MD 21205, USA.
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