Determining the Effectiveness of Using Patient-Reported Outcomes in Pediatric Clinical Practices.

PROBLEM: Patient-reported outcomes (PROs) are increasingly recognized in pediatric clinical care as adding essential information relevant to actual care. However, the effectiveness of using PROs in pediatric clinical settings has not been fully explored with synthesized evidence. The aim of this study was to evaluate the effectiveness of using patient-reported outcomes in pediatric clinical practices. ELIGIBILITY CRITERIA: We searched four English and three Chinese databases to identify studies that examine the effectiveness of using PROs in pediatric clinical practices published from the inception date of each database to January 2020. SAMPLE: Ten articles met the inclusion criteria. RESULTS: There was wide a variation in the ten studies' designs, samples, PROs administered (type, length, timing, mode), and type of outcomes evaluated. The effect sizes of using PROs on three categories of outcomes (patient, process of care and health service) were assessed. Of 70 measured outcomes, 32 were positive, 5 were negative, and 33 were mixed. CONCLUSIONS: Overall, there is a weak but trending positive impact of using PROs in pediatric clinical practice. IMPLICATIONS: More rigorous study designs with sources of bias controlled are needed to more directly assess the impact of using PROs in pediatric care. If findings continue to be positive, then an implementation model addressing the numerous influencing factors is recommended to integrate PROs into pediatric care.

The Experiences of Chinese Children 5- to 7-year-old during Cancer Treatment Reflected Through Interviews and Drawings.

Background: For children with cancer, the experience during treatment can be challenging. There is a limited number of studies on self-reported treatment experiences of younger Chinese children with cancer using qualitative methods. Objectives: This study aimed at exploring the experience of Chinese children aged 5 to 7 years during cancer treatment reflected through interviews and drawings. Methods: This study used a descriptive qualitative design with the technique of "draw-and-tell." Participants were enrolled from the pediatric oncology inpatient department of one national children's medical center in China. They were asked to draw a picture of "your feelings in the hospital." An inductive content analysis approach was used. Results: Twelve participants were enrolled (8 male, mean age 5.7 years). Four themes were established: (1) suffering from adverse treatment effects; (2) perceiving changed relationships; (3) being thankful for others; and (4) trying out coping strategies. Conclusion: Chinese children aged 5 to 7 years expressed multiple cancer treatment impacts. They appreciated others' support and had their own way to cope with treatment demands. The authors also extended the dynamic nature of using the "draw-and-tell" methodology. Study findings highlight the importance of inviting and hearing the voice of young children during their cancer treatment, with particular consideration of the influence of disease, treatment, child development, family dynamics, and culture.

Symptom Experience of Children With Cancer Younger Than Eight Years of Age: An Integrative Review.

CONTEXT: Children with cancer endure multiple symptoms during treatment. However, there remains a lack of systematic approaches to capture the whole picture of the symptom experience of children with cancer younger than eight years of age. OBJECTIVE: The purpose of this study was to conduct an integrative review to explore symptom experience of children with cancer younger than eight years of age. METHODS: A literature search of PubMed, CINAHL, Web of Science, PsycINFO, Cochrane databases, and four Chinese databases was performed to identify empirical studies, followed by an evaluation of empirical quality and data extraction and synthesis. RESULTS: Twelve articles covering 11 symptoms met the inclusion criteria. Children with cancer under the age of eight years experienced multiple intense symptoms, especially pain, worry, and anxiety. PedsQL™ Cancer Module (for age five to seven years) was the most commonly used instruments. There were limited data on these children's symptom quality, timing, and distress. Discordance between a child's age and symptom intensity was noted. Inconsistent concordance existed between children and their proxy symptom reports. CONCLUSION: Children with cancer younger than eight years of age experience multiple symptoms. There is a need to investigate the full symptom profiles of these young children in consideration of their developmental nuances; to examine the concordance among different symptom reporters; and to conduct more qualitative studies to explore their symptom experience.