ABSTRACT
PROBLEM IDENTIFICATION: This systematic review will examine the social support needs of bereaved parents in the specific context of pediatric cancer by synthesizing the qualitative evidence. Social support encompasses emotional, practical, informational, and meaning-making support needs. LITERATURE SEARCH: The Joanna Briggs Institute procedures for conducting qualitative systematic reviews guided every stage of this review. Four databases (PsychInfo, CINAHL, Pubmed, and ASSIA) were systematically searched, in addition to the gray literature and scoping review. Through a five-step critical appraisal process 11 out of 668 potential articles were identified as meeting the inclusion criteria. DATA EVALUATION/SYNTHESIS: Relevant findings were synthesized with a thematic-synthesis approach. Findings, which follow the journey of bereaved parents integrated under the core-category "Needs." This encompasses of four higher-level categories: Last days: Parent needs when caring for their dying child Rest in peace: Parent needs during the child's death Feeling abandoned: Parent needs for contact after the child's death Searching for Meaning: Parents needs when making sense of loss. CONCLUSION: Informational support needs is largely unexplored in academic literature. Staff in the treating-hospital are central in offering bereavement-support to parents, who may otherwise feel that they have lost their second home (hospital) and second family (staff).
Subject(s)
Bereavement , Needs Assessment , Neoplasms/mortality , Parent-Child Relations , Parents/psychology , Humans , Qualitative ResearchABSTRACT
BACKGROUND: High-risk neuroblastoma (HR NBL) treatment requires intensive induction chemotherapy. The profoundly emetogenic agents used can compromise nutritional status. Our institution introduced a new antiemetic guideline in 2010 incorporating regular dexamethasone, in addition to ondansetron, for all highly emetogenic protocols. PROCEDURE: A retrospective comparative review of pediatric patients diagnosed with HR NBL who received rapid COJEC induction chemotherapy as per HR-SIOPEN NBL trial. Prophylactic antiemetics were prescribed regardless of chemotherapy emetogenicity in group A (2004-2010) but for defined time periods considering chemotherapy emetogenicity in group B (2010-2017). RESULTS: Sixty-three children were eligible for inclusion (median age, 31 months; range, 1-88 months). Group A had more episodes of emesis than group B (189 vs. 116, P < 0.0001). There was a significant difference in weight-for-age Z score change between the groups by induction end (P = 0.0027). Four children (13%) in group A lost >10% body weight versus none in group B. Nutrition support (NS) was utilized by 29 children (94%) in group A and 22 children (69%) in group B. Group A had a median of 3 (range, 1-7) admissions for febrile neutropenia (FN) versus a median of 1.5 (range, 0-4) for group B (P = 0.003) during induction. CONCLUSION: The review of our guidelines led to reduced emesis frequency for group B. They also required less NS, followed expected growth trajectories more closely and had fewer FN admissions. We propose that this may have occurred due to better emesis control resulting in improved nutritional status and associated enhanced immune function.
Subject(s)
Antiemetics/therapeutic use , Induction Chemotherapy/adverse effects , Neuroblastoma/drug therapy , Nutritional Status/drug effects , Vomiting/prevention & control , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Child , Child, Preschool , Dexamethasone/therapeutic use , Female , Humans , Infant , Infant, Newborn , Male , Nausea/chemically induced , Nausea/prevention & control , Ondansetron/therapeutic use , Practice Guidelines as Topic , Retrospective Studies , Vomiting/chemically inducedABSTRACT
An audit was conducted of the management of chemotherapy-induced nausea and vomiting in children and young people in the national Irish paediatric cancer unit. Over three months, the anti-emetic medication and the incidence of nausea and vomiting in 50 consecutive patient episodes were recorded among 25 children receiving chemotherapy for diverse malignancies. Anti-emetic prescription was found to be unrelated to the emetogenic potential of the chemotherapy received, so that effectiveness varied. Dexamethasone was used in only one case. Twenty children did not take any anti-emetics following discharge, although 11 experienced delayed vomiting, evidence-based guidelines were established and now include anti-emetic prescription that is proportional to the emetogenic potential of the chemotherapeutic regimen. It is also recommended that staff, patients, families and carers should receive education about the need for prescription and use of anti-emetics after discharge.