A comparison of the clinical effectiveness and cost of specialised individually delivered parent training for preschool attention-deficit/hyperactivity disorder and a generic, group-based programme: a multi-centre, randomised controlled trial of the New Forest Parenting Programme versus Incredible Years.

The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33-54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)-12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)-12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome-Parent ratings of child's ADHD symptoms (Swanson, Nolan & Pelham Questionnaire-SNAP-IV). Secondary outcomes-teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference - 0.009 95% CI (- 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [- 0.189 95% CI (- 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [- 0.16 95% CI (- 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches.

Practical approaches to seeking assent from children.

AIM: To describe and evaluate two approaches--a storyboard and a wordsearch--that the authors used with children aged four to 12 years to obtain assent. BACKGROUND: The assent process is vital in helping children to understand the elements of a research project and to make a choice of whether or not to participate. However, the methods for obtaining assent are not well documented. DATA SOURCES: Two researchers' thematic reviews of the primary researcher's field notes, taken during a study of eating problems during chemotherapy. DISCUSSION: The assent process appeared to be an enjoyable, positive experience for many children. They appeared to understand what participation entailed--that it was voluntary and that they had a choice. CONCLUSION: When using child-centred techniques, children are aware of what being in a research study will mean to them. IMPLICATIONS FOR PRACTICE: Researchers can be confident in gaining assent from children as young as five years.

Providing nutritional support for patients during cancer treatment.

Children and young people with cancer often experience a diminished oral intake and exhibit subsequent weight loss and poor nutrition as a result of the side effects of treatments. This article studies the case of a five-year-old boy who developed nutritional problems to demonstrate the need for clear and systematic guidelines and protocols for nurses and health professionals to make uniform decisions in the management of such situations.

Compassionate care intervention for hospital nursing teams caring for older people: a pilot cluster randomised controlled trial.

OBJECTIVE: Compassionate care continues to be a focus for national and international attention, but the existing evidence base lacks the experimental methodology necessary to guide the selection of effective interventions for practice. This study aimed to evaluate the Creating Learning Environments for Compassionate Care (CLECC) intervention in improving compassionate care. SETTING: Ward nursing teams (clusters) in two English National Health Service hospitals randomised to intervention (n=4) or control (n=2). Intervention wards comprised two medicines for older people (MOPs) wards and two medical/surgical wards. Control wards were both MOPs. PARTICIPANTS: Data collected from 627 patients and 178 staff. EXCLUSION CRITERIA: reverse barrier nursed, critically ill, palliative or non-English speaking. All other patients and all nursing staff and Health Care Assistant HCAs were invited to participant, agency and bank staff were excluded. INTERVENTION: CLECC, a workplace intervention focused on developing sustainable leadership and work-team practices to support the delivery of compassionate care. CONTROL: No educational activity. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary-Quality of Interaction Schedule (QuIS) for observed staff-patient interactions. Secondary-patient-reported evaluations of emotional care in hospital (PEECH); nurse-reported empathy (Jefferson Scale of Empathy). RESULTS: Trial proceeded as per protocol, randomisation was acceptable. Some but not all blinding strategies were successful. QuIS observations achieved 93% recruitment rate with 25% of patient sample cognitively impaired. At follow-up there were more total positive (78% vs 74%) and less total negative (8% vs 11%) QuIS ratings for intervention wards versus control wards. Sixty-three per cent of intervention ward patients scored lowest (ie, more negative) scores on PEECH connection subscale, versus 79% of control. This was not a statistically significant difference. No statistically significant differences in nursing empathy were observed. CONCLUSIONS: Use of experimental methods is feasible. The use of structured observation of staff-patient interaction quality is a promising outcome measure inclusive of hard to reach groups. TRIAL REGISTRATION NUMBER: ISRCTN16789770.

Exploring the work of nurses who administer chemotherapy to children and young people.

PURPOSE OF THE RESEARCH: To explore the knowledge, attitudes and beliefs of nurses who administer chemotherapy to children and young people. METHODS AND SAMPLE: A national postal survey of nurses working within the 21 cancer centres in the United Kingdom and Ireland. The questionnaire included 25-items addressing the attitudes, beliefs and concerns regarding nurses' roles, support mechanisms and educational preparation related to administration of chemotherapy. RESULTS: In total 286/507 (56%) questionnaires were returned. The majority of nurses worked in inpatient +/-outpatient (78%) settings and most gave chemotherapy on a daily basis (61%). The median time working in oncology was 10 [range 0.5-32] years and time administering chemotherapy was 8 [0.1-32] years. Aspects of administration that caused the most worry included treatment side-effects, extravasation, dealing with allergic/anaphylactic reactions and knowledge deficits in colleagues. There was no significant difference in worry according to level of nurse education but those with an oncology qualification had less Knowledge-related worry (p = 0.05). There was no difference in attitude according to level of education or having an oncology qualification. There were significant correlations between time qualified, time working in oncology and the number of years administering chemotherapy and the worry domains (ranging from r = -0.14 to r = -0.24, p < 0.05); and attitude to chemotherapy (ranging from r = 0.12 to r = 0.26, p < 0.001). CONCLUSION: As anticipated nurses new to chemotherapy administration were initially anxious about the role and they worried about making a drug error. Education and support from colleagues appears to have a positive effect on reducing worry and increasing competence.

What's it like when you find eating difficult: children's and parents' experiences of food intake.

BACKGROUND: Despite significant advances in supportive care, children and families continue to face many challenges managing the consequences of cancer therapies. The purpose of this study was to explore the eating experiences of children, both at home and in hospital. OBJECTIVE: The objective of the study was to explore the perceptions and experiences of children and their families regarding food intake and discover how nutritional issues are managed by children and families. METHODS: A stratified sample was recruited according to stage in treatment journey, risk of developing nutritional problems, and aged 4 to 12 years undergoing chemotherapy at a cancer center in London, was recruited. This qualitative study involved the use of 2 key visual storytelling techniques: (1) photographs and drawings contained in a scrapbook or diary used as interview stimuli and (2) in-depth interviews with parents. RESULTS: Our study revealed a complex interplay between the context of care, added to an individual child's desires and nutritional needs that are constantly changing during therapy. Failures in the hospital system to meet the nutritional needs of children placed extra stress on parents to provide food for their children. CONCLUSIONS: A relaxed and creative approach to tempting and keeping children engaged with food and eating was a focus for parents, which avoided what they described as making a "big deal about it." Poor information meant that children and parents were not always prepared for the adverse effects of therapies. IMPLICATIONS FOR PRACTICE: This study contributes much to the emerging description of practice guidance and informs strategies that can be used by children and parents.