The Impact of Qualification and Hospice Education on Staff Attitudes during Palliative Care in Pediatric Oncology Wards-A National Survey.

BACKGROUND: Our knowledge about the attitudes of healthcare staff to palliative care in pediatric oncology is scarce. We aimed to assess their perceptions of palliative care in Hungary and find answers to the question of how to provide good palliative care for children. METHOD: Physicians (n = 30) and nurses (n = 43) working in the field of pediatric oncology (12 of them specialized in hospice care) were interviewed. Palliative care practice (communication, integration of palliative care, professionals' feelings and attitudes, and opportunities for improvement) was assessed by semi-structured interviews evaluated in a mixed quantitative and qualitative way by narrative categorical content analysis and thematic analysis. RESULTS: All providers displayed high negative emotions, positive evaluations, and used many active verbs. Nurses showed higher levels of denial, more self-references, and were more likely to highlight loss. Physicians emphasized the importance of communication regarding adequate or inadequate palliative care. Hospice specialists showed a higher passive verb rate, a lower self-reference, a lower need for psychological support, and a greater emphasis on teamwork and professional aspects. CONCLUSION: Our results show that nurses are more emotionally stressed than doctors in palliative care in pediatric oncology. To our knowledge, a study comparing doctors and nurses in this field has yet to be carried out. Our results suggest that pediatric oncological staff can positively evaluate a child's palliative care despite the emotional strain. Regarding hospices, professional practice in palliative care may be a protective factor in reducing emotional distress and achieving professional well-being.

Medical Communication during the Transition to Palliative Care in Pediatric Oncology in Hungary-The Parents' Perspective.

The transition to palliative care (PC) is a critical aspect of pediatric oncology, and it requires a high level of communication skills from doctors, which could be best judged by the parents of children who have died from cancer. Our aim was to explore the parents' perspectives regarding the timing of the consultation on the implementation of PC, as well as facets of verbal and nonverbal communication in Hungary. Semistructured interviews were conducted with parents who had lost a child to cancer within the past 1-5 years. Interview transcripts (n = 23) were scrutinized with interpretative phenomenological analysis. The parents frequently associated palliation with end-of-life care and they clearly delimited the transition to PC after curative treatments had been exhausted. The parents were ambivalent with regard to the use of the word "death" during this consultation, and they often did not receive information on what to expect (e.g., regarding symptoms) or on who to turn to for further information or support (e.g., concerning bereavement). Although significant progress could be observed in the organization of pediatric palliative care in Hungary, there is still no widely accepted communication method for the transition to sole PC. There is a need for a culturally sensitive approach to refining the recommendations on the word use and communication protocol in pediatric PC in Hungary.

When and how to integrate oncology and palliative care? / Mikor és hogyan integráljuk az onkológiai és a palliatív ellátást?

Összefoglaló. A palliatív ellátások korai bevonása az onkológiai betegek ellátásába elonnyel jár mind a beteg életminosége, mind a kezelés színvonala, mind a költséghatékonyság szempontjából. Szükség van egy olyan modellre, mely alapján a megfelelo idoben, a megfelelo beteg a megfelelo minoségu palliatív ellátásban részesül. Ebben a közleményben a palliatív ellátás korai integrációjának elonyei, szintjei és a speciális palliatív ellátás fogalmának ismertetése után a leginkább elterjedt beutalási modellek elonyeit és hátrányait mutatjuk be a nemzetközi szakirodalom alapján. A speciális palliatív ellátást igénylo betegek kiszurésére szolgáló, prognózisalapú modellek hátránya, hogy nincs elég kapacitás az ilyen módon beutalt nagyszámú beteg ellátására, ezért széles körben nem terjedtek el. A tüneteken alapuló modellek sokszor bonyolultak és a mindennapi klinikai gyakorlatban nem használatosak. Az új kutatások alapján egyszeru, gyakorlatias kérdéssorokat alkalmaznak, melyekkel könnyen kiemelhetok, akik profitálnak a speciális palliatív intervencióból. Ezek közül a Yale egyetemi és a PALLIA -10 modellt ismertetjük részletesen. Amennyiben az aktív onkológiai ellátást végzok a megfelelo palliatív beutalási kritériumokat ismerik és alkalmazzák, a betegek idoben jutnak a megfelelo komplex kezeléshez anélkül, hogy a palliatív ellátórendszer túlterhelodne. Orv Hetil. 2021; 162(44): 1769-1775. Summary. Early integration of palliative care into the trajectory of cancer care brings advantages into the patients' quality of life, the level of care and cost-efficiency, too. On the basis of a predefined model, the right patient may receive the right level of palliative care at the right time. Having defined the advantages, the levels of early integration of palliative care and the concept of special palliative care, we also aim to describe the advantages and disadvantages of the most common referral models on the basis of international literature in this article. The drawback of prognosis-based models to identify patients needing special palliative care is the lack of capacity to provide care for the large number of patients so recognised; therefore they have not become widespread. Needs-based models tend to be complicated and thus rarely applied in everyday clinical practice. On the basis of new researches, simple, pragmatic questionnaires are utilised through which the patients who could benefit from special palliative care interventions are easy to identify. Here we give a detailed report of the Yale University and PALLIA-10 models. On condition that appropriate palliative referral criteria are known and applied by active oncology care providers, patients may receive adequate complex care without the palliative care system being overloaded. Orv Hetil. 2021; 162(44): 1769-1775.

[Special aspects of medical communication in the field of pediatric oncology focusing on palliative care]. / Az orvosi kommunikáció sajátosságai a gyermekonkológia területén, különös tekintettel a palliatív ellátásra.

Relation between the treating physician, the child with cancer and his/her parents is decisive in the field of pediatric oncology. Medical communication plays a crucial role in this relation. The quality of communication is particularly emphasized during the phase of palliative care in the case of children with incurable malignant disease. The proper medical communication during pediatric palliative care is subject of intensive research which is hindered by the sensitivity of the topic and the difficulties with inclusion of parents whose child has been lost or receiving palliative treatment and of health-care providers, respectively. In the present work, we review the publications focusing on palliative care in the field of pediatric oncology. Despite extensive research, only few investigations focus on the practical aspects of medical communication. Reports on the effectiveness of practical implementation of the existing theories are lacking. Drawing general conclusions is highly hindered by socio-cultural differences, including the diverse parental expectations towards doctors in different cultural and religious settings. However, there is a general agreement that early, simultaneous integration of palliative care at the time of diagnosis sharing is crucial. With the current knowledge, it is essential to conduct further research in this field considering the different socio-cultural backgrounds as well. Orv Hetil. 2020; 161(9): 323-329.

[Alternative therapy in childhood cancer]. / Alternatív terápia a gyermekonkológiában.

INTRODUCTION: In Hungary there are as many as 300 children diagnosed with malignant tumor each year. Along with the traditional treatments, alternative remedies have been increasingly applied in the past two decades despite the availability of the more complex and more effective malignant tumor treatments. AIMS: The authors attempted to find out about the applied alternative remedies for childhood cancer outside the traditional treatments, to determine how frequently they were applied and to examine what psychological factors had lead to their application. PATIENTS: Children's parents, getting active treatment and also the ones that have been rehabilitated at the II. Department of Pediatrics, Semmelweis University. RESULTS: 60 percent of the 34 children being examined were getting several kinds of therapy. The most frequently applied alternative remedies were the following: nature products, diet supplements, herbs, diet changes. The parents' choice was mainly influenced by other parents' opinions (42%), frequently appearing commercials in media (26%) and their current financial background (23%). The authors have found on the base of their research that the general aim of parents was: to help their own incapability to help (31%), to make sure about the efficiency of the treatment (45%). CONSEQUENCES: Independently of demographic or clinical facts the use of alternative remedies are excessively widespread and popular with children having tumor. Thus it is not advisable or reasonable to absolutely refuse them since they are quite widespread and people tend to strongly believe in them. As for doctors, they are to give professional advice and help with choosing the alternative remedies that are not harmful or even more, the ones that can make traditional treatments more effective.