Pediatric Oncology Health Care Providers Research Articles

Impact of the COVID-19 pandemic on pediatric oncology providers globally: A mixed-methods study.

BackgroundCoronavirus disease 2019 (COVID‐19) disrupted pediatric oncology care globally, increasing demands on health care providers (HCPs) who adapted to continue care. This study sought to characterize the pandemic's impact on pediatric oncology HCPs worldwide.MethodsA 60‐item survey focused on changes to clinical care, resources, and effects on clinicians. A diverse subgroup of institutions was purposefully selected for focus groups that explored teamwork, communication, and changes to care delivery.ResultsThe survey included 311 responses from 213 institutions representing 79 countries. Sixteen institutions participated in 19 multidisciplinary focus groups in 8 languages. Decreased clinical staff availability was cited by 51% of institutions as a major impact. Staffing modifications included decreased provider availability (66% of institutions), roles or responsibility changes, and transfer outside the specialty. Physical effects included frequent COVID‐19 illness; 8% of respondents reported HCP deaths. Fifty percent of providers did not have the necessary personal protective equipment. HCPs also experienced psychological distress and financial concerns. Findings indicated more frequent impact on nurses than other providers. Impacts were described across all hospital resource levels, with staffing modifications more frequent in countries with higher COVID‐19 incidence (P < .001) and mortality rate (P = .004). Focus groups revealed negative impacts were stabilized by increased teamwork, communication, contributions outside usual roles, policies aimed at optimizing safety, and feeling that they were contributing.ConclusionsCOVID‐19 had a profound impact on the pediatric oncology workforce, creating challenging modifications to staffing and resulting in physical, psychological, and financial distress. Despite these challenges, HCPs caring for children with cancer came together to continue to provide high‐quality care.

Sharing psychosocial risk screening information with pediatric oncology healthcare providers: Service utilization and related factors.

Psychosocial morbidity in pediatric oncology patients and their caregivers is widely recognized. Although routine systematic psychosocial screening has been proposed as a standard of care, screening is still limited. The present study assessed whether supplying the patient's treating team of healthcare providers with psychosocial risk screening information near diagnosis would increase the rate of documented psychosocial contacts, particularly for patients/families with elevated risk. The effect of demographic and clinical factors was also examined. Ninety-three families with a child/youth newly diagnosed with cancer participated. Families were randomly assigned to a care as usual control group (n=44) or an intervention group (n=49) where the treating team was provided with a summary of family psychosocial risk, measured by the Psychosocial Assessment Tool (PAT). The PAT was completed by the primary caregiver, who also provided demographic information. The number of psychosocial intervention contacts documented in the medical charts was examined. The rate of psychosocial intervention did not significantly differ between the groups (P>0.05). The intensity of the child's cancer treatment was found to be the only significant predictor of the number of documented psychosocial intervention contacts (β=0.396, P<0.001). Clinical factors appear to be more predictive of the rate of psychosocial intervention provided to pediatric oncology patients and their families than informing the treating team of family psychosocial risk. Additional research is required to address the gap between psychosocial risk screening, psychosocial intervention, and family outcomes.

Human Flourishing in Adolescents with Cancer: Experiences of Pediatric Oncology Health Care Professionals

PurposeThis study explores human flourishing (HF) in adolescents with cancer (AC) as witnessed by their health care providers, and it develops a list of critical attributes associated with HF to describe the positive outcomes witnessed. Design and MethodsOur study used a qualitative descriptive design incorporating data from an open-ended electronic survey and semi-structured individual interviews with 17 pediatric oncology health care providers. ResultsWe found 3 major themes (positive forward motion, connectedness, and self-character) representing 11 critical attributes of human flourishing in AC: (1) initiative and enterprise, (2) positivity and evocativeness, (3) tranquility and maturity, (4) perseverance and tenacity, (5) compassion and empathy, (6) social engagement and connection, (7) wisdom and translation into life, (8) supportive background, (9) self-awareness and self-agency, (10) transcendence and full potential, and (11) meaning-making. ConclusionsUnderstanding the concept of HF as it applies to the needs of AC is a step toward establishing it as a comprehensive health care goal and toward developing care provider guidelines for its promotion. Practice ImplicationsGiven the attributes of HF in AC, nurses can consider HF as an ultimate nursing care outcome and should focus on goals of care beyond disease treatment and symptoms mitigation when providing care for this population. Holistic, individualized assessment, timely care during each phase of treatment, and developmentally tailored intervention should be provided.

Defining a "Good Death" in Pediatric Oncology: A Mixed Methods Study of Healthcare Providers.

Delivering optimal end-of-life (EOL) care to children and adolescents is a healthcare priority, yet relatively little is known about what patients, families, and healthcare providers (HCPs) consider “best” practices. The objective of this study was to identify factors that pediatric oncology HCPs consider important for EOL care. This was a cross-sectional mixed methods study. Participants were multidisciplinary pediatric oncology staff who completed surveys and participated in semi-structured qualitative interviews. Interviews were analyzed using a modified grounded theory approach. Provider statements were compared based on years of experience (≤10 or >10 years) and discipline (non-physician or physician). A total of n = 19 staff (74% female) enrolled, including physicians (n = 8), advanced practice providers (n = 4), nurses (n = 2), music/art therapists (n = 2), physical therapists (n = 1), educators (n = 1), and chaplains (n = 1). Most HCPs identified communication, symptom control, and acceptance as features of a “good” death. Compared to physicians, non-physicians focused on relationships (67% vs. 33%, p = 0.007); HCPs with ≤10 years of experience (n = 11) more frequently identified the benefits of a multidisciplinary team (74% vs. 26%, p = 0.004). This study identified many common HCP-defined components of “good” pediatric EOL care in addition to some differing perspectives depending on discipline and experience. Incorporating diverse HCP perspectives with those of the patient and family can guide contemporary high-quality pediatric EOL clinical care and education.

Human Flourishing in Adolescents with Cancer: Perspectives of Health Care Providers

Background: Despite the challenging nature of a cancer diagnosis, a unique cohort of adolescents experience a remarkable trajectory of positive growth and development during and following their cancer-related experiences [1]. Human flourishing, a concept describing an optimal form of human life and development [2], has a potential to provide a comprehensive explanation of the unique growth experienced by some adolescents with cancer, yet it has rarely been studied in this population. We investigated the concept of flourishing from the perspectives of pediatric oncology health care providers (POHCP) who spend significant quality and quantities of time with adolescents and their families [3]. Objective: The purpose of this study was to investigate the perspectives of POHCP on: 1) exemplary stories of adolescents with cancer who have flourished, and 2) critical attributes characteristic of flourishing adolescents. Method: A mixed-methods descriptive, exploratory study was conducted with a sample of 11 POHCPs (e.g., physician, nurse, child life therapist, psychologist) who completed an electronic survey with open-ended questions; and a focus group of 6 pediatric oncology nurses. Descriptive statistics were used to analyze the critical attribute characteristics. A conventional content analysis technique was used to analyze the textual data. Results: The 15 critical attribute characteristics were classified into five categories: emotional, psychological, social, functional, and spiritual dimensions. The textual data was categorized into 5 capability themes: Lead one’s own life; Stand on firm ground; Grow and transcend through experiences; Make a better world; Move forward to better future. Conclusion: Human flourishing in adolescents with cancer cross modes of development from intrapersonal, interpersonal, and person-environmental components. Prior to the development of intervention studies to promote flourishing in adolescents with cancer, studies are needed to explore how the comprehensive components are scaffolded in clinical care and in the family environment. View a PDF of this Poster Presentation

Barriers to Medication Access in Pediatric Oncology in the United States.

Timely medication access in pediatric oncology is important; yet barriers are poorly described. We surveyed pediatric oncology health care providers at National Cancer Institute Community Oncology Research Program sites on their experience with the impact of drug acquisition difficulties, prior authorization (PA) requests, insurance denials, and patient copays leading to deviations or delays from prescribed treatment for their pediatric/adolescent/young adult patients in calendar year 2016. PA requests, the most frequently cited issue, created a deviation or delay from planned chemotherapy and supportive care treatment in at least 61% of respondents. Half of the respondents believed that PA-induced delays had a negative impact on care. Two-thirds of respondents felt that delays in starting therapy due to barriers in medication access created psychologic or emotional distress for the patient or family. Pediatric cancer patients may be receiving inferior care as a result of barriers to medication access.

Staff Perceptions of Symptoms, Approaches to Assessment, and Challenges to Assessment Among Children With Cancer.

Nurses are often the first to recognize and respond to children's symptoms. This descriptive, exploratory study characterized how pediatric oncology health care providers characterize and assess children's cancer-related symptoms. The study also explored challenges associated with symptom assessment and information perceived as helpful in planning interventions. The setting was a Children's Oncology Group-affiliated hospital in the Intermountain West of the United States. Twenty-two pediatric oncology health care providers (95% female; 68% nurses) participated in one of four focus group sessions. Sessions were facilitated by two individuals and included six open-ended questions addressing participants' perspectives of cancer-related symptoms, approaches to symptom assessment, challenges and frustrations encountered when assessing symptoms, and information needed to plan interventions. Participants identified 75 physical and psychosocial responses that included both subjectively experienced symptoms and other consequences of the cancer experience. Qualitative content analysis procedures organized other responses into categories and subcategories. Participants most frequently reported using observational approaches including physical assessment findings and observation of the child's behavior to identify symptoms. Strategies that sought the child's input such as the use of a rating scale or seeking the child's verbal description were less frequently named. Participants related discerning and interpreting the child's behaviors as a challenge to symptom assessment. They also reported attention to symptom characteristics as important to planning interventions. Future directions include building capacity to support child-centric symptom assessment. Development of reliable and valid resources for use in clinical settings may support a more child-centric approach to symptom assessment.

Knowledge, Beliefs, and Behaviors Related to Palliative Care Delivery Among Pediatric Oncology Health Care Providers.

The care of pediatric patients with cancer and their families is complex and rapidly evolving. Despite significant advances in outcomes, symptoms of the disease and complications of therapy continue to cause suffering that may improve with the involvement of pediatric palliative care (PPC) services. This descriptive study responds to the observation of great variability in PPC utilization within pediatric oncology. Data collected from 156 health care professionals (nurses, advanced practice professionals, and physicians) from a statewide hematology alliance evaluates the knowledge, beliefs, and perceived barriers to PPC involvement. Data analysis reveals significant variability when comparing respondents from professional roles and practice environments. Despite progress in PPC availability, care delivery remains incongruent with current recommendations. Knowledge gained from this study emphasizes the important role for all health care providers in advocating for support of PPC programs, educating the public, and committing to intentional involvement of PPC services while caring for pediatric oncology patients.

Burnout in pediatric oncology healthcare providers: Protection and vulnerability

IntroductionBurnout is a condition characterized by emotional exhaustion, depersonalization and reduced personal accomplishment, resulting from the inability to cope with chronic job stress. Healthcare providers at pediatric oncology units, who care for children with life-threatening illnesses, are exposure to high levels of stress, which increases the risk for developing burnout, with consequences in their personal health and quality of patient care.ObjectiveTo assess the prevalence and sources of burnout on a multidisciplinary team of a pediatric oncology unit.MethodsParticipants were a convenience sample of 16 pediatric oncology professionals, including medical, nursing, and related health staff from a Portuguese pediatric oncology center. Participants completed the Portuguese version of the Copenhagen Burnout Inventory.ResultsAll three subscales that compose this Inventory were found to have burnout below normal levels (cut-off ≥ 50 points). However, personal and work-related subscales showed mean values in the superior limit of normality (48 ± 14, 18 points and 49, 48 ± 12, 23 points, respectively). Nevertheless, when analyzed the patient-related subscale, we found low levels of burnout in the majority of responders. These findings are similar to the existing literature, which suggests that patient care and interactions with children are the least stressful aspect of working in this specialty.ConclusionDespite the high levels of stress exposure in pediatric oncology units, results suggest that the majority of professionals are not actually in burnout. However, the obtained values advice for the need of prevention and workplace approaches to staff's well-being and stress reduction, in order to avoid burnout development.Disclosure of interestThe authors have not supplied their declaration of competing interest.

UNDERSTANDING SIBLING ADAPTATION TO CHILDHOOD CANCER

Clinical research conducted over the past 40 years has described adjustment difficulties healthy siblings face when they have a brother or sister with childhood cancer. Research on healthy siblings of children with pediatric malignancies has advanced over the past few years and has broadened from distinguishing psychosocial problems following the patient?s death to identifying stressors during the illness experience. More recent research endeavors have focused on recognizing what behaviors or interventions health care providers understand to be most significant in promoting the patient?s, parents?, and siblings? coping efforts with childhood cancer and its treatment. In addition, descriptive research is exploring interventions used by pediatric oncology health care providers to render social support to siblings of children with cancer (Murray, 1999). Despite the growing body of literature on sibling adaptation to childhood cancer, an understanding of this experience from a developmental perspective is lacking. This lack of theoretical understanding may contribute to inadequate care of siblings of children with cancer. Understanding the meaning cancer has for well siblings is critical. This article discusses the theoretical framework of child development in relation to understanding sibling adaptation to the childhood cancer experience.