1
40
19
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2020 Oncology List
Text
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Oncology 2020 List
URL Address
<a href="http://doi.org/10.1016/j.jpainsymman.2019.08.010" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.jpainsymman.2019.08.010</a>
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Title
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Seven Types of Uncertainty When Clinicians Care for Pediatric Patients With Advanced Cancer
Publisher
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Journal of Pain and Symptom Management
Date
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2020
Subject
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child; human; palliative therapy; controlled study; article; pediatrics; childhood cancer; patient referral; Uncertainty; qualitative analysis; cancer patient; cancer prognosis; oncologist; pediatric patient; semi structured interview; organization; care behavior; Advanced cancer
Creator
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Hill D L; Walter J K; Szymczak J E; DiDomenico C; Parikh S; Feudtner C
Description
An account of the resource
Context: Clinicians deciding whether to refer a patient or family to specialty palliative care report facing high levels of uncertainty. Most research on medical uncertainty has focused on prognostic uncertainty. As part of a pediatric palliative referral intervention for oncology teams we explored how uncertainty might influence palliative care referrals.
Identifier
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<a href="http://doi.org/10.1016/j.jpainsymman.2019.08.010" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2019.08.010</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
Advanced Cancer
Article
Cancer Patient
Cancer Prognosis
care behavior
Child
Childhood Cancer
Controlled Study
DiDomenico C
Feudtner C
Hill D L
Human
Journal of Pain and Symptom Management
Oncologist
Oncology 2020 List
Organization
Palliative Therapy
Parikh S
Patient Referral
pediatric patient
Pediatrics
Qualitative Analysis
Semi Structured Interview
Szymczak J E
Uncertainty
Walter J K
-
Dublin Core
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Title
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October 2020 List
Text
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Citation List Month
October 2020 List
URL Address
<a href="http://doi.org/10.1542/peds.2019-2465" target="_blank" rel="noreferrer noopener">http://doi.org/10.1542/peds.2019-2465</a>
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Title
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State Variation in Posthospital Home Nursing for Commercially Insured Medically Complex Children
Publisher
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Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
Subject
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After Care; Child; Descriptive Statistics; Geographic Factors; Health – Economics; Health Care Costs; Health Services Accessibility; Home Nursing; Human; Insurance; Medically Fragile; Patient Discharge; Probability; Prospective Studies; Retrospective Design
Creator
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Rasooly I R; Shults J; Guevara J P; Feudtner C
Description
An account of the resource
BACKGROUND AND OBJECTIVES: Home nursing is essential for children with medical complexity (CMC), but provision varies substantially across states. Our objectives were to quantify state-to-state variability in distribution of posthospitalization home nursing to commercially insured CMC and to rank-order states. METHODS: Retrospective cohort study of hospitalized commercially insured children with ≥1 complex chronic condition from birth to 18 years of age in the Truven MarketScan database. Cohort eligibility criteria were hospital discharge between January 2013 and November 2016 and at least 30 days of follow-up after discharge. Two primary outcome measures were used: receipt of any home nursing within 30 days of hospital discharge (yes or no) and number of days of posthospitalization home nursing (1-30 days). A composite metric encompassing both receipt and quantity was created by evaluating the 95th percentile of days of home nursing (0-30 days). RESULTS: Overall, 9.9% of the sample received home nursing. After we adjusted for patient characteristics, the probability of receiving home nursing varied across states, ranging from 3.4% to 19.2%. Among home nursing recipients, the adjusted median home nursing days across states ranged from 6.6 to 24.5 days. The adjusted 95th percentile of days of home nursing (across the entire of sample, including recipients and nonrecipients of home nursing) ranged from 6.8 to 22.6 days. CONCLUSIONS: We observed striking state-to-state variability in receipt of home nursing and mean number of days of posthospitalization home nursing among commercially insured CMC after adjustment for demographic and clinical differences. This suggests opportunities for state-level improvement.
Identifier
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<a href="http://doi.org/10.1542/peds.2019-2465" target="_blank" rel="noreferrer noopener">10.1542/peds.2019-2465</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
After Care
Child
Descriptive Statistics
Feudtner C
Geographic Factors
Guevara J P
Health – Economics
Health Care Costs
Health Services Accessibility
Home Nursing
Human
Insurance
Medically Fragile
October 2020 List
Patient Discharge
Pediatrics
Probability
Prospective Studies
Rasooly I R
Retrospective Design
Shults J
-
Dublin Core
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Title
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September 2020 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
September 2020 List
URL Address
<a href="http://doi.org/10.1016/j.jpainsymman.2020.07.024" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.jpainsymman.2020.07.024</a>
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Title
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What do parents value regarding pediatric palliative and hospice care in the home setting?
Publisher
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Journal of Pain and Symptom Management
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
Subject
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discrete choice experiment; home-based care; pediatric hospice care; pediatric palliative care
Creator
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Boyden J Y; Ersek M; Deatrick J A; Widger K; LaRagione G; Lord B; Feudtner C
Description
An account of the resource
CONTEXT: Children with life-shortening serious illnesses and medically complex care needs are often cared for by their families at home. Little, however, is known about what aspects of pediatric palliative and hospice care in the home setting (PPHC@Home) families value the most. OBJECTIVE: To explore how parents rate and prioritize domains of PPHC@Home as the first phase of a larger study that developed a parent-reported measure of experiences with PPHC@Home. METHODS: Twenty domains of high-value PPHC@Home, derived from the National Consensus Project's Guidelines for Quality Palliative Care, the literature, and a stakeholder panel, were evaluated. Using a discrete choice experiment, parents provided their ratings of the most and least valued PPHC@Home domains. We also explored potential differences in how subgroups of parents rated the domains. RESULTS: Forty-seven parents participated. Overall, highest-rated domains included Physical Aspects of Care: Symptom Management, Psychological/EmotionalSupportfor the Child, and Care Coordination. Lowest-rated domains included Spiritual and Religious Aspects of Care and Cultural Aspects of Care. In exploratory analyses, parents who had other children rated the Psychological/Emotional Aspects of Care for the Sibling(s) domain significantly higher than parents who did not have other children (P=0.02). Furthermore, bereaved parents rated the CaregiverSupportat the End of Life domain significantly higher than parents who were currently caring for their child (P=0.04). No other significant differences in domain ratings were observed. CONCLUSIONS: Knowing what parents value most about PPHC@Home provides the foundation for further exploration and conversation about priority areas for resource allocation and care improvement efforts.
Identifier
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<a href="http://doi.org/10.1016/j.jpainsymman.2020.07.024" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2020.07.024</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
Boyden J Y
Deatrick J A
discrete choice experiment
Ersek M
Feudtner C
Home-based Care
Journal of Pain and Symptom Management
LaRagione G
Lord B
Pediatric Hospice Care
Pediatric Palliative Care
September 2020 List
Widger K
-
Dublin Core
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Title
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August 2020 List
Text
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Citation List Month
August 2020 List
URL Address
<a href="http://doi.org/10.1089/jpm.2020.0205" target="_blank" rel="noreferrer noopener">http://doi.org/10.1089/jpm.2020.0205</a>
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Lessons Learned: Identifying Items Felt to Be Critical to Leading a Pediatric Palliative Care Program in the Current Era of Program Development
Publisher
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Journal of Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
Subject
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pediatric palliative care; program development
Creator
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Miller E G;Weaver M S; Ragsdale L; Hills T; Humphrey L; Williams C S P; Morvant A; Pitts B; Waldman E; Lotstein D; Linebarger J; Feudtner C; Klick J C
Description
An account of the resource
Background: The experience of starting and growing a pediatric palliative care program (PPCP) has changed over the last 10 years as rapid increases of patient volume have amplified challenges related to staffing, funding, standards of practice, team resilience, moral injury, and burnout. These challenges have stretched new directors' leadership skills, yet, guidance in the literature on identifying and managing these challenges is limited. Methods: A convenience sample of 15 PPCP directors who assumed their duties within the last 10 years were first asked the following open-ended question: What do you wish you had known before starting or taking over leadership of a PPCP? Responses were grouped into themes based on similarity of content. Participants then ranked these themes based on importance, and an online discussion further elucidated the top ten themes. Results: Thirteen directors responded (86.7%; 69% female). The median age of their current-state PPCP was 5.1 years (range: 0.3-9.3), and the median number of covered pediatric-specific hospital beds was 283 (range: 170-630). Their responses generated 51 distinct items, grouped into 17 themes. Themes ranked as most important included "Learn how to manage, not just lead," "Negotiate everything before you sign anything," and "Balance patient volume with scope of practice." Conclusion: These themes regarding challenges and opportunities PPCP directors encountered in the current era of program growth can be used as a guide for program development, a self-assessment tool for program directors, a needs-assessment for program leadership, and a blueprint for educational offerings for PPCP directors.
Identifier
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<a href="http://doi.org/10.1089/jpm.2020.0205" target="_blank" rel="noreferrer noopener">10.1089/jpm.2020.0205</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
August 2020 List
Feudtner C
Hills T
Humphrey L
Journal of Palliative Medicine
Klick J C
Linebarger J
Lotstein D
Miller E G
Morvant A
Pediatric Palliative Care
Pitts B
Program Development
Ragsdale L
Waldman E
Weaver M S
Williams C S P
-
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Title
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August 2020 List
Text
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Citation List Month
August 2020 List
URL Address
<a href="http://doi.org/10.1016/j.jpainsymman.2020.04.077" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.jpainsymman.2020.04.077</a>
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Poly-Symptomatology in Pediatric Palliative Care Patients: Baseline Evaluation of SHARE Parent-Reported Data (RP409)
Publisher
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Journal of Pain and Symptom Management
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
Subject
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symptom management; pediatric palliative care; medical complexity; Poly-Symptomatology; parental report data
Creator
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Feudtner C; Hays R; Friedrichsdorf S; Johnston E; Friebert S; Kang T; Wolfe J
Description
An account of the resource
Objectives: * Describe the study design of this study. * Specify the 5 most prevalent symptoms in pediatric palliative care. * Describe how symptom count, frequency, and severity contribute to poly-symptomatology. Importance: Pediatric palliative care (PPC) teams care for patients with a wide variety of conditions, often with substantial medical complexity, making symptom management challenging. Parental report data regarding the frequency and severity of symptoms in these patients has been limited. Objective(s): Characterize the prevalence, frequency, and severity of specific symptoms, as reported by parents of patients receiving PPC. Method(s): Parent-reported data were gathered from baseline questionnaires in a two-year longitudinal study being conducted at 7 children's hospitals in the Pediatric Palliative Care Research Network (PPCRN) SHARE project. Data included child's demographic and clinical characteristics, and 15 symptoms measured via the Memorial Symptom Assessment Scale, which scores symptom frequency (1, almost never; 2, sometimes; 3, a lot; 4, almost always) and severity (1, slight; 2, moderate; 3, severe; 4, very severe). Result(s): Of the 501 PPC patients thus far enrolled with completed data, 55% were male, 66% white, mean age of 7.3 years (+/-7.3 SD); the most prevalent complex chronic morbidities included neurologic (48%), cardiovascular (47%), and respiratory (34%) conditions; 72% were technology-dependent. Parents reported an average of 4.9 (+/-3.3 SD) symptoms per patient. The five most common symptoms were pain (55%; among patients with pain, mean frequency, 2.6; mean severity, 2.3), lack of energy (53%; 2.8; 2.4), irritability (47%; 2.4; 2.1), drowsiness (43%; 2.6; 2.2), and shortness of breath (39%; 2.7; 2.4). 10% of patients had markedly elevated level of symptoms (minimal frequency and severity scores of "a lot" and "severe" for each symptom), with the typical patient in this subgroup having 6 symptoms. Conclusion(s): A majority of children receiving palliative care are experiencing poly-symptomatology. An important sub-group of patients suffer frequently from numerous severe symptoms. Impact: Assessment and management of poly-symptomatology is a critical aspect of PPC. Copyright © 2020
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<a href="http://doi.org/10.1016/j.jpainsymman.2020.04.077" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2020.04.077</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
August 2020 List
Feudtner C
Friebert S
Friedrichsdorf S
Hays R
Johnston E
Journal of Pain and Symptom Management
Kang T
Medical Complexity
parental report data
Pediatric Palliative Care
Poly-Symptomatology
Symptom Management
Wolfe J
-
Dublin Core
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Title
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July 2020 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
July 2020 List
URL Address
<a href="http://doi.org/10.1542/peds.2019-4018" target="_blank" rel="noreferrer noopener">http://doi.org/10.1542/peds.2019-4018</a>
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Title
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"Good-Parent Beliefs": Research, Concept, and Clinical Practice
Publisher
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Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
Subject
The topic of the resource
administration; communication skills; hospice; interpersonal skills; palliative medicine; practice management
Creator
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Weaver M S; October T; Feudtner C; Hinds P S
Description
An account of the resource
Parents of ill children have willingly identified their personal beliefs about what they should do or focus on to fulfill their own internal definition of being a good parent for their child. This observation has led to the development of the good-parent beliefs concept over the past decade. A growing qualitative, quantitative, and mixed-methods research base has explored the ways that good-parent beliefs guide family decision-making and influence family relationships. Parents have expressed comfort in speaking about their good-parent beliefs. Whether parents achieve their unique good-parent beliefs definition affects their sense of whether they did a good job in their role of parenting their ill child. In this state-of-the-art article, we offer an overview of the good-parent beliefs concept over the past decade, addressing what is currently known and gaps in what we know, and explore how clinicians may incorporate discussions about the good-parent beliefs into clinical practice.
Identifier
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<a href="http://doi.org/10.1542/peds.2019-4018" target="_blank" rel="noreferrer noopener">10.1542/peds.2019-4018</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
Administration
Communication Skills
Feudtner C
Hinds P S
Hospice
interpersonal skills
July 2020 List
October T
Palliative Medicine
Pediatrics
Practice Management
Weaver M S
-
Dublin Core
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Title
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February 2020 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
February 2020 List
URL Address
<a href="http://doi.org/10.1016/j.earlhumdev.2019.104931" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.earlhumdev.2019.104931</a>
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Title
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Withholding and withdrawal of life-sustaining treatments for neonate in Japan: Are hospital practices associated with physicians' beliefs, practices, or perceived barriers?
Publisher
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Early human development
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Subject
The topic of the resource
advance care planning; article; female; hospital policy; human; human experiment; institutional care; intensive care; Japan; life sustaining treatment; male; neonatologist; newborn; questionnaire
Creator
An entity primarily responsible for making the resource
Yotani N; Nabetani M; Feudtner C; Honda J; Kizawa Y; Iijima K
Description
An account of the resource
OBJECTIVE: To describe the current status of withholding or withdrawal of life-sustaining interventions (LSI) for neonates in Japan and to identify physician- and institutional-related factors that may affect advance care planning (ACP) practices with parents. STUDY DESIGN: A self-reported questionnaire was administered to assess frequency of withholding and withdrawing intensive care at the respondent's facility, the physician's degree of affirming various beliefs about end-of-life care that was compared to 7 European countries, their self-reported ACP practices and perceived barriers to ACP. Three neonatologists at all 298 facilities accredited by the Japan Society for Neonatal Health and Development were surveyed, with 572 neonatologists at 217 facilities responding.
Identifier
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<a href="http://doi.org/10.1016/j.earlhumdev.2019.104931" target="_blank" rel="noreferrer noopener">10.1016/j.earlhumdev.2019.104931</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2019
Advance Care Planning
Article
Early Human Development
February 2020 List
Female
Feudtner C
Honda J
hospital policy
Human
Human Experiment
Iijima K
institutional care
Intensive Care
Japan
Kizawa Y
Life Sustaining Treatment
Male
Nabetani M
Neonatologist
Newborn
Questionnaire
Yotani N
-
Dublin Core
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Title
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February 2020 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
February 2020 List
URL Address
<a href="http://doi.org/10.1186/s12904-019-0504-8" target="_blank" rel="noreferrer noopener">http://doi.org/10.1186/s12904-019-0504-8</a>
Dublin Core
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Title
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A conceptual model of barriers and facilitators to primary clinical teams requesting pediatric palliative care consultation based upon a narrative review
Publisher
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BMC Palliative Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Subject
The topic of the resource
Communication inhibitors; Group processes; Patient care team; Pediatric palliative care
Creator
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Walter J K; Hill D L; DiDomenico C; Parikh S; Feudtner C
Description
An account of the resource
BACKGROUND: Despite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents. DISCUSSION: Building on a prior model of parent regoaling and relevant research literature, we argue for a conceptual model of the challenges and facilitators a clinical team might face in shifting from a restorative-focused treatment plan to a plan that includes palliative aspects, resulting in a subspecialty palliative care referral. Like patients and families, clinicians and clinical teams may recognize that a seriously ill patient would benefit from palliative care and shift from a restorative mindset to a palliative approach. We call this transition "clinician regoaling". Clinicians may experience inhibitors and facilitators to this transition at both the individual and team level which influence the clinicians' willingness to consult subspecialty palliative care. The 8 inhibitors to team level regoaling include: 1) team challenges due to hierarchy, 2) avoidance of criticizing colleagues, 3) structural communication challenges, 4) group norms in favor of restorative goals, 5) diffusion of responsibility, 6) inhibited expression of sorrow, 7) lack of social support, 8) reinforcement of labeling and conflict. The 6 facilitators of team regoaling include: 1) processes to build a shared mental model, 2) mutual trust to encourage dissent, 3) anticipating conflict and team problem solving, 4) processes for reevaluation of goals, 5) sharing serious news as a team, 6) team flexibility. CONCLUSIONS: Recognizing potential team level inhibitors to transitioning to palliative care can help clinicians develop strategies for making the transition more effectively when appropriate.
Identifier
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<a href="http://doi.org/10.1186/s12904-019-0504-8" target="_blank" rel="noreferrer noopener">10.1186/s12904-019-0504-8</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2019
BMC Palliative Care
Communication inhibitors
DiDomenico C
February 2020 List
Feudtner C
Group Processes
Hill D L
Parikh S
Patient Care Team
Pediatric Palliative Care
Walter J K
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
October 2019 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
October 2019 List
URL Address
<a href="http://doi.org/10.1016/j.acap.2019.07.008" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.acap.2019.07.008</a>
Dublin Core
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Title
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Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital
Publisher
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Academic pediatrics.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Subject
The topic of the resource
death; article; child; female; human; major clinical study; male; palliative therapy; retrospective study; controlled study; terminal care; resuscitation; education; medical record review; statistics; burnout; drug withdrawal; Burnout; End-of-Life Care; life sustaining treatment; Palliative Care; postgraduate student; resident; Resident Education
Creator
An entity primarily responsible for making the resource
Trowbridge A; Bamat T; Griffis H; McConathey E; Feudtner C; Walter J K
Description
An account of the resource
OBJECTIVES: Pediatric residents are expected to be competent in end of life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures. METHOD(S): Retrospective chart review of all deceased patients at one children's hospital over three years collected patient demographics, time and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within 48 hours of death. Descriptive statistics are presented. RESULT(S): Of 579 patients who died during the study period, 46% had resident involvement. Most deaths occurred in the NICU (30% of all deaths) however, resident exposure to EOL care most commonly occurred in the PICU (52% of resident exposures) and were after withdrawals of life-sustaining therapy (41%), followed by non-escalation (31%) and failed resuscitation (15%). During their post-graduate year (PGY)-1, <1% of residents encountered a patient death. During PGY-2 and PGY-3, 96% and 78%, respectively, of residents encountered at least one death. During PGY-2, residents encountered a mean of 3.5 patient deaths (range 0-12); during PGY-3, residents encountered a mean of 1.4 deaths (range 0-5). Residents observed for their full 3-year residency encountered a mean of 5.6 deaths (range 2-10). CONCLUSION(S): Pediatric residents have limited but variable exposure to EOL care, with most exposures in the ICU after withdrawal of life-sustaining technology. Educators should consider how to optimize EOL education with limited clinical exposure, and design resident support and education with these variable exposures in mind. Copyright © 2019. Published by Elsevier Inc.
Identifier
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<a href="http://doi.org/10.1016/j.acap.2019.07.008" target="_blank" rel="noreferrer noopener">10.1016/j.acap.2019.07.008</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2019
Academic pediatrics.
Article
Bamat T
Burnout
Child
Controlled Study
Death
Drug Withdrawal
Education
End-of-life Care
Female
Feudtner C
Griffis H
Human
Life Sustaining Treatment
Major Clinical Study
Male
McConathey E
Medical Record Review
October 2019 List
Palliative Care
Palliative Therapy
postgraduate student
Resident
resident education
Resuscitation
Retrospective Study
Statistics
Terminal Care
Trowbridge A
Walter J K
-
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October 2019 List
Text
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October 2019 List
URL Address
<a href="http://doi.org/10.1016/j.jpainsymman.2019.08.011" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.jpainsymman.2019.08.011</a>
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Challenges and Priorities for Pediatric Palliative Care Research in the United States and Similar Practice Settings: Report from a Pediatric Palliative Care Research Network Workshop
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Journal of Pain and Symptom Management
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Subject
The topic of the resource
palliative care; decision-making; funding; pediatric; family; infrastructure; methodology; research; symptoms; training
Creator
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Feudtner C; Rosenberg A R; Boss R D; Wiener L; Lyon M E; Hinds P S; Bluebond-Langner M; Wolfe J
Description
An account of the resource
CONTEXT: In order to dramatically advance the evidence base for pediatric palliative care (PPC) interventions, practices, and programs in the United States and similar practice settings, the field needs to better understand the challenges and opportunities for rigorous scholarship. OBJECTIVES: The Pediatric Palliative Care Research Network conducted a workshop to clarify challenges and identify key priorities. METHODS: The workshop focused on PPC research topics and methods, including: outcomes measurement, qualitative inquiry, analyses of "big data," prospective collection of research data, case series and cohort studies, and intervention trials, with synthesizing summary and follow-up discussions. All attendees reviewed and approved the final report. RESULTS: Five common challenges were identified: patient diversity and small population size; interdependencies and dynamic interactions between child, family members, and disease processes over time; outcomes and measurement; workforce and infrastructure limitations; and presumed burden of PPC research upon participants. Seven priorities emerged: bolster training and development of PPC investigators; develop core resources; advance symptom measurement (and measurements of other exposures and outcomes); improve symptom management and quality of life interventions; improve communication, elicitation of goals of care, and decision-making; understand family impact and facilitate or improve family adaptation and coping; and analyze and improve systems of care, policy, and education. CONCLUSION: These challenges and priorities identify key research areas that can guide individual investigators and research funders to advance the field.
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<a href="http://doi.org/10.1016/j.jpainsymman.2019.08.011" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2019.08.011</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2019
Bluebond-Langner M
Boss R D
Decision-making
Family
Feudtner C
Funding
Hinds P S
infrastructure
Journal of Pain and Symptom Management
Lyon M E
Methodology
October 2019 List
Palliative Care
Pediatric
Research
Rosenberg A R
Symptoms
Training
Wiener L
Wolfe J
-
Dublin Core
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Title
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March 2019 List
Text
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March 2019 List
URL Address
<a href="http://doi.org/10.1016/j.jpainsymman.2019.01.005" target="_blank" rel="noreferrer noopener"> http://doi.o rg/10.1016/j.jpainsymman.2019.01.005</a>
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Pediatric Palliative Care in the Multi-Cultural Context: Findings from a workshop conference
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Journal of Pain and Symptom Management
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Subject
The topic of the resource
culture; palliative care; Pediatric; family; religion; health disparity; race/ethnicity
Creator
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Rosenberg A R; Bona K; Coker T; Feudtner C; Houston K; Ibrahim A; Macauley R; Wolfe J; Hays R
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<a href="http://doi.org/10.1016/j.jpainsymman.2019.01.005" target="_blank" rel="noreferrer noopener"> 10.1016/j.jpainsymman.2019.01.005</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Description
An account of the resource
CONTEXT: In our increasingly multicultural society, providing sensitive and respectful pediatric palliative care is vital. OBJECTIVES: We held a one-day workshop conference with stakeholders and pediatric clinicians to identify suggestions for navigating conflict when cultural differences are present and for informing standard care-delivery. METHODS: Participants explored cases in one of four workshops focused on differences based on either race/ethnicity, economic disparity, religion/spirituality, or family-values. Each workshop was facilitated by two authors; separate transcriptionists recorded workshop discussions in real-time. We used content analyses to qualitatively evaluate the texts and generate recommendations. RESULTS: Participants included 142 individuals representing over 6 unique disciplines, 25 of the United States, and 3 nations. Whereas the conference focused on pediatric palliative care, findings were broadly generalizable to most medical settings. Participants identified key reasons cultural differences may create tension and then provided frameworks for communication, training, and clinical care. Specifically, recommendations included phrases to navigate emotional conflict, broken trust, unfamiliar family values, and conflict. Suggested approaches to training and clinical care included the development of core competencies in communication, history taking, needs assessment, and emotional intelligence. Important opportunities for scholarship included qualitative studies exploring diverse patient- and family-experiences, quantitative studies examining health disparities, and randomized clinical trials testing interventions designed to improve community partnerships, communication, or child health outcomes. CONCLUSION: Taken together, findings provide a foundation for collaboration between patients, families, and clinicians of all cultures.
2019
Bona K
Coker T
Culture
Family
Feudtner C
Hays R
health disparity
Houston K
Ibrahim A
Journal of Pain and Symptom Management
Macauley R
March 2019 List
Palliative Care
Pediatric
race/ethnicity
Religion
Rosenberg A R
Wolfe J
-
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Title
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2018 Oncology List
Text
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Oncology 2018 List
URL Address
<a href="http://doi.org/10.1016/j.jpainsymman.2018.01.019" target="_blank" rel="noreferrer noopener">http://doi.o
rg/10.1016/j.jpainsymman.2018.01.019</a>
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Title
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Pediatric Oncology Providers' Perceptions of a Palliative Care Service: The Influence of Emotional Esteem and Emotional Labor
Publisher
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Journal of Pain and Symptom Management.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Subject
The topic of the resource
article
Creator
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Szymczak JE; Schall T; Hill DL; Walter JK; Parikh S; DiDomenico C; Feudtner C
Description
An account of the resource
Context: Pediatric palliative care consults for children with cancer often occur late in the course of disease and close to death, when earlier involvement would reduce suffering. The perceptions that pediatric oncology providers hold about the pediatric palliative care service (PPCS) may shape referral patterns. Objectives: To explore how pediatric oncology providers at one institution perceived the hospital's PPCS and the way these perceptions may influence the timing of consultation. Methods: We conducted semistructured qualitative interviews with pediatric oncology providers at a large children's hospital. Interviews were audio-recorded, transcribed, and analyzed by two coders using a modified grounded theory approach. Results: We interviewed 16 providers (10 physicians, one nurse practitioner, two social workers, two psychologists, and one child life specialist). Three core perceptions emerged: 1) the PPCS offers a diverse range of valuable contributions to the care of children with advancing cancer; 2) providers held favorable opinions about the PPCS owing to positive interactions with individual palliative care specialists deemed extraordinarily emotionally skilled; and 3) there is considerable emotional labor involved in calling a PPCS consult that serves as a barrier to early initiation. Conclusion: The pediatric oncology providers in our study held a highly favorable opinion about their institution's PPCS and agreed that early consultation is ideal. However, they also described that formally consulting PPCS is extremely difficult because of what the PPCS symbolizes to families and the emotional labor that the provider must manage in introducing them. Interventions to encourage the early initiation of palliative care in this population may benefit from a focus on the emotional experiences of providers.
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<a href="http://doi.org/%2010.1016/j.jpainsymman.2018.01.019" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2018.01.019</a>
2018
Article
DiDomenico C
Feudtner C
Hill DL
Journal of Pain and Symptom Management.
Oncology 2018 List
Parikh S
Schall T
Szymczak JE
Walter JK
-
Dublin Core
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Title
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2018 Oncology List
Text
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Citation List Month
Oncology 2018 List
URL Address
<a href="http://doi.org/10.1002/cncr.31668" target="_blank" rel="noreferrer noopener">http://doi.o
rg/10.1002/cncr.31668</a>
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The Relationship Between Household Income and Patient-Reported Symptom Distress and Quality of Life in Children With Advanced Cancer: A Report From the PediQUEST Study
Publisher
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Cancer
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Subject
The topic of the resource
pain; poverty; palliative therapy; major clinical study; advanced cancer; outcome assessment; cancer patient; cohort analysis; distress syndrome; human; article; child; female; male; quality of life; prevalence; secondary analysis; household income; patient-reported outcome; highest income group; lowest income group
Creator
An entity primarily responsible for making the resource
Ilowite MF; Al-Sayegh H; Ma C; Dussel V; Rosenberg AR; Feudtner C; Kang TI; Wolfe J; Bona K
Description
An account of the resource
Background: Children with advanced cancer experience high symptom distress, which negatively impacts their health-related quality of life (HRQOL). To the authors' knowledge, the relationship between income and symptom distress and HRQOL is not well described. Methods: The Pediatric Quality of Life and Symptoms Technology (PediQUEST) multisite clinical trial evaluated an electronic patient-reported outcome system to describe symptom distress and HRQOL in children with advanced cancer via repeated surveys. The authors performed a secondary analysis of PediQUEST data for those children with available parent-reported household income (dichotomized at 200% of the Federal Poverty Level and categorized as low income [<$50,000/year] or high income [>=$50,000/year]). The prevalence of the 5 most commonly reported physical and psychological symptoms was compared between groups. Multivariable generalized estimating equation models were used to test the association between household income and symptom distress and HRQOL. Results: A total of 78 children were included in the analyses: 56 (72%) in the high-income group and 22 (28%) in the low-income group. Low-income children were more likely to report pain than high-income children (64% vs 42%; P=.02). In multivariable models, children from low-income families demonstrated a uniform trend toward higher total (beta<inf>low-high</inf>=3.1; 95% confidence interval [95% CI], -0.08 to 6.2 [P=.06]), physical (beta=3.8; 95% CI, -0.4 to 8.0 [P=.09]), and psychological (beta=3.46; 95% CI, -1.91 to 8.84 [P=.21]) symptom distress compared with children from high-income families. Low income was associated with a uniform trend toward lower total (beta=-7.9; 95% CI, -14.8, to -1.1 [P=.03]), physical (beta=-11.2; 95% CI, -21.2 to -1.2 [P=.04]), emotional (beta=-5.8; 95% CI, -13.6 to 2.0 [P=.15]), social (beta=-2.52; 95% CI, -9.27 to 4.24 [P=.47]), and school (beta=-9.8; 95% CI, -17.8 to -1.8 [P=.03]) HRQOL. Conclusions: In this cohort of children with advanced cancer, children from low-income families were found to experience higher symptom burden and worse QOL.
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<a href="http://doi.org/%2010.1002/cncr.31668" target="_blank" rel="noreferrer noopener">10.1002/cncr.31668</a>
2018
Advanced Cancer
Al-Sayegh H
Article
Bona K
Cancer
Cancer Patient
Child
Cohort Analysis
Distress Syndrome
Dussel V
Female
Feudtner C
highest income group
household income
Human
Ilowite MF
Kang TI
lowest income group
Ma C
Major Clinical Study
Male
Oncology 2018 List
outcome assessment
Pain
Palliative Therapy
patient-reported outcome
Poverty
Prevalence
Quality Of Life
Rosenberg AR
Secondary Analysis
Wolfe J
-
Dublin Core
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Title
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2018 Oncology List
Text
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Citation List Month
Oncology 2018 List
URL Address
<a href="http://doi.org/10.1007/s00520-018-4190-5" target="_blank" rel="noreferrer noopener">http://doi.o
rg/10.1007/s00520-018-4190-5</a>
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The codesign of an interdisciplinary team-based intervention regarding initiating palliative care in pediatric oncology
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Supportive Care in Cancer
Date
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2018
Subject
The topic of the resource
feasibility study; palliative therapy; childhood cancer; solid malignant neoplasm; human; article; child; female; male; clinical article; bone marrow transplantation; uncertainty; frustration
Creator
An entity primarily responsible for making the resource
Hill DL; Walter JK; Casas JA; DiDomenico C; Szymczak JE; Feudtner C
Description
An account of the resource
Purpose: Children with advanced cancer are often not referred to palliative or hospice care before they die or are only referred close to the child's death. The goals of the current project were to learn about pediatric oncology team members' perspectives on palliative care, to collaborate with team members to modify and tailor three separate interdisciplinary team-based interventions regarding initiating palliative care, and to assess the feasibility of this collaborative approach. Methods: We used a modified version of experience-based codesign (EBCD) involving members of the pediatric palliative care team and three interdisciplinary pediatric oncology teams (Bone Marrow Transplant, Neuro-Oncology, and Solid Tumor) to review and tailor materials for three team-based interventions. Eleven pediatric oncology team members participated in four codesign sessions to discuss their experiences with initiating palliative care and to review the proposed intervention including patient case studies, techniques for managing uncertainty and negative emotions, role ambiguity, system-level barriers, and team communication and collaboration. Results: The codesign process showed that the participants were strong supporters of palliative care, members of different teams had preferences for different materials that would be appropriate for their teams, and that while participants reported frustration with timing of palliative care, they had difficulty suggesting how to change current practices. Conclusions: The current project demonstrated the feasibility of collaborating with pediatric oncology clinicians to develop interventions about introducing palliative care. The procedures and results of this project will be posted online so that other institutions can use them as a model for developing similar interventions appropriate for their needs.
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<a href="http://doi.org/%2010.1007/s00520-018-4190-5" target="_blank" rel="noreferrer noopener">10.1007/s00520-018-4190-5</a>
2018
Article
Bone Marrow Transplantation
Casas JA
Child
Childhood Cancer
Clinical Article
DiDomenico C
Feasibility Study
Female
Feudtner C
frustration
Hill DL
Human
Male
Oncology 2018 List
Palliative Therapy
solid malignant neoplasm
Supportive Care In Cancer
Szymczak JE
Uncertainty
Walter JK
-
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Title
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January 2019 List
Text
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January 2019 List
URL Address
<a href="http://doi.org/10.1016/j.acap.2018.11.001" target="_blank" rel="noreferrer noopener"> http://doi.org/ 10.1016/j.acap.2018.11.001</a>
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Title
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Development and pilot testing of a coping kit for parents of hospitalized children
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Academic Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Creator
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Hill Douglas L; Carroll KW; Snyder KJG; Mascarenhas M; Erlichman J; Patterson CA; Barakat Lamia P; Feudtner C
Description
An account of the resource
Objective Serious pediatric illness places great stress on families. Parents who learn coping skills may better manage these stressors. This study sought to develop and refine a stress coping intervention for parents of hospitalized children, assess the intervention acceptability among these parents, and gather preliminary data on stress, negative and positive affect, anxiety, depression, and self-efficacy. Methods We conducted an observational study in 2 phases, enrolling parents of children who were inpatients with serious illness, 10 in Phase 1 and 40 in Phase 2. All parents completed at baseline measures of stress and psychological well-being and were introduced to the Coping Kit for Parents. Follow-up interviews were conducted at one week (all parents) and one month (Phase 2 parents only) regarding the acceptability of the intervention. Results At baseline, parents reported that stressful situations were frequent (mean=30.6, SD=6.8) and difficult (mean=26.2, SD=7.1), and revealed elevated levels of negative affect (mean=27.3, SD=7.7), depression (mean=8.5, SD=3.7) and anxiety (mean=11.3, SD=3.1), and moderate levels of self-efficacy related to their child's illness (mean=3.3, SD=0.5). The majority of parents used the kit regularly and on a scale of 1 to 7 agreed that the kit was helpful (mean=6.0, SD=0.9), interesting (mean=5.7, SD=1.3), practical (mean=5.7, SD=1.4), enjoyable (mean=6.0, SD=1.3), and they would recommend it to other parents (mean=6.4, SD=0.9). Conclusions The Coping Kit for Parents is an acceptable stress management intervention that could be made available to parents of children with serious illness at pediatric hospitals with minimal staff training or time commitment.
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<a href="http://doi.org/10.1016/j.acap.2018.11.001" target="_blank" rel="noreferrer noopener">10.1016/j.acap.2018.11.001</a>
2018
Academic Pediatrics
Barakat Lamia P
Carroll KW
Erlichman J
Feudtner C
Hill Douglas L
January 2019 List
Mascarenhas M
Patterson CA
Snyder KJG
-
Dublin Core
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Title
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December 2018 List
Text
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December 2018 List
URL Address
<a href="http://doi.org/10.1542/peds.2017-4182" target="_blank" rel="noreferrer noopener"> http://doi.o
rg/10.1542/peds.2017-4182</a>
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Title
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Modes of Death Within a Children's Hospital
Publisher
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Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Subject
The topic of the resource
Human; Length of Stay; Child; Hospitalization; Intensive Care Units Pediatric; Treatment Failure; Referral and Consultation; Palliative Care; Hospitals Pediatric; Intensive Care Units Neonatal; Resuscitation; Confidence Intervals; Odds Ratio; Qualitative Studies; Descriptive Statistics; Race Factors; Retrospective Design; Whites; Blacks; Hospital Mortality -- In Infancy and Childhood; Multiple Logistic Regression
Creator
An entity primarily responsible for making the resource
Trowbridge A; Walter JK; McConathey E; Morrison W; Feudtner C
Description
An account of the resource
BACKGROUND: Knowledge about how children die in pediatric hospitals is limited, and this hinders improvement in hospital-based end-of-life care. METHODS: We conducted a retrospective chart review of all the patients who died in a children's hospital between July 2011 and June 2014, collecting demographic and diagnostic information, hospital length of stay, location of death, and palliative care consultation. A qualitative review of provider notes and resuscitation records was used to create 5 mutually exclusive modes of death, which were then assigned to each patient. Analysis included the calculation of descriptive statistics and multinomial logistic regression modeling. RESULTS: We identified 579 patients who were deceased; 61% were <1 year of age. The ICU was the most common location of death (NICU 29.7%; PICU 27.8%; cardiac ICU 16.6%). Among the 5 modes of death, the most common was the withdrawal of life-sustaining technology (40.2%), followed by nonescalation (25.6%), failed resuscitation (22.8%), code then withdrawal (6.0%), and death by neurologic criteria (5.3%). After adjustment, patients who received a palliative care consultation were less likely to experience a code death (odds ratio 0.31; 95% confidence interval 0.13--0.75), although African American patients were more likely than white patients to experience a code death (odds ratio 2.46; 95% confidence interval 1.05--5.73), mostly because of code events occurring in the first 24 hours of hospitalization. CONCLUSIONS: Most deaths in a children's hospital occur in ICUs after the withdrawal of life-sustaining technology. Race and palliative care involvement may influence the manner of a child's death.
Identifier
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<a href="http://doi.org/10.1542/peds.2017-4182" target="_blank" rel="noreferrer noopener">10.1542/peds.2017-4182</a>
2018
Blacks
Child
Confidence Intervals
December 2018 List
Descriptive Statistics
Feudtner C
Hospital Mortality -- In Infancy and Childhood
Hospitalization
Hospitals Pediatric
Human
Intensive Care Units Neonatal
Intensive Care Units Pediatric
Length Of Stay
McConathey E
Morrison W
Multiple Logistic Regression
Odds Ratio
Palliative Care
Pediatrics
Qualitative Studies
Race Factors
Referral And Consultation
Resuscitation
Retrospective Design
Treatment Failure
Trowbridge A
Walter JK
Whites
-
Dublin Core
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Title
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December 2018 List
Text
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Citation List Month
December 2018 List
URL Address
<a href="http://doi.org/10.1542/peds.2018-0516C" target="_blank" rel="noreferrer noopener"> http://doi.o rg/10.1542/peds.2018-0516C</a>
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Title
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Parental Personal Sense of Duty as a Foundation of Pediatric Medical Decision-making
Publisher
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Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Creator
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Feudtner C; Schall T; Hill D
Description
An account of the resource
We describe a model of parental (or more broadly, surrogate) decision-making that includes 5 aspects of decision-making that other models simplify or omit. First, we describe problem structuring recognizing that parents often face multiple potential problems or decisions with multiple potential solutions, rather than a single problem, and the initial challenge is deciding which of the problems to focus on. Second, we discuss sense-making recognizing that difficult decisions are not made in isolation but are often part of a confusing, labyrinthian situation in which disoriented parents must make a series of decisions over time in hopes of getting closer to 1 or more goals. Third, we describe path dependency recognizing that decisions influence what and how decisions are made later. Fourth, we discuss personal sense of duty recognizing that parents and other surrogate decision-makers have central personal roles, self-identities, and relationships with the patient, culminating in a personal sense of duty, such as what they perceive they should do to be in their own judgment a "good parent," which substantially affects their decision-making. Fifth, we describe self-judgments recognizing that parents experience distress when they judge themselves as falling short of their duties or if they think others are judging them for falling short. Clinical practice, medical ethics, and research regarding decision support can all benefit by acknowledging and addressing these key aspects of medical decision-making.
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<a href="http://doi.org/10.1542/peds.2018-0516C" target="_blank" rel="noreferrer noopener">10.1542/peds.2018-0516C</a>
2018
December 2018 List
Feudtner C
Hill D
Pediatrics
Schall T
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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October 2018 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
September 2018 List
URL Address
<a href="http://doi.org/10.1542/peds.142.1_MeetingAbstract.638" target="_blank" rel="noreferrer noopener">http://doi.o rg/10.1542/peds.142.1_MeetingAbstract.638</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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If I could just chime in here': ”: Communication Patterns of Interprofessional Teams in the Pediatric Cardiac Intensive Care Unit
Publisher
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Pediatrics
Date
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2018
Creator
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Walter J; Schall T; DeWitt A; Arnold R; Feudtner C
Description
An account of the resource
Purpose: To describe the communication of interdisciplinary teams in a pediatric cardiac intensive care unit (CICU) when developing care plans and preparing for family meetings because little is known about how interdisciplinary teams communicate with each other about care plan development in the CICU. Methods: Audio recordings were made of weekly CICU team meetings including representatives from all interdisciplinary care providers prior to meeting with a patient’s family. Quantitative case coding described percentage …
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1542/peds.142.1_MeetingAbstract.638" target="_blank" rel="noreferrer noopener">10.1542/peds.142.1_MeetingAbstract.638</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2018
Arnold R
DeWitt A
Feudtner C
Pediatrics
Schall T
September 2018 List
Walter J
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
October 2018 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
September 2018 List
URL Address
<a href="http://doi.org/10.1542/peds.142.1_MeetingAbstract.659" target="_blank" rel="noreferrer noopener">http://doi.o rg/10.1542/peds.142.1_MeetingAbstract.659</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Interprofessional Team Meetings in the Pediatric Cardiac Intensive Care Unit
Publisher
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Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Creator
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Walter J; Sachs Emily; DeWitt A; Arnold R; Feudtner C
Description
An account of the resource
Purpose: To evaluate communication behaviors and interprofessional team interactions during family meetings in the pediatric cardiac intensive care unit (CICU) because little is known about how interdisciplinary teams communicate with each other about care plan development in the CICU. Methods: Meetings of family members and CICU clinicians were audio recorded. We used quantitative case-coding to compare the duration of contributions made by attendees, …
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1542/peds.142.1_MeetingAbstract.659" target="_blank" rel="noreferrer noopener">10.1542/peds.142.1_MeetingAbstract.659</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2018
Arnold R
DeWitt A
Feudtner C
Pediatrics
Sachs Emily
September 2018 List
Walter J