Psycho-oncology
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Follow-up practices with bereaved families are considered a part of good medical care, yet little is known about pediatric oncologists' protocol with families when their patients die. The objective of this study was to examine follow-up practices employed by pediatric oncologists after patient death using an in-depth qualitative analysis. ⋯ While the majority of pediatric oncologists at two Canadian centers engage in some follow-up practices with bereaved families, these practices are complex and challenging because of the emotional nature of these interactions. Medical institutions should provide both structured time for this follow-up work with families, as well as medical education and financial and emotional support to pediatric oncologists who continue caring for these families long after their child has died.
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Most cancer patients desire information about care options at the end of life, including cardiopulmonary resuscitation (CPR). Communicating such care options can be challenging and is part of advance care planning (ACP). Our prior studies with video educational media produced data on patients' categoric preferences (yes/no/unsure) for CPR; however, the thematic underpinnings of these educated preferences in patients treated for advanced cancer aren't well known. ⋯ Findings identified that while sometimes difficult to discuss, advance care planning is desired, deemed helpful, and ideally begun early by clinicians, and that video education is an appropriate and affirming initiator of discussions. These themes are incorporated into our ongoing research on cancer patient-specific values and education about care options.
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A lack of longitudinal studies has hampered the understanding of the development of posttraumatic stress symptoms (PTSS) in parents of children diagnosed with cancer. This study examines level of PTSS and prevalence of posttraumatic stress disorder (PTSD) from shortly after diagnosis up to 5 years after end of treatment or child's death, in mothers and fathers. ⋯ From 3 months after end of treatment the level of PTSS is stable. Mothers and bereaved parents are at particular risk for PTSD. The results are the first to describe the development of PTSS in parents of children diagnosed with cancer, illustrate that end of treatment is a period of vulnerability, and that a subgroup reports PTSD 5 years after end of treatment or child's death.