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Biomedical subjects

Donna Drew

Publications and source records attributed to Donna Drew.

5 recordsLinked to original sources
PubMed2005

End-of-life care preferences of pediatric patients with cancer.

PURPOSE: The viewpoint of the terminally ill child at the time of an end-of-life decision has not been formally investigated. We identified the preferences of children and adolescents with advanced cancer about their end-of-life care and the factors that influenced their decisions. PATIENTS AND METHODS: Pediatric patients 10 or more years of age were interviewed within 7 days of participating in one of the following three end-of-life decisions: enrollment onto a phase I trial (n = 7), adoption of a do not resuscitate order (n = 5), or initiation of terminal care (n = 8). The patient, a parent, and the primary pediatric oncologist were interviewed separately by using open-ended interview questions. RESULTS: Twenty patients, aged 10 to 20 years (mean, 17 years and 4 months), with a refractory solid tumor (n = 12), brain tumor (n = 4), or leukemia (n = 4) participated. Eighteen patients (90%) accurately recalled all of their treatment options and identified their own death as a consequence of their decision. The factors that were most frequently identified included the following: for patients, caring about others (n = 19 patients); for parents, the child's preferences (n = 18 parents); and for physicians, the patient's prognosis and comorbid conditions (n = 14 physicians). CONCLUSION: These children and adolescents with advanced cancer realized that they were involved in an end-of-life decision, understood the consequences of their decision, and were capable of participating in a complex decision process involving risks to themselves and others. The decision factors most frequently reported by patients were relationship based; this finding is contrary to existing developmental theories.

Adolescent↗
PubMed2005

Parental grieving after a child dies from cancer: is stress from stem cell transplant a factor?

AIM: to investigate psychological distress, family functioning and complicated grieving in parents whose child had died from cancer, and as a function of whether: (a) the deceased child had also received stem cell transplant (SCT) any time during curative treatment; and (b) the place of the child's death (home or hospital). DESIGN: a cross-sectional case-match design. SAMPLE: Fifty-six Australian bereaved parents in two groups: 28 whose child had also received SCT, matched with 28 (on deceased patient variables) whose child had not received SCT. RESULTS: parents in the 'SCT group' (n = 28) reported relatively higher levels of depression, anxiety and stress, and - for those whose child had also died in hospital - a greater likelihood of meeting the criteria for traumatic grief than those parents whose deceased child had not received SCT. There were no significant group differences in family functioning. CONCLUSION: routine psychosocial screening, especially for families undergoing SCT, may contribute usefully to a proactive model of palliative care in identifying parents at risk for complicated bereavement outcomes.

Adaptation, Psychological↗
PubMed2004

Bereavement outcomes for parents who lose a child to cancer: are place of death and sex of parent associated with differences in psychological functioning?

Despite increasing cure rates, cancer is a leading cause of non-accidental death in childhood. Models of psychosocial care in pediatric cancer may therefore need to address bereavement planning for a 'minority group' of parents (approximately 25%) for whom cure of their child is not possible. This study addresses a gap in knowledge concerning long-term bereavement and psychological outcomes for parents, as a function of the sex of the parent and the place of the child's death: home versus hospital. Fifty Australian parents (25 father-mother dyads), whose child had died at least 1 year prior to study participation, independently completed measures of psychological functioning (depression, anxiety and stress), family functioning, and pathological grieving (separation distress, and traumatic distress). The results showed some support for a hypothesized interaction between place of death and sex of parent. Fathers reported significantly higher levels of depression, anxiety and stress when the child died in hospital rather than at home. By way of contrast, differences for mothers as function of place of death were not reflected in psychological outcomes but were more closely tied to symptoms of pathological grieving. The findings are discussed with respect to the needs for services for surviving adult family members, especially for fathers who may have an enhanced psychological vulnerability after the death of a child in hospital rather than at home.

Adaptation, Psychological↗