Withdrawing treatment for children and young people: Decision-making experiences of health professionals

Background: The decision to withdraw or withhold treatment from children can be a complex and emotional decision-making process for everyone who is involved. With the complexity of decision-making in paediatric medicine ever increasing due to an increased number of cases, there is a growing need to understand how treatment decisions are made, the impact this has on those making the decisions and how professionals can be supported throughout the decision-making process. Objectives: The aim of this qualitative study was to explore the decision-making experiences of professionals working in healthcare during withdrawing treatment from children. The study examined factors that influence professionals in deciding whether to withdraw a child from treatment and how decision-making is managed amongst professionals as an individual and as a team.Method: A purposive sample of health professionals (HCPs) working at a Children’s Hospital in the UK, with children with life-limiting illnesses where treatment has been withdrawn, were invited to participate. All participants were given the option to partake in the research in several ways to maximise their potential to participate. This included digitally-recorded face-to-face semi-structured interviews, skype or telephone interviews. Data was transcribed verbatim, anonymised, and analysed using a thematic framework method. Results: A total of fifteen participants were interviewed. The interview transcripts produced rich data which highlighted how HCPs decide on withdrawing treatment for a child. The thematic analysis process that was applied to the transcripts elicited key concepts. Five interrelated themes with associated subthemes were generated to help understand the experiences of health professionals in decision-making on withdrawing a child’s treatment: 1) Best Interests of the Child (2) Multidisciplinary Approach (3) External Factors (4) Psychological Wellbeing (5) Recommendations to support decision-making. Although those five themes emerged, the most prominent one was that all decisions were based on the best interests of a child. This led to professionals considering several factors such as exploring all treatment options, the severity of the condition and the competency of the child to decide. Further to this, professionals felt that the child’s family played a huge role amongst the decision-making process with communication and cultural factors such as health professionals ‘playing god’ being reported as key influencers. Conclusion: The decision-making process was identified as being predominately medically led with medical professionals making the decision. A shared decision-making approach could support professionals, children, and their families if decisions are made collectively. Future research should investigate the views from parents and families on withdrawing treatment and how this influences the decision-making process. To strengthen further studies within this area, a greater number of male health professionals should be included to offer further robust views from the perspectives of diverse health professionals

Putting children forward for epilepsy surgery:a qualitative study of UK parents' and health professionals' decision-making experiences

Background Against a backdrop of recommendations for increasing access to and uptake of early surgical intervention for children with medically intractable epilepsy, it is important to understand how parents and professionals decide to put children forward for epilepsy surgery and what their decisional support needs are. Aim The aim of this study was to explore how parents and health professionals make decisions regarding putting children forward for pediatric epilepsy surgery. Methods Individual interviews were conducted with nine parents of children who had undergone pediatric epilepsy surgery at a specialist children's hospital and ten healthcare professionals who made up the children's epilepsy surgery service multidisciplinary healthcare team (MDT). Three MDT meetings were also observed. Data were analyzed thematically. Findings Four themes were generated from analysis of interviews with parents: presentation of surgery as a treatment option, decision-making, looking back, and interventions. Three themes were generated from analysis of interviews/observations with health professionals: triangulating information, team working, and patient and family perspectives. Discussion Parents wanted more information and support in deciding to put their child forward for epilepsy surgery. They attempted to balance the potential benefits of surgery against any risks of harm. For health professionals, a multidisciplinary approach was seen as crucial to the decision-making process. Advocating for the family was perceived to be the responsibility of nonmedical professionals. Conclusion Decision-making can be supported by incorporating families into discussions regarding epilepsy surgery as a potential treatment option earlier in the process and by providing families with additional information and access to other parents with similar experiences

Health professionals' views and experiences of discussing weight with children and their families:A systematic review of qualitative research

Background: Healthcare professionals are ideally placed to discuss weight management with children and families to treat and prevent childhood obesity. The aim of this review was to collect and synthesize primary research evidence relating to health professional's views and experiences of discussing weight with children and their families. Methods: Systematic searches were conducted using the following databases: MEDLINE (OVID), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE (OVID), PsycINFO (OVID) and Healthcare Management Information Consortium (HMIC). Twenty-six full text qualitative studies published in English Language journals since inception to October 2019 were included. Papers were quality assessed and synthesized using an inductive thematic analysis approach. Results: Data analysis generated five themes: sensitivity of the issue, family–professional relationships, whole systems approach, professional competency and sociocultural context. Conclusion: Supporting behaviour change through discussion of healthy weight with children and families is an important part of the health professional's role. Tailored information for professionals, including resources and training, facilitates them to confidently talk to children and families about weight prioritized within interventions. The success of such interventions requires commitment from a range of professionals to ensure healthy weight is tackled through a whole system approach

Covid-19 public health road map: Eating behaviour

This roadmap aims to support health officials to consider changes to eating behaviour that may have occurred during the Covid-19 pandemic and to use psychologically-informed behaviour change approaches to optimise health improvement and mitigate negative eating patterns. It will focus on eating a balanced diet, as opposed to eating behaviours related to disordered eating. This guidance should be used alongside the Achieving Behaviour Change (ABC) guide {1} for local government and partners, and the Improving People’s Health behavioural and social science strategy {2} {1}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/875385/PHEBI_Achieving_Behaviour_Change_Local_Government.pdf {2}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/744672/Improving_Peoples_Health_Behavioural_Strategy.pd

Covid-19 public health road map: Sedentary behaviour

This roadmap aims to support health officials to consider changes to sedentary behaviour that may have occurred during the Covid-19 pandemic and to use psychologically informed behaviour change approaches to optimise health improvement and mitigate an increase in time spent sitting or lying down. This guidance should be used alongside the Achieving Behaviour Change (ABC) guide {1} for local government and partners, and the Improving People’s Health behavioural and social science strategy {2} {1}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/875385/PHEBI_Achieving_Behaviour_Change_Local_Government.pdf {2}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/744672/Improving_Peoples_Health_Behavioural_Strategy.pdfFinal Published versio

Covid-19 public health road map: Physical activity

This roadmap aims to support health officials to consider changes to physical activity that may have occurred during the Covid-19 pandemic and to use psychologically-informed behaviour change approaches to optimise health improvement and mitigate a reduction in activity levels. This guidance should be used alongside the Achieving Behaviour Change (ABC) guide {1} for local government and partners, and the Improving People’s Health behavioural and social science strategy {2} {1}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/875385/PHEBI_Achieving_Behaviour_Change_Local_Government.pdf {2}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/744672/Improving_Peoples_Health_Behavioural_Strategy.pdfFinal Published versio

A four-week remote group intervention to increase cervical cancer screening

Objectives: The aim of this project was to design and deliver a group intervention to increase uptake of cervical cancer screening in Wolverhampton, United Kingdom. Study Design: This short communication outlines the development process and service evaluation outcomes for a pilot group online cervical screening intervention. Methods: The intervention used the COM-B model and was informed by a literature review and survey responses. The four-week online intervention was delivered for 30-45 minutes per week via Zoom. The intervention employed behaviour change techniques including behavioural practice and rehearsal, modelling, and information about health consequences. Service evaluation was completed using open-text questions and multiple-choice survey responses including a knowledge quiz at: baseline, after session one, after session four, and at six-week follow-up. Results: Nine individuals took part in the intervention and six attended all four sessions. The service evaluation illustrated that increased capability, opportunity, and motivation to attend cervical screening was not achieved after one week but was achieved following four weeks of attendance. Attendee feedback suggested that the sessions were useful. However, the most common recommendations for improvement were to have longer sessions and more time for questions. Conclusion: Online group interventions may improve intentions to attend cervical screening appointments. However, this form of intervention was unable to address the practical barriers surrounding obtaining an appointment

The effectiveness of physical activity interventions in improving well-being across office-based workplace settings: a systematic review

© 2018 The Royal Society for Public Health Objectives: Although the benefits of regular physical activity (PA) are widely accepted, most of the population fails to meet the recommended levels of activity. Public health bodies such as the World Health Organisation emphasise promoting PA within workplaces as a key intervention setting to reach the health and well-being of the working population. Given the importance of well-being in workplace settings, it seems worthwhile to explore the evidence of effectiveness in the literature. This systematic review aims to assess the effectiveness of PA interventions for improving psychological well-being in working adults. It provides a review of current evidence, assesses the quality of the research into this topic area and identifies issues and recommendations for future research. Study design: A systematic review guided by the Cochrane Handbook was conducted. Methods: PsycINFO, PubMed, ScienceDirect, Web of Science, Embase, MEDLINE and Cochrane Library literature searches were conducted from 2007 to April 2017. Using the keywords ‘Physical Activity’; ‘Exercise’; ‘Wellbeing’; ‘Employee’ and ‘Workplace’, five articles were obtained that fit the inclusion criteria. Inclusion criteria were a workplace setting, an intervention including a PA intervention and an outcome measure including well-being. Extraction of articles and quality assessment of the articles were performed independently by two authors using the Cochrane's data extraction form and the Cochrane's risk of bias. Owing to heterogeneity in population characteristics, intervention components, outcome measures and the durations of interventions, a narrative synthesis was conducted. Results: The review identified five office-based workplace PA interventions in promoting psychological well-being in 1326 participants. The included studies varied substantially in sample size characteristics, methodological quality, duration of follow-up, types of interventions and assessed outcomes. Three of the five included studies were of high quality. The types of PA intervention included yoga, exercise and three studies focussing on walking interventions. The findings evidenced that exercise, yoga and walking interventions improve well-being as measured across workplace settings compared with no intervention. Some studies did not include a placebo control group and therefore, a form of PA intervention regardless of the type may be better than no intervention at all. Conclusion: This review found mixed evidence that PA interventions can be effective in improving well-being across office settings. Although, the findings are promising, because of methodological failings, there is no conclusive evidence. Current evidence indicates that employees can improve their psychological well-being by participating in any form of PA interventions in an office setting

Decision-making experiences of health professionals in withdrawing treatment for children and young people: A qualitative study

Objective: To explore factors that influence professionals in deciding whether to withdraw treatment from a child and how decision making is managed amongst professionals as an individual and as a team. Study Design: Semi-structured interviews were conducted with a purposive sample of health professionals working at a UK Children's Hospital, with children with life-limiting illnesses whose treatment has been withdrawn. Data were transcribed verbatim, anonymized and analysed using a thematic framework method. Results: A total of 15 participants were interviewed. Five interrelated themes with associated subthemes were generated to help understand the experiences of health professionals in decision making on withdrawing a child's treatment: (1) understanding the child's best interests, (2) multidisciplinary approach, (3) external factors, (4) psychological well-being and (5) recommendations to support shared decision making. Conclusion: A shared decision-making approach should be adopted to support professionals, children and their families to make decisions collectively