Children's and parent's perceptions of a magnetic resonance imaging examination

The aim of this study was to describe children’s and parents’ perceptions after a magnetic resonance imaging (MRI) examination. Semistructured interviews with eight children and eight parents were conducted. The interviews were analyzed using a phenomenographical approach. Both children and parents perceived a sense of security when they received preparation/information. The children perceived that it was positive to have their parents present. Children and parents also felt a sense of security from the positive attitude of the health professionals. They perceived anxiety if they felt that the preparation/information they were given was insufficient. The MRI scanner caused anxiety because of its size, design, and sound, and they were anxious about the risk of a failed examination. The children talked much about the difficulty of lying still. The parents perceived that more information about the MRI examination should be offered. By having the knowledge of how children and their parents perceive an MRI examination could help and guide health professionals for better understanding and high-quality care

When children undergo radiotherapy. Exploring care, developing and testing preparation procedures

Radiotherapy (RT) is a repetitive treatment divided into daily fractions, scheduled five days a week from one up to several weeks depending upon the child’s diagnosis. Although RT is painless and non-invasive, children experience anxiety. Depending on the child’s age, anxiety or inability to comply, they may require sedation or general anaesthesia (GA), meaning that some children receive GA over 30 times during their RT, which may have a negative effect on the child's health. The overall aim of this thesis was to explore care, develop and test preparation procedures for children with cancer undergoing RT. Radiotherapy nurses’ (RTN) perceptions of caring for children undergoing RT and parents’ lived experiences while their child underwent RT was explored. Based on the findings, previous research and theoretical framework, age-appropriateinformation and preparation procedures for children undergoing RT were developed and tested for feasibility and effectiveness in terms of need for GA and anxiety. Furthermore, the impact of age-appropriate information and preparation procedures for children with cancer undergoing RT on parents’ and family functioning, parents’ anxiety and hospital costs compared to traditional care was evaluated.Semi-structured interviews of RTNs were conducted and the interviews were analysed using a phenomenographical approach. Parents wrote a diary about their lived experience while their child underwent RT and the diaries were analysed with hermeneutic phenomenological methodology. A quasi-experimental controlled clinical trial was conducted. Seventeen children aged 3-18 years and 31 parents receiving age-appropriate preparation procedures were compared with 16 children and 32 parents in a control group. The children and parents in the control group received traditional care and in the intervention group, they received age-appropriate information and preparation procedures. The child’s and parents’ anxiety was measured and the child’s emotional behaviour was observed during the first three fractions, then at every fifthfraction and the last fraction. Furthermore, the parents answered questionnaires about their sense of coherence, and their and the families’ functioning.The findings showed that the RTNs perceived that they provided holistic care, created a sense of security and became committed. The RTNs wished to meet the family and child before the treatment began. Continuity with healthcare professionals and routines was a priority and keeping the balance between care, technology and communication were important parts as well as broadening their competence regarding childcare. The analyses of the parents’ diaries showed that the parents experienced their child’s RT as a balancing act involving coercing and protecting their child, balancing despair and hope, and feelings of powerlessness and trying to gain control. Being close to their child, meeting the same healthcare professionals and finding routines and strategies duringtreatment was experienced as important. The whole family was in need of support and they wished for help to coordinate the care. To maintain normality in daily life it was important for the parents to gain control. The developed age-appropriate information and preparation procedures, including written information, in advance meeting the RTN, doll-models to play with, pay a visit to the treatment room, watch a movie or listen to music during RT and hold onto a “safety-string”, were found feasible and acceptable. No statistically significant differences were found concerning the number of children receiving GA or their and the parents’ anxiety. However, three children planned for GA in the intervention group completed their RT without GA, including 73 fractions awake. Children receiving GA, regardless of group, showed significantly higher negative emotional behaviour. Parents whose children received GA showed significantly increased anxiety. Parents of children in the intervention group showedsignificantly better communication at the first and last fraction and better socialfunction at the child's last fraction. There were no significant differences between the groups concerning hospital costs. However, hospital costs for the three children not receiving GA in the intervention group were reduced by SEK 385 002.In conclusion, this thesis has shown that age-appropriate information and preparation procedures for children with cancer undergoing RT are important for the children, parents and healthcare. If a child is able to undergo RT without receiving GA, it means fewer risks and restrictions for the individual child, and less anxiety for both the child and the parents. Furthermore, healthcare costs are reduced, which makes it possible to prioritize other areas where anaesthetic professionals are needed. To demonstrate effectiveness, a larger study with a more homogeneous group of children is needed

Caring for children undergoing radiotherapy treatment: Swedish radiotherapy nurses' perceptions.

The aim was to explore radiotherapy nurses' perceptions of their experiences of caring for children undergoing radiotherapy treatment for cancer

Parents' Lived Experiences During Their Children's Radiotherapy

BACKGROUND: The aim of radiotherapy is to provide a cure and/or symptomatic relief for children with cancer. Treatment is delivered on a daily basis, 5 days per week, over the course of 5 to 35 days. Many parents find that leaving their children alone during treatment and exposing them to radiation is a challenging experience. To gain an understanding of parents' lived experiences, 10 parents were asked to keep a diary while their children underwent radiotherapy.METHODS: A descriptive inductive design with a hermeneutic-phenomenological approach was chosen to analyze the diaries. The parents were asked to write down their lived experiences while their children underwent radiotherapy. Daily notes, both short and long, were desirable.FINDINGS: The parents described radiotherapy as a balancing act involving a constant attempt to maintain a balance between coercing and protecting their children in order to improve their children's chances of survival. Meanwhile, the parents themselves were struggling with their own despair and feelings of powerlessness. While protecting their children, they experienced a sense of hope and felt that they had gained control.CONCLUSION: Parents' daily written reflections are important for clinical practice and provide vital knowledge. Parents need support when focusing on coercing and protecting their children and help with information and routines that enable them gain control

Age-appropriate preparations for children with cancer undergoing radiotherapy : A feasibility study

The aim of this study was to test age-appropriate information and preparation procedures for children with cancer undergoing radiotherapy (RT) for feasibility and effectiveness in terms of the need for general anesthesia (GA) and anxiety. In a quasi-experimental controlled clinical trial, 17 children aged 3–18 years receiving age-appropriate preparation were compared with 16 children in a control group. Feasibility in terms of recruitment, compliance, and acceptability was assessed. Effectiveness was assessed by the number of children who underwent treatment without GA and their respective fractions and validated instruments measured the children’s anxiety and emotional behavior. The preparation parts were delivered as intended without any additional personnel and without dropouts in the intervention group (IG) and therefore found feasible and acceptable. No statistic significances were found concerning the number of children receiving GA or anxiety. However, three children planned for GA in the IG completed their treatments, including 73 fractions awake. Children receiving GA, regardless of group, showed significantly higher negative emotional behavior. Giving children individualized preparation may decrease the need for GA during RT, which gives benefits in terms of fewer risks and restrictions in life for the child and lower costs for health care

Impact of Age-appropriate Preparations for Children With Cancer Undergoing Radiotherapy on Parents and Family Functioning, Parents' Anxiety and Hospital Costs – A Feasibility Study

Purpose: The aim was to evaluate the impact of age-appropriate information and preparation procedures for children with cancer undergoing radiotherapy on 1) parents and family functioning, parents' anxiety and 2) hospital costs compared to traditional care. Design and Methods: An un-matched quasi-experimental controlled clinical trial was conducted consisting of a control group including 31 parents of 16 children receiving traditional care and an intervention group including 32 parents of 17 children receiving age-appropriate preparation including seven parts. Validated instruments measured parents and family functioning and parents' anxiety. Hospital costs were calculated. Results: Parents in the intervention group showed better communication throughout their child's radiotherapy (p = 0.01) and at their child's last fraction, parental social functioning improved (p = 0.02). Parents of children receiving general anesthesia, regardless of group, showed higher levels of anxiety (p = 0.04). In general, results regarding hospital costs lacked statistical significance. Development of the intervention was calculated to be USD 4.624. Conclusion: Parents who receive age-appropriate information and preparation together with their child benefits in terms of improved communication and social functioning. When children avoid general anesthesia the parents experienced less anxiety and costs for the hospital was lowered. Practice Implication: Age-appropriate preparations consisting of basic, non-costly utilities and a structured approach are important. If more children are able to undergo radiotherapy without general anesthesia, it means for the individual child fewer risks and restrictions, and for the parents decreased anxiety. For the healthcare, it means lower costs, which enables the hospital to prioritize other areas of pediatric care