Is there a choice when a sibling is ill? : Experiences of children and adolescents who donated stem cells to a sibling

Purpose: When healthy children/adolescents are potential stem cell donors to a sibling, ethical questions arise due to reduced autonomy and dependency on their family. This study aimed to explore the experiences of children/ adolescents in Sweden who donated stem cells to a severely ill sibling. Method: Semi-structured interviews were conducted with thirteen donors, aged 6-17 years at the time of the donation, all with surviving siblings. The interviews were transcribed verbatim and analysed using qualitative content analysis. Result: The main category in this study was The presumed 'choice' when a sibling is ill. The experience included being Proud without an actual choice, highlights that the donors were proud to contribute, and perceptions of a request without a choice. Focusing on the ill sibling and the outcomes reveals that they were worried and protected the sibling, and downplayed the importance of their own effort. They experienced a Need of support and information, which derived from receiving information without communication about what they really needed to know, but also the importance of support through play and talk. Conclusion: The donation involves the young donor in the care, implying an opportunity to bring the family back together. They have no real choice, when their sibling is ill and the lack of information about possible alternatives indicate that there was no option to decline. There is also a need to focus on the experiences of young donors whose siblings died after the transplantation

Clinical implications of the ISC technique for breast cancer radiotherapy and comparison with clinical recommendations

Purpose: The project studied the implications of using the irregular surface compensator (ISC) technique in comparison to three-dimensional conformal radiation therapy (3D-CRT) for breast cancer treatment. ISC is an electronic compensation algorithm that modulates the fluence across the radiation fields to compensate for irregularly shaped surfaces and deliver a homogeneous dose to a compensation plane. Methods: Ten breast cancer patients (five left- and five right-sided) were planned with both techniques. The planning was done for 50 Gy in 25 fractions with 2 Gy per fraction in all patients. Physical parameters such as doses to the clinical target volume (CTV-T) and the planned target volume (PTV), heterogeneity index and doses to lung and heart were determined and compared for the treatment plans. Results: The ISC technique led to significantly better coverage of the CTV-T and PTV in almost all patients with statistically significant better homogeneity of the dose distribution. The contralateral lung and the heart receive the same doses with both ISC and 3D-CRT plans. However, ISC showed a trend towards decreasing the volumes of the ipsilateral lung irradiated with high doses. Consequently this led to better compliance with the national recommendations for breast radiotherapy. Conclusion: The ISC technique leads to an improvement of the target coverage and the radiation burden of the ipsilateral lung thus allowing better compliance with the national recommendations and increasing the potential for improved quality of life for breast cancer patients. It should therefore be preferred over 3D-CRT for breast cases with difficult dose homogeneity to the PTV or CTV-T

Taking care of oneself by regaining control - a key to continue living four to five decades after a suicide attempt in severe depression

Background: Depression is a strong risk factor for suicide and suicide attempt. Several studies have examined the pathway to suicide attempt, but few studies have considered aspects important for overcoming being suicidal. The aim of the present study was to examine personal strategies to continue living after a suicide attempt. Methods: A qualitative grounded theory approach was used. Thirteen former inpatients diagnosed with severe depression (1956-1969) participated in a follow-up 42-56 years after their last suicide attempt, which occurred between the ages of 21 and 45. They were interviewed on one occasion between June 2013 and January 2014, using semi-structured interviews. Results: The pathway to a suicide attempt was defined as 'being trapped in an overwhelming situation'. Three categories described the recovery process: 'coming under professional care', 'experiencing relief in the personal situation', and 'making a decision to continue living'. These categories emerged in a core category, labelled 'taking care of oneself by regaining control'. Overcoming being suicidal occurred regardless of recovering from depression. Conclusion: In the very long-term course following a suicide attempt, the process of recovery is multi-dimensional and fluctuating, and includes appropriate treatment, connecting with others, decision making, and overcoming existential issues

Quand perte de sens rime avec souffrance : analyse qualitative du vécu des médecins à l’annonce d’une mauvaise nouvelle en oncologie

International audienceThe aim of this study is to explore physicians’ subjective experience when breaking bad news in oncology. This study is based on a qualitative analysis (Interpretative Phenomenological Analysis) of 22 interviews of physicians working in hospitals. The analysis shows that the meaning that physicians give to the announcement and their role was a decisive element on their emotional experience of the announcement. These results present new elements of our understanding of physicians’ experience when breaking bad news in oncology, which should be integrated into physicians’ training.Cette étude vise à explorer l’expérience subjective des médecins confrontés à l’annonce de mauvaises nouvelles en cancérologie. Elle repose sur l’analyse qualitative (Analyse interprétative phénoménologique) de 22 entretiens menés auprès de médecins hospitaliers. Cette analyse révèle que le sens que les médecins donnent à l’annonce et à leur rôle est déterminant dans leur vécu émotionnel de l’annonce. Ces résultats amènent de nouveaux éléments de compréhension du vécu des médecins à l’annonce d’une mauvaise nouvelle en cancérologie à intégrer aux formations des médecins

Treatment decision making

© 2020, Springer Nature Switzerland AG. Treatment decision making (TDM) is complex due to the varying decisions which have to be made about diagnosis, treatment options, toxicity, and outcomes of treatment. Shared decision making is complicated by the triadic relationship of parent/caregiver, child and clinician typical in pediatric care. Increasing attention on how best to incorporate child and adolescent and young adult (AYA) voices in decision making is described. We review TDM from the various perspectives of those involved in making decisions about treatment, including parents, children, AYAs, family, and the health care team. Those involved in TDM bring with them their individual characteristics that include values, preferences, past experiences, and cognitive abilities. Interwoven with these influences are the person’s environment, social determinants, and relationships. We incorporate into our discussion the available research literature concluding with what is ready for translation into clinical practice and recommendations for future research to fully understand the varying perspectives and factors which influence TDM and the nurse’s important role in supporting children and their families