Family-centred care for hospitalised children aged 0-12 years (Review)

This is an update of the Cochrane systematic review of family-centred care published in 2007 (Shields 2007). Family-centred care (FCC) is a widely used model in paediatrics, is thought to be the best way to provide care to children in hospital and is ubiquitous as a way of delivering care. When a child is admitted, the whole family is affected. In giving care, nurses, doctors and others must consider the impact of the child's admission on all family members. However, the effectiveness of family-centred care as a model of care has not been measured systematically. To assess the effects of family-centred models of care for hospitalised children aged from birth (unlike the previous version of the review, this update excludes premature neonates) to 12 years, when compared to standard models of care, on child, family and health service outcomes. In the original review, we searched up until 2004. For this update, we searched: the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library, Issue 12 2011); MEDLINE (Ovid SP); EMBASE (Ovid SP); PsycINFO (Ovid SP); CINAHL (EBSCO Host); and Sociological Abstracts (CSA). We did not search three that were included in the original review: Social Work Abstracts, the Australian Medical Index and ERIC. We searched EMBASE in this update only and searched from 2004 onwards. There was no limitation by language.\ua0We performed literature searches in May and June 2009 and updated them again in December 2011. We searched for randomised controlled trials (RCTs) including cluster randomised trials in which family-centred care models are compared with standard models of care for hospitalised children (0 to 12 years, but excluding premature neonates). Studies had to meet criteria for family-centredness. In order to assess the degree of family-centredness, we used a modified rating scale based on a validated instrument, (same instrument used in the initial review), however, we decreased the family-centredness score for inclusion from 80% to 50% in this update. We also changed several other selection criteria in this update: eligible study designs are now limited to randomised controlled trials (RCTs) only; single interventions not reflecting a FCC model of care have been excluded; and the selection criterion whereby studies with inadequate or unclear blinding of outcome assessment were excluded from the review has been removed. Two review authors undertook searches, and four authors independently assessed studies against the review criteria, while two were assigned to extract data. We contacted study authors for additional information. Six studies found since 2004 were originally viewed as possible inclusions, but when the family-centred score assessment was tested, only one met the minimum score of family-centredness and was included in this review. This was an unpublished RCT involving 288 children post-tonsillectomy in a care-by-parent unit (CBPU) compared with standard inpatient care.The study used a range of behavioural, economic and physical measures. It showed that children in the CBPU were significantly less likely to receive inadequate care compared with standard inpatient admission, and there were no significant differences for their behavioural outcomes or other physical outcomes. Parents were significantly more satisfied with CBPU care than standard care, assessed both before discharge and at 7 days after discharge. Costs were lower for CPBU care compared with standard inpatient care. No other outcomes were reported. The study was rated as being at low to unclear risk of bias. This update of a review has found limited, moderate-quality evidence that suggests some benefit of a family-centred care intervention for children's clinical care, parental satisfaction, and costs, but this is based on a small dataset and needs confirmation in larger RCTs. There is no evidence of harms. Overall, there continues to be little high-quality quantitative research available about the effects of family-centred care. Further rigorous research on the use of family-centred care as a model for care delivery to children and families in hospitals is needed. This research should implement well-developed family-centred care interventions, ideally in randomised trials. It should investigate diverse participant groups and clinical settings, and should assess a wide range of outcomes for children, parents, staff and health services

Scoping review of the literature about family-centred care with caregivers of children with cystic fibrosis

Background: Cystic fibrosis is a severe, life-shortening, inherited condition which imposes an enormous burden on the family and patient, and family-centred care (FCC) is postulated as the optimal model of care for these children and families.\ud \ud Aims: To search for literature investigating the use of FCC as a model of care in cystic fibrosis units for children under 13 years.\ud \ud Methods: A comprehensive search of the following databases was conducted: Cochrane Library, CINAHL, Embase, Medline, PsycINFO. Using the PRISMA flow chart and processes of the United Kingdom Centre for Reviews and Dissemination, we selected relevant studies. The detailed search strategies are available from the authors. We set clearly defined inclusion and exclusion criteria, and had we found any studies, we would have analysed them; however, none were found that specifically examined the topic. We decided to use this as a scoping study.\ud \ud Findings: One hundred and twenty-one studies were identified that met the inclusion criteria for types of studies about cystic fibrosis, but none were about FCC.\ud \ud Discussion: This brief report illustrates the need for research into the application of FCC as a way of caring for children and families where one or more of the children have cystic fibrosis. Implications for practice Families of children with cystic fibrosis need supportive care in health services.\ud \ud Conclusions: Further research is required to explore whether or not cystic fibrosis care is family-centred, and models of care that meet the needs of all family members need to be developed, tested and used

Family-centred care for hospitalised children aged 0-12 years: a systematic review of quasi-experimental studies (Protocol)

[Extract] \ud \ud Review objective\ud \ud The objective is to identify the effectiveness of family-centred models of care for hospitalised children aged 0-12 years (excluding premature neonates) when compared to standard models of care.\ud \ud Background\ud \ud Until at least the late 1950s, hospitals worldwide tended to be bleak places for children. It was believed that visits from parents would inhibit effective care and were detrimental to the child, who would become distressed when the parents left. Researchers began to suggest, however, that children whose parents did not visit them suffered acute emotional trauma which may have long-term psychological consequences in adolescence and adulthood. In 1956, the British government commissioned a report into the welfare of children in hospital. The resulting report, the Platt Report recommended that visiting be unrestricted, that mothers stay in hospital with their child, and that training of medical and nursing staff should promote understanding of the emotional needs of children. The process of change has resulted in a humanisation of paediatrics, although the movement away from traditional approaches to health service delivery to the involvement of families in all aspects of the planning, delivery, and evaluation of health care has been slow

Cost comparison of five Australasian obesity prevention interventions for children aged from birth to two years

BACKGROUND: In the absence of rigorous evidence of cost-effectiveness for early childhood obesity prevention interventions, the next-best option may be for decision-makers to consider the relevant costs of interventions when allocating resources. OBJECTIVES: This study aimed to estimate systematically the cost of five obesity prevention interventions in children aged 0-2 years, undertaken in research settings in Australia and New Zealand. METHODS: A standardised costing protocol informed the costing methodology, ensuring comparability of results across interventions. Micro-costing was undertaken, with intervention costs defined from the funder perspective and valued in 2018 Australian dollars using unit costs from the trials or market rates. RESULTS: Interventions varied widely in their resource use. The total cost per participant ranged from $80 for the CHAT SMS intervention arm (95$77-$82) to$1135 for the Healthy Beginnings intervention (95% UI $1059-$1189). Time costs of personnel delivering interventions contributed >50% of total intervention costs for all included studies. CONCLUSIONS: An understanding of the costs associated with intervention delivery modes is important, alongside effectiveness. Telephone delivery may include unexpected costs associated with connection to intervention participants at convenient times. A SMS-based intervention had the lowest delivery cost in this study.</p

Protocol for the development of Core Outcome Sets for Early intervention trials to Prevent Obesity in CHildren (COS-EPOCH)

Introduction Childhood overweight and obesity is prevalent in the first 5 years of life, and can result in significant health and economic consequences over the lifetime. The outcomes currently measured and reported in randomised controlled trials of early childhood obesity prevention interventions to reduce this burden of obesity are heterogeneous, and measured in a variety of ways. This variability limits the comparability of findings between studies, and contributes to research waste. This protocol presents the methodology for the development of two core outcome sets (COS) for obesity prevention interventions in children aged from 1 to 5 years from a singular development process: (1) a COS for interventions targeting physical activity and sedentary behaviour and (2) a COS for interventions targeting child feeding and dietary intake. Core outcomes related to physical activity and sedentary behaviour in children aged ≤1 year will also be identified to complement an existing COS for early feeding interventions, and provide a broader set of core outcomes in this age range. This will result in a suite of COS useful for measuring and reporting outcomes in early childhood obesity prevention studies, including multicomponent interventions. Methods and analysis Development of the COS will follow international best practice guidelines. A scoping review of trial registries will identify commonly reported outcomes and associated measurement instruments. Key stakeholders involved in obesity prevention, including policy-makers/funders, parents, researchers, health practitioners and community and organisational stakeholders will participate in an e-Delphi study and consensus meeting regarding inclusion of outcomes in the COS. Finally, recommended outcome measure instruments will be identified through literature review and group consensus. Ethics and dissemination Deakin University Human Research Ethics Committee (HEAG-H 231-2020). The COS will be disseminated through peer-reviewed publications and engagement with key stakeholders

Development of Core Outcome Sets for Early intervention trials to Prevent Obesity in CHildren (COS-EPOCH)

Purpose: Core Outcome Sets (COS) are agreed minimum sets of outcomes recommended for measurement in studies for specific conditions or areas of health. COS development aims to improve the consistency, comparability and transparency of study findings and can help to reduce research waste. Few COS for public health interventions currently exist and there are no published COS that can be applied to obesity prevention interventions in children aged from birth to five years that include outcomes for multiple behaviour domains (e.g. food intake, movement, sleep). This study describes the development of a COS for randomised controlled trials (RCTs) evaluating lifestyle interventions for the prevention of obesity in 0-5 year olds (COS-EPOCH), and highlights some of the challenges faced in COS development.Methods: Overseen by an international Steering Group, the COS development process follows the Core Outcome Set-STAndards for Development recommendations. Development consists of three stages: (i) a scoping review of early childhood obesity prevention RCTs, identifying potential outcomes and measurement instruments; (ii) a modified Delphi study to determine core outcomes by relevant stakeholder group, followed by a consensus meeting to finalise core outcome recommendations; and, (iii) determination of recommended measurement instruments.Results/findings: Scoping review identified 170 relevant studies, with preliminary findings demonstrating there are a large number of outcomes currently collected in early childhood obesity prevention RCTs, and a broad range of outcome measurement instruments and methodologies employed. This high level of variation between studies makes evidence synthesis challenging, and further highlights the need for an agreed set of core outcomes. Delphi study development and recruitment is underway. Challenges in the development of the COS-EPOCH include the multiplicity of potential outcomes for inclusion, and the heterogeneity in completeness of study reporting in trial registries and the literature.Conclusions: The development of the COS-EPOCH will provide trialists with standardised sets of outcomes spanning the early childhood timeframe that takes into account this unique period of child development and incorporates multiple risk factors targeted in interventions. Effective dissemination of the COS-EPOCH will play a critical role in its future uptake