Managing low‐risk febrile neutropenia in children in the time of COVID‐19: What matters to parents and clinicians

Abstract

Aim The Australian ‘There is no place like home’ project is implementing a paediatric low‐risk febrile neutropenia (FN) programme across eight paediatric hospitals. We sought to identify the impact of the coronavirus disease 2019 (COVID‐19) pandemic on programme implementation. Methods Paediatric oncology, infectious diseases and emergency medicine health‐care workers and parent/carers were surveyed to explore the impact of the COVID‐19 pandemic on home‐based FN care. Online surveys were distributed nationally to health‐care workers involved in care of children with FN and to parents or carers of children with cancer. Results Surveys were completed by 78 health‐care workers and 32 parents/carers. Overall, 95% of health‐care workers had confidence in the safety of home‐based FN care, with 35% reporting changes at their own hospitals in response to the pandemic that made them more comfortable with this model. Compared to pre‐pandemic, >50% of parent/carers were now more worried about attending the hospital with their child and >80% were interested in receiving home‐based FN care. Among both groups, increased telehealth access and acceptance of home‐based care, improved patient quality of life and reduced risk of nosocomial infection were identified as programme enablers, while re‐direction of resources due to COVID‐19 and challenges in implementing change during a crisis were potential barriers. Conclusion There is strong clinician and parent/carer support for home‐based management of low‐risk FN across Australia. Changes made to the delivery of cancer care in response to the pandemic have generally increased acceptance for home‐based treatments and opportunities exist to leverage these to refine the low‐risk FN programme.

Examining health-related quality of life in pediatric cancer patients with febrile neutropenia: Factors predicting poor recovery in children and their parents

“…Discrete choice experiments that have examined treatment preferences of parents with children undergoing active cancer treatment have found that many parents still prefer inpatient management over outpatient management for low-risk FN episodes [ 4 , 6 ], whilst parents who valued HRQoL were more likely to opt for outpatient care [4] . More recently, a clear preference for home-based treatment of low-risk FN was identified by clinicians and parents due to perceived improvements in HRQoL [28] . This highlights the importance of consumer engagement when home-based FN care pathways are developed and implemented to ensure that parent and patient concerns and reservations are appropriately addressed.…”

Cost‐effectiveness of home‐based care of febrile neutropenia in children with cancer

“…[30][31][32][33] A recent survey of parents of children with cancer and FN similarly identified strong themes of perceived wellbeing, and reduced impact on the family due to home-based care. 21 However, these qualitative data are captured infrequently, and more attention should be directed towards routinely embedding QoL measures in paediatric research as well as to understand the most effective method of obtaining reliable information from children and their families. By incorporating a broader perspective in our analysis, we are able to show the value of the home-based FN programme from the families' viewpoint.…”

“…Although these numbers were small, our evaluation took this into account to reflect the real‐world application of the programme. The feasibility of safely treating higher risk patients through the programme, together with increasing clinician acceptance in managing cancer patients at home, 21 has prompted a programme update. Currently, all children with FN, irrespective of underlying FN risk status, may be considered for home‐based care, provided HITH‐eligibility criteria are fulfilled and a minimum in‐hospital observation complied with.…”

“…Paediatric studies have shown that patients and families often value the comfort, familiarity of home environment and reduced disruption to family life that comes with home‐based care and, given the opportunity, tend to prefer this model 30–33 . A recent survey of parents of children with cancer and FN similarly identified strong themes of perceived well‐being, and reduced impact on the family due to home‐based care 21 . However, these qualitative data are captured infrequently, and more attention should be directed towards routinely embedding QoL measures in paediatric research as well as to understand the most effective method of obtaining reliable information from children and their families.…”

Cuidados a criança com câncer frente a pandemia de COVID-19: Revisão integrativa da literatura

“…Embora a atual pandemia pela COVID-19 tenha tido pouco impacto no nível de confiança e interesse, contribuído para mudanças na atenção de cuidados a crianças com câncer, que em geral melhorou a aceitabilidade desse modelo de atenção. Para facilitar o atendimento domiciliar destacou a importância da segurança, infraestrutura hospitalar, comunicação e conhecimento das evidências como fatores-chave para os profissionais de saúde (Haeusler et al, 2021).…”