Pediatric Education Discharge Support Strategies for Newly Diagnosed Children With Cancer

Abstract

Background Discharge education practices vary among institutions and lack a standardized approach for newly diagnosed pediatric oncology patients and their parents. Objective The purpose of this American Nurses Credentialing Center–supported pediatric multisite trial was to determine the feasibility and effectiveness of 2 nurse-led Parent Education Discharge Support Strategies (PEDSS) for families with a child who is newly diagnosed with cancer. Interventions/Methods A cluster randomized clinical trial design assigned 16 Magnet-designated sites to a symptom management PEDSS intervention or parent support and coping PEDSS intervention. Outcome measures evaluated at baseline, 1, and 2 months after diagnosis include symptom experiences, parent perceptions of care, unplanned service utilization, and parent evaluation of the PEDSS interventions. Results There were 283 newly diagnosed children and their parent participating in this study. Linear mixed models revealed pain differed over time by the intervention; children in the symptom management group had a greater decrease in pain. Greater nausea and appetite disturbances were experienced by older children in both groups. Fatigue and sleep disturbance showed a significant decrease over time in both groups. The symptom management group reported significantly greater satisfaction with the PEDSS intervention. Conclusions This study is among the first to examine the effects of 2 different early-discharge planning strategies for families of a newly diagnosed child with cancer. The evidence supports a standardized discharge education strategy that can be successfully implemented across institutions. Implications for Practice Nurses play a major role in the educational preparation and discharge of newly diagnosed pediatric cancer patients and their families.

A Structured Discharge Education Intervention for Parents of Newly Diagnosed Pediatric Oncology Patients

“…We focused only on discharge education process changes involving nursing and did not report changes in physician or psychosocial processes that may have occurred as a result of the intervention. It is also unknown what impact the intervention may have had on the child's coping, adjustment, and symptom burden, as there were not included as study outcomes; however, a study that evaluated a structured teaching intervention targeted toward symptom management showed promising results (Hockenberry et al, 2021). Future studies are needed to explore the relationship between the provision of quality discharge education in pediatric oncology, and patient- and parent-focused outcomes.…”

Health Literacy in Parents of Children Newly Diagnosed With Cancer and Comprehension of Key Concepts Related to Their Child's Care

“…Importantly, advancements in care have led to both improved outcomes and increasingly complex treatment protocols. For example, some cancers, such as acute lymphoblastic leukemia, have treatment protocols that can last over 2 years (Hunger & Mullighan, 2015). Throughout the entirety of the treatment, parents/caregivers of children with cancer are expected to manage care for their child, including being able to recognize when to seek emergent care (Haugen et al, 2016).…”

“…Adult learners have differing preferences for acquiring new information and skills, including listening (aural), seeing (visual), reading and writing, and doing (kinesthetic). Fleming and Mills (1992) further describe these four learning styles, as follows: Auditory learners prefer spoken educational sessions such as lectures and discussions; visual learners prefer pictures and images that represent the concept they are trying to comprehend; those who prefer reading and writing benefit from the information presented in written form, such as in a textbook or list; while kinesthetic learners prefer to move through the task or objective, and demonstration with return demonstration works well for these learners. Some learners may have a single preferred learning style, while others may learn best via a combination of two or more styles.…”

“…Using data from these studies, Landier et al (2016) convened an expert panel to evaluate the evidence and develop recommendations, establishing the importance of limiting parent education at the time of diagnosis to include only essential elements, with the goal of reducing information overload. Recently, Hockenberry et al (2021) provided evidence that a standardized new diagnosis pediatric oncology discharge education plan can be successfully implemented across multiple institutions. Hockenberry et al (2021) also established that discharge plans focused on symptom management, compared with those focused on coping with a new cancer diagnosis, were most helpful to parents.…”

“…Recently, Hockenberry et al (2021) provided evidence that a standardized new diagnosis pediatric oncology discharge education plan can be successfully implemented across multiple institutions. Hockenberry et al (2021) also established that discharge plans focused on symptom management, compared with those focused on coping with a new cancer diagnosis, were most helpful to parents. These studies all contribute to establishing an understanding of the essential components of pediatric oncology parent education for children newly diagnosed with cancer.…”