| 1. |
|
|
| 2. |
- Hedén, Lena, et al.
(författare)
-
Low-dose oral midazolam reduces fear and distress during needle procedures in children with cancer
- 2009
-
Ingår i: Pediatric Blood & Cancer. - : Wiley. - 1545-5009 .- 1545-5017. ; 53:7, s. 1200-1204
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDChildren with cancer often mention needle procedures as the most frightening, distressing, and sometimes painful aspect of the disease and treatment. The aim was to investigate whether children experience less fear, distress, and/or pain according to parents, nurses, and children >or=7 years of age when they receive oral midazolam versus placebo before a needle is inserted in a subcutaneously implanted intravenous port.PROCEDUREFifty children 1-18 years of age who were being treated in a pediatric oncology and hematology setting were included consecutively when undergoing routine needle insertion into an intravenous port. All children were subjected to one needle insertion in this randomized, triple-blind, placebo-controlled study in which orally administered midazolam (n = 24) 0.3 mg/kg body weight (maximum 10 mg) was compared with placebo (n = 26). Parents, nurses, and children >or=7 years reported the patients' fear, distress, and pain on 0-100 mm Visual Analogue Scales.RESULTSFear was lower in the midazolam group according to parents (P = 0.001), nurses (P = 0.001), and children (P = 0.015). Parents and nurses also reported lower distress (P = 0.020 and 0.007, respectively). Post hoc analyses indicated that the effects were more pronounced in younger children (<7 years of age).CONCLUSIONLow-dose oral midazolam was effective in reducing fear and distress in pediatric oncology patients, especially in younger children, undergoing subcutaneous port needle insertion.
|
|
| 3. |
- Hedén, Lena, et al.
(författare)
-
Randomized interventions for needle procedures in children with cancer
- 2009
-
Ingår i: European Journal of Cancer Care. - : Hindawi Limited. - 0961-5423 .- 1365-2354. ; 18:4, s. 358-363
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine whether children experience less fear, distress and pain connected to a routine needle insertion in an intravenous port when subjected to an intervention: blowing soap bubbles or having a heated pillow vs. standard care. Twenty-eight children, 2-7 years, cared for at a paediatric oncology unit, undergoing a routine needle insertion in an intravenous port were included consecutively. All children were subjected to two needle insertions; at the first they received standard care, and at the second standard care + a randomized intervention. Parents and nurses assessed children's fear, distress and pain on 0-100 mm visual analogue scales. According to parents' report, children experienced less fear when subjected to intervention vs. standard care reported by parents (P < 0.001). Children also experienced less fear (P < 0.05) and distress (P < 0.05) when subjected to standard care + blowing soap bubbles vs. standard care (n = 14), and less fear when subjected to standard care + heated pillow vs. standard care (P < 0.05). Nurses' reports did not show any differences for standard care + intervention vs. standard care. Blowing soap bubbles or having a heated pillow is more effective than standard care in reducing children's fear and distress in needle procedures, according to parents' report.
|
|
| 4. |
- Hedström, Mariann, et al.
(författare)
-
Accuracy of assessment of distress, anxiety, and depression by physicians and nurses in adolescents recently diagnosed with cancer
- 2006
-
Ingår i: Pediatric Blood & Cancer. - : Wiley. - 1545-5009 .- 1545-5017. ; 46:7, s. 773-9
-
Tidskriftsartikel (refereegranskat)abstract
- Background. As staff members prioritize medical resources forpatients, it is imperative to find out whether their assessments ofpatients’ health status agree with patients’ assessments. The degree towhich physicians and nurses can identify the distress, anxiety, anddepression experienced by adolescents recently diagnosed withcancer was examined here. Procedure. Adolescents undergoingchemotherapy (13–19 years, n¼53), physicians (n¼48), and nurses(n¼53) completed a structured telephone interview, 4–8 weeksafter diagnosis or relapse, investigating disease and treatment-relateddistress, anxiety, and depression. Results. The accuracy of staffratings of physical distress could be considered acceptable.However, problems of a psychosocial nature, which were frequentlyoverestimated, were difficult for staff to identify. Staff underestimatedthe distress caused by mucositis and worry about missing schoolmore than they overestimated distress. These aspects were some ofthe most prevalent and overall worst according to the adolescents.Both physicians and nurses overestimated levels of anxiety anddepression. Nurses tended to show higher sensitivity than physiciansfor distress related to psychosocial aspects of distress, whilephysicians tended to show higher accuracy than nurses for physicaldistress. Conclusions. Staff was reasonably accurate at identifyingphysical distress in adolescents recently diagnosed with cancerwhereas psychosocial problems were generally poorly identified.Thus, the use of staff ratings as a ‘‘test’’ to guide specific supportseems problematic. Considering that the accuracy of staff ratingsoutside a research study is probably lower, identification of andaction taken on adolescent problems in relation to cancer diagnosisand treatment need to rely on direct communication.
|
|
| 5. |
- Hedström, Mariann, 1965-
(författare)
-
Distress among Adolescents with Cancer
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The primary aim was to investigate the distress perceived by adolescents with cancer treated in paediatric oncology. In Study I, especially distressing events for children/adolescents with cancer were identified by interviews with children/adolescents/parents and nurses. Data were analysed with content analysis. A range of physical and emotional concerns was identified. Physical concerns are of a rather similar nature across age groups. Emotional concerns vary more between age groups. For children 8-12 years, emotional concerns are rather frequent. In Study II distressing and positive aspects related to some care situations for adolescents with cancer were identified by interviews with adolescents and nurses. Data were analysed with content analysis. A range of negative aspects, e.g. fear of alienation, fear of dying, altered appearance and physical concerns, as well as positive aspects, e.g. positive relations to staff and being well cared for were identified. The aspects of distress identified in Studies I and II formed the basis for a structured interview-guide, used in Studies III and IV. Adolescents, recently diagnosed with cancer, physicians and nurses were interviewed by telephone about distress, anxiety, depression and well-being experienced by the adolescents. Adolescent ratings of prevalence, levels and worst aspects of distress do not necessarily agree, however, worry missing school and mucositis are among those rated with the highest prevalence, levels and those perceived as the overall worst. The findings from Study IV demonstrate that physicians and nurses underestimate the distress caused by worry missing school and mucositis. The accuracy of physician and nurse ratings of physical distress is acceptable, however, this is not the case for psychosocial distress. It can be concluded that it is crucial to consider how questions are asked when interpreting the significance of the answers, and that action on adolescent problems in relation to cancer diagnosis and treatment need to rely on direct communication.
|
|
| 6. |
- Hedström, Mariann, et al.
(författare)
-
Perceptions of distress among adolescents recently diagnosed with cancer
- 2005
-
Ingår i: Journal of pediatric hematology/oncology (Print). - 1077-4114 .- 1536-3678. ; 27:1, s. 15-22
-
Tidskriftsartikel (refereegranskat)abstract
- With the goal of studying perceived distress among adolescents recently diagnosed with cancer, 56 adolescents were interviewed by telephone 4 to 8 weeks after diagnosis. The interviews included a structured interview guide, the Hospital Anxiety and Depression Scale, and the subscales Mental Health and Vitality from SF-36. "Losing hair" and "missing leisure activities" were identified as the most prevalent aspects of distress, whereas "missing leisure activities" and "fatigue" were rated with the highest levels of distress. "Worry about not getting well," "mucositis," "nausea," "pain from procedures and treatments," and "worry about missing school" were rated as the overall worst aspects by most adolescents. Twelve percent reached the cutoff score for potential clinical anxiety and 21% for potential clinical depression. Ratings of Mental Health and Vitality were lower than norm values. Prevalence of pain from procedures/treatments was higher among those who scored in the clinical range of depression, and more adolescents who were treated at a local hospital scored in the clinical range of anxiety. The findings show that ratings of prevalence, levels, and aspects perceived as the worst are not necessarily in accordance, that adolescents scoring in the clinical range of psychological distress are in the minority, and that the adolescents experience reduced physical and mental well-being.
|
|
| 7. |
|
|
| 8. |
- Ljungman, Gustaf
(författare)
-
Smärta hos barn : Diagnostik och behandling
- 2005
-
Ingår i: Anestesi (andra upplagan) kap 52. - : S. Lieber, Lund 2005 (Slovenien). - 9147051930 ; , s. 609-617
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 9. |
|
|
| 10. |
- Mattsson, Elisabet, 1959-
(författare)
-
Cancer During Adolescence: Psychosocial Consequences and Methodological Issues
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate psychosocial consequences of cancer during adolescence, using a longitudinal approach. An additional aim was to investigate if mode of administration has an influence on adolescents’ and young adults’ self-reported psychosocial function. In Study I participants, aged 13-23 years, were randomised according to two modes of administration, telephone interview and postal questionnaire, and asked to complete the Hospital Anxiety and Depression Scale (HADS) and Short Form 36 (SF-36). The telephone mode resulted in a higher response rate, better self-rated psychosocial function (except for the youngest age group), overall lower Cronbach’s alpha values, and a larger percentage of ceiling effects compared to the postal mode. A higher proportion of males than females chose not to participate in the postal mode. In Study II and III adolescents diagnosed with cancer completed the HADS and two sub-scales from the SF-36 (Mental Health and Vitality) 4-8 weeks, 6, 12, and 18 months after diagnosis. In Study II adolescents with cancer were compared to a reference group from the general population. Shortly after diagnosis the cancer group rated their psychosocial function as worse compared to the reference group. However, the differences gradually disappeared over time and were then reversed, resulting in the cancer group reporting better vitality and lower levels of anxiety and depression than the reference group eighteen months after diagnosis. In Study III five distinct psychosocial states were identified, characterised by: psychosocial dysfunction (state A), poor psychosocial function (state B), incomplete psychosocial function (state C), good psychosocial function (state D), and excellent psychosocial function (state E). Shortly after diagnosis more adolescents than expected by chance were found in states A and C and fewer were found in states D and E. Eighteen months after diagnosis a different pattern emerged, where more adolescents than expected were found in state E and fewer than expected in state C. In Study IV adolescents, two years after diagnosis, reported problems with physical impairment, intrusive thoughts, feelings of alienation, and problems catching up with school. However, a majority of the participants also reported positive consequences with regard to the cancer disease: a more positive view of life, good self-esteem, knowledge and experience with regard to disease and hospital care, good relations, broader perspectives, and material gains. Study V, a review of the literature, indicates that survivors of childhood/adolescent cancer do not differ from comparison groups with regard to relations to others and relation to self. However, some findings highlight that friendship and marital status are areas of concern, and parenthood and sexuality are areas of potential concern. In conclusion, mode of administration influences adolescents’ and young adults’ self-reported psychosocial function and is related to age. Psychosocial function increases with time from diagnosis for most adolescents diagnosed with cancer. However, some individuals remain in poor psychosocial states during the first eighteen months after diagnosis. Increased efforts should be taken to identify these individuals.
|
|
