Katri Eskola1,2, Eva Bergstraesser3, Karin Zimmermann1,3, Eva Cignacco1,4. 1. Institute of Nursing Science, University of Basel, Switzerland. 2. Clinical Nurse Specialist, Triemli Hospital, Zurich, Switzerland. 3. University Children's Hospital Zurich, Switzerland. 4. Health Division, University of Applied Sciences Bern, Switzerland.
Abstract
AIM: To understand parents' experiences and needs during a child's end-of-life care at home and to identify systemic factors that influence its provision. BACKGROUND: A child's end-of-life phase is an extremely difficult time for the whole family. Parents have specific needs, especially when they care for a dying child at home. DESIGN: Concurrent embedded mixed methods design. METHODS: This sub-study of the nationwide survey, 'Paediatric End-of-Life Care Needs in Switzerland' (2012-2015) included 47 children who received EOL care at home from 2011-2012. We extracted quantitative data from patients' medical charts and obtained information via parental questionnaire and then compared parents whose child died at home or in hospital by computing generalized estimation equations. We thematically analysed interviews with parents who provided EOL care at home. RESULTS: Parents created an intimate lifeworld and a sense of normality for the child at home. They constantly balanced the family's lifeworld with the requirements and challenges posed by the outside world. This work exhausted parents. Parental 'readiness' and social support drove EOL care for children at home. Parents needed practical help with housekeeping and had negative experiences when dealing with insurance. In only 34.8% of cases was a child's EOL home care supported by paediatric palliative care team. CONCLUSION: Paediatric end-of-life care at home is only feasible if parents make extraordinary efforts. If family-centred end-of-life home care is provided by a hospital-based paediatric palliative home care team, which includes paid housekeeping help and psychological support, parents' needs could be better met.
AIM: To understand parents' experiences and needs during a child's end-of-life care at home and to identify systemic factors that influence its provision. BACKGROUND: A child's end-of-life phase is an extremely difficult time for the whole family. Parents have specific needs, especially when they care for a dying child at home. DESIGN: Concurrent embedded mixed methods design. METHODS: This sub-study of the nationwide survey, 'Paediatric End-of-Life Care Needs in Switzerland' (2012-2015) included 47 children who received EOL care at home from 2011-2012. We extracted quantitative data from patients' medical charts and obtained information via parental questionnaire and then compared parents whose child died at home or in hospital by computing generalized estimation equations. We thematically analysed interviews with parents who provided EOL care at home. RESULTS: Parents created an intimate lifeworld and a sense of normality for the child at home. They constantly balanced the family's lifeworld with the requirements and challenges posed by the outside world. This work exhausted parents. Parental 'readiness' and social support drove EOL care for children at home. Parents needed practical help with housekeeping and had negative experiences when dealing with insurance. In only 34.8% of cases was a child's EOL home care supported by paediatric palliative care team. CONCLUSION: Paediatric end-of-life care at home is only feasible if parents make extraordinary efforts. If family-centred end-of-life home care is provided by a hospital-based paediatric palliative home care team, which includes paid housekeeping help and psychological support, parents' needs could be better met.
Authors: Jackelyn Y Boyden; Douglas L Hill; Karen W Carroll; Wynne E Morrison; Victoria A Miller; Chris Feudtner Journal: J Palliat Med Date: 2019-11-07 Impact factor: 2.947
Authors: Karin Zimmermann; Eva Cignacco; Sandra Engberg; Anne-Sylvie Ramelet; Nicolas von der Weid; Katri Eskola; Eva Bergstraesser; Marc Ansari; Christoph Aebi; Reta Baer; Maja Beck Popovic; Vera Bernet; Pierluigi Brazzola; Hans Ulrich Bucher; Regula Buder; Sandra Cagnazzo; Barbara Dinten; Anouk Dorsaz; Franz Elmer; Raquel Enriquez; Patricia Fahrni-Nater; Gabi Finkbeiner; Bernhard Frey; Urs Frey; Jeannette Greiner; Ralph-Ingo Hassink; Simone Keller; Oliver Kretschmar; Judith Kroell; Bernard Laubscher; Kurt Leibundgut; Reta Malaer; Andreas Meyer; Christoph Stuessi; Mathias Nelle; Thomas Neuhaus; Felix Niggli; Geneviève Perrenoud; Jean-Pierre Pfammatter; Barbara Plecko; Debora Rupf; Felix Sennhauser; Caroline Stade; Maja Steinlin; Lilian Stoffel; Karin Thomas; Christian Vonarburg; Rodo von Vigier; Bendicht Wagner; Judith Wieland; Birgit Wernz Journal: BMC Pediatr Date: 2018-02-16 Impact factor: 2.125