Staff Perceptions of Symptoms, Approaches to Assessment, and Challenges to Assessment Among Children With Cancer.

Nurses are often the first to recognize and respond to children's symptoms. This descriptive, exploratory study characterized how pediatric oncology health care providers characterize and assess children's cancer-related symptoms. The study also explored challenges associated with symptom assessment and information perceived as helpful in planning interventions. The setting was a Children's Oncology Group-affiliated hospital in the Intermountain West of the United States. Twenty-two pediatric oncology health care providers (95% female; 68% nurses) participated in one of four focus group sessions. Sessions were facilitated by two individuals and included six open-ended questions addressing participants' perspectives of cancer-related symptoms, approaches to symptom assessment, challenges and frustrations encountered when assessing symptoms, and information needed to plan interventions. Participants identified 75 physical and psychosocial responses that included both subjectively experienced symptoms and other consequences of the cancer experience. Qualitative content analysis procedures organized other responses into categories and subcategories. Participants most frequently reported using observational approaches including physical assessment findings and observation of the child's behavior to identify symptoms. Strategies that sought the child's input such as the use of a rating scale or seeking the child's verbal description were less frequently named. Participants related discerning and interpreting the child's behaviors as a challenge to symptom assessment. They also reported attention to symptom characteristics as important to planning interventions. Future directions include building capacity to support child-centric symptom assessment. Development of reliable and valid resources for use in clinical settings may support a more child-centric approach to symptom assessment.