Elana E. Evan

Psychosocial dimensions of cancer in adolescents and young adults.

Psychosocial research examining the impact of cancer on adolescents and young adults has focused mostly on domains relating to family, psychological/emotional impact and social effects. An overview of the evidence‐based literature available in each of these domains is presented to highlight the trends and provide a basis for clinical application. A review of the research literature was conducted to summarize what is known regarding the psychosocial dimensions of cancer in adolescents and young adults. Key elements critical to the psychosocial adaptation of the adolescents and young adults with cancer, as well as later effects of the cancer experience, are discussed in terms of clinical implications. A case example is utilized to demonstrate the application of what has been investigated empirically in regard to psychosocial dimensions of cancer in young adults and adolescents. Studies have identified various psychosocial challenges that adolescents and young adults experience when faced with cancer. Further research, incorporating the effects of treatment stage and developmental level of the patient on specific psychosocial dimensions of the cancer experience, is needed. Evidence‐based information regarding the influence and interaction of family, psychological and emotional state, and social status of adolescents and young adults with cancer can aid clinicians when developing psychosocial assessment and treatment approaches for these patients. Cancer 2006.

Sexual health and self-esteem in adolescents and young adults with cancer

A diagnosis of cancer compounds the complexities of adolescent development. Self‐esteem and sexual health have a significant impact on adolescent identity formation, especially those young patients coping with a diagnosis of cancer. Knowledge of sexual health, interpersonal relationships, and body image concerns are factors that have an impact on the development of self‐esteem during these transition periods into adulthood. A clinical perspective on these issues was utilized to highlight the nature of self‐esteem and sexuality in adolescents and young adults with cancer. Case examples and clinical recommendations from a workshop on self‐esteem and sexuality in adolescents and young adults with cancer are presented. Understanding the adolescents and young adults stage of identity formation, their social and developmental histories, and methods for increasing self‐esteem can give insight to healthcare professionals in fostering positive self‐esteem and sexual health in these young patients. Through the awareness of the specific factors affecting adolescents and young adults with cancer, oncology teams can assist in creating an atmosphere for the growth of positive self‐esteem and sexual health in their adolescent patients. Cancer 2006.

Understanding communication among health care professionals regarding death and dying in pediatrics

OBJECTIVE Effective communication regarding death and dying in pediatrics is a vital component of any quality palliative care service. The goal of the current study is to understand communication among health care professionals regarding death and dying in children. The three hypotheses tested were: (1) hospital staff (physicians of all disciplines, nurses, and psychosocial clinicians) that utilize consultation services are more comfortable communicating about death and dying than those who do not use such services, (2) different disciplines of health care providers demonstrate varying levels of comfort communicating about a range of areas pertaining to death and dying, and (3) health care staff that have had some type of formal training in death and dying are more comfortable communicating about these issues. METHODS A primary analysis of a survey conducted in a tertiary care teaching childrens hospital. RESULTS Health care professionals who felt comfortable discussing options for end of life care with colleagues also felt more comfortable: initiating a discussion regarding a childs impending death with his/her family (r = 0.42), discussing options for terminal care with a family (r = 0.58), discussing death with families from a variety of ethnic/cultural backgrounds (r = 0.51), guiding parents in developmentally age-appropriate discussions of death with their children (r = 0.43), identifying and seeking advice from a professional role model regarding management concerns (r = 0.40), or interacting with a family following the death of a child (r = 0.51). Among all three disciplines, physicians were more likely to initiate discussions with regards to a childs impending death (F = 13.07; p = 0.007). Health care professionals that received formal grief and bereavement training were more comfortable discussing death. Significance of the results: The results demonstrated that consultation practices are associated with a higher level of comfort in discussing death and dying in pediatrics.

Post-Traumatic Stress Symptoms in Pediatric Heart Transplant Recipients.

Traumatic experiences are not unusual in pediatric heart transplant (HT) recipients before and after transplantation. Post-traumatic stress symptoms (PTSS) present at the time of transplant evaluation and developing afterward occur with an unknown frequency. We sought to determine the burden of these symptoms in heart transplant patients. We reviewed 51 consecutive HTs between 2003-2007, including 40 primary transplants and 11 re-transplants. Symptoms were present in 17 of the 51 patients (34%) at the time of orthotopic heart transplantation evaluation. None met the criteria for full post traumatic stress disorder. Transplant complications were examined. Nineteen subjects of the total sample had rejection in the first year following transplant. Rejection rates in the first year was 41% for those with PTSS (7 of 17 patients) and 36% for those without (12 of 33 patients) (P=n.s). Of those patients presenting for a second heart transplant, 55% had PTSS at the time of transplant evaluation and/or the peritransplant period; whereas, (28%) undergoing a primary transplant had PTSS. In addition to symptoms resulting from the disease process leading to HT and other prior experiences, the HT itself seems to present a large psychiatric burden on patients. All patients need to be followed before and after HT for signs and symptoms related to PTSS. Future studies should be undertaken to determine if preventative detection and treatment of patients with these PTSS symptoms early can lead to better outcomes.

A Qualitative Approach to Understanding Quality of Life in Pediatric Palliative Care

Helping pediatric patients achieve an optimal quality of life despite their serious illness is a hallmark for providing excellent pediatric palliative care. There is controversy regarding how to define pediatric Quality of Life (QoL) and how to assess this construct in children. Currently, there is no pediatric QoL instrumentation that has been standardized on population children with advanced disease. This qualitative study sought to determine what is quality of life from the perspective of pediatric patients with advanced disease? Twenty-nine pediatric patients (child mean age 14.7 years, range 9-21 years) participated in the current study. Through analysis, we identified three domains of QoL (physical, psychological, social) and a lifestyle values category. These results are important first steps for providing direction to future studies aimed at modifying QoL instruments in order to better understand the pediatric patient’s illness experience and improve QoL when they are facing advanced disease.