Journal of Pediatric Oncology Nursing

Journal of Pediatric Hematology/Oncology Nursing, Ahead of Print. <br/>Background: When a potential stem cell donor to a seriously ill child is a healthy sibling below 18 years, Swedish parents have the legal right and obligation to decide on behalf of the donor child. However, there are potentially conflicting loyalties when parents have one severely ill child in need for a cure and one healthy child who will be subjected to medical procedures. This study explored parents’ experiences related to their decision on stem cell donation, as well as ethical considerations in the donation process where outcomes are uncertain. Method: Individual interviews were performed with 18 parents of 13 minor donors after successful hematopoietic stem cell transplantations. Interviews were analyzed using inductive Reflexive Thematic Analysis. Results: The parents were living with the threat of losing a child, and in this context, the main theme No conflicting loyalties was found and included four subthemes; Focus on the ill child, Sibling as the preferred donor, Obvious that the healthy child should donate, and Keep on keeping on. Conclusion: When a healthy child is a potential donor to an ill sibling, their parents’ main focus is on the cure for the ill child. The lack of obvious conflicting loyalties among parents highlights the need to secure an ethical process for healthy minor donors and the importance of a separate donor advocate for these minor donors.

Journal of Pediatric Hematology/Oncology Nursing, Volume 41, Issue 4, Page 240-251, July/August 2024. <br/>Background: The end of treatment (EOT) is a significant time point along the childhood cancer treatment–survivorship continuum, and is recognized as a time when childhood cancer survivors (CCS) and their families experience significant vulnerability and stress. There is a call by families and healthcare professionals alike for standardized, comprehensive EOT services to successfully navigate through this transition period and better cope with posttreatment medical, physical, and social-emotional issues. Method: A multidisciplinary team of pediatric oncology health care professionals developed and implemented a two-session psychoeducational program to address these EOT needs. To evaluate the Shooting for the STARS (Survivors Tackling All Roadblocks Successfully) EOT Transition Program, a pretest–posttest repeated measures design was utilized. A convenience sample of 47 parents/caregivers and 29 CCS completed surveys before, during, and after the EOT services were received. Analysis of relationships and changes over time was conducted using Spearman-ranked correlations and Friedman tests, a nonparametric repeated measures analysis of variance. Results: All respondents reported program satisfaction, with 94.7% feeling somewhat or very prepared for ending treatment. Participants’ distress levels tended to decrease over time. Parent/caregiver-reported levels of CCS’ anxiety, fatigue, pain interference, and physical mobility significantly improved over the time period during which families participated in the Shooting for the STARS Program. Discussion: This nurse-led, evidence-based program was determined to be feasible and acceptable. It may contribute to improved health-related quality of life and decrease distress over time.

Journal of Pediatric Hematology/Oncology Nursing, Volume 41, Issue 4, Page 252-264, July/August 2024. <br/>Background: Animal-assisted intervention (AAI) involving live visits with canines shows strong promise to improve quality of life (QOL) in hospitalized youth with cancer or blood disorders. The emerging field of virtual AAI allows access to AAI regardless of setting and extends to children at home. Youth and Pet Survivors™ (YAPS) is a novel form of virtual AAI with dog and cat pen pals who share a diagnosis of cancer or serious illness. Little is known about how exchanging letters with animals with a shared diagnosis influences perceived QOL, and how the human–animal bond (HAB) is expressed in letter narratives. Method: A thematic narrative analysis approach was used to analyze a secondary dataset consisting of letters and interviews from children in YAPS. The research team designed a conceptual framework to guide the analysis, integrating concepts of perceived QOL, the HAB, and emotional social support. Results: Collectively, the letter and interview texts illustrated cocreated stories of the HAB. Themes included the virtual HAB as a mirror, constructing identity in the context of the HAB, expressions of the mutuality of the HAB, happiness with having a pen pal, illness story, and connection to normalcy. Answers to research questions operationalize the influence of virtual AAI. Discussion: Having an animal pen pal improved perceived QOL and was a potent source of emotional social support across the illness trajectory, supporting YAPS as a nurse-led intervention for facilitating adjustment to illness. This study adds a conceptual framework and scientific evidence to the emerging field of virtual AAI.

Journal of Pediatric Hematology/Oncology Nursing, Ahead of Print. <br/>Background: Despite American Society of Clinical Oncology and Children's Oncology Group recommendations, the rate of sperm-banking for newly diagnosed adolescent and young adult males with cancer remains between 18% and 35%. The purpose of this study was to examine recent literature regarding decision-making and fertility preservation prior to the initiation of therapy for adolescents and young adults diagnosed with cancer. Method: A search of multiple online databases was undertaken for peer-reviewed studies between the years of 2010 and 2022. The databases CINAHL, PubMed, PsycInfo, Scopus, Google Scholar, and forward citation search was employed using the same Boolean search phrases in each database. Some 402 articles were then screened for relevance by title, abstract, and full review based on inclusion/exclusion criteria for synthesis. Results: Ten articles met criteria to be included in this review. Three themes were identified as impacting the decision to cryopreserve sperm prior to the initiation of therapy. Provider recommendation, parent recommendation, and referral for fertility specialist consult emerged as statistically significant factors in the decision to attempt sperm banking. Discussion: While the most significant factor impacting the decision to preserve fertility, parents reported they were more likely to recommend this to their child if they received clear recommendations from the medical team. Pediatric oncology physicians and nurses are in a unique position to positively impact quality of life and psychosocial outcomes in survivors of pediatric cancer by providing up-to-date evidence-based information, risk assessment, recommendations, and/or referral to fertility preservation specialists to families and patients.

Journal of Pediatric Hematology/Oncology Nursing, Ahead of Print. <br/>Background: Legacy building is a priority for pediatric oncology. Storytelling is one strategy to help children document their legacies. Understanding story content would advance knowledge of how children want to be remembered but this has yet to be explored. This study explored content of digital stories created by children with advanced cancer. Method: Facebook advertisements were used to recruit families of children (7–17) with relapsed/refractory cancer to participate in a randomized controlled trial testing a legacy intervention through storytelling. Parent–child dyads (N = 150) were randomly assigned to an intervention or usual care group. A web program guided children to answer legacy questions and upload photographs, movies, and music. Families received the final digital stories. Experienced qualitative coders developed a hierarchical coding system to identify major categories/subcategories within 78 stories. Results: Stories included 1,516 unique story entries, including text, photographs, and movies. Two major categories emerged from the data: (a) story entry medium and (b) story content. Photographs frequently reflected people, objects, pets, and places while text often described personal preferences, goals, dreams, and other people. The story content overall included references to (a) people, (b) setting/location, (c) cancer, (d) objects/activities, and (e) expression of emotions/beliefs. Exemplar quotes, counts, and frequencies for each category are reported. Discussion: Children documented their legacies through stories that emphasized the value of family relationships and children's desires to be known for personal traits/preferences. Children chose to include cancer in their stories, indicating that cancer is a part of how children perceive their legacies. Registration Number: ClinicalTrials.gov NCT04059393.