Nursing interventions in palliative care in Pediatric Oncology: an integrative review

Sousa, Amanda Danielle Resende Silva e; Silva, Liliane Faria da; Paiva, Eny Dórea

doi:10.1590/0034-7167-2018-0121

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 72 (2) • Mar-Apr 2019 • https://doi.org/10.1590/0034-7167-2018-0121 copy

Nursing interventions in palliative care in Pediatric Oncology: an integrative review

Intervenciones de enfermería en los cuidados paliativos en Oncología Pediátrica: una revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to identify, in scientific productions, nursing interventions in palliative care in children and adolescents with cancer.

Method:

integrative review of the literature through the databases: CINAHL, MEDLINE, IBECS, LILACS and SCIELO, carried out in October and November 2017.

Results:

we analyzed 18 articles that met the inclusion criteria. The results showed that, among the articles selected, Brazil is the country with the largest number of publications and that interventions such as music therapy, massage, ludic application, early consultation of palliative care, social interventions and physical exercises aimed at the resolution of a specific symptom obtained better results when compared to interventions that aimed at the comprehensiveness of palliative care.

Final Consideration:

we conclude that greater emphasis should be given to palliative care in academic and professional training and that further studies in search of the best evidence should be conducted to support nursing Evidence-Based Practices.

Descriptors:
Palliative Care; Nursing Diagnosis; Child; Adolescent; Neoplasms

PICO	DESC	MESH	CINAHL Titles
P	Criança OR adolescente OR neoplasias	Child OR adolescent OR neoplasms	Child OR adolescent
P	AND	AND	AND
I	Cuidados paliativos OR diagnóstico de enfermagem	Palliative care OR nursing diagnoses OR oncoly nursing OR Pediatric nursing OR nursing assessment OR Hospice and Palliative Care Nursing	Palliative care OR oncology nursing OR nursing diagnoses
I	AND	AND	AND
C
O	Qualidade de vida	Quality of life	Quality of life

Databases	Articles Found	Articles Excluded	Articles Selected	Articles Repeated	Total of Articles Analized
LILACS	17	11	6	0	6
IBECS	1	1	0	0	0
SCIELO	4	1	3	3	0
CINAHL	29	26	3	1	3
PUBMED	68	59	9	3	9
TOTAL	119	98	21	7	18

Nº	Title	Authors and Year of publishing	Level of Evidence	Outlining and number of patients/setting	Intervention Studied	Outcome
1⁽¹⁴14 Pearson HN. “You’ve Only Got One Chance to Get it Right”: Children’s câncer Nurses’ Experiences of Provinding Palliative Care in the Acute Hospital Setting. Issues Comprehensive Pediatr Nurs [Internet]. 2013[cited 2018 Feb 18];36(3):188-211. Available from: https://www.tandfonline.com/doi/full/10.3109/01460862.2013.797520?scroll=top&needAccess=true https://www.tandfonline.com/doi/full/10.... ⁾	"You've only got one chance to get it right": Children's cancer nurses' experiences of providing palliative care in the acute hospital setting	Helen Nina Pearson 2013	Level 6	Qualitative study (N=7) Hospital	Management of symptons and family.	The poor training of nurses in palliative care leaves them without theoretical subsidies to perform palliative care in practice.
2⁽¹⁵15 Monteiro ACM, Rodrigues BMRD, Pacheco STA, Pimenta LS. Nurses’ work with children with cancer: palliative care. Rev Enferm UERJ [Internet]. 2014[cited 2018 Feb 17];22(6):778-83. Available from: http://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/15665/13478 http://www.e-publicacoes.uerj.br/index.p... ⁾	A atuação do enfermeiro junto à criança com câncer: cuidados paliativos	Ana Claudia Moreira Monteiro, Benedita Maria Rêgo Deusdará Rodrigues, Sandra Teixeira de Araújo Pacheco and Luana Sena Pimenta 2014	Level 6	Descriptive study qualitative (N=14) Hospital	To provide comfort, meet the child's needs (physical, psychological and social), quality of life (play), give spiritual, emotional and religious support, care for the family.	Palliative Care of nurses is based on the promotion of comfort and well-being, through sensitive listening, emotional support for the child and the family.
3⁽¹⁶16 Batalha LMC, Mota AASC. Massage in children with cancer: effectiveness of a protocol. J Pediatr [Internet]. 2013[cited 2018 Feb 17];89(6):595−600. Available from: http://www.scielo.br/pdf/jped/v89n6/en_v89n6a13.pdf http://www.scielo.br/pdf/jped/v89n6/en_v... ⁾	A massagem na criança com câncer: eficácia de um protocolo	Luís Manuel da Cunha Batalhaa, and Aida A.S.C. Mota 2013	Level 2	Controlled randomized study (N=52) Hospital	Pain-relief massage.	Pain relief after each massage session and decrease of pain interference when walking after 7 days of intercalated massage.
4⁽¹⁷17 Mutti CF, Padoin SMM, Paula CC, Souza IEO, Terra MG, Quintana AM. Cuidado de enfermagem à criança que tem doença oncológica avançada: ser-com no cotidiano assistencial. Ciênc Cuid Saúde [Internet]. 2012[cited 2018 fev 17]; 11(1):113-20. Available from: http://ojs.uem.br/ojs/index.php/CiencCuidSaude/article/download/18867/pdf http://ojs.uem.br/ojs/index.php/CiencCui... ⁾	Cuidados de enfermagem à criança que tem doença oncológica avançada: Ser-com no cotidiano assistencial	Cintia Flores Mutti, Stela Maris de Mello Padoin, Cristiane Cardoso de Paula, Ivis Emília de Oliveira Souza, Marlene Gomes Terra, Alberto Manuel Quintana 2012	Level 6	Qualitative study (N=15) Hospital	Comprehensive care for the child and the family.	Pediatric Oncology care transcends ethical issues and routines, being fundamental the nursing team the development of competencies to meet the singularities of the child and his family.
5⁽¹⁸18 Çelebioĝlu A, Gürol A, Yildirim ZK, Büyükavci M. Effects of massage therapy on pain and anxiety arising from intrathecal therapy or bone marrow aspiration in children with cancer. Int J Nurs Practice [Internet]. 2014[cited 2018 Feb 17];23(6):708-12. Available from: http://onlinelibrary.wiley.com/doi/10.1111/ijn.12298/abstract http://onlinelibrary.wiley.com/doi/10.11... ⁾	Effects of massage therapy on pain and anxiety arising from intrathecal therapy or bone marrow aspiration in children with cancer	Ayda Çelebiog˘lu, Ays¸ and Gürol, Zuhal Keskin Yildirim, Mustafa Büyükavci 2014	Level 4	Control-case study (N=25) Hospital	Massage to control acute procedural pain and anxiety in children with cancer, submitted to intrathecal therapy or bone marrow aspiration.	The study provided preliminary evidence of the effectiveness of massage in relieving pain in children with cancer undergoing intrathecal therapy or bone marrow aspiration.
6⁽¹⁹19 Yu L, Mo L, Tang Y, Huang X, Tan J. Effects of nursing intervention models on social adaption capability development in preschool children with malignant tumors: a randomized control trial. Psycho-Oncology [Internet]. 2014[cited 2018 Feb 20];23(6):708-12. Available from: http://onlinelibrary.wiley.com/doi/10.1002/pon.3572/abstract http://onlinelibrary.wiley.com/doi/10.10... ⁾	Effects of nursing intervention models on social adaption capability development in preschool children with malignant tumors: a randomized control trial	Lu Yu1, Lin Mo, Yan Tang, Xiaoyan Huang1 and Juan Tan1 2014	Level 2	Controlled randomized study (N=120) Hospital	Group interventions, family-centered model of nursing care (to improve social adaptation in children with cancer).	Family-centered care, with physical, psychological and social interventions, based on children and parents increased the children's social adaptation capacity.
7⁽²⁰20 Tsai YL, Huang KL, Wong TT, Chiang IT. Efficacy of therapeutic play for pediatric brain tumor patients during external beam radiotherapy. Childs Nerv Syst [Internet]. 2013[cited 2018 Feb 17];29(7):1123-29. Available from: https://link.springer.com/article/10.1007/s00381-013-2099-3 https://link.springer.com/article/10.100... ⁾ Efficacy of therapeutic play for pediatric brain tumor patients during external beam radiotherapy Yu-Li Tsai, Shiow-Chwen Tsai, Sang-Hue Yen, Kai-Lin Huang, Pei-Fan Um, Hueh-Chun Liou, Tai-Tong Wong, I-Chun Lai, Pin Liu, Hsiao-Ling Lou, I-Tsun Chiang, Yi-Wei Chen 2013 Level 3 Controlled clinical study without randomization (N=9) Hospital Therapeutic game to reduce anxiety in children and adolescents with brain tumors before radiotherapy.						The use of the therapeutic game has brought many benefits such as: reduction of anxiety, increased cooperation of the child with the team, reduction of the use of sedation during radiotherapy, reduction of children's fear of radiotherapy.
8⁽²¹21 Lafond DA, Patterson PK, Hinds OS, Sill A, Michael M. Establishing Feasibility of Early Palliative Care Consultation in Pediatric Hematopoietic Stem Cell Transplantation. J Pediatric Oncol Nurs [Internet]. 2015 [cited 2018 Feb 17];32(5):265-77. Available from: http://journals.sagepub.com/doi/abs/10.1177/1043454214563411 http://journals.sagepub.com/doi/abs/10.1... ⁾	Establishing Feasibility of Early Palliative Care Consultation in Pediatric Hematopoietic Stem Cell Transplantation	Deborah A. Lafond, Katherine Patterson Kelly, Pamela S. Hinds, Ann Sill, and Michele Michael 2015	Level 4	Longitudinal cohort study (N=12) Hospital	Early consultation of palliative care.	The study demonstrated the feasibility of early integration of palliative care consultations to children with cancer, thus favoring the family acceptance of interventions in palliative care.
9⁽²²22 Montgomery K, Sawin KJ, Hendricks-Ferguson VL. Experiences of pediatric oncology patients and their parents at end of life: a systematic review. J Pediatric Oncol Nurs [Internet]. 2015[cited 2018 Feb 18];33(2):85-104. Available from: http://journals.sagepub.com/doi/abs/10.1177/1043454215589715?journalCode=jpob http://journals.sagepub.com/doi/abs/10.1... ⁾	Experiences of Pediatric Oncology Patients and Their Parents at End of Life: A Systematic Review	Kathleen Montgomery, Kathleen J. Sawin and Verna L. Hendricks- Ferguson 2015	Level 1	Systematic review (N=43 articles analyzed)	Management of symptoms in palliative care.	Nurses have the opportunity to assess and address the needs of children and their parents throughout the palliative care process, whether in the physiological, emotional or psychosocial aspects.
10⁽²³23 Citak EA, Toruner EK, Gunes NB. Exploring Communication Difficulties in Pediatric Hematology: Oncology Nurses. Asian Pacific J Cancer Prevention [Internet]. 2013 [cited 2018 Feb 18];14(9):5477-82. Available from: http://www.koreascience.or.kr/article/ArticleFullRecord.jsp?cn=POCPA9_2013_v14n9_5477 http://www.koreascience.or.kr/article/Ar... ⁾	Exploring Communication Difficulties in Pediatric Hematology: Oncology Nurses	Ebru Akgun Citak, Ebru Kilicarslan Toruner and Nebahat Bora Gunes 2013	Level 6	Qualitative descriptive study (N=8) Hospital	Communication with children and families.	The results showed that there are difficulties in communication between nurses and children with cancer and their relatives and that these difficulties increase in times of crisis such as in relapses.
11⁽²⁴24 Long EAT. Health-related quality of life and its association with self-esteem and fatigue among children diagnosed with cancer. J Clin Nurs [Internet]. 2016[cited 2018 Feb 20];25(21-21):3391-9. Available from: http://onlinelibrary.wiley.com/doi/10.1111/jocn.13467/abstract http://onlinelibrary.wiley.com/doi/10.11... ⁾	Health-related quality of life and its association with self-esteem and fatigue among children diagnosed with cancer	Ekhlas Al-Gamal and Tony Long 2016	Level 6	Comparative descriptive study (N=70) Hospital ambulatory	Pharmacological and non-pharmacological strategies in the control of fatigue.	To minimize the damages caused by fatigue, strategies should be created to encourage the practice of physical exercises, socialization with children of the same age and permanence in school.
12⁽²⁵25 França JRFS, Costa SFG, Lopes MEL, Nóbrega MML, França ISX. The importance of communication in pediatric oncology palliative care: focus on Humanistic Nursing Theory. Rev Lati-Am Enfermagem [Internet]. 2013[cited 2018 Feb 18];21(3):780-6. Available from: http://www.scielo.br/pdf/rlae/v21n3/0104-1169-rlae-21-03-0780.pdf http://www.scielo.br/pdf/rlae/v21n3/0104... ⁾	Importância da comunicação nos cuidados paliativos em oncologia pediátrica: enfoque na Teoria Humanística de Enfermagem	Jael Rúbia Figueiredo de Sá França, Solange Fátima Geraldo da Costa, Maria Emilia Limeira Lopes, Maria Miriam Lima da Nóbrega and Inacia Sátiro Xavier de França. 2013	Level 6	Qualitative study (N=10) Hospital	Communication as a humanization strategy in palliative care.	Communication is the axis for care in Nursing. It is configured as an effective element in palliative care with the child and promotes holistic care.
13⁽²⁶26 Monteiro ACM, Pacheco STA, Rodrigues BMRD. O Enfermeiro e o cuidado da criança com câncer sem possibilidade de cura atual. Esc Anna Nery [Internet]. 2012[cited 2018 Feb 18];16(4):741-6. Available from: http://www.scielo.br/pdf/ean/v16n4/14.pdf http://www.scielo.br/pdf/ean/v16n4/14.pd... ⁾	O enfermeiro e o cuidar da criança com câncer sem possibilidade de cura atual	Ana Claudia Moreira Monteiro, Benedita Maria Rêgo Deusdará Rodrigues and Sandra Teixeira de Araújo Pacheco 2012	Level 6	Qualitative study (N=12) Hospital	Care centered on comfort and pain control.	Comfort is the way of caring for the nurse in palliative care, focused on protection, solicitude and listening, acting on the relief of symptoms and suffering, directing care to the family as well.
14⁽²⁷27 Soares VA, Silva LF, Cursino EG, Goes FGB. The use of playing by the nursing staff on palliative care for children with cancer. Rev Gaúcha de Enferm [Internet]. 2014[cited 2018 Feb 2018];35(3):111-6. Available from: http://www.scielo.br/pdf/rgenf/v3 fev 18]5n3/1983-1447-rgenf-35-03-00111.pdf http://www.scielo.br/pdf/rgenf/v3 fev 18... ⁾	O uso do brincar pela equipe de enfermagem no cuidado paliativo de crianças com câncer	Vanessa Albuquerque Soares, Liliane Faria da Silva, Emília Gallindo Cursino and Fernanda Garcia Bezerra Goes 2014	Level 6	Qualitative descriptive study (N=11) Hospital	Use of the toy in palliative care.	Playing in palliative care facilitates communication, interaction and relieves the child's tense in traumatic and painful procedures.
15⁽²⁸28 Docherty S, Robb S, Salimi CP, Cherven B, Stegenga K, Hendricks-Ferguson V, Roll L, Stickler MD, Haase J. Parental perspectives on a behavioral health music intervention for adolescent/young adult resilience during cancer treatment: report from the children’s oncology group. J Adol Health [Internet]. 2013[cited 2018 Feb 19];52(2):170-8. Available from: http://www.jahonline.org/article/S1054-139X(12)00211-X/fulltext http://www.jahonline.org/article/S1054-1... ⁾	Parental Perspectives on a Behavioral Health Music Intervention for Adolescent/Young Adult Resilience During Cancer Treatment: Report From the Children's Oncology Group	Sharron L. Docherty, Sheri L. Robb, Celeste Phillips-Salimi, Brooke Cherven, Kristin Stegenga, Verna Hendricks-Ferguson, Lona Roll, Molly Donovan Stickler and Joan Haase 2013	Level 6	Qualitative descriptive study (N=16) Hospital	Music therapy in palliative care.	The parents evaluated that the music therapy in their children was useful and significant, increasing the resilience in relation to the coexistence with the disease.
16⁽²⁹29 Reis TLR, Paula CC, Potrich T, Padoin SMM, Bin A, Mutti CF, Bubadué RM. Relações estabelecidas pelos proﬁssionais de enfermagem no cuidado às crianças com doença oncológica avançada. Aquichan [Internet]. 2014[cited 2018 Feb 18];14(4):496-508. Available from: http://www.scielo.org.co/pdf/aqui/v14n4/v14n4a05.pdf http://www.scielo.org.co/pdf/aqui/v14n4/... ⁾	Relações estabelecidas pelos profissionais de enfermagem no cuidado às crianças com doença oncológica avançada	Thamiza L. da Rosa dos Reis, Cristiane Cardoso de Paula, Tassiana Potrich, Stela Maris de Mello Padoin, Aline Bin, Cintia Flores Mutti and Renata de Moura Bubadué 2014	Level 6	Qualitative descriptive study (N=15) Hospital	Nursing team relationships in the care of children with advanced cancer disease.	The research points out the need for Permanent Education to professionals, as well as support for everyday care situations, in order to minimize negative feelings and enable humanized care, promoting quality of life.
17⁽³⁰30 Li HCW, Williams PD, Lopez V, Chung JOK, Chiu SY. Relationships among therapy-related symptoms, depressive symptoms, and quality of life in chinese children hospitalized with cancer. Cancer Nurs [Internet]. 2013[cited 2018 Feb 21];36(5):346-54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23059766 https://www.ncbi.nlm.nih.gov/pubmed/2305... ⁾	Relationships Among Therapy-Related Symptoms, Depressive Symptoms, and Quality of Life in Chinese Children Hospitalized With Cancer	Ho Cheung William, Phoebe D. Williams, FAAN Violeta Lopez, Joyce Oi Kwan Chung and Sau Ying Chiu 2013	Level 3	Cross-sectional study (N=135) Hospital	Intervention to promote psychosocial well-being.	To minimize the damages caused by fatigue, strategies should be created to encourage the practice of physical exercises, socialization with children of the same age and permanence in school.
18⁽³¹31 Chang CW, Mu PF, Jou ST, Wong TT, Chen YC. Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Fatigue in Children and Adolescents with Cancer. Worldviews Evidence-Based Nurs [Internet]. 2013[cited 2018 Feb 18];10(4):208-17. http://onlinelibrary.wiley.com/doi/10.1111/wvn.12007/abstract http://onlinelibrary.wiley.com/doi/10.11... ⁾	Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Fatigue in Children and Adolescents With Cancer	Chi-Wen Chang, Pei-Fan Mu, Shiann-Tarng Jou, Tai-Tong Wong and Yu- Chih Chen 2013	Level 1	Systematic review with meta-analysis(N=6 articles analyzed)	Non-pharmacological interventions in the control of fatigue in children and adolescents with cancer.	Of the six studies, one was for massage and one for health education, and it was not possible to perform meta-analysis. The practice of physical exercises was efficient in improving fatigue in four analyzed articles.

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[1] Corresponding Author: Amanda Danielle Resende Silva e Sousa E-mail: amanda.eliel@hotmail.com