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Healthcare Assignment: Issues Faced By Mothers In Paediatric Cancer

Question

Task:
Conduct a research and prepare a well-structured healthcare assignment critically discussing about the issue faced by the mothers in paediatric cancer.

Answer

Identify PICO
The research on healthcare assignment focuses on the problem faced by the mothers in paediatric cancer and strategies to cope up to improve their physical and mental health. It discusses the stressful condition faced by the mothers when their child is diagnosed with cancer.

This research is based on the therapies, relaxation sessions, and counselling sessions that can be provided to the mothers in oncology wards to reduce their psychological distress and help them adapt and accept the new situation (Halliday, et.al., 2017).

The study involves the comparison between working women and non-working women involving other aspects like social support, family support, family-friendly work like, and other beliefs.

The research outcome shows that several mothers in paediatric cancer seek social support, family support. On contrary, a few mothers believe religious activities will give them the strength to withstand the situation and provide their child with a better situation (Nikseresht, et.al., 2016).

Inclusion and exclusion criteria
The inclusion and exclusion criteria for the study of coping strategies to improve physical and mental health for mothers in paediatric cancer are discussed below. The inclusion criteria involve clinical features, demographic features and the exclusion criteria involve co-morbidity that might impact the study or its results (Patino, and Ferreira, 2018). The inclusion criteria here are mothers of age ? 50 years (demographic aspect), relaxation sessions or psychotherapies to the mothers in paediatric cancer (clinical aspect); exclusion criteria in the study is mothers suffering from other diseases or any other factor that might limit the participants of the mothers in the study).

The inclusion and exclusion criteria help to make a clear judgement and identify the impact of these factors on the results (Demaerschalk, et.al., 2016).

Search Strategy
The foundation of your search strategy is the inclusion criteria and the well-defined review questions. Before starting the research, the first step is to understand the objective, review the question and the information needed to be conveyed through it. For instance, sought the type of data required for your study, studies that report the data or the limitations of the study, and restrictions applied during the research to shorten the time required to perform the search. In this study, the type of study is qualitative, it uses the ethnographic study to report the data, a restriction applied to shorten the period of search and applying custom search range for a publication date (Eriksen, and Frandsen, 2018). Applying this basic search strategy will also improve the quality of results and ensure that the data recoup is both valid and relevant. Once the review question is finalized you will create a grid map to determine the effectiveness of your interest. The study is aligned with each component of PICO where P stands for problem or the population we are speaking about, I stands for interest or intervention of the study, C stands for context or comparison of the study, and O stands for the outcome of the study (Dupont, et.al., 2016). Consider an instance of our study, coping strategies to improve physical and mental health for mothers in paediatric cancer. Within this title the four components of PICO are present. Mothers in paediatric cancer (population), coping strategies (interventions), physical and mental health improvisation (context), psychotherapies, exercises, counselling sessions (outcome).

Text words or keywords: The first step of any search strategy is to align similar words in a logic grid (Bramer, et.al., 2018). Often in literature, we come across keywords that are used as a part of your concept in the study. Start your study with a simple search of words such as paediatric cancer, mothers in childhood cancer, physical and mental health of mothers in paediatric cancer, and psychotherapies. The keywords can be easily identified by going through the titles or abstracts of the fetched papers. The free text words can also be obtained from your research question (Bramer, et.al., 2018). For example, is the word mothers are paediatric cancer is used synonymously with the term mothers in childhood cancer? Also, going through the literature review will help you further in finding new keywords.

Another point while doing a general search for as many relevant keywords as possible. This is because different authors use different terms to cite the same concept. Including more key terms or synonymous words while searching will improve your data and help you get through more relevant topics (such as psychological distress instead of mental health).

Subject heading or index terms are strategies that must be included in your comprehensive search. Index terms refer to the bibliographic databases that describe the content of published articles. The index terms can be scratched from the review question (Booth, 2016). You can search in databases (such as EMBASE, Medline) to know whether the index term identified by you is related to your context or not. For example, searching the word psychotherapy in the Medline database will show similar words like depression, anxiety, or anxiety management. It is suggested to search simple words before searching for index terms. Controlled vocabulary will help you to recoup relevant articles (Booth, 2016). After the search, several citations will be opened you can search any article relevant to the topic by clicking on the title.

Irrespective of the searching platform, the process of search strategy will be the same. The controlled vocabulary will help you go through the databases and to do so there must be sound knowledge about the index terms. It is suggested that while developing the search strategy it is necessary to go through the search results to continue to get relevant and valid results.

The last step of the search strategy is reporting results. It means that any researcher should be able to retrieve the same data and get to the same conclusions. In similar terms, it means the systematic review is reproducible. Once the search is complete, you can go through each article based on your inclusion and exclusion criteria.

Information Sources
Information sources are referred to the places or sections or databases that can be referred to complete the systematic review. The utmost prioritized source of information is electronic bibliographic databases. These databases help to retrieve relevant documents based on authentic reviews. Peer nomination and reference scanning list are the other two identified ways of sources of information. Medline is the most common database used for identifying any piece of information. More than 70% of the data is retrieved from an electronic bibliographic database (Aagaard, et.al., 2016).

The suggested databases to be used for sources of information are Embase, Medline, Joanna Briggs Institute, Web of Science, Scopus, Cochrane Library, PsycINFO, and CINAHL. Hand searches and conference literature are optional. The Cochrane Library consists of a large database for health and medical sciences. Medline covers the highest database in all aspects whereas Embase covers one-third of the relevant topics. The data is Embase is 85% similar to that in Medline. There is no controlled vocabulary in the Web of Science database and also does not cover all scientific journals. PsycINFO database can be used to search about psychotherapies as it contains data for behavioural and cognitive therapies. Hand searches in Google scholar is an extra source of information but it can be time-consuming (Mamikutty, et.al., 2021). The scope of data retrieved or evidence collected for your title can be broadened by using grey works of literature but the uncontrolled vocabulary is something to be kept in mind (Paez, 2017). Out of these many databases, only five should be referred to in writing your research review.

The data can be retrieved from unpublished literature, published literature, or journals. It is thus multidisciplinary in nature. Shreds of evidence from library information, electronic bibliographic databases, hand searches, and grey works of literature can provide a piece of extensive knowledge about the topic and can help you in getting valid and relevant data for your systematic review (Paez, 2017).

Assessment of methodological quality and provide rational for the selected tool
Several papers mention methodological quality and reporting quality. This is done to evaluate the methodology, characteristics, and quantity over some time. Some reports evaluate the methodological quality, a few evaluate the reporting quality and the remaining use both for evaluation. This evaluation is done using the tool JBI.

Research suggests that tools used to measure the methodological quality and reporting quality in a systematic review varies. A study suggested that the most acceptable method of quality evaluation of systematic review is JBI (Zeng, et.al., 2015).Another study listed nine methods of evaluating the quality of the systematic review. New tools and guidelines help in improving the quality of methodologies and reporting. Several institutes have their standards for maintaining or assessing the quality of their methodologies. To get quality results of systematic review interventions some suggests using CASP. There is always confusion about the tools to be used to assess the quality of the method and the quality of the report due to the availability of a plethora of tools. There is a possible constraint to this systematic review. The assessment of methodological quality whether at trial or systematic review is unforeseen upon the reporting quality (Munn, et.al., 2020).

The JBI tool is used to assess the methodological quality of the proposed systematic review. The result obtained is reviewed and analysed as per the criteria of the JBI tool. The JBI tool addresses the importance of comprehensive and transparent review. It also addresses the designs of the case series, the risk involved and the bias risk associated with the case (Munn, et.al., 2020). The JBI tool usually includes a series of questions considering the factors discussed above.

The JBI tool is one of the critical appraisal tools used for the systematic review and is approved to assess the quality of methodologies. The JBI tool of case series comprehends the basic 10 questions, a negative reply to any of the question impact the overall quality of the case series (Zeng, et.al., 2015).

The JBI tool for assessing the case series is discussed below.

QUESTION

YES

NO

UNCLEAR

NOT APPLICABLE

Were the case series includes clear inclusion criteria?

 

 

 

 

Did the case series using the reliable and standard method for all the participants?

 

 

 

 

Did the case series use valid methods for assessing the participant’s condition?

 

 

 

 

Was there was a subsequent inclusion of participants?

 

 

 

 

Did the case series had the complete inclusion of the participants?

 

 

 

 

Did the case study clearly mention the demographics of the participants involved?

 

 

 

 

Did the case study has a clear reporting of participant’s clinical information?

 

 

 

 

Was there was a clear reporting of outcomes or the results?

 

 

 

 

Was there clear demographic information about the site or the centre?

 

 

 

 

Was the statistical analysis of the study was suitable?

 

 

 

 


The review focuses on the mothers in paediatric cancer. The qualitative aspect of the study will focus on the strategies that can be implemented to reduce the stress of mothers whose children are diagnosed with cancer. The quantitative aspect of the review will focus on the professional information passed from the healthcare practitioners to the mothers during the sessions and its impact on post-traumatic growth (Nakayama, et.al., 2017). The review will incorporate the role of psychotherapies in mothers in paediatric cancer residing in both developed and developing countries. The major focus is on the mothers and the strategies that can help them to deal with the situation and improvise their physical and mental health. These are the inclusion criteria of the study developed from the PICO. The quality of the paper is only relevant or valid when it is following the inclusion criteria. The papers are only useful when the data generated from them are valid, relevant, and is linked to other sources of information. The scales used to evaluate the quality of RCT is generally higher and is diverse in nature. To evaluate the methodological quality and reporting quality of RCT focuses on both the quality of trials as well as the tools.

Data extraction
Data is a piece of information obtained from a study. For this review, the data collected includes participants, context, comparison, interventions, results and outcomes. Reviewers should plan a proper strategy before retrieving any data for their study. There must be proper planning or protocol in advance that must be followed before collecting the data (Schmidt, et.al., 2020). There must be proper involvement of other practitioners or oncologists while collecting the data this will help the reviewer to align the pieces of evidence properly.

The review focuses on the data collected using qualitative analysis. The population of the review is the mothers in paediatric cancer. The methodology obtained from several studies is based on the cohort study that shows the impact of various factors on mothers in paediatric cancer. As seen in the review, it shares about the family and social support. The review also shares the percentage of women that believe in religious beliefs to cope up with the situation. Several interventions like psychological sessions, therapies, counselling and exercises are discussed in the systematic review. There is a comparison between the lifestyle and adaptation ways of working and non-working women. The review also shares a difference in opinion about religious and non-religious beliefs of mothers and their role in improving the quality of life. Data is also collected about the distancing of women from the social environment to deal with the situation as socialising may act as a stressor and can cause distress. The professional information is another intervention raised in the study and how such intervention is capable of satisfying mothers are also discussed.

Qualitative data is collected from the pieces of evidence using the standardized JBI tool. The qualitative data is collected from all the papers present in the review. The shreds of evidence for quantitative data are standardized using another JBI instrument.

The data retrieved is composed of research objectives, review questions, significant outcome, study methods or context, populations, and all the interventions.

The data extracted can be presented in the form of the table discussed below:

Author / date

Topic / aim / research questions

Paradigm / methodology

Conceptual/ theoretical model

Context/ setting / sample

Data collection & analysis

Findings

Future research

Sharma, Shyam & Grover (2018)

The research aims to identify the various strategies used by parents in paediatric cancer.

Qualitative

 

A total of 120 people participated in the research out of which 60 were healthy children’s caregivers and the rest were caregivers of children with cancer.

Informed consent or ethical considerations were taken.

Socio-demographic parameters were taken to conduct the research. Coping scale revised was used to measure the coping strategies

According to the study, it was obtained that emotion-focused coping strategies are preferred more than problem-focused coping strategies by the parents in paediatric cancer. The mothers of paediatric cancer patients must be provided with mental health services in addition to the package of cancer treatment for their children. The oncology ward must have a section for mental health counselling that can help parents to overcome stress, depression, and anxiety. This is because cancer can weaken the mental health of the parents and this disablement can worsen the quality of care provided by the parents.

Barriers in maintaining the quality of life, role of caregivers, and its impact on maintaining the quality of life.

Zucchetti, Ambrogio, Bertolotti, Besenzon, Borghino, Candela,Galletto, &Fagioli, 2020

The aim of the study is to examine the impact of the psychosocial intervention of paediatric oncology in child-parent unit settings.

To compare the usual standardized care with highly complex psychological interventions.

Non-randomized designs, intensive and structured interventions.

Informed consent was taken from each of the participants and ethical consent was taken from the hospital.

Watson’s theory of human caring- no discussion of the model in a discussion of results.

The cancer diagnostics centre was the hub to conduct the research; Families remained closer to their patients. All the psychologists were working in close association with the oncologist. The eligibility of the research was patients suffering from any cancer within a span

200 child-parents units participated in the research out of which 119 belong to standardized usual care units and the rest belongs to high-intensity psychological interventions child parents care units.

The findings of the study were structured and high-intensity interventions play a major role in affecting the psychological aspects of parent-child care units. High-intensity tailored interventions have a positive role in balancing life. Families and parents must be provided with constant psychological support throughout the treatment. It is furthermore suggested to have counselling strategies and psychological interventions for mothers in paediatric cancer.

To study the role of parents and caregivers in the research as this study was focused on the role of professionals. Also, a randomized study must be considered to compare the usual care with psychological interventions.

 

Data Synthesis
Data synthesis is a step where all the data retrieved from the reviews is compiled and evaluated. The outcomes of the review are determined by the synthesis part of the review. The two types of data synthesis in a systematic review are qualitative data synthesis and quantitative data synthesis. The type of data used is solely dependent on the data synthesized, compiled, and extracted from the data of the studies. For quantitative information, tools that can be used to summarize the data are: similar data are grouped together, presentation of results using graphs or pie charts, and graphically displaying the result, for example, forest plots (Moeyaert, 2019). The data can be summarized for qualitative results using the mentioned ways. The data retrieved can be summarized using the content or thematic analysis, and written words or textual description (Lockwood, et.al., 2017). It does not matter whatever tools you are using, data synthesis is solely about the outcome of all the data presented together. It also tells about the quality of the study and highlights the issues and effects of these studies. Quantitative analysis is also known as meta-analysis because there is a systematic representation of the data (Moeyaert, 2019). It is recommended that the data synthesized must match your objectives and review questions. A Forest plot is a good way to summarise the quantitative results because it helps in estimating the difference arise from different studies for a similar condition.

Qualitative analysis of data is also known as thematic analysis in health sciences. The three basic steps of qualitative analysis are the creation of analytical themes, advancement of descriptive themes, and line by line text coding. The meaning of these three steps summarizes to explain that the reviewers go ahead of primary studies and create a new hypothesis.

The data retrieved must be collected from two separate and independent reviewers. The JBI tool will help in pooling the data of qualitative research together. This standardization protocol will help in the synthesis of a new set of statements and findings. These accumulations of a new set of data will help in the assemblage of new findings. The level 1 and level 2 findings can be put together for better understanding that is based on the quality and similarity of the data. These data or findings will be assembled together to give rise to a new set of findings presented in a single paper (level 3 findings). The level 3 finding is a form of textual finding.

Heterogeneity of the retrieved data must be maintained when working with quantitative reviews. The quantitative data is based on mean differences, 95% confidence interval, odds ratios, and double data entry.

According to the review, the data will be combined using a thematic structure. Whilst the descriptive theme will focus on the basic studies, the analytical theme will focus on the interpretation and overall the review will be able to generate a compact explanation.

Conclusion
The paper deals with several ways to design research starting from search strategy to data synthesis. Several search strategies are mentioned above to retrieve relevant data out of which keywords or index terms help in retrieving the data in lesser time. The data can be easily extracted from various sources. The sources of information are electronic bibliographic databases, grey works of literature, hand on searches, and library searches. It can be concluded that data extraction is one of the tedious processes as it often includes incomplete and unseen data and ambiguous clinical trial texts. Synthesis of data is another major step of a systematic review. It is the step where all the data retrieved from different reviews are compiled and assessed. The overall review is based on the entire evidence retrieved, the consistency in all the data findings, the positive impact of strategies on the population, and the association between the objectives of the review.

References
Aagaard, T., Lund, H., &Juhl, C. (2016). Optimizing literature search in systematic reviews–are MEDLINE, EMBASE and CENTRAL enough for identifying effect studies within the area of musculoskeletal disorders?. BMC medical research methodology, 16(1), 1-11. https://link.springer.com/article/10.1186/s12874-016-0264-6

Booth, A. (2016). Searching for qualitative research for inclusion in systematic reviews: a structured methodological review. Systematic reviews, 5(1), 1-23. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0249

Bramer, W. M., de Jonge, G. B., Rethlefsen, M. L., Mast, F., &Kleijnen, J. (2018). A systematic approach to searching: an efficient and complete method to develop literature searches. Journal of the Medical Library Association: JMLA, 106(4), 531. 10.5195/jmla.2018.283

Demaerschalk, B. M., Kleindorfer, D. O., Adeoye, O. M., Demchuk, A. M., Fugate, J. E., Grotta, J. C., ... & Smith, E. E. (2016). Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47(2), 581-641. https://doi.org/10.1161/STR.0000000000000086

Dupont, J. C. K., Pritchard-Jones, K., &Doz, F. (2016). Ethical issues of clinical trials in paediatric oncology from 2003 to 2013: a systematic review. The Lancet Oncology, 17(5), e187-e197. https://doi.org/10.1016/S1470-2045(16)00142-X

Eriksen, M. B., &Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA, 106(4), 420. 10.5195/jmla.2018.345

Halliday, G. C., Miles, G. C. P., Marsh, J. A., Kotecha, R. S., &Alessandri, A. J.. (2017). Regular exercise improves the well-being of parents of children with cancer. Pediatric Blood & Cancer, 64(12), e26668. https://doi.org/10.1002/pbc.26668

Lockwood, C., Porrit, K., Munn, Z., Rittenmeyer, L., Salmond, S., Bjerrum, M., ...&Stannard, D. (2017). Systematic reviews of qualitative evidence. JBI Reviewer’s Manual [internet], 23-71.https://doi.org/10.46658 /JBIMES-20-03

Mamikutty, R., Aly, A. S., &Marhazlinda, J. (2021). Databases Selection in a Systematic Review of the Association between Anthropometric Measurements and Dental Caries among Children in Asia. Children, 8(7), 565. https://doi.org/10.3390/children8070565

Moeyaert, M. (2019). Quantitative synthesis of research evidence: multilevel meta-analysis. Behavioral Disorders, 44(4), 241-256. https://doi.org/10.1177/0198742918806926

Munn, Z., Barker, T. H., Moola, S., Tufanaru, C., Stern, C., McArthur, A., &Aromataris, E. (2020). Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI evidence synthesis, 18(10), 2127-2133. 10.11124/JBISRIR-D-19-00099

Nakayama, N., Mori, N., Ishimaru, S., Ohyama, W., Yuza, Y., Kaneko, T., ...& Matsushima, E. (2017). Factors associated with posttraumatic growth among parents of children with cancer. Psycho?oncology, 26(9), 1369-1375. https://doi.org/10.1002/pon.4307

Nikseresht, F., Rassouli, M., Torabi, F., Farzinfard, F., Mansouri, S., &Ilkhani, M. (2016). The effect of spiritual care on mental health in mothers of children with cancer. Holistic nursing practice, 30(6), 330-337. 10.1097/HNP.0000000000000175

Paez, A. (2017). Gray literature: An important resource in systematic reviews. Journal of Evidence?Based Medicine, 10(3), 233-240. https://doi.org/10.1111/jebm.12266

Patino, C. M., & Ferreira, J. C. (2018). Inclusion and exclusion criteria in research studies: definitions and why they matter. JornalBrasileiro de Pneumologia, 44, 84-84. https://doi.org/10.1590/S1806-37562018000000088

Schmidt, L., Olorisade, B. K., McGuinness, L. A., Thomas, J., & Higgins, J. P. (2020). Data extraction methods for systematic review (semi) automation: A living review protocol. F1000Research, 9. 10.12688/f1000research.22781.2

Sharma, R., Shyam, R., & Grover, S. (2018). Coping strategies used by parents of children diagnosed with cancer. Indian journal of social psychiatry, 34(3), 249.10.4103/ijsp.ijsp_57_18.

Zeng, X., Zhang, Y., Kwong, J. S., Zhang, C., Li, S., Sun, F., & Du, L. (2015). The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta?analysis, and clinical practice guideline: a systematic review. Journal of evidence-based medicine, 8(1), 2-10. https://doi.org/10.1111/jebm.12141

Zucchetti, G., Ambrogio, G., Bertolotti, M., Besenzon, L., Borghino, F., Candela, F., Galletto, C., &Fagioli, F.. (2020). Effects of a high-intensity psychosocial intervention among child–parent units in pediatric oncology. Tumori Journal, 106(5), 362–368. https://doi.org/10.1177/0300891620926226

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