Description and evaluation of a French grief workshop for children and adolescents bereaved of a sibling or parent.

BACKGROUND: Childhood bereavement is common, and is associated with elevated symptoms of grief with distress and impairment. However, few developmentally appropriate interventions to support grieving children are available to date. In Toulouse, France we developed an innovative four-session group intervention to support grieving families and evaluated its feasibility and acceptability. METHODS: The workshop consists of four sessions over 4 months, open to children bereaved of a sibling or parent, and co-facilitated by two mental health professionals. After an intake assessment, children were placed into closed groups according to age and relation to the deceased. The session content was balanced between creative activities and grief-related discussions. Overall satisfaction was evaluated in March-April of 2020 by an 8-question online survey of children and parents having participated between 2011 and 2019. Freeform commentaries were analysed using the thematic synthesis process. RESULTS: Of the 230 emails sent in March 2020, 46 children and 81 parents agreed to participate (55% response rate). The families reported an overall high level of satisfaction regarding the intervention that was rated as good to excellent. A majority of respondents considered their participation in the workshop helpful and in accordance with their expectations. Most would recommend the workshop to a friend, and would participate again in the group if needed. The group intervention helped reduce social isolation, facilitated grief expression, and supported the creation of a sense of community among bereaved families. CONCLUSIONS: Encouraging community and mutual support among grieving families is fundamental in bereavement care. Our four-session workshop held over 4 months and led by mental health professionals aimed to help reduce social isolation and foster coping skills through artistic creation and group discussion. Our results highlight the potential need for family bereavement support over a longer period and a provision of a variety of services. Our intervention model is feasible for families, and further studies examining its efficacy are warranted.

Peritraumatic distress predicts prolonged grief disorder symptom severity after the death of a parent in children and adolescents.

Background: In 2015 nearly 140 million children and adolescents under 18 had experienced the death of one or both parents. Parental death is often considered the most traumatic event that a child can experience in their lifetime. While parental loss may lead to the development of prolonged grief disorder (PGD), little is known about risk factors for such negative mental health outcome in children. Objective: The present study aims to examine peritraumatic reactions as predictors of PGD in children who lost a parent. Method: Thirty-four children (M age = 10.9, SD = 3.2, 67.6% females) who lost a parent (time since death = 4.6 months, SD = 2.3) were assessed for peritraumatic distress and peritraumatic dissociation experienced at the time of the loss, and for PGD symptom severity at three timepoints post-loss (<6 months; 6-12 months; >12 months). Results: PGD score was correlated with peritraumatic distress (.61; p < .01) but not with peritraumatic dissociation (.24; p = .3). Results from the mixed-model regression analysis identified peritraumatic distress as the only significant predictor of PGD symptom severity (B = 1.58, SE = .31; p < .0001), with no statistically significant effect of peritraumatic dissociation (B = - .43, SE = .36; p = .2), or time (B = - 3.84, SE = 2.99; p = .2). Conclusion: Our results suggest that peritraumatic distress might be useful to identify children at risk for developing PGD, and in need of further support. The development of early preventive strategies to prevent PGD in parentally bereaved children who experienced high peritraumatic distress is warranted.

Antecedentes: En el 2015 cerca de 140 millones de niños y adolescentes menores a 18 años experimentaron la muerte de uno o ambos padres. La muerte parental es considerada a menudo como el evento más traumático que un niño puede experimentar en su vida. Mientras que la pérdida parental puede conducir al desarrollo de Duelo Prolongado (PGD), poco se sabe respecto a los factores de riesgo para dicha consecuencia negativa en la salud mental de los niños.Objetivo: El presente estudio apunta a examinar reacciones peritraumáticas como predictores de PGD en niños que han perdido un padre o madre.Método: Treinta y cuatro niños (Edad promedio = 10.9, DE = 3.2, 67,6% mujeres) quienes perdieron su padre o madre (tiempo desde la muerte = 4.6 meses, DE=2.3) fueron evaluados en relación a angustia peritraumática y disociación peritraumática experimentados al momento de la pérdida, y en relación a severidad sintomática de PGD en tres momentos diferentes tras la pérdida (< 6 meses; 6-12 meses; > 12 meses).Resultados: El puntaje de PGD se correlacionó con angustia peritraumática (0.61; p < .01) pero no con disociación peritraumática (0.24; p = .3). Resultados del análisis de regresión de modelo mixto identificaron a la angustia peritraumática como el único predictor significativo para severidad sintomática de PGD (B = 1.58; p < .0001), sin efecto estadísticamente significativo de disociación peritraumática (B = ­ 0.43; p = .2) o según el tiempo (B = ­ 3.84; p = .2).Conclusión: Nuestros resultados sugieren que la angustia peritraumática puede ser útil para identificar niños en riesgo de desarrollar PGD, y en necesidad de mayor apoyo. Está justificado el desarrollo de estrategias preventivas tempranas para prevenir PGD en niños en duelo por pérdida parental que experimentan angustia peritraumática severa.

Multicenter randomized trial of chewing gum for preventing oral mucositis in children receiving chemotherapy.

The properties of saliva led us to hypothesize that the salivary flow increase induced by gum chewing might protect the oral mucosa from lesions due to cancer chemotherapy. We conducted a multicenter randomized trial to evaluate the efficacy of chewing gum in preventing oral mucositis in 145 children receiving chemotherapy regimens expected to induce WHO grade 3-4 oral mucositis in at least 30% of patients. Patients were allocated at random to standard oral care with or without 5 gum pieces per day. No overall reduction in severe oral mucositis occurred in the gum arm (51%) compared with the standard arm (44%). VIDE, COPADM, and multidrug intensive chemotherapy caused severe oral mucositis in 75% of patients in both arms. In patients receiving less toxic regimens, a decrease in WHO grade 1-4 oral mucositis was noted in the gum arm compared with the standard arm (49% vs. 72%, P=0.03). In the multivariate analysis, the risk of oral mucositis was related only to the type of chemotherapy regimen, suggesting that further strategies for preventing oral mucositis could be mainly based on these criteria.

[2003 clinical practice guideline: Standards, Options and Recommendations for pain assessment in adult and children with cancer (summary report)]. / Recommandations pour la pratique clinique: Standards, Options et Recommandations pour l'évaluation de la douleur chez l'adulte et l'enfant atteints d'un cancer (mise à jour)--rapport abrégé.

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the French Federation of Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVE: To update clinical practice guidelines for the assessment of pain in adult or children with cancer in collaboration with the French society for pain study and treatment. METHOD: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guideline has been defined, the document is submitted for review by independent reviewers. RESULTS: This article is a summary version of the full document presenting the clinical practice guidelines with algorithms. The main recommendations concern the means used to evaluate pain and its consequences and their use in specific cases (acute or chronic pain, patients able to communicate or not, children under or over 6 years old). Others recommendations were also established concerning the evaluation ofpsychological, social and family context, the evaluation of pain in hospital or at home, in terminal phase patients and for the establishment of a therapeutic strategy and follow-up of patient with pain.