Health Care Providers' Perceptions of Nutrition Support in Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients.

One of the most common side effects of medical treatment for patients with an oncologic diagnosis is malnutrition. There is limited research that broadly assesses the perceptions of health care providers (HCPs) regarding nutrition support in the pediatric population. The purpose of this study was to describe the perceptions of nutrition support among pediatric oncology and hematopoietic stem cell transplant HCPs. The study used a cross-sectional descriptive design using a 31-item survey. Results of the survey indicated that nurses were more likely to initiate conversations about nutrition support during the first month of diagnosis, while midlevel providers and physicians initiated discussions in response to a change in nutritional status evidenced by decreased oral intake or weight loss. Participants reported resistance by patients and families more often for enteral nutrition compared with parenteral nutrition. Findings suggest a need to develop a more unified service line-based approach for initiating discussions related to nutrition support that incorporate patient and family perceptions.

Evidence-Based Practice Recommendations to Prevent/Manage Post-Lumbar Puncture Headaches in Pediatric Patients Receiving Intrathecal Chemotherapy.

Post-lumbar puncture headaches (PLPHs) are a known complication of lumbar puncture procedures. Children undergoing treatment for cancer often undergo multiple lumbar punctures, placing them at increased risk for PLPHs. There are currently no guidelines for the prevention or management of PLPHs in children. A team was therefore assembled to conduct a systematic review of the evidence in relationship to PLPHs in the pediatric population. Clinical questions were developed and used to guide the literature review. Twenty-four articles were deemed appropriate for use and were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Based on the review of evidence, strong recommendations are made for the use of smaller needle sizes and for the use of pencil point needles during lumbar puncture procedures. Weak recommendations are made for needle orientation and positioning following the procedure as well as for interventions used to treat PLPHs once they occur. There is a need for additional, pediatric-specific studies to further examine the issue of PLPH prevention and treatment.

Perceptions of nutrition support in pediatric oncology patients and parents.

An estimated 60% of pediatric oncology patients experience malnutrition during cancer therapy. Initiation of enteral nutrition (EN) and parenteral nutrition (PN) are interventions aimed at maintaining and promoting growth. Limited literature addressing perceptions of nutrition support methods exists. To develop effective guidelines on nutrition education, it is important to understand perceptions regarding nutrition support. The purpose of this pilot study was to describe perceptions of pediatric oncology patients and parents regarding the use of EN and PN and identify influencing variables. A convenience sample of pediatric oncology patients and parents were surveyed at a large Midwestern children's hospital. The majority of those surveyed chose PN over EN if they or their child were unable to eat or maintain their nutritional status. Perceptions may be influenced by comfort, ease of nutrition or medication administration, experience, health care team's recommendation, choice, and image. This study provides health care professionals an initial opportunity to understand perceptions of EN and PN, which may provide a foundation for a multi-institutional study and enhance patient and family education.