Barriers to end-of-life discussion with advanced cancer patient as perceived by oncologists, certified/specialized nurses in cancer nursing and medical social workers.

OBJECTIVE: The objectives of this study were to identify barriers to end-of-life discussion with advanced cancer patients and their families as perceived by oncologists, certified/specialized nurses in cancer nursing (hereafter, collectively referred to as 'nurses') and medical social workers, as well as to clarify their opinions about effective strategies to facilitate end-of-life discussion. METHODS: A questionnaire survey was distributed to 4354 medical professionals working at 402 designated regional cancer hospitals in Japan. Responses were obtained from 494 oncologists (valid response rate 30.7%), 993 nurses (46.7%) and 387 medical social workers (48.1%). RESULTS: Among the barriers to end-of-life discussion with advanced cancer patients, factors related to patients and families, such as 'Family members' difficulty accepting loved one's poor prognosis', were recognized as the most important issues, which was the common view shared across the three types of medical professionals who participated in this study. Nurses and medical social workers were significantly more likely than oncologists to recognize as important issues 'Health care team disagreement about goals of care' and 'Lack of training to have conversations for end-of-life discussion'. To facilitate end-of-life discussion, 'providing mental and emotional support for the patients and their families after end-of-life discussion' was needed most as perceived by the respondents regardless of their profession. CONCLUSIONS: Barriers impeding end-of-life discussion were factors related to patients and their families, and oncologists' close cooperation with nurses and medical social workers is important in providing emotional support for patients and families. To facilitate end-of-life discussion, it is important to share information on patients' prognosis and goals for treatment among oncologists and other medical professionals, as well as strengthen communication skill of these medical professions.

Related visual impairment to mother-infant interaction and development in infants with bilateral retinoblastoma.

PURPOSE: This study was conducted with infants diagnosed with bilateral retinoblastoma (RB) and their mothers. It explored characteristics of the mother-infant interaction, the infants' developmental characteristics and related risk factors. METHOD: Cross-sectional statistical analysis was performed with 18 dyads of one-year-old infants with bilateral RB and their mothers. RESULTS: Using the Japanese Nursing Child Assessment Teaching Scale (JNCATS) results showed that infants with RB had significantly lower scores compared to normative Japanese scores on all of the infants' subscales and "Child's contingency" (p < 0.01). Five infants with visual impairment at high risk of developmental problems had a pass rate of 0% on six JNCATS items. There were positive correlations between Developmental quotients (DQ) and JNCATS score of "Responsiveness to caregiver" (ρ = 0.50, p < 0.05) and DQ and "Child's contingency" (ρ = 0.47, p < 0.05). CONCLUSIONS: Infants with visual impairment were characterized by high likelihood of developmental delays and problematic behaviors; they tended not to turn their face or eyes toward their mothers, smile in response to their mothers' talking to them or the latter's changing body language or facial expressions, or react in a contingent manner in their interactions. These infant behaviors noted by their mothers shared similarities with developmental characteristics of children with visual impairments. These findings indicated a need to provide support promoting mother-infant interactions consistent with the developmental characteristics of RB infants with visual impairment.

A Prospective Study of Factors Related to Mother-Infant Interaction in One-year-old Infants with Retinoblastoma.

This study aimed to clarify the relationships among developmental characteristics of retinoblastoma (RB) infants, mother-infant interaction, and mental health of mothers. Prospective studies were conducted twice with 13 dyads of mothers and infants who were between one (Time 1) and two years old (Time 2). Cross-sectional and longitudinal analyses were performed. The mean Developmental Quotients (DQ) significantly decreased between Time 1 and Time 2 (p < .05). Four (30.8%) infants showed DQ p < 85 at Time 1. They showed a DQ below the borderline at Time 2 and their developmental changes were different from RB infants in the normal DQ range. Infant Behavior Checklist-R (IBC-R) scores negatively correlated with DQ (p < .05). The mothers' Japanese Nursing Child Assessment Teaching Scale (JNCATS) scores were significantly higher than the normative mean. The IBC-R scores negatively correlated with mothers' JNCATS scores at Time 1 (ρ = -.66, p < .05) and positively correlated with the child domain scores on the Parenting Stress Index at Time 2 (ρ = .62, p < .05). Some RB infants showed a developmental delay. Mother-child interactions were negatively affected and mothers recognized their infants' problem. The support needs to be provided in early infancy.