Pediatric Education Discharge Support Strategies for Newly Diagnosed Children With Cancer

Marilyn Hockenberry, Author Affiliations: Duke University School of Nursing, Durham, North Carolina (Drs Hockenberry and Hatch and Ms Arthur); Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois (Ms Haugen and Ms Coyne); Cohen Children's Medical Center, New Hyde Park, New York (Ms Slaven); Nationwide Children's Hospital, Columbus, Ohio (Dr Skeens); Children's Health System of Texas Children's Medical Center, Dallas, Texas (Ms Patton); American Family Children's Hospital, University of Wisconsin Health, Madison (Dr Montgomery); Northwestern Medicine Central DuPage Hospital, Chicago, Illinois (Ms Trimble); St Jude Children's Hospital, Memphis, Tennessee (Ms Hancock); King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (Mr Ahmad); St Louis Children's Hospital, Washington University School of Medicine, Missouri (Ms Daut and Ms Glover); Levine Children's Hospital, Charlotte, North Carolina (Ms Brown); The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine (Ms St Pierre); West Virginia University Medicine, Morgantown (Ms Shay); St Peter's University Hospital, New Brunswick, New Jersey (Ms Maloney); Nicklaus Children's Hospital, Miami, Florida (Ms Burke).


BACKGROUND: Discharge education practices vary among institutions and lack a standardized approach for newly diagnosed pediatric oncology patients and their parents. OBJECTIVE: The purpose of this American Nurses Credentialing Center-supported pediatric multisite trial was to determine the feasibility and effectiveness of 2 nurse-led Parent Education Discharge Support Strategies (PEDSS) for families with a child who is newly diagnosed with cancer. INTERVENTIONS/METHODS: A cluster randomized clinical trial design assigned 16 Magnet-designated sites to a symptom management PEDSS intervention or parent support and coping PEDSS intervention. Outcome measures evaluated at baseline, 1, and 2 months after diagnosis include symptom experiences, parent perceptions of care, unplanned service utilization, and parent evaluation of the PEDSS interventions. RESULTS: There were 283 newly diagnosed children and their parent participating in this study. Linear mixed models revealed pain differed over time by the intervention; children in the symptom management group had a greater decrease in pain. Greater nausea and appetite disturbances were experienced by older children in both groups. Fatigue and sleep disturbance showed a significant decrease over time in both groups. The symptom management group reported significantly greater satisfaction with the PEDSS intervention. CONCLUSIONS: This study is among the first to examine the effects of 2 different early-discharge planning strategies for families of a newly diagnosed child with cancer. The evidence supports a standardized discharge education strategy that can be successfully implemented across institutions. IMPLICATIONS FOR PRACTICE: Nurses play a major role in the educational preparation and discharge of newly diagnosed pediatric cancer patients and their families.