Dataset Information

Meta-ethnography of experiences of early discharge, with a focus on paediatric febrile neutropenia.

ABSTRACT:

Purpose (stating the main purposes and research question)

Many children have no significant sequelae of febrile neutropenia. A systematic review of clinical studies demonstrated patients at low risk of septic complications can be safely treated as outpatients using oral antibiotics with low rates of treatment failure. Introducing earlier discharge may improve quality of life, reduce hospital acquired infection and reduce healthcare service pressures. However, the review raised concerns that this might not be acceptable to patients, families and healthcare professionals.

Methods

This qualitative synthesis explored experiences of early discharge in paediatric febrile neutropenia, including reports from studies of adult febrile neutropenia and from other paediatric conditions. Systematic literature searching preceded meta-ethnographic analysis, including reading the studies and determining relationships between studies, translation of studies and synthesis of these translations.

Results

Nine papers were included. The overarching experience of early discharge is that decision-making is complex and difficult and influenced by fear, timing and resources. From this background, we identified two distinct themes. First, participants struggled with practical consequences of treatment regimens, namely childcare, finances and follow-up. A second theme identified social and emotional issues, including isolation, relational and environmental challenges. Linking these, participants considered continuity of care and the need for information important.

Conclusions

Trust and confidence appeared interdependent with resources available to families-both are required to manage early discharge. Socially informed resilience is relevant to facilitating successful discharge strategies. Interventions which foster resilience may mediate the ability and inclination of families to accept early discharge. Services have an important role in recognising and enhancing resilience.

SUBMITTER: Morgan JE

PROVIDER: S-EPMC5847030 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Meta-ethnography of experiences of early discharge, with a focus on paediatric febrile neutropenia.

Morgan Jessica E JE Cleminson Jemma J Stewart Lesley A LA Phillips Robert S RS Atkin Karl K

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 20171229 4

<h4>Purpose (stating the main purposes and research question)</h4>Many children have no significant sequelae of febrile neutropenia. A systematic review of clinical studies demonstrated patients at low risk of septic complications can be safely treated as outpatients using oral antibiotics with low rates of treatment failure. Introducing earlier discharge may improve quality of life, reduce hospital acquired infection and reduce healthcare service pressures. However, the review raised concerns t ...[more]

PMID: 29285558

Similar Datasets

Project description:ObjectivesA systematic review of paediatric low-risk febrile neutropenia found that outpatient care is safe, with low rates of treatment failure. However, this review, and a subsequent meta-ethnography, suggested that early discharge of these patients may not be acceptable to key stakeholders. This study aimed to explore experiences and perceptions of patients, parents and healthcare professionals involved in paediatric febrile neutropenia care in the UK.SettingThree different centres within the UK, purposively selected from a national survey on the basis of differences in their service structure and febrile neutropenia management.ParticipantsThirty-two participants were included in eight focus group discussions.Primary outcomesExperiences and perceptions of paediatric febrile neutropenia care, including possible future reductions in therapy.ResultsParticipants described a quest for certainty, in which they attempted to balance the uncertainty involved in understanding, expressing and negotiating risk with the illusion of certainty provided by strict protocols. Participants assessed risk using both formal and informal stratification tools, overlaid with emotional reactions to risk and experiences of risk within other situations. The benefits of certainty provided by protocols were counterbalanced by frustration at their strict constraints. The perceived benefits and harms of previous inpatient care informed participants' appraisals of future treatment strategies.ConclusionsThis study highlighted the previously underestimated harms of admission for febrile neutropenia and the paternalistic nature of decision making, along with the frustrations and challenges for all parties involved in febrile neutropenia care. It demonstrates how the same statistics, generated by systematic reviews, can be used by key stakeholders to interpret risk differently, and how families in particular can view the harms of therapeutic options as different from the outcomes used within the literature. It justifies a reassessment of current treatment strategies for these children and further exploration of the potential to introduce shared decision making.

Project description:OBJECTIVE:Despite evidence supporting physical activity in primary and secondary prevention, many individuals do not meet recommended levels. Mobile health is a field with a growing evidence base and is proposed as a convenient method for delivering health interventions. Despite qualitative exploration of stakeholder perspectives, there is a lack of synthesis to inform evidence-based design. This study aims to resolve this by identifying and synthesising qualitative research on the experience of using mobile health applications to promote physical activity. METHOD:A systematic review focused on qualitative research, mobile health and physical activity was conducted in October 2017 using CINAHL, ERIC, EMBASE, MEDLINE and PsycINFO databases. The protocol was registered with the Prospero database (Registration: CRD42018080610). Results were synthesised as a meta-ethnography. RESULTS:Fifteen studies were included, covering a variety of populations, including people with diabetes, obesity, and serious mental illness. Five themes emerged: (a) personal factors and the experience of using mobile health, (b) mobile health and changes in thinking that support physical activity, (c) the experience of mobile health features, including prompts, goal setting and gamification, (d) the experience of personalised mobile health and physical activity, (e) technical and user issues in mobile health and their effect on experience. CONCLUSION:Personal factors and features of the device influenced the experience of using mobile health to support physical activity. The two mechanisms through which mobile health use facilitated physical activity were strengthening of motivation and changes in self-awareness and strategising. Experiences were not entirely unproblematic as technical issues and adverse effects related to self-monitoring were noted. This synthesis provides insight into the experience of mobile health and is useful for researchers and healthcare practitioners interested in designing user-informed mobile health interventions for promoting physical activity.

Dataset Information

Meta-ethnography of experiences of early discharge, with a focus on paediatric febrile neutropenia.

Purpose (stating the main purposes and research question)

Methods

Results

Conclusions

Publications

Meta-ethnography of experiences of early discharge, with a focus on paediatric febrile neutropenia.

Similar Datasets

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