Patient, parent, and physician perspectives on pediatric oncology rounds

doi:10.1016/S0022-3476(88)80316-0

The Journal of Pediatrics

Volume 112, Issue 3, March 1988, Pages 378-384

https://doi.org/10.1016/S0022-3476(88)80316-0 Get rights and content

To provide data to guide physicians regarding the extent to which pediatric patients and their families should be involved in decision-making discussions by their health care teams, we compared the standard rounding procedure in a pediatric oncology unit (rounds conducted out of earshot) with bedside rounds in which management was discussed in front of patients and parents. Type of rounds was alternated in 2-week blocks for 4 months. The impact of the two types of rounds of 35 parents and children was studied. Parents preferred bedside rounds to standard rounds, and perceived increased opportunifies to obtain information and ask questions. Parents and children differed, in their reports of how much bedside rounds upset children. Older children, compared with younger children, more strongly disliked standard rounds; this appeared to be related to feelings of exclusion. The two types of rounds differed in their effectiveness in providing specific types of education to residents. The finding suggest that bedside rounds have a positive impact on parents' attitudes toward physicians, that they do not dilute the child's sense of relationship with the primary attending physician, and that they contribute to certain aspects of resident education.

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A survey of the attitudes and perceptions of multidisciplinary team members towards family presence at bedside rounds in the intensive care unit
2014, Intensive and Critical Care Nursing
To describe the attitudes and perceptions of intensive care unit (ICU) staff [critical care physicians and fellows (MDs), registered nurses (RNs), allied health discipline (HD) and managers] towards family presence at bedside rounds.
We developed, tested and administered a questionnaire to the multidisciplinary staff.
24-Bed medical surgical ICU.
160/221 (72.4%) individuals responded, including 12 MDs, 95 RNs, 48 HD personnel, 4 managers and 1 unspecified. While most MDs strongly agreed and HD and management groups somewhat agreed, most RNs strongly disagreed with providing family members the option to attend rounds. Over 50% of respondents either strongly or somewhat agreed that the presence of family members prolongs rounds, reduces the medical education provided to the team and constrains delivery of negative medical information. Compared to MDs, RNs expressed greater reservation to family presence at rounds. Among RNs, more experienced RNs, expressed greater reservation with family presence during rounds.
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Citation Excerpt :
Family-centered rounds are defined as “interdisciplinary work rounds at the bedside in which the patient and family share in the control of the management plan as well as in the evaluation of the process itself” (Sisterhen et al., 2007). Studies from Canada (Landry et al., 2007), the United States (Kleiber et al., 2006; Lewis et al., 1988; Muething et al., 2007; Phipps et al., 2007; Schiller and Anderson, 2003), and Israel (Rotman-Pikielny et al., 2007) have reported significant improvement in parental satisfaction and communication with the medical team when family-centered rounds are implemented. In contrast, a more recent American study (Rosen et al., 2009) found no significant difference in parental and patient satisfaction with the introduction of family-centered rounds.
Involvement of family in bedside rounds is one strategy to implement family-centered care to help families get clear information about their child, and be actively involved in decision-making about care. However in developing countries such as Pakistan, daily bedside rounds include the physician, residents, medical students and a nurse/technician. Parents are not currently a part of these rounds.
To assess whether family-centered rounds improve parents’ and health care professionals’ satisfaction, decrease patient length of stay, and improve time utilization when compared to traditional practice rounds in a population with a low literacy rate, socioeconomic status, and different cultural values and beliefs.
A non-randomized before–after study design.
A private hospital in Karachi, Pakistan.
A convenience sample of 82 parents, whose children were hospitalized for a minimum of 48 h, and 25 health care professionals able to attend two consecutive rounds.
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Parents’ ratings during the family-centered rounds were significantly higher for some parental satisfaction items: evidence of team work (p = 0.007), use of simple language during the rounds (p = 0.002), feeling of inclusion in discussion at rounds (p = 0.03), decision making (p = 0.01), and preference for family-centered rounds (p = <0.001). No significant differences were found in health care professionals’ satisfaction between rounds. Patient length of stay was significantly reduced in the family-centered rounds group, while no significant difference was found in the duration of rounds. Family-centered rounds served as an opportunity for parents to correct/add to patient history or documentation.
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^*: Supported in part by a grant from the Academic Senate, University of California, and the Department of Social Work, University of California, San Francisco.

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Original articlePatient, parent, and physician perspectives on pediatric oncology rounds*

Psychosomatics

J Pediatr

Treating the pediatric cancer patient: a review

J Pediatr Psychol

Words as scalpels: transmitting evidence in the clinical dialogue

Ann Intern Med

Group discussions with the parents of leukemic children

Pediatrics

Therapeutic choices made by patients with end-stage cancer

J Pediatr

Disease-related communication and depression in pediatric cancer patients

J Pediatr Psychol

The child with cancer: patterns of communication and denial

J Consult Clin Psychol

Therapeutic choices by children with cancer

J Pediatr

Adjustment in children with cancer

J Pediatr Psychol

Original article
Patient, parent, and physician perspectives on pediatric oncology rounds*