Publications by authors named "Lucy Coombes"

Background: Development of a paediatric palliative care child and family centred outcome measure is a priority for health care professionals, researchers and advocates. It is methodologically challenging to develop a measure relevant for such a heterogenous population with complex needs. Involving children in measuring development is vital.

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  • - Palliative care for children is crucial but underutilized; this study investigates factors affecting access and referrals for such care.
  • - A scoping review analyzed 195 articles on barriers and facilitators to referrals, identifying influences at individual, interpersonal, organizational, community, and societal levels.
  • - While numerous barriers to pediatric palliative care are documented, the interventions aimed at improving access are less thoroughly explored, with many initiatives occurring mainly at the organizational level.
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  • - The Children's Palliative Outcome Scale (C-POS) is being developed using best practices in outcome measure development, with a focus on cognitive testing to ensure the tool is clear and relevant for its intended users.
  • - A study involved cognitive interviews with children aged 5-17 with life-limiting conditions and their parents/carers, where adjustments were made to the C-POS to improve its comprehensibility and inclusivity, particularly for non-verbal children.
  • - The results suggest that cognitive interviewing improved the validity and acceptability of the C-POS, indicating it can be effectively used in routine practice for assessing the needs of children with life-limiting conditions.
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  • The study explores how to effectively implement person-centred outcome measures in palliative care for children with life-threatening or life-limiting conditions, as current evidence is limited compared to adult care.
  • Interviews with 26 children, 40 parents, 13 siblings, 15 healthcare professionals, and 12 health commissioners revealed strong support for such measures, highlighting benefits like improved communication and prioritization of patient needs.
  • Identified challenges include potential increased staff workload, risks around data usage, and barriers such as privacy concerns and the need for child-friendly language, while facilitators include clear communication of benefits and trusted professional support during the process.
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  • Children and young people with life-limiting conditions express their experiences using a mix of medical terms and personal language, indicating a deep understanding of their health.
  • A study involving 26 participants aged 5-17 revealed that they describe their condition through comparisons and metaphors, highlighting feelings of loss and isolation compared to peers.
  • By focusing on how these young individuals articulate their experiences, healthcare professionals can have more meaningful discussions that address their unique needs and concerns.
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  • There is currently no validated outcome measure for pediatric palliative care outside sub-Saharan Africa, making it essential for stakeholders to be involved in developing effective measures.* -
  • The study aimed to establish consensus among experts on what items should be included in a pediatric palliative care outcome measure, using a two-phase approach involving a modified Delphi survey and item generation meetings.* -
  • Results showed differing priorities between professionals and parents, with professionals focusing on physical symptoms while parents cared more about psychosocial and practical issues, alongside valuable input from a young advisory group.*
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Background: Self-reported health data from children with life-limiting conditions is rarely collected. To improve acceptability and feasibility of child and family-centred outcome measures for children, they need to be designed in a way that reflects preferences, priorities and abilities.

Objectives: The aim was to identify preferences for patient-reported outcome measure design (recall period, response format, length, administration mode) to improve the feasibility, acceptability, comprehensibility and relevance of a child and family-centred outcome measure, among children with life-limiting conditions and their family members.

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Background: Despite being a core domain of palliative care, primary data on spiritual and existential concerns has rarely been collected among children with life-limiting and life-threatening conditions and their families. Existing evidence has tended to focus on the religious aspects among children with cancer.

Aim: To identify the spiritual needs of children with life-limiting and life-threatening conditions.

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Unlabelled: This study aims to identify the symptoms, concerns, and care priorities of children with life-limiting conditions and their families. A semi-structured qualitative interview study was conducted, seeking perspectives from multiple stakeholders on symptoms, other concerns, and care priorities of children and young people with life limiting and life-threatening conditions and their families. Participants were recruited from six hospitals and three children's hospices in the UK.

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Objectives: To identify published evidence on person-centered outcome measures (PCOMs) used in dementia care and to explore how PCOMs facilitate shared decision-making and improve outcomes of care. To build a logic model based on the findings, depicting linkages with PCOM impact mechanisms and care outcomes.

Design: Mixed-methods systematic review.

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Context: Children and young people with life-limiting or life-threatening conditions and their families are potentially vulnerable during COVID-19 lockdowns due to pre-existing high clinical support needs and social participation limitations.

Objectives: To explore the impact of the COVID-19 pandemic and lockdowns on this population.

Methods: Sub-analysis of an emergent COVID-19 related theme from a larger semi-structured interview study investigating priority pediatric palliative care outcomes.

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Background: Phase of Illness is used to describe the stages of a patient's illness in the palliative care setting. Categorization is based on individual needs, family circumstances, and the adequacy of a care plan. Substantial (κ = .

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Background And Aims: No published studies have looked at the dosing and use of rapid onset fentanyl preparations in children. The primary aim of this study was to assess whether there is a correlation between effective dose of rapid onset fentanyl and background oral morphine equivalent analgesia in children less than 18 years old. Secondary objectives included establishing whether there is a correlation between effective dose of rapid onset fentanyl and age and weight.

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  • The study evaluates the effectiveness of a commonly used "surprise question" among multidisciplinary teams in predicting the survival outcomes of children with life-limiting conditions.
  • The results indicate high sensitivity (83.3%) and specificity (93.2%) for predicting life expectancy at both 3 and 12 months, highlighting the tool's accuracy in identifying those who may need palliative care.
  • The findings suggest that the surprise question can improve communication about end-of-life care and help allocate resources effectively for children's hospice care.
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  • - The demand for palliative care services for children is increasing due to advancements in medical technology, making effective outcome measures essential for improving care quality and effectiveness.
  • - A systematic review analyzed 3460 articles, narrowing it down to 41 relevant papers that assessed the psychometric properties of 22 health-related quality-of-life measures for pediatric palliative care, revealing significant gaps in data quality and consistency.
  • - No ideal outcome assessment measure currently exists for pediatric palliative care, as many standard measures do not adequately address the diverse needs of affected children; further efforts are needed to adapt or create more tailored assessment tools.
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Background: More than 90% of patients with diffuse intrinsic pontine glioma (DIPG) will die within 2 years of diagnosis. Patients deteriorate rapidly during the disease course, which severely impairs their quality of life. To date, no specific research on this clinically important subject has been conducted.

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Children, young people and their families come into contact with a large number of health and social care professionals within hospital, education and community settings following a cancer diagnosis. The multiprofessional team best supports these families through an open and communicative approach to care. The side effects of cancer treatment include fever, infection, gastrointestinal upset, altered body image and psychological impact on children, young people and their families.

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