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.MethodsThis 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.ResultsNine 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.ConclusionsTrust 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.Electronic supplementary materialThe online version of this article (10.1007/s00520-017-3983-2) contains supplementary material, which is available to authorized users.

COVID‐19 and children with cancer: Parents’ experiences, anxieties and support needs

“…The survey content was developed based on currently available literature, [17][18][19] expert clinician input, and parental review. It contained the following sections and number of closed statement items: Experiences (n = 6), Information (n = 7), Decisions (n = 7) and Support needs (n = 5) ( Figure 1…”

Quest for certainty regarding early discharge in paediatric low-risk febrile neutropenia: a multicentre qualitative focus group discussion study involving patients, parents and healthcare professionals in the UK

“…Participants discussed many issues similar to those found in the earlier meta-ethnography. 11 Participants spoke of the tiring nature of travelling, particularly at night time or during the rush hour. Distance from the hospital played a key role in whether early discharge regimens would be accepted, with families living close to the treating hospital more likely to accept outpatient care.…”

“… 10 A meta-ethnography of the existing qualitative literature surrounding early discharge revealed that there may be challenges surrounding practical logistics, and social or emotional issues, influenced by fear, timing and resources. 11 However, the data focused almost exclusively on parental views, lacked exploration of the influence of healthcare settings and had little disease-specific data about febrile neutropenia.…”

Recent advances in the prevention and management of infections in children undergoing treatment for cancer

“…The focus has moved to defining how narrow a spectrum of antibacterial can be safely used 12 and ways of discontinuing treatment quickly. Research has confirmed patients and their families want to be treated as safely as possible but get out of hospital as soon as they can to improve their life experience 13, 14 .…”