Family-centred care for children in hospital

 

Abstract

Background

Family-centred care (FCC) is a widely used model in paediatrics, and is felt instinctively to be the best way to provide care to children in hospital. However, its effectiveness has not been measured.

Objectives

The primary objective of this review was to assess the effects of family-centred models of care for hospitalised children when compared to standard or professionally-centred models of care, on child, family and health service outcomes.

Search methods

We searched: MEDLINE (1966 to February 2004); the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, Issue 2, 2004); CINAHL (1982 to February 2004); PsycINFO (1972 to February 2004); ERIC (1982 to February 2004); Sociological Abstracts (1963 to February 2004); Social Work Abstracts (1977 to February 2004); and AMI (Australasian Medical Index) (1966 to February 2004).

Selection criteria

We searched for randomised controlled trials (RCTs) or quasi-randomised controlled trials including cluster randomised trials and controlled clinical trials (CCTs), and controlled before and after studies (CBAs), in which family-centred care models are compared with professionally-centred models of care for hospitalised children (aged up to 12 years). Studies also had to meet criteria for family-centredness and methodological quality. In order to assess studies for the degree of family-centredness, this review utilised a modified rating scale based on a validated instrument.

Data collection and analysis

Two review authors undertook the searches, and three authors independently assessed trial quality and extracted data. We contacted study authors for additional information.

Main results

No studies met inclusion criteria, and hence no analysis could be undertaken. Five studies came close to inclusion. Three of these studies were excluded primarily because of inadequate or unclear blinding of outcome assessment, while for one study the age group was outside the parameters of this review. One study met most criteria, but the children were aged up to 18 years. We contacted the study authors who kindly provided a subset analysis, but on further examination the study also proved to have inadequate blinding procedures and so was not included. It was not possible to undertake any subset analysis of populations. Of the other studies identified through the search, 13 met some of the inclusion criteria but were reports of qualitative research and are reviewed elsewhere.

Authors' conclusions

This review has highlighted the dearth of high quality quantitative research about family-centred care. A much more stringent examination of the use of family-centred care as a model for care delivery to children and families in health services is needed.

 

Plain language summary

Family-centred care for children in hospital

When a child comes into hospital, the whole family is affected. In giving care, nurses, doctors and those caring for the child must consider the impact of the child's admission on all the family members. 'Family-centred care' (FCC) has developed as one way of caring for children in hospital. FCC means that during a hospital admission, care is planned by the health staff around the whole family, not just the individual child. However, with the way family structures are changing in society, questions are being asked about how care is best delivered. To make sure that children are cared for in ways that minimise emotional trauma and assist in recovery, it is important that such ways of delivering care are measured to see if they are effective.

This review has tried to do that by examining research about family-centred care. We assessed potentially-relevant studies against criteria that identify important parts of FCC. Despite extensive searching we found no studies we could include in this review which would allow us to measure the effectiveness of FCC. We did find 13 studies which described, using qualitative research, aspects of FCC, and we have written a separate paper about these. Our main conclusion from this review, however, is that more research, using factors which can be measured, is needed to assess whether FCC really works to improve a child's experience of hospitalisation.

 

摘要

背景

以家庭為中心之方式照護住院孩童

以家庭為中心之照護是廣泛使用於小兒科之照護模式，也很直覺地被認為是照護住院孩童之最佳方式。然而其有效性尚未被評量。

目標

這篇回顧性文章最主要的目的是評估以家庭為中心照護住院孩童模式之成效，並與標準的或以專業為中心的照護模式做比較，評估其對於孩童、家庭及健康照護之成效。

搜尋策略

我們搜尋了以下資料，包括：MEDLINE (從1966年至2004年2月) ；考科藍註冊中心對照試驗 (the Cochrane Central Register of Controlled Trials, CENTRAL), (The Cochrane Library, Issue 2, 2004); CINAHL (1982 to February 2004); PsycINFO (1972 to February 2004); ERIC (1982 to February 2004); Sociological Abstracts (1963 to February 2004); Social Work Abstracts (1977 to February 2004); and AMI (Australasian Medical Index) (1966 to February 2004).

選擇標準

我們搜尋隨機對照試驗 (randomised controlled trials, RCTs) 或準隨機對照試驗 (quasirandomized control trials) 包括集束隨機抽樣試驗、臨床對照試驗和事前事後對照試驗，針對住院孩童 (年齡至12歲) 以家庭為中心照護模式與以專業為中心模式相比較。所有研究必須是以家庭為中心，並符合研究品質基本要求。為了評估以家庭為中心的程度，本研究將使用一個經修改有效度驗證過的工具來評估

資料收集與分析

由兩位作者著手搜尋工作，三位作者獨立進行各試驗品質之評估及摘錄文獻資料。另外我們也聯絡研究作者來收集額外的資料。

主要結論

在搜尋之後發現沒有任何研究符合納入條件，因此也無法進行分析。有五篇研究接近我們所需要的條件，其中三篇因為於結果評估中盲法不足或不清楚而被排除，一篇是研究對象的年齡分組超過了本篇研究之範圍。另外一篇文章雖符合條件但研究對象孩童年齡是至18歲。我們聯絡了此篇文章之作者，他也親切地提供其他不同分組之分析，然而在進一步檢查之後，仍因盲法不足而被排除，因此也不能進行其他分組之分析。其他研究在進行搜尋確認之後，有13篇文章符合條件但僅限於是質性研究之報告因此於他處再作討論之。

作者結論

此篇回顧性文章強調以家庭為中心之照護方式在高品質量性研究方面之不足。因此以家庭為中心的照護模式運用於兒童與家庭之醫療服務需要一個更為嚴格的檢視。

翻譯人

本摘要由成功大學附設醫院侯宜彣翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

當孩童生病住院時，全家都會因而受到影響。所以對醫師、護理人員及照護者來說，必須考量孩童生病住院時對整個家庭所帶來的影響。以家庭為中心之醫療照護模式應用於住院病童之照護，意指當病童住院時，醫療人員需整體評估病童家庭狀況再作計畫，而非僅考量病童本身而已。然而因當前社會變遷導致家庭結構的改變，目前問題在於如何提供最好的醫療照顧。為了確保兒童在醫療照護中盡量減少感情創傷並協助其恢復，很重要的是需測量此醫療服務提供方式是否有效。這篇回顧性文章試圖審查以家庭為中心之相關照護研究來確認其有效性。我們針對「以家庭為中心之照護方式」的重要確立標準來評估可能相關的研究。儘管在廣泛搜尋之後無任何研究符合本篇「以家庭為中心之照護方式」成效評估。但我們找到13篇質性研究來說明以家庭為中心之照護，也因此另外寫了一篇文章來探討。本篇回顧性文章主要結論為我們需要更多研究使用可以衡量之因素來評估是否「以家庭為中心之照護方式」可以改善兒童的住院經驗。