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Evidence-Based Recommendations for the Appropriate Level of Sedation to Manage Pain in Pediatric Oncology Patients Requiring Procedures: A Systematic Review From the Children's Oncology Group [Formula: see text]. 以证据为基础,为需要接受手术治疗的儿科肿瘤患者提供适当镇静程度的建议:儿童肿瘤学小组的系统回顾[公式:见正文]。
IF 1.7 3区 医学 Q2 NURSING Pub Date : 2020-01-01 Epub Date: 2019-07-13 DOI: 10.1177/1043454219858610
Elizabeth A Duffy, Tara Adams, Clifton P Thornton, Beth Fisher, Jennifer Misasi, Sally McCollum

Repeated invasive and painful procedures are often necessary components of pediatric cancer treatment. Adequate pain control during procedures is essential; however, procedure-related pain may be underestimated and undertreated. Currently, there is not a standard approach for the appropriate level of sedation to manage procedure-related pain in children with cancer. A team was assembled to review the evidence and develop recommendations to determine the appropriate level of sedation necessary for pain control in patients undergoing pediatric oncology procedures. After a systematic search of the literature, 15 research-based articles were synthesized and critically appraised. A recommendation was made related to the level of sedation utilized for bone marrow aspirates and bone marrow biopsies. There is a need for further research related to the necessary level of sedation for patients undergoing pediatric oncology procedures.

在儿科癌症治疗中,反复进行侵入性和痛苦的手术往往是必要的组成部分。手术过程中适当的疼痛控制至关重要;然而,与手术相关的疼痛可能被低估和治疗不足。目前,对于控制癌症患儿手术相关疼痛的适当镇静程度还没有一个标准的方法。我们组建了一个团队来审查证据并制定建议,以确定对接受儿科肿瘤手术的患者进行疼痛控制所需的适当镇静程度。在对文献进行系统性检索后,对 15 篇基于研究的文章进行了综合和批判性评估。就骨髓抽吸术和骨髓活检术中使用的镇静剂水平提出了建议。有必要进一步研究接受儿科肿瘤手术的患者所需的镇静程度。
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引用次数: 6
Experiences of Young Children With Cancer and Their Parents With Nurses’ Caring Practices During the Cancer Trajectory 幼儿癌症患者及其父母在癌症发展过程中护理实践的经验
IF 1.7 3区 医学 Q2 NURSING Pub Date : 2020-01-01 DOI: 10.1177/1043454219874007
K. Enskär, Laura Darcy, M. Björk, Susanne Knutsson, K. Huus
Children with cancer require repeated hospitalizations and the family’s everyday life and routines undergo change. Concrete descriptions of how nurses act when caring for children with cancer throughout the various phases of care and treatment are sparsely highlighted in the literature. The aim of this study was to describe young children with cancer and their parents’ experiences of nurses’ caring practices over a 3-year period, from diagnosis to follow-up. This study is based on semistructured interviews with 25 children newly diagnosed with cancer, aged 1 to 6 years, and their parents, connected to a pediatric oncology unit in Sweden. Child and parent data were analyzed with a deductive content analysis using Swanson’s theory of caring. The result shows that nurse care practices directed toward young children with cancer and their parents are to some extent similar across a 3-year period from diagnosis to follow-up but also differ in some ways. Nurses’ caring practices aim to support children and parents in the transition to a “new normal.” Child- and family-friendly care processes include the following: creating hope and a trustful relationship, asking rather than assuming, providing knowledge and information, performing tasks skillfully, displaying an interest in the child’s and parents’ life outside the hospital, and helping the family to trust in the future and other health care providers. Based on these results, we recommend the development of a standardized and structured nursing care plan or clinical guideline with detailed information on how to carry out clinical nurse care practices in the different phases.
患有癌症的儿童需要反复住院治疗,家庭的日常生活和惯例也会发生变化。在护理和治疗的各个阶段,护士在照顾患有癌症的儿童时如何采取行动的具体描述在文献中很少得到强调。本研究的目的是描述患有癌症的幼儿及其父母从诊断到随访的3年期间护士护理实践的经历。这项研究是基于半结构化访谈的25名儿童新诊断为癌症,年龄在1至6岁,以及他们的父母,连接到儿科肿瘤单位在瑞典。采用斯旺森的关爱理论,对儿童和家长的数据进行演绎内容分析。结果表明,从诊断到随访的3年期间,护士对患有癌症的幼儿及其父母的护理在某种程度上是相似的,但在某些方面也有所不同。护士的护理实践旨在支持儿童和家长过渡到“新常态”。对儿童和家庭友好的护理过程包括以下内容:创造希望和信任关系,询问而不是假设,提供知识和信息,熟练地完成任务,对儿童和父母在医院外的生活表现出兴趣,并帮助家庭信任未来和其他卫生保健提供者。基于这些结果,我们建议制定一个标准化和结构化的护理计划或临床指南,详细说明如何在不同阶段开展临床护理实践。
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引用次数: 21
Assessment of the Role of the Pediatric Nurse in Patient Education and Follow-up of Patients Receiving Oral Anticancer Treatment 儿科护士在患者教育和口服抗癌治疗患者随访中的作用评估
IF 1.7 3区 医学 Q2 NURSING Pub Date : 2020-01-01 DOI: 10.1177/1043454219871081
Sara Shinnick
Objective: To assess the role of the pediatric nurse/advanced practice provider in patient education and follow-up of patients receiving oral anticancer therapy. Methods: Association of Pediatric Hematology/Oncology Nurses members were invited to participate in a survey that focused on the nurses’ roles in patient education of patients taking oral oncolytic agents. Data were collected via a 16-item questionnaire. Respondents included 197 nurses and advanced practice providers. Content analysis techniques were used to describe the qualitative data while Fisher’s exact test and chi-square test were used in the quantitative statistical analysis. Results: Seventy-one percent of respondents reported some type of involvement in patient education. Knowledge as well as comfort level improved as years of oncology nursing experience increased. Generally, policies and procedures are in place; however, nurses noted there is a need for improved oral oncolytic guidelines. Nurses also reported a need for improved and updated educational resources. Conclusion: While the development of oral oncolytic agents continues to rise, findings show a need to develop evidence-based guidelines for nurses, which include management of oral oncolytic dosing, adverse events, and safety issues.
目的:评价儿科护士/高级执业医师在接受口服抗癌治疗的患者教育和随访中的作用。方法:邀请儿科血液学/肿瘤学护士协会成员参与调查,重点关注护士在口服溶瘤药物患者患者教育中的作用。数据通过16项问卷收集。受访者包括197名护士和高级执业医师。定性数据采用内容分析技术描述,定量统计分析采用Fisher精确检验和卡方检验。结果:71%的受访者表示参与了某种形式的患者教育。随着肿瘤护理经验年数的增加,知识水平和舒适度也随之提高。一般来说,政策和程序是到位的;然而,护士们指出,有必要改进口腔溶瘤治疗指南。护士还报告需要改进和更新教育资源。结论:随着口服溶瘤药物的发展不断增加,研究结果表明,有必要为护士制定循证指南,包括口服溶瘤药物剂量、不良事件和安全问题的管理。
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引用次数: 4
Measuring Burnout in Pediatric Oncology Staff: Should We Be Using the Maslach Burnout Inventory? 测量儿科肿瘤学工作人员的职业倦怠:我们应该使用Maslach职业倦怠量表吗?
IF 1.7 3区 医学 Q2 NURSING Pub Date : 2020-01-01 DOI: 10.1177/1043454219873638
S. Mukherjee, A. Tennant, B. Beresford
Burnout in health service staff is a cause for concern since it has negative consequences for the individual affected, the wider organization, and patients. The Maslach Burnout Inventory–Human Services Survey (MBI-HSS) has been widely used to assess the prevalence of burnout within oncology services. The MBI-HSS is a self-report measure comprising three subscales—Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). This article reports on the first study to investigate the psychometric properties of the MBI-HSS when administered to pediatric oncology staff. Two hundred and three pediatric oncology staff recruited through seven UK Principal Treatment Centers (PTCs) and a children’s cancer charity completed the MBI-HSS. The factor structure of the instrument was tested using confirmatory and exploratory factor analysis, with Rasch analysis applied to assess whether the measure meets the requirements of an interval-level scale. Cronbach alpha was used to assess internal reliability. Factor analysis did not support the traditional three-factor structure of the MBI-HSS but instead suggested seven factors. Rasch analysis and alpha coefficients indicated that while the EE and the PA subscales fulfilled the requirements of an interval-level measure for group-level diagnosis, DP did not. Further investigation revealed a “floor effect” on many DP items. Whereas the EE and PA subscales of the MBI-HSS can be used in research with pediatric oncology staff working in PTCs, there are considerable problems with the DP subscale, and researchers should be cautious in interpreting data from this subscale.
卫生服务人员的职业倦怠令人担忧,因为它对受影响的个人、更广泛的组织和患者都有负面影响。Maslach职业倦怠量表-人类服务调查(MBI-HSS)已被广泛用于评估肿瘤服务中职业倦怠的患病率。MBI-HSS是一种自我报告量表,包括三个子量表——情绪耗竭(EE)、人格解体(DP)和个人成就(PA)。这篇文章报告了第一项研究,以调查MBI-HSS的心理测量特性时,给予儿科肿瘤工作人员。通过七个英国主要治疗中心(ptc)和一个儿童癌症慈善机构招募的203名儿科肿瘤学工作人员完成了MBI-HSS。采用验证性因子分析和探索性因子分析对仪器的因子结构进行检验,并采用Rasch分析来评估该测量是否满足区间水平量表的要求。采用Cronbach alpha评估内部信度。因子分析不支持传统的MBI-HSS的三因素结构,而是提出了七个因素。Rasch分析和alpha系数表明,虽然情感表达和情感表达量表满足群体水平诊断的区间水平测量要求,但情感表达量表却没有。进一步的调查揭示了许多DP物品的“地板效应”。虽然MBI-HSS的情感表达和情感表达量表可用于对在ptc工作的儿科肿瘤学工作人员的研究,但DP量表存在相当大的问题,研究人员在解释该量表的数据时应谨慎。
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引用次数: 11
Pediatric Oncology Nursing: Defining Care Through Science 儿科肿瘤护理:通过科学定义护理
IF 1.7 3区 医学 Q2 NURSING Pub Date : 2020-01-01 DOI: 10.1007/978-3-030-25804-7
G. Reaman
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引用次数: 7
How Does Creative Arts Therapy Reduce Distress for Children With Cancer? A Metasynthesis of Extant Qualitative Literature 创造性艺术疗法如何减轻癌症儿童的痛苦?现存定性文献的综合
IF 1.7 3区 医学 Q2 NURSING Pub Date : 2019-11-26 DOI: 10.1177/1043454219888807
Jennifer L. Raybin, E. Barr, M. Krajicek, Jacqueline Jones
Introduction: As more children survive cancer, attention must be paid to their quality of life (QOL). Integrative therapies are an ideal modality for nurses to advocate for reducing distress and improving QOL for children with cancer. Creative arts therapy is a type of integrative health that may improve QOL in this population. Therefore, the research question was asked, “For children with cancer, what opportunities exist for creative arts therapy to reduce distress?” Method: A metasynthesis of the extant qualitative research was conducted to answer the research question. Seven qualitative studies were identified, which included 162 participants. New themes were identified through rigorous analyzation by the study team of each study as individual data. Results: Four derived analytic themes emerged through the analysis: (a) connection is established through creative expression, (b) coping is facilitated by creative arts, (c) communication is enabled by creative arts interventions, and (d) continuance (the concept of time) is experienced through creative arts. Examples of each theme with subthemes are delineated, including expressive quotes. Summary: Through this qualitative synthesis of studies with creative arts therapy, evocative opportunities to reduce the distress associated with the disease experience are revealed. Nurses are called now to promote creative arts therapy to improve the symptoms in children with cancer.
随着越来越多的儿童从癌症中存活下来,人们必须关注他们的生活质量(QOL)。综合治疗是护士倡导减少癌症患儿痛苦和改善生活质量的理想方式。创造性艺术疗法是一种综合健康,可以改善这一人群的生活质量。因此,研究的问题是,“对于患有癌症的儿童,创造性艺术疗法存在哪些机会来减少痛苦?”方法:对已有的定性研究进行综合分析,回答研究问题。确定了7项定性研究,其中包括162名参与者。每个研究的研究小组通过严格的分析确定了新的主题,作为单独的数据。结果:通过分析产生了四个衍生的分析主题:(a)通过创造性表达建立联系,(b)通过创造性艺术促进应对,(c)通过创造性艺术干预实现沟通,以及(d)通过创造性艺术体验延续(时间概念)。每个主题和副主题的例子都被描绘出来,包括富有表现力的引用。总结:通过创造性艺术疗法的定性综合研究,揭示了减少与疾病经历相关的痛苦的唤起机会。护士们现在被要求推广创造性艺术疗法,以改善癌症儿童的症状。
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引用次数: 6
A Review of Literature on Health-Related Quality of Life of Retinoblastoma Survivors 视网膜母细胞瘤幸存者健康相关生活质量的文献综述
IF 1.7 3区 医学 Q2 NURSING Pub Date : 2019-11-25 DOI: 10.1177/1043454219888805
Paula J. Belson, J. Eastwood, M. Brecht, R. Hays, N. Pike
Background: Retinoblastoma is a malignant tumor of the eye that typically presents in early childhood and occurs in approximately 1 in 20,000 births. While active treatment of the tumor is typically completed in childhood, survivors often suffer from long-term effects from treatment including visual impairment, facial deformities, and fear of recurrence or secondary cancer. However, little is known how these long-term effects affect their health-related quality of life (HRQOL). Purpose: To review the literature on HRQOL in retinoblastoma survivors. Method: We searched three electronic databases from January 2005 to December 2018 for original research articles reporting on HRQOL or individual domains such as function, cognition, and psychosocial outcomes in retinoblastoma survivors. Results: A total of 59 articles were reviewed and 15 were identified as eligible. Five of the studies reported worse HRQOL in retinoblastoma survivors than controls or general population norms. Parent-proxy ratings were worse than survivors’ self-reports. Conclusion: Our findings confirm the need for further HRQOL research to assess the factors influencing long-term outcomes associated with treatment in adolescent and young adult retinoblastoma survivors. By identifying any potential deficits in specific domains of HRQOL, early interventions might be developed to improve HRQOL in retinoblastoma survivors.
背景:视网膜母细胞瘤是一种眼部恶性肿瘤,通常出现在儿童早期,发生率约为2万分之一。虽然肿瘤的积极治疗通常在儿童时期完成,但幸存者经常遭受治疗的长期影响,包括视力损害,面部畸形,以及对复发或继发性癌症的恐惧。然而,很少有人知道这些长期影响如何影响他们的健康相关生活质量(HRQOL)。目的:回顾有关视网膜母细胞瘤幸存者HRQOL的文献。方法:我们检索了2005年1月至2018年12月的三个电子数据库,检索了有关视网膜母细胞瘤幸存者HRQOL或功能、认知和心理社会结局等单个领域的原创研究文章。结果:共纳入文献59篇,纳入文献15篇。五项研究报告视网膜母细胞瘤幸存者的HRQOL比对照组或一般人群差。父母代理的评分比幸存者的自我报告更差。结论:我们的研究结果证实需要进一步的HRQOL研究来评估影响青少年和青壮年视网膜母细胞瘤幸存者治疗相关的长期预后的因素。通过识别HRQOL特定区域的任何潜在缺陷,可以开发早期干预措施来改善视网膜母细胞瘤幸存者的HRQOL。
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引用次数: 10
Nurse–Patient Connectedness and Nurses’ Professional Quality of Life: Experiences of Volunteering at a Pediatric Oncology Camp 护患关系和护士的职业生活质量:在儿科肿瘤夏令营志愿服务的经验
IF 1.7 3区 医学 Q2 NURSING Pub Date : 2019-11-18 DOI: 10.1177/1043454219887671
B. Cherven, Dorothy Jordan, S. Hale, M. Wetzel, C. Travers, Kylie Smith
Objective: Pediatric oncology nurses can experience burnout, vicarious traumatization, and compassion fatigue related to the unique stressors of their profession. Opportunities to enhance nurses’ professional commitment and nurse–patient connectedness may mitigate these stressors. This study explored the impact of volunteering at a local oncology camp on pediatric oncology nurses’ professional quality of life and connectedness with their oncology patients. Method and Sample: Pediatric oncology nurses from a single institution were invited to participate in this mixed methods study. Participants completed a survey assessing professional quality of life, professional commitment, and patient connectedness. Nurses who had oncology camp volunteer experience were invited to participate in a qualitative interview. Results: Compared with noncamp nurses (n = 23), camp nurses (n = 25) had increased odds of a low burnout score (odds ratio = 6.74, 95% confidence interval [1.10, 41.43], p = .039) and increased odds of a high compassion satisfaction score (odds ratio = 4.69, 95% confidence interval [1.14, 19.32], p = .033). Qualitative interviews supported the impact of volunteering at camp on nurses’ personal and professional perspective, nursing practice, and delivery of person-centered care. Conclusion: Volunteering at a pediatric oncology camp provided nurses the opportunity to engage with patients, share experiences, and view patients as individuals while still maintaining professional boundaries. Nurses who volunteer at camp described a perspective moving beyond patient-centered to person-centered care, and for some pediatric oncology nurses, camp volunteering may be a novel way to mitigate burnout and an important tool to enhance resiliency.
目的:儿科肿瘤科护士可能会经历与其职业独特压力源相关的倦怠、替代性创伤和同情疲劳。加强护士专业承诺和护患联系的机会可能会缓解这些压力。这项研究探讨了在当地肿瘤学营地做志愿者对儿科肿瘤学护士的专业生活质量以及与肿瘤学患者的联系的影响。方法和样本:来自单一机构的儿科肿瘤学护士被邀请参与这项混合方法研究。参与者完成了一项评估职业生活质量、职业承诺和患者联系的调查。有肿瘤营志愿者经验的护士被邀请参加一次定性访谈。结果:与非住院护士(n=23)相比,营地护士(n=25)低倦怠评分的几率增加(比值比=6.74,95%置信区间[1.1041.43],p=.039),高同情满意度评分的几率也增加(比值比=4.69,95%置信间隔[1.1419.32],p=.033),以及提供以人为本的护理。结论:儿科肿瘤营的志愿服务为护士提供了与患者接触、分享经验和将患者视为个体的机会,同时仍保持专业界限。在营地做志愿者的护士描述了一种从以患者为中心到以人为中心的护理的观点,对于一些儿科肿瘤学护士来说,营地志愿服务可能是缓解倦怠的一种新方法,也是增强复原力的重要工具。
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引用次数: 6
Spiritual Care: Minimizing the Vulnerability of Parents Whose Children With Cancer Face the End of Life 精神关怀:最大限度地减少癌症儿童面临生命终结的父母的脆弱性
IF 1.7 3区 医学 Q2 NURSING Pub Date : 2019-11-13 DOI: 10.1177/1043454219887509
Cheryl L. Petersen
There is a distinct lack of literature related to the spiritual care of parents whose children with cancer are at the end of life. This has led to a dearth in evidence about how nurses may intervene with spiritual care interventions to best support these vulnerable parents. The purpose of this scoping review was to examine the evidence regarding the value of spirituality/spiritual care in minimizing the vulnerability of parents whose children were diagnosed with cancer and who faced the end of life. The Arksey and O’Malley methodological framework guided the analysis of the reviewed quantitative and qualitative literature. Spirituality and spiritual care provided bereaved parents and parents of children with cancer with necessary support and enhanced coping to allow them to better deal with this devastating experience. Spirituality and spiritual care instilled hope, assisted in the search for meaning and purpose, and guided parents to develop continuing bonds with their child. Through skillful communication, pediatric oncology nurses may guide parents of children who face the end of life to strengthen relationships that offer support, plan activities that provide opportunities for hope and connection, and identify sources of meaning in their experiences.
关于癌症患儿生命垂危的父母的精神关怀,明显缺乏相关文献。这导致缺乏关于护士如何通过精神护理干预来最好地支持这些弱势父母的证据。这项范围界定审查的目的是审查有关精神/精神护理在最大限度地减少儿童被诊断为癌症并面临生命终结的父母的脆弱性方面的价值的证据。Arksey和O'Malley的方法论框架指导了对所审查的定量和定性文献的分析。精神和精神关怀为失去亲人的父母和癌症儿童的父母提供了必要的支持,并加强了应对,使他们能够更好地应对这一毁灭性的经历。灵性和精神关怀灌输了希望,有助于寻找意义和目标,并引导父母与孩子建立持续的联系。通过熟练的沟通,儿科肿瘤学护士可以指导面临生命终结的孩子的父母加强提供支持的关系,计划提供希望和联系机会的活动,并确定他们经历的意义来源。
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引用次数: 5
Challenges to Family Management for Caregivers of Adolescent and Young Adult Survivors of Childhood Brain Tumors [Formula: see text]. 儿童脑肿瘤青少年幸存者照顾者家庭管理面临的挑战[公式:见正文]。
IF 1.7 3区 医学 Q2 NURSING Pub Date : 2019-11-01 Epub Date: 2019-05-03 DOI: 10.1177/1043454219844229
Nicole SanGiacomo, Jennifer Toth, Wendy Hobbie, Elizabeth Broden, Elizabeth Ver Hoeve, Kathleen A Knafl, Lamia Barakat, Sue Ogle, Janet A Deatrick

Due to the complexity of cancer late effects, the education required to provide anticipatory guidance and support to the caregivers of adolescent and young adult (AYA) survivors of childhood brain tumors can be difficult. Therefore, identifying challenges to family management (FM) could be helpful in anticipating complications with the integration of tumor and treatment late effects into family life. Building on previous research that described FM for children with chronic conditions, children who survived cancer, and the Family Management Styles Framework, the purpose of this study was to identify FM challenges for caregivers of AYA survivors of childhood brain tumors to guide clinical practice and research. Directed content analysis was used to identify FM challenges in data from semistructured interviews with 45 maternal caregivers for AYA survivors of childhood brain tumors living with them. Caregivers were largely White (89%) with an average age of 52 years, educated beyond the high school level (67%), and were partnered or married (53%). On average, caregivers had been caring for the AYA for 21 years since diagnosis, and 56% of their survivors had moderate functional restrictions. A primary and a secondary analyst were assigned to the data for each interview and completed a single summary matrix. A list of challenges was created by the research team based on Family Management Styles Framework, the literature, and clinical expertise. Seven core challenges to FM were identified: ensuring survivor well-being, supporting survivor independence, encouraging sibling well-being, planning family activities, sustaining parents as caregivers, attending to survivor late effects, and providing support and advocacy.

由于癌症晚期效应的复杂性,为儿童脑肿瘤青少年幸存者的照顾者提供预见性指导和支持所需的教育可能很困难。因此,识别家庭管理(FM)所面临的挑战有助于预测将肿瘤和治疗晚期效应融入家庭生活的并发症。以往的研究描述了慢性病儿童、癌症幸存儿童的家庭管理,以及家庭管理风格框架(Family Management Styles Framework),在此基础上,本研究的目的是识别亚健康儿童脑肿瘤幸存者的照顾者在家庭管理方面面临的挑战,以指导临床实践和研究。本研究采用了定向内容分析法,从对 45 名与儿童脑肿瘤亚青幸存者共同生活的母亲照顾者进行的半结构式访谈数据中识别出家庭管理面临的挑战。照顾者大多是白人(89%),平均年龄 52 岁,受过高中以上教育(67%),有伴侣或已婚(53%)。自确诊以来,照顾者平均已照顾了 21 年,56% 的幸存者有中度功能限制。每次访谈都有一名主要分析师和一名辅助分析师负责数据分析,并完成一份汇总表。研究小组根据 "家庭管理风格框架"、文献和临床专业知识创建了一份挑战清单。确定了家庭管理的七项核心挑战:确保幸存者的福祉、支持幸存者的独立、鼓励兄弟姐妹的福祉、规划家庭活动、支持父母作为照顾者、关注幸存者的后期影响,以及提供支持和倡导。
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引用次数: 9
期刊
Journal of Pediatric Oncology Nursing
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