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Family-centred care for children in hospital
L Shields1, J Pratt, L M Davis
1University of Hull, Faculty of Health and Social Care, Cottingham Rd, Hull, UK, HU6 7RX. L.Shields@hull.ac.uk
Insights
Despite its intuitive appeal, evidence for family-centred care (FCC) in hospitals is lacking. This review found no high-quality quantitative studies to support its effectiveness for hospitalised children.
Area of Science:
- Pediatric healthcare research
- Health services research
Background:
- Family-centred care (FCC) is a common pediatric model.
- Its effectiveness in hospital settings remains unquantified.
Purpose of the Study:
- To assess the impact of family-centred care models versus standard or professionally-centred models.
- Outcomes for children, families, and health services were evaluated.
Main Methods:
- Searched multiple databases (MEDLINE, CENTRAL, CINAHL, PsycINFO, ERIC, etc.) up to February 2004.
- Included RCTs, quasi-RCTs, CCTs, and CBAs for hospitalized children (up to 12 years).
- Assessed studies for family-centredness and methodological quality.
Main Results:
- No studies met the inclusion criteria for quantitative analysis.
- Five studies were close but excluded due to methodological flaws (e.g., blinding, age range).
- Qualitative research on FCC exists but was reviewed separately.
Conclusions:
- A significant lack of high-quality quantitative research on family-centred care was identified.
- More rigorous examination of FCC's use in healthcare is necessary.
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 Strategy:
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.
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