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Rose M, Graham CD, O'Connell N, Vari C, Edwards V, Taylor E, McCracken LM, Radunovic A, Rakowicz W, Norton S, Chalder T. A randomised controlled trial of acceptance and commitment therapy for improving quality of life in people with muscle diseases. Psychol Med 2023; 53:3511-3524. [PMID: 35192788 PMCID: PMC10277769 DOI: 10.1017/s0033291722000083] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/15/2021] [Accepted: 01/06/2022] [Indexed: 01/09/2023]
Abstract
UNLABELLED Abstract. BACKGROUND Chronic muscle diseases (MD) are progressive and cause wasting and weakness in muscles and are associated with reduced quality of life (QoL). The ACTMuS trial examined whether Acceptance and Commitment Therapy (ACT) as an adjunct to usual care improved QoL for such patients as compared to usual care alone. METHODS This two-arm, randomised, multicentre, parallel design recruited 155 patients with MD (Hospital and Depression Scale ⩾ 8 for depression or ⩾ 8 for anxiety and Montreal Cognitive Assessment ⩾ 21/30). Participants were randomised, using random block sizes, to one of two groups: standard medical care (SMC) (n = 78) or to ACT in addition to SMC (n = 77), and were followed up to 9 weeks. The primary outcome was QoL, assessed by the Individualised Neuromuscular Quality of Life Questionnaire (INQoL), the average of five subscales, at 9-weeks. Trial registration was NCT02810028. RESULTS 138 people (89.0%) were followed up at 9-weeks. At all three time points, the adjusted group difference favoured the intervention group and was significant with moderate to large effect sizes. Secondary outcomes (mood, functional impairment, aspects of psychological flexibility) also showed significant differences between groups at week 9. CONCLUSIONS ACT in addition to usual care was effective in improving QoL and other psychological and social outcomes in patients with MD. A 6 month follow up will determine the extent to which gains are maintained.
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Affiliation(s)
- Michael Rose
- Department of Neurology, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Christopher D. Graham
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast BT9 5BN, Northern Ireland
| | - Nicola O'Connell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Chiara Vari
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Victoria Edwards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Emma Taylor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Lance M. McCracken
- Department of Psychology, Uppsala University, Postal Box 1225, 751 42 Uppsala, Sweden
| | - Aleksander Radunovic
- Barts and the London MND Centre, Royal London Hospital, Whitechapel, London, EH1 1BB, UK
| | - Wojtek Rakowicz
- Wessex Neurological Service, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Department of Inflammation Biology, Faculty of Life Sciences and Medicine, Centre for Rheumatic Disease, King's College London, Weston Education Centre, London, SE5 8AF, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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Kumpf VJ, Neumann ML, Kakani SR. Advocating for a patient- and family centered care approach to management of short bowel syndrome. Nutr Clin Pract 2023; 38 Suppl 1:S35-S45. [PMID: 37115033 DOI: 10.1002/ncp.10966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 04/29/2023] Open
Abstract
Patient- and family centered care (PFCC) is a model of providing healthcare that incorporates the preferences, needs, and values of the patient and their family and is built on a solid partnership between the healthcare team and patient/family. This partnership is critical in short bowel syndrome (SBS) management since the condition is rare, chronic, involves a heterogenous population, and calls for a personalized approach to care. Institutions can facilitate the practice of PFCC by supporting a teamwork approach to care, which, in the case of SBS, ideally involves a comprehensive intestinal rehabilitation program consisting of qualified healthcare practitioners who are supported with the necessary resources and budget. Clinicians can engage in a range of processes to center patients and families in the management of SBS, including fostering whole-person care, building partnerships with patients and families, cultivating communication, and providing information effectively. Empowering patients to self-manage important aspects of their condition is an important component of PFCC and can enhance coping to chronic disease. Therapy nonadherence represents a breakdown in the PFCC approach to care, especially when nonadherence is sustained, and the healthcare provider is intentionally misled. An individualized approach to care that incorporates patient/family priorities should ultimately enhance therapy adherence. Lastly, patients/families should play a central role in determining meaningful outcomes as it relates to PFCC and shaping the research that affects them. This review highlights needs and priorities of patients with SBS and their families and suggests ways to address gaps in existing care to improve outcomes.
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Affiliation(s)
- Vanessa J Kumpf
- Department of Pharmacy, Clinical Programs, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Human Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marie L Neumann
- Department of Surgery, Division of Transplant Surgery, University of Nebraska Medical Center, Nebraska, Omaha, USA
- Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Uhlenbusch N, Bal A, Balogh B, Braun A, Geerts A, Hirschfield G, Janik MK, Lohse AW, Milkiewicz P, Papp M, Poppe C, Schramm C, Löwe B. Improving quality of life in patients with rare autoimmune liver diseases by structured peer-delivered support (Q.RARE.LI): study protocol for a transnational effectiveness-implementation hybrid trial. BMC Psychiatry 2023; 23:193. [PMID: 36964518 PMCID: PMC10039546 DOI: 10.1186/s12888-023-04669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Psychosocial support is a crucial component of adequate rare disease care, but to date psychosocial support needs of this patient population are insufficiently met. Within Q.RARE.LI, we strive to evaluate the effectiveness of a structured, transdiagnostic, and location-independent psychosocial support intervention in routine care of patients with rare autoimmune liver diseases in five countries and prepare its implementation. METHODS Within an effectiveness-implementation hybrid trial, we aim to a) investigate the effectiveness of the intervention in routine care in five diverse healthcare systems and b) assess implementation outcomes, examine and prepare the implementation context, and develop country-specific implementation strategies. To assess effectiveness, we will include N = 240 patients with rare autoimmune liver diseases. Within a two-armed randomized controlled trial (allocation ratio 1:1), we will compare structured and peer-delivered psychosocial support in addition to care-as-usual (CAU) with CAU alone. Outcomes will be assessed via electronic database entry prior to intervention, directly after, and at a three-month follow-up. Our primary effectiveness outcome will be mental health-related quality of life at post-assessment. Secondary outcomes include depression and anxiety severity, perceived social support, helplessness, and disease acceptance. Implementation outcomes will be assessed within a mixed-methods process evaluation. In a quantitative cross-sectional survey, we will examine perceived acceptability and feasibility in patients, peer-counselors, and healthcare providers involved in delivery of the intervention. In qualitative focus groups, we will analyze the implementation context and determine barriers and facilitators for implementation with different stakeholders (patients and/or representatives, peer-counselors, healthcare providers, health insurers). Based on these results, we will derive country-specific implementation strategies and develop a concrete implementation plan for each country. DISCUSSION The intervention is expected to help patients adjust to their disease and improve their mental quality of life. The transdiagnostic and location-independent program has the potential to reach patients for psychosocial support who are usually hard to reach. By preparing the implementation in five countries, the project can help to make low-threshold psychosocial support available to many patients with rare diseases and improve comprehensive healthcare for an often neglected group. TRIAL REGISTRATION ISRCTN15030282.
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Affiliation(s)
- Natalie Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Arpinder Bal
- Toronto Centre for Liver Disease, University Health Network, Toronto, Canada
| | - Boglárka Balogh
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Annika Braun
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Geerts
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Gideon Hirschfield
- Toronto Centre for Liver Disease, University Health Network, Toronto, Canada
| | - Maciej K Janik
- Department of Hepatology, Transplantology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ansgar W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Piotr Milkiewicz
- Department of Hepatology, Transplantology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
- Translational Medicine Group, Pomeranian Medical University, Pomeranian, Poland
| | - Mária Papp
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Carine Poppe
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Christoph Schramm
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Center for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Tumiene B, Peters H, Melegh B, Peterlin B, Utkus A, Fatkulina N, Pfliegler G, Graessner H, Hermanns S, Scarpa M, Blay JY, Ashton S, McKay L, Baynam G. Rare disease education in Europe and beyond: time to act. Orphanet J Rare Dis 2022; 17:441. [PMID: 36536417 PMCID: PMC9761619 DOI: 10.1186/s13023-022-02527-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/02/2022] [Indexed: 12/23/2022] Open
Abstract
People living with rare diseases (PLWRD) still face huge unmet needs, in part due to the fact that care systems are not sufficiently aligned with their needs and healthcare workforce (HWF) along their care pathways lacks competencies to efficiently tackle rare disease-specific challenges. Level of rare disease knowledge and awareness among the current and future HWF is insufficient. In recent years, many educational resources on rare diseases have been developed, however, awareness of these resources is still limited and rare disease education is still not sufficiently taken into account by some crucial stakeholders as academia and professional organizations. Therefore, there is a need to fundamentally rethink rare disease education and HWF development across the whole spectrum from students to generalists, specialists and experts, to engage and empower PLWRD, their families and advocates, and to work towards a common coherent and complementary strategy on rare disease education and training in Europe and beyond. Special consideration should be also given to the role of nurse coordinators in care coordination, interprofessional training for integrated multidisciplinary care, patient and family-centered education, opportunities given by digital learning and fostering of social accountability to enforce the focus on socially-vulnerable groups such as PLWRD. The strategy has to be developed and implemented by multiple rare disease education and training providers: universities, medical and nursing schools and their associations, professional organizations, European Reference Networks, patient organizations, other organizations and institutions dedicated to rare diseases and rare cancers, authorities and policy bodies.
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Affiliation(s)
- Birute Tumiene
- grid.6441.70000 0001 2243 2806Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Harm Peters
- grid.6363.00000 0001 2218 4662Dieter Scheffner Center for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité - Universitätsmedizin, Berlin, Germany ,Association of Medical Schools in Europe e.V., Berlin, Germany
| | - Bela Melegh
- grid.9679.10000 0001 0663 9479Department of Medical Genetics, and Szentagothai Research Center, University of Pecs, School of Medicine, Pecs, Hungary
| | - Borut Peterlin
- grid.29524.380000 0004 0571 7705Clinical Institute of Genomic Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Algirdas Utkus
- grid.6441.70000 0001 2243 2806Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania ,Association of Medical Schools in Europe e.V., Berlin, Germany
| | - Natalja Fatkulina
- grid.6441.70000 0001 2243 2806Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - György Pfliegler
- grid.7122.60000 0001 1088 8582Centre for Rare Diseases, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Holm Graessner
- grid.10392.390000 0001 2190 1447Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany ,grid.411544.10000 0001 0196 8249Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Sanja Hermanns
- grid.10392.390000 0001 2190 1447Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany ,grid.411544.10000 0001 0196 8249Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Maurizio Scarpa
- grid.411492.bRegional Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Jean-Yves Blay
- grid.7849.20000 0001 2150 7757Centre Léon Berard, University Claude Bernard Lyon 1& Unicancer Lyon, Lyon, France
| | - Sharon Ashton
- grid.433753.5EURORDIS - Rare Diseases Europe, Paris, France
| | - Lucy McKay
- Medics4RareDiseases, High Wycombe, England, UK
| | - Gareth Baynam
- grid.1012.20000 0004 1936 7910Telethon Kids Institute and the Faculty of Health and Medical Sciences, Division of Paediatrics, He University of Western Australia, Nedlands, WA Australia ,grid.413880.60000 0004 0453 2856Western Australian Register of Developmental Anomalies and Genetic Services of Western Australia, Perth, WA Australia ,Rare Care Centre, Child and Adolescent Health Service, Perth, WA Australia
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Holmes R, Patel A, Desai AP. Psychiatric Disorders and Their Treatment: Impact of Outcomes in Patients With Chronic Liver Disease. Clin Liver Dis (Hoboken) 2022; 20:32-37. [PMID: 36033426 PMCID: PMC9405520 DOI: 10.1002/cld.1204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
- Rachel Holmes
- Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisIN
| | - Anahli Patel
- Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisIN
| | - Archita P. Desai
- Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisIN
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Uhlenbusch N, Manthey C, Nestoriuc Y, Andresen V, Lohse AW, Löwe B. [Psychosocial Support for People with Ulcerative Colitis and Irritable Bowel Syndrome: A Feasibility Study on Need, Focus and Viability]. Psychother Psychosom Med Psychol 2022; 72:481-490. [PMID: 35584778 DOI: 10.1055/a-1785-5496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Ulcerative colitis (UC) and irritable bowel syndrome (IBS) are associated with high somatic symptom burden, reduced quality of life, and increased psychological distress. The subjective burden, the wish of many patients, and the involvement of psychological processes in symptom perception justify the development of psychosocial support services. We aimed to evaluate need, content and feasibility of such an offer. We included patients with both UC and RDS in order to identify disease-specific and trans-diagnostic aspects for psychosocial interventions. METHODS We conducted telephone interviews with adult patients with UC or IBS using a standardized interview guide. We used numerical rating scales and open-ended questions to assess burden of and coping with the disease, disease-related expectations and anxiety, satisfaction with care, support and information needs, and preferences regarding support programs. We calculated descriptive metrics for quantitative variables as well as diagnosis-specific group comparisons. The answers to the open questions were summarised and counted in close accordance with the participants' statements. RESULTS N=35 patients (UC: n = 15; IBS: n=20) participated (age: M=40.80, SD=14.56; 71% female). In both groups, patients showed a medium level of disease burden, with higher rates for IBS. Both groups reported disease-related anxiety, with higher levels in patients with IBS. Disease-related expectations did not differ between groups. Patients with IBS showed low satisfaction with care and felt less informed about their disease than patients with UC. Both groups indicated a high motivation of participating in a psychological support program and named illness-related expectations and illness anxiety as important components of such. DISCUSSION The results confirm an increased need for psychosocial support and the relevance of disease-related expectations and anxiety for both diseases. Differences in symptom perception and care satisfaction indicate the importance of disease-specific elements in psychosocial therapy programs. CONCLUSION The results demonstrate the high need for psychosocial support of patients with UC and IBS and indicate the feasibility of a psychosocial therapy program.
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Affiliation(s)
- Natalie Uhlenbusch
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Manthey
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Yvonne Nestoriuc
- Professur für Klinische Psychologie, Helmut-Schmidt-Universität Universität der Bundeswehr Hamburg, Hamburg, Germany.,Institut für systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Viola Andresen
- Viszeral-Medizinisches Zentrum, Israelitisches Krankenhaus Hamburg, Hamburg, Germany
| | - Ansgar W Lohse
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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