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Jonassaint CR, Parchuri E, O'Brien JA, Lalama CM, Lin J, Badawy SM, Hamm ME, Stinson J, Lalloo C, Carroll CP, Saraf SL, Gordeuk VR, Cronin R, Shah N, Lanzkron SM, Liles D, Trimnell C, Bailey L, Lawrence RH, Abebe KZ. Mental health, pain and likelihood of opioid misuse among adults with sickle cell disease. Br J Haematol 2024; 204:1029-1038. [PMID: 38171495 PMCID: PMC10939903 DOI: 10.1111/bjh.19243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
Depressive symptoms are prevalent in individuals living with sickle cell disease (SCD) and may exacerbate pain. This study examines whether higher depressive symptoms are associated with pain outcomes, pain catastrophizing, interference and potential opioid misuse in a large cohort of adults with SCD. The study utilized baseline data from the 'CaRISMA' trial, which involved 357 SCD adults with chronic pain. Baseline assessments included pain intensity, daily mood, the Patient Health Questionnaire (PHQ), the Generalized Anxiety Disorders scale, PROMIS Pain Interference, Pain Catastrophizing Scale, the Adult Sickle Cell Quality of Life Measurement Information System and the Current Opioid Misuse Measure. Participants were categorized into 'high' or 'low' depression groups based on PHQ scores. Higher depressive symptoms were significantly associated with increased daily pain intensity, negative daily mood, higher pain interference and catastrophizing, poorer quality of life and a higher likelihood of opioid misuse (all p < 0.01). SCD patients with more severe depressive symptoms experienced poorer pain outcomes, lower quality of life and increased risk of opioid misuse. Longitudinal data from this trial will determine whether addressing depressive symptoms may potentially reduce pain frequency and severity in SCD.
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Affiliation(s)
| | - Ektha Parchuri
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julia A O'Brien
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christina M Lalama
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan Lin
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Megan E Hamm
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Stinson
- Child Health Evaluative Sciences in Research Institute, Hospital for Sick Children and Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Chitra Lalloo
- Child Health Evaluation Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Sickle Cell Center for Adults, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Santosh L Saraf
- Department of Medicine, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Victor R Gordeuk
- Department of Medicine, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert Cronin
- Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Nirmish Shah
- Division of Hematology, Division of Pediatric Hematology/Oncology, Sickle Cell Transition Program, Duke University, Durham, North Carolina, USA
| | - Sophie M Lanzkron
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Sickle Cell Center for Adults, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Darla Liles
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Lakiea Bailey
- Sickle Cell Community Consortium, Atlanta, Georgia, USA
| | - Raymona H Lawrence
- The Jiann-Ping Hsu College of Public Health, Georgia Southern University in Statesboro, Statesboro, Georgia, USA
| | - Kaleab Z Abebe
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hood AM, Crosby LE, Hanson E, Shook LM, Lebensburger JD, Madan-Swain A, Miller MM, Trost Z. The influence of perceived racial bias and health-related stigma on quality of life among children with sickle cell disease. ETHNICITY & HEALTH 2022; 27:833-846. [PMID: 32896156 PMCID: PMC7937762 DOI: 10.1080/13557858.2020.1817340] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objectives: Individuals with sickle cell disease (SCD) experience significant health problems that may result in unpredictable pain episodes and frequent healthcare utilization. Disparities in clinical care may contribute to health-related stigma and racial bias for this majority African-American/Black population. There is less known about the influence of health-related stigma and racial bias on the health-related quality of life (HRQOL) of children with SCD. In the present study, we assessed these relationships and identified differences across demographic factors (i.e. age, gender).Design: Data was collected from African American children with SCD aged 8-16 years (57% male, 63% HbSS). Children completed the Childhood Stigma Scale (adapted for SCD), the Child Perceptions of Racism in Children and Youth scale, and the Pediatric Quality of Life Inventory Sickle Cell Disease Module. Caregivers provided demographic information.Results: In the first regression model, health-related stigma (p = .007) predicted HRQOL, but neither age nor gender were significant predictors. In the second regression model, age (p = .03) predicted HRQOL, but neither gender nor racial bias were significant predictors. Of interest, there was a significant interaction between age, gender, and racial bias (p = .02). Specifically, older girls who reported high levels of perceived racial bias had poorer HRQOL.Conclusions: Our study highlights the need for increased awareness about the effects of health-related stigma and racial bias on HRQOL for children with SCD, particularly for older girls who endorse racial bias. Our findings will guide future stigma and bias reduction interventions that may meet the needs of older girls with SCD.
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Affiliation(s)
- Anna M Hood
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lori E Crosby
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eva Hanson
- Department of Medical Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lisa M Shook
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey D Lebensburger
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Avi Madan-Swain
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Megan M Miller
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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Bele S, Teela L, Zhang M, Rabi S, Ahmed S, van Oers HA, Gibbons E, Dunnewold N, Haverman L, Santana MJ. Use of Patient-Reported Experience Measures in Pediatric Care: A Systematic Review. Front Pediatr 2021; 9:753536. [PMID: 34988035 PMCID: PMC8721567 DOI: 10.3389/fped.2021.753536] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/26/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: Patient-reported Experience Measures (PREMs) are validated questionnaires, that gather patients' and families' views of their experience receiving care and are commonly used to measure the quality of care, with the goal to make care more patient and family-centered. PREMs are increasingly being adopted in pediatric population, however knowledge gaps exist around understanding the use of PREMs in pediatrics. Objective: To identify and synthesize evidence on the use of PREMs in pediatric healthcare settings and their characteristics. Evidence Review: Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines governed the conduct and reporting of this review. An exhaustive search strategy was applied to MEDLINE, EMBASE, PsycINFO, Cochrane Library, and CINAHL databases to identify relevant peer-reviewed articles from high-income countries. Additionally, gray literature was searched to capture real-world implementation of PREMs. All the articles were screened independently by two reviewers in two steps. Data was extracted independently, synthesized, and tabulated. Findings from gray literature was synthesized and reported separately. Risk of bias for the studies identified through scientific databases was assessed independently by two reviewers using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: The initial search identified 15,457 articles. After removing duplicates, the title and abstracts of 11,543 articles were screened. Seven hundred ten articles were eligible for full-text review. Finally, 83 articles met the criteria and were included in the analyses. Of the 83 includes studies conducted in 14 countries, 48 were conducted in USA, 25 in European countries and 10 in other countries. These 83 studies reported on the use of 39 different PREMs in pediatric healthcare settings. The gray literature retrieved 10 additional PREMs. The number of items in these PREMs ranged from 7 to 89. Twenty-three PREMs were designed to be completed by proxy, 10 by either pediatric patients or family caregivers, and 6 by pediatric patients themselves. Conclusion and Relevance: This comprehensive review is the first to systematically search evidence around the use of PREMs in pediatrics. The findings of this review can guide health administrators and researchers to use appropriate PREMs to implement patient and family-centered care in pediatrics.
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Affiliation(s)
- Sumedh Bele
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research Support Unit, Calgary, AB, Canada
| | - Lorynn Teela
- Psychosocial Department, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Muning Zhang
- Bachelor of Health Sciences Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarah Rabi
- Bachelor of Sciences Program, Queen's University, Kingston, ON, Canada
| | - Sadia Ahmed
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research Support Unit, Calgary, AB, Canada
| | - Hedy Aline van Oers
- Psychosocial Department, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Nicole Dunnewold
- Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Maria J. Santana
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research Support Unit, Calgary, AB, Canada
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Mulchan SS, Wakefield EO, Martin SR, Ayr-Volta L, Krenicki K, Zempsky WT. Navigating Ethical Challenges for Pediatric Sickle Cell Pain Management in the Context of the Opioid Epidemic. Clin J Pain 2021; 38:88-94. [PMID: 34803155 DOI: 10.1097/ajp.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/02/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim was to describe the impact of the opioid epidemic on pain management practices in pediatric sickle cell disease (SCD) and propose a conceptual framework for navigating ethical decision-making in pediatric sickle cell pain management. METHODS A review of the literature on ethical challenges in the management of sickle cell pain was conducted and considered in the context of the opioid epidemic and psychosocial factors affecting youth with SCD. The Integrated Ethical Framework for Pain Management (IEFPM) was applied to pediatric sickle cell pain management using a clinical case example. RESULTS Implicit bias, health-related stigma, and potential neurocognitive impairment all present unique challenges in ethical decision-making for youth with SCD. National guidelines for prescribing opioid medication may complicate providers' clinical decision-making and affect their sickle cell pain management practices. The IEFPM was found to be applicable to ethical decision-making for pediatric sickle cell pain and captures both patient-related and provider-related aspects of clinical pain management. DISCUSSION The opioid epidemic has exacerbated existing ethical challenges for pain management among youth with SCD. The IEFPM provides a conceptual model that can be integrated into health care settings to facilitate ethical decision-making and promote greater health equity in the clinical management of pediatric sickle cell pain.
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Affiliation(s)
- Siddika S Mulchan
- Connecticut Children's, Hartford
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Emily O Wakefield
- Connecticut Children's, Hartford
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Sarah R Martin
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine, Orange, CA
| | - Lauren Ayr-Volta
- Connecticut Children's, Hartford
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Kayla Krenicki
- Department of Psychology, Southern Connecticut State University, New Haven, CT
| | - William T Zempsky
- Connecticut Children's, Hartford
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
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Sil S, Lee JL, Klosky J, Vaz A, Mee L, Cochran S, Thompson B, Coakley R. The comfort ability program for adolescents with sickle cell pain: Evaluating feasibility and acceptability of an inpatient group-based clinical implementation. Pediatr Blood Cancer 2021; 68:e29013. [PMID: 33742546 PMCID: PMC8085908 DOI: 10.1002/pbc.29013] [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: 11/13/2020] [Revised: 02/05/2021] [Accepted: 02/28/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Integration of nonpharmacological therapies, such as cognitive and behavioral pain management strategies, is recommended to support comprehensive disease and pain management among children and adolescents with sickle cell disease (SCD). The Comfort Ability Program for Sickle Cell Pain (CAP for SCP) introduces psychological and biobehavioral pain management strategies to children and adolescents with SCD. This study aimed to pilot the implementation of the CAP for SCP in a group setting to children and adolescents hospitalized for SCD pain examining feasibility, acceptability, and preliminary effectiveness on improving pain knowledge and coping efficacy. METHOD Adaptation of CAP for SCP into a three-session group format was guided by four phases of the Dynamic Adaptation Process model: Exploration, Preparation, Implementation, and Sustainment. Youth with SCD (n = 57) hospitalized for pain participated in at least one session and completed self-report of knowledge of pain management skills, pain coping efficacy, and treatment acceptance. Completion rates of sessions and qualitative feedback were gathered to evaluate feasibility and acceptability. RESULTS Feasibility of conducting inpatient group sessions was suboptimal; however, patients and medical providers reported moderate to high levels of treatment acceptance. Patients also reported significant improvements in knowledge of pain management skills following session 1. CONCLUSIONS CAP for SCP is a patient-centered first-line psychoeducational intervention that can be integrated into clinical practice settings to introduce youth to cognitive and behavioral pain management strategies to support SCD pain management.
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Affiliation(s)
- Soumitri Sil
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jennifer L. Lee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - James Klosky
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Angela Vaz
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Laura Mee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Shavontia Cochran
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Beth Thompson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Rachael Coakley
- Department of Anesthesia, Critical Care, and Pain Medicine and Department of Psychiatry, Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts, USA
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Houwing ME, Buddenbaum M, Verheul TCJ, de Pagter APJ, Philipsen JNJ, Hazelzet JA, Cnossen MH. Improving access to healthcare for paediatric sickle cell disease patients: a qualitative study on healthcare professionals' views. BMC Health Serv Res 2021; 21:229. [PMID: 33712013 PMCID: PMC7953612 DOI: 10.1186/s12913-021-06245-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/01/2021] [Indexed: 01/10/2023] Open
Abstract
Background In well-resourced countries, comprehensive care programs have increased life expectancy of patients with sickle cell disease, with almost all infants surviving into adulthood. However, families affected by sickle cell disease are more likely to be economically disenfranchised because of their racial or ethnic minority status. As every individual child has the right to the highest attainable standard of health under the United Nations Convention on the Rights of the Child, it is essential to identify both barriers and facilitators with regard to the delivery of adequate healthcare. Optimal healthcare accessibility will improve healthcare outcomes for children with sickle cell disease and their families. Healthcare professionals in the field of sickle cell care have first-hand experience of the barriers that patients encounter when it comes to effective care. We therefore hypothesised that these medical professionals have a clear picture of what is necessary to overcome these barriers and which facilitators will be most feasible. Therefore, this study aims to map best practises and lessons learnt in order to attain more optimal healthcare accessibility for paediatric patients with sickle cell disease and their families. Methods Healthcare professionals working with young patients with sickle cell disease were recruited for semi-structured interviews. An interview guide was used to ensure the four healthcare accessibility dimensions were covered. The interviews were transcribed and coded. Based on field notes, initial codes were generated, to collate data (both barriers and solutions) to main themes (such as “transportation”, or “telecommunication”). Through ongoing thematic analysis, definitive themes were formulated and best practices were reported as recommendations. Quotations were selected to highlight or illustrate the themes and link the reported results to the empirical data. Results In 2019, 22 healthcare professionals from five different university hospitals in the Netherlands were interviewed. Participants included (paediatric) haematologists, nurses and allied health professionals. Six themes emerged, all associated with best practices on topics related to the improvement of healthcare accessibility for children with sickle cell disease and their families. Firstly, the full reimbursement of invisible costs made by caregivers. Secondly, clustering of healthcare appointments on the same day to help patients seeing all required specialists without having to visit the hospital frequently. Thirdly, organisation of care according to shared care principles to deliver specialised services as close as possible to the patient’s home without compromising quality. Fourthly, optimising verbal and written communication methods with special consideration for families with language barriers, low literacy skills, or both. Fifthly, improving the use of eHealth services tailored to users’ health literacy skills, including accessible mobile telephone contact between healthcare professionals and caregivers of children with sickle cell disease. Finally, increasing knowledge and interest in sickle cell disease among key stakeholders and the public to ensure that preventive and acute healthcare measures are understood and safeguarded in all settings. Conclusion This qualitative study describes the views of healthcare professionals on overcoming barriers of healthcare accessibility that arise from the intersecting vulnerabilities faced by patients with sickle cell disease and their families. The recommendations gathered in this report provide high-income countries with a practical resource to meet their obligations towards individual children under the United Nations Convention on the Rights of the Child.
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Affiliation(s)
- Maite E Houwing
- Department of Pediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Marit Buddenbaum
- Department of Pediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Thijs C J Verheul
- Department of Cell Biology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anne P J de Pagter
- Department of Pediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Jacobus N J Philipsen
- Department of Cell Biology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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Quigley DD, Palimaru A, Lerner C, Hays RD. A Review of Best Practices for Monitoring and Improving Inpatient Pediatric Patient Experiences. Hosp Pediatr 2020; 10:277-285. [PMID: 32071119 PMCID: PMC11111154 DOI: 10.1542/hpeds.2019-0243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT Achieving high-quality patient-centered care requires assessing patient and family experiences to identify opportunities for improvement. With the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, hospitals can assess performance and make national comparisons of inpatient pediatric experiences. However, using patient and family experience data to improve care remains a challenge. OBJECTIVE We reviewed the literature on best practices for monitoring performance and undertaking activities aimed at improving pediatric patient and family experiences of inpatient care. DATA SOURCES We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO. STUDY SELECTION We included (1) English-language peer-reviewed articles published from January 2000 to April 2019; (2) articles based in the United States, United Kingdom, or Canada; (3) articles focused on pediatric inpatient care; (4) articles describing pediatric patient and family experiences; and (5) articles including content on activities aimed at improving patient and family experiences. Our review included 25 articles. DATA EXTRACTION Two researchers reviewed the full article and abstracted specific information: country, study aims, setting, design, methods, results, Quality Improvement (QI) initiatives performed, internal reporting description, best practices, lessons learned, barriers, facilitators and study implications for clinical practice, patient-experience data collection, and QI activities. We noted themes across samples and care settings. RESULTS We identified 10 themes of best practice. The 4 most common were (1) use evidence-based approaches, (2) maintain an internal system that communicates information and performance on patient and family experiences to staff and hospital leadership, (3) use experience survey data to initiate and/or evaluate QI interventions, and (4) identify optimal times (eg, discharge) and modes (eg, print) for obtaining patient and family feedback. These correspond to adult inpatient best practices. CONCLUSIONS Both pediatric and adult inpatient best practices rely on common principles of culture change (such as evidence-based clinical practice), collaborative learning, multidisciplinary teamwork, and building and/or supporting a QI infrastructure that requires time, money, collaboration, data tracking, and monitoring. QI best practices in both pediatric and adult inpatient settings commonly rely on identifying drivers of overall ratings of care, rewarding staff for successful implementation, and creating easy-to-use and easy-to-access planning and QI tools for staff.
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Affiliation(s)
| | | | - Carlos Lerner
- Division of General Internal Medicine and Health Services Research
- University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Ron D Hays
- RAND Corporation, Santa Monica, California
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and
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Wakefield EO, Pantaleao A, Popp JM, Dale LP, Santanelli JP, Litt MD, Zempsky WT. Describing Perceived Racial Bias Among Youth With Sickle Cell Disease. J Pediatr Psychol 2019; 43:779-788. [PMID: 29562253 DOI: 10.1093/jpepsy/jsy015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/07/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives Sickle cell disease (SCD) predominately affects Black Americans. This is the first study of its kind to describe the racial bias experiences of youth with SCD and their reactions to these experiences. Methods Participants were 20 youth with SCD (ages 13-21 years) who were asked to describe any racial bias events they experienced, as recorded on the Perception of Racism in Children and Youth measure (PRaCY). Interviews were recorded, transcribed, and analyzed by two independent raters using a conventional content analysis approach. Results All participants reported at least one incident of racial bias. Content analysis of racial bias events (n = 104) yielded 4 categories and 12 subcategories as follows: Perpetrator (Peers, Authority Figures, and General Public), Type of Racial Bias (Explicit, Implicit), Behavioral Reaction (Approach, Avoidant), and Emotional Response (Dysphoria, Anger, Unconcerned, Inferior, Anxious). Discussion This study provides a description of racial bias experiences within community and medical settings and highlights the need for further evaluation of the impact of racial bias among youth with SCD.
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Affiliation(s)
- Emily O Wakefield
- Department of Psychology, University of Hartford.,Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, University of Connecticut School of Medicine
| | - Ashley Pantaleao
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center
| | - Jill M Popp
- Department of Research, Connecticut Children's Medical Center
| | | | - James P Santanelli
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center
| | - Mark D Litt
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center
| | - William T Zempsky
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, University of Connecticut School of Medicine
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Abstract
OBJECTIVE Little is known about the role of perceived racial bias and health-related stigma on the health of youth with sickle cell disease (SCD). The purpose of this study was to investigate the occurrence of perceived racial bias and health-related stigma among youth with SCD and its relationship with psychological and physical well-being. METHODS Twenty-eight youth with SCD, ages 13 to 21, were recruited from outpatient and inpatient settings at an urban children's medical center. Participants completed measures of perceived racial bias, perceived health-related stigma, depression, quality of life, and pain burden. RESULTS Most participants endorsed occurrences of racial bias and health-related stigma. The findings indicate that greater perceived racial bias was associated with greater pain burden, and greater perceived health-related stigma was related to lower quality of life. CONCLUSION Perceived racial bias and health-related stigma may be important to consider for future research investigating the psychological and physiological features of SCD for youth.
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10
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Haywood C, Lanzkron S, Hughes M, Brown R, Saha S, Beach MC. The Association of Clinician Characteristics with their Attitudes Toward Patients with Sickle Cell Disease: Secondary Analyses of a Randomized Controlled Trial. J Natl Med Assoc 2015; 107:89-96. [PMID: 27269495 DOI: 10.1016/s0027-9684(15)30029-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A high level of evidence exists to suggest that negative attitudes held by clinicians toward persons with sickle cell disease serve as important barriers to the delivery of high quality care to this patient population. Little is known, though, about the characteristics of clinicians that may be predictive of these negative attitudes. METHODS During spring and summer 2009, we conducted a randomized controlled trial to test an intervention to improve clinician attitudes toward persons with sickle cell disease. Participating clinicians completed questionnaires regarding their demographic characteristics and their attitudes toward sickle cell patients. Principal clinician characteristics of interest included their race, professional discipline (nurse/physician), and the amount of their recent exposure to sickle cell patients in pain. Secondary analyses from this trial are presented here. MAIN FINDINGS Asian clinicians reported more negative attitudes towards these patients than did Black or White clinicians, nurses reported more negative attitudes than physicians, and clinicians with the greatest levels of recent exposure to sickle cell patients in pain reported more negative attitudes than did clinicians with lower levels of recent exposure. CONCLUSIONS Our findings could facilitate the development of tailored educational resources needed to improve the quality of care delivered to persons with sickle cell disease, a national priority for sickle cell efforts.
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Affiliation(s)
- Carlton Haywood
- The Johns Hopkins School of Medicine, The Johns Hopkins Berman Institute of Bioethics.
| | | | - Mark Hughes
- The Johns Hopkins School of Medicine, The Johns Hopkins Berman Institute of Bioethics
| | | | - Somnath Saha
- Section of General Internal Medicine, Oregon Health and Science University, Division of General Internal Medicine & Geriatrics
| | - Mary Catherine Beach
- The Johns Hopkins School of Medicine, The Johns Hopkins Berman Institute of Bioethics
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11
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Haywood C, Williams-Reade J, Rushton C, Beach MC, Geller G. Improving Clinician Attitudes of Respect and Trust for Persons With Sickle Cell Disease. Hosp Pediatr 2015; 5:377-84. [PMID: 26136312 DOI: 10.1542/hpeds.2014-0171] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To test the effect of 1 high-intensity, and 1 reduced-intensity, educational intervention designed to improve health care provider attitudes toward youth with sickle cell disease (SCD). METHODS We exposed a regional sample of pediatric health care providers to a 2.5-day high-intensity educational and experiential intervention using videos about the SCD patient experience. Additionally, we traveled to a different set of regional health care institutions and offered pediatric providers a reduced-intensity intervention, consisting of a 90-minute lunchtime in-service centered on our same set of videos about the patient's experience. We assessed the impact of both interventions by taking pre/post measurements of the negative and positive attitudes expressed by participating providers toward patients with SCD. RESULTS Both interventions tested elicited improvements in the SCD attitudes expressed by the pediatric providers as suggested through a reduction in measured negative attitude scores (20.0 vs 12.1, P < .001), and an improvement in positive attitude scores (67.1 vs 72.2, P < .001). Further testing suggested that the high-intensity intervention elicited a stronger effect than the reduced-intensity intervention across multiple attitudinal domains. CONCLUSIONS Video-based interventions can be used to improve the attitudes of pediatric providers toward patients with SCD. The availability of interventions of varying intensities provides greater flexibility in designing efforts to advance the quality of SCD care through the improvement of provider attitudes.
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Affiliation(s)
- Carlton Haywood
- The Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; and
| | | | - Cynda Rushton
- The Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; and
| | - Mary Catherine Beach
- The Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; and
| | - Gail Geller
- The Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; and
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Abstract
BACKGROUND The aims of this study were to describe guardian perceptions of the experiences of a sample of youth with sickle cell disease (SCD) in rural emergency departments (EDs) with a focus on overall patient satisfaction and characteristics of care. PROCEDURE Guardians of 139 children with SCD (0 to 17 y) seen at a rural pediatric SCD clinic completed a survey concerning their children's ED experiences in the past 6 months, including information about ED wait times, quality of communications and interactions with the ED health care providers, pain management, perceptions of speed of care, and overall satisfaction. RESULTS About 41% of guardians reported that their child visited the ED in the past 6 months. Guardians reported moderate satisfaction with ED care. About 25% of those who visited the ED indicated that health care providers did not spend enough time with them and their children did not receive speedy care. Shorter ED wait times and higher ratings of speed of care predicted higher satisfaction. CONCLUSIONS Families of youth with SCD are experiencing longer wait times in rural EDs which contribute to dissatisfaction with care. Efforts are needed to develop strategies to reduce ED wait times and improve speed of care which may improve outcomes following ED care.
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Abstract
To document the impact of Tourette syndrome on the health care needs of children and access to health care among youth with Tourette syndrome, parent-reported data from the 2007-2008 National Survey of Children's Health were analyzed. Children with Tourette syndrome had more co-occurring mental disorders than children with asthma or children without Tourette syndrome or asthma and had health care needs that were equal to or greater than children with asthma (no Tourette syndrome) or children with neither asthma nor Tourette syndrome. Health care needs were greatest among children with Tourette syndrome and co-occurring mental disorders, and these children were least likely to receive effective care coordination. Addressing co-occurring conditions may improve the health and well-being of children with Tourette syndrome. Strategies such as integration of behavioral health and primary care may be needed to improve care coordination.
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Affiliation(s)
- Rebecca H Bitsko
- 1Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Thompson AA. Sickle cell disease and racism: real or false barriers? Pediatr Blood Cancer 2013; 60:349-50. [PMID: 23255423 DOI: 10.1002/pbc.24418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/06/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Alexis A Thompson
- Division of Hematoloy- Oncology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611, USA.
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15
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The impact of race and disease on sickle cell patient wait times in the emergency department. Am J Emerg Med 2013; 31:651-6. [PMID: 23380119 DOI: 10.1016/j.ajem.2012.11.005] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/13/2012] [Indexed: 11/23/2022] Open
Abstract
STUDY OBJECTIVE To determine whether patients with sickle cell disease (SCD) experience longer wait times to see a physician after arrival to an emergency department (ED) compared to patients with long bone fracture and patients presenting with all other possible conditions (General Patient Sample), and to attempt to disentangle the effects of race and disease status on any observed differences. METHODS A cross-sectional, comparative analysis of year 2003 through 2008 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of nonfederal emergency department visits in the United States. Our primary outcome was wait time (in minutes) to see a physician after arrival to an ED. A generalized linear model was used to examine ratios of wait times comparing SCD visits to the two comparison groups. RESULTS SCD patients experienced wait times 25% longer than the General Patient Sample, though this difference was explained by the African-American race of the SCD patients. SCD patients waited 50% longer than did patients with long bone fracture even after accounting for race and assigned triage priority. CONCLUSIONS Patients with SCD presenting to an ED for care experience longer wait times than other groups, even after accounting for assigned triage level. The African-American race of the SCD patients, and their status as having SCD itself, both appear to contribute to longer wait times for these patients. These data confirm patient anecdotal reports and are in need of intervention.
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Raphael JL, Rattler TL, Kowalkowski MA, Mueller BU, Giordano TP. The medical home experience among children with sickle cell disease. Pediatr Blood Cancer 2013; 60:275-80. [PMID: 22522496 PMCID: PMC3427710 DOI: 10.1002/pbc.24184] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 04/02/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND While a large body of research documents acute care services for children with sickle cell disease (SCD), little is known about the primary care experiences of this population. The goal of this study was to determine to what extent children with SCD experienced care consistent with a patient-centered medical home (PCMH). PROCEDURE We collected and analyzed data from 150 children, ages 1-17 years, who received care within a large children's hospital. The primary dependent variable was access to a PCMH or its four individual components (regular provider, comprehensive care, family-centered care, and coordinated care) as determined by parental report. Multivariate logistic regression was conducted to investigate associations between socio-demographic variables and having access to a PCMH. RESULTS Only 11% (16/150) of children qualified as having a PCMH, achieving the required thresholds in all four components. Approximately half of children had access to two or fewer components. Over 90% of children were reported to have a personal provider. Two-thirds of children had access to comprehensive care. Almost 60% of children were reported to receive family-centered care. Only 20% of children had access to coordinated care. No consistent associations were found between socio-demographic variables and having access to a PCMH or its individual components. CONCLUSIONS Within our study sample, children with SCD experienced multiple deficiencies in having access to a PCMH, particularly with respect to care coordination. However, further studies with larger samples are needed to determine associations between socio-demographic variables and having a PCMH.
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Affiliation(s)
- Jean L. Raphael
- Department of Pediatrics, Baylor College of Medicine, Hematology/Oncology, Houston, TX
| | - Tiffany L. Rattler
- Department of Pediatrics, Baylor College of Medicine, Hematology/Oncology, Houston, TX
| | | | - Brigitta U. Mueller
- Department of Pediatrics, Baylor College of Medicine, Hematology/Oncology, Houston, TX
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Weisberg D, Balf-Soran G, Becker W, Brown SE, Sledge W. "I'm talking about pain": sickle cell disease patients with extremely high hospital use. J Hosp Med 2013; 8:42-6. [PMID: 23169484 DOI: 10.1002/jhm.1987] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 09/11/2012] [Accepted: 09/17/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND A small minority of sickle cell disease patients accounts for the majority of inpatient hospital days. Admitted as often as several times a month, over successive years, this cohort of patients has not been studied in depth despite their disproportionate contribution to inpatient hospital costs in sickle cell disease. OBJECTIVE To characterize the subjective experience of extremely high hospital use in patients with sickle cell disease, and generate hypotheses about the antecedents and consequences of this phenomenon. DESIGN Qualitative study involving in-depth, open-ended interviews using a standardized interview guide. SETTING A single urban academic medical center. PARTICIPANTS Eight individuals, of varying age and gender, identified as the sickle cell disease patients who are among the highest hospital use patients over a 3-year period. RESULTS A common narrative emerged from the interview transcripts. Participants were exposed to the hospital environment and intravenous (IV) opioids at a young age, and this exposure was associated with extremely high hospital use in adulthood, evident in descriptions of multiple dimensions of their lives: pain and opioid medication use, interpersonal relationships, and personal development. CONCLUSIONS Our results suggest a systematic, self-reinforcing process of isolation from mainstream society, support structures, and caregivers, based on increasing hospitalization, growing dependency on opioid medications, as well as missed developmental milestones. Further study and interventions should be geared towards breaking this spiraling cycle with long-term strategies in disease management and social integration.
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Affiliation(s)
- Daniel Weisberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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White PH, McManus MA, McAllister JW, Cooley WC. A primary care quality improvement approach to health care transition. Pediatr Ann 2012; 41:e1-7. [PMID: 22587507 DOI: 10.3928/00904481-20120426-07] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Patience H White
- George Washington University School of Medicine and Health Sciences, USA.
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Growing up with sickle cell disease: a pilot study of a transition program for adolescents with sickle cell disease. J Pediatr Hematol Oncol 2011; 33:379-82. [PMID: 21602723 DOI: 10.1097/mph.0b013e318211bb2e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We implemented the Duke Sickle Cell Disease (SCD) Transition Program for adolescents with SCD and investigated the knowledge about SCD; concerns and emotions about transitioning; and the initial impact of the Transition Program. Thirty-three adolescents participated in the initial study. Gaps in knowledge included ethnicities affected by SCD and inheritance of SCD. Adolescents were primarily concerned about transferring to a new medical team. There was a mix of both positive and negative emotions that varied over time. Overall, we have identified educational gaps and concerns and emotions about transitioning, which we will address through the Duke SCD Transition Program.
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Stanton MV, Jonassaint CR, Bartholomew FB, Edwards C, Richman L, DeCastro L, Williams R. The association of optimism and perceived discrimination with health care utilization in adults with sickle cell disease. J Natl Med Assoc 2011; 102:1056-63. [PMID: 21141295 DOI: 10.1016/s0027-9684(15)30733-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We evaluated the effect of perceived discrimination, optimism, and their interaction on health care utilization among African American adults with sickle cell disease (SCD). METHODS Measures of optimism and perceived discrimination were obtained in 49 African American SCD patients. Multiple regression analyses controlling for sex and age tested effects of optimism and perceived discrimination on the number of emergency department visits (ED) and number and duration of hospitalizations over the past year. RESULTS A perceived discrimination-optimism interaction was associated with number of emergency departments visits (b = .29, p = .052), number of hospitalizations (b = .36, p = .019), and duration of hospitalizations (b = .30, p = .045) such that those with high perceived discrimination/high optimism had the greatest health care utilization. CONCLUSIONS African American SCD patients with high perceived discrimination/high optimism had greater health care utilization than patients who reported either low perceived discrimination or low optimism. This study suggests that patient personality and coping styles should be considered when evaluating the effects of stress on SCD-related outcomes.
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Affiliation(s)
- Michael V Stanton
- Department of Psychology and Neuroscience, Duke University Medical Center, Durham, North Carolina, USA
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21
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Liem RI, Cole AH, Pelligra SA, Mason M, Thompson AA. Parental attitudes toward research participation in pediatric sickle cell disease. Pediatr Blood Cancer 2010; 55:129-33. [PMID: 20213846 DOI: 10.1002/pbc.22450] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Socio-cultural attitudes and perceptions are commonly cited barriers to the recruitment of African-Americans for medical research, yet no studies have examined the factors influencing research participation among individuals with sickle cell disease (SCD) or caregivers of children with SCD. PROCEDURE We distributed a 32-item, self-administered survey to parents or legal guardians of children with SCD over a 6-month period. We used Pearson's chi-square to determine factors associated with a favorable attitude toward research participation and logistic regression to determine independent associations. RESULTS We collected 151 surveys in this pilot study. In general, 86% of respondents believed more research needed to be done for SCD and 57% would allow their child to participate in a medical research study, corresponding to a favorable attitude. Respondent belief that more research needed to be done for SCD (OR 23.4, 95% CI 4.5-121.9, P = 0.001), perception of greater severity of their own child's SCD (OR 2.7, 95% CI 1.0-7.1, P = 0.041) and prior exposure to research (OR 3.2, 95% CI 1.0-10.3, P = 0.043) were significantly associated with a favorable attitude, although only the first two remained independent associations in our regression model. Attitude toward research participation was not affected by respondent country of birth. CONCLUSIONS Parents of children with SCD who allow participation in medical research are likely to believe that more research is needed in SCD and that their child's SCD is moderate to severe. Developing effective tools, based on identified knowledge gaps related to clinical research, may improve research participation in this population.
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Affiliation(s)
- Robert I Liem
- Division of Hematology, Oncology & Stem Cell Transplant, Children's Memorial Hospital, Chicago, Illinois, USA.
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