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Düken ME, Yayan EH. Psychosocial conditions of children after liver transplant: Post-traumatic stress, depression, and anxiety. J Pediatr Nurs 2024; 75:e75-e80. [PMID: 38216348 DOI: 10.1016/j.pedn.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/14/2024]
Abstract
AIM This study aimed to determine psychosocial conditions, post-traumatic stress, depression, and anxiety of children who underwent a liver transplant. METHOD This is a relational descriptive study, which was conducted between March 2019 and December 2020 in the Inonu University Liver Transplantation Institute Pediatric Liver Transplant Clinic. The "Child Information Form," "Child Post-Traumatic Stress Reaction Index," "State-Trait Anxiety Inventory for Children-Trait Form," and "Children's Depression Inventory" were used to collect data. The study was conducted with 71 children who had a previous liver transplant. RESULTS Of the participating children, 56.3% were girls, 63.4% continued their primary school education after the transplant, 32.5% were diagnosed with cirrhosis, 39.4% received the transplant in 2017, 32.4% received it from the mother, and 25.4% received it from a cadaveric donor. Although it had been at least 3 years since the transplant, 47.9% exhibited moderate and 43.7% severe post-traumatic stress responses. There was a significant negative relationship between the age of children with a liver transplant and trait anxiety and post-traumatic stress responses (path coefficients β = -0.268, p = 0.002; β = -0.166, p = 0.023, respectively). There was a significant positive relationship between anxiety and post-traumatic stress responses of the children after the transplant and there was a statistically significant relationship between the path coefficients (β = 0.750; p < 0.001). CONCLUSION Children who underwent a liver transplant had post-traumatic stress disorder, depression, and trait anxiety.
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Affiliation(s)
- Mehmet Emin Düken
- Harran University, Health Sciences of Faculty -Department of Child Health and Diseases Nursing, Şanlıurfa 63000, Turkey; Inönü University, Faculty of Nursing- Department of Child Health and Diseases Nursing, Malatya 44280, Turkey.
| | - Emriye Hilal Yayan
- Inönü University, Faculty of Nursing- Department of Child Health and Diseases Nursing, Malatya 44280, Turkey.
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2
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Hetzer B, Meryk A, Kropshofer G, Salvador C, Riedl D, Lehmann J, Rumpold G, Haid A, Schneeberger-Carta V, Holzner B, Crazzolara R. Integration of Daily Patient-Reported Outcome Measures in Pediatric Stem Cell Transplantation. Transplant Cell Ther 2023; 29:776.e1-776.e7. [PMID: 37741458 DOI: 10.1016/j.jtct.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023]
Abstract
Patients' reports of their health status are increasingly used in hematopoietic stem cell transplantation (SCT) to better understand the negative impact on symptom burden and quality of life. Little is known regarding the implementation in routine clinical care, particularly how it can be used to improve supportive care. We sought to the evaluate feasibility of capturing daily patient-reported outcomes (PROs) in the acute phase of SCT to measure physical and psychosocial symptom burden. In this single-center prospective observational study, we assessed daily PRO from conditioning to neutrophil engraftment in children (age 1 to 18 year) who underwent allogeneic or autologous SCT for malignant and nonmalignant disease. The most common acute adverse effects of chemotherapy (pain, nausea, loss of appetite, sleep disturbance, and physical performance impairment) were reported daily via ePROtect, a web-based program designed to integrate health responses. From February 2021 to March 2023, 20 children undergoing allogeneic (allo-) SCT (n = 11) or autologous (auto-) SCT (n = 9) and their proxies consented to participation, all of whom were included in this analysis. A total of 359 PRO questionnaires were completed, corresponding to a median daily completion rate of 72.7% (interquartile range, 60.4% to 83.6%). After conditioning, pain perception anticipated the rise of infectious parameters and the development of mucositis, thus initiating supportive treatment. Patients reported the strongest symptom burden at a median of 8.5 days post-transplantation. At 4 weeks post-transplantation, baseline values were restored for all symptoms. There were no significant differences between auto-SCT and allo-SCT, except for nausea and loss of appetite after administration of antithymocyte globulin in allo-SCT. This study empirically documents the daily health status of children undergoing SCT and proposes an attractive modus operandi on how continuous feedback on health-related symptoms can be integrated into daily clinical practice.
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Affiliation(s)
- Benjamin Hetzer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Meryk
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Salvador
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria; Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Jens Lehmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandra Haid
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.
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3
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Ward J, Smith J, Powers K, Hellsten M, Murray P. Parent Psychological Distress is Associated with Symptom Burden and Health-Related Quality of Life in Children and Adolescents Undergoing Stem Cell Transplantation or Chimeric Antigen Receptor-T Therapy. Transplant Cell Ther 2023:S2666-6367(23)01241-1. [PMID: 37086850 DOI: 10.1016/j.jtct.2023.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/09/2023] [Accepted: 04/14/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor T-cell (CAR-T) therapy are potentially curative treatment options for children with life-threatening conditions, but can result in a high symptom burden, poor health-related quality of life (HRQoL), and parent psychological distress. OBJECTIVES The purpose of this study is to describe, over time, the association between parent psychological distress with symptom burden and HRQoL among children undergoing HSCT or CAR-T therapy. STUDY DESIGN This multisite study employed a longitudinal, repeated measures design. English and Spanish-speaking parents and their children ages 2-18 years with planned HSCT or CAR-T therapy were eligible. Parents completed self-report measures of psychological distress (Beck Anxiety and Depression Inventories, Perceived Stress Scale) at 4 timepoints: pre-cell infusion, and days +30, +60, +90 after the child's cell infusion. The Memorial Symptom Assessment Scale and PedsQL Cancer Module were administered to children (parent-proxy for younger children) at corresponding timepoints. A symptom cluster called parent distress was created from each parent outcome using exploratory factor analysis. Longitudinal parallel process modeling was used to study the relationship between parent distress and child symptoms and HRQoL over time. RESULTS In total, 140 child/parent dyads (280 participants) were enrolled across 4 sites. Child mean age was 8.4 years/SD=5, 56.4% were male, primarily with an underlying diagnosis of malignancy (72.9%). Most parents were mothers (80.7%), mean age of 39 years/SD=8.1. Parent distress was consistently higher than normative means generated from non-clinical samples of adults. High frequency of suicidal ideation was reported by parents (38.5% at baseline, 37% at day +30, 27.4% at day +60. 33.6% at day +90). A significant relationship between parent distress, child HRQoL and child symptoms was observed at baseline and through day +90. CONCLUSION Findings suggest that parents experience clinically relevant psychological distress throughout their child's HSCT or CAR-T therapy and this parent distress is associated with child HRQoL and symptom scores. Increased psychoeducational support tailored to address parental psychological distress is needed and has potential to positively impact the child's HRQoL and symptoms.
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Affiliation(s)
- Jessica Ward
- Research Nurse Scientist, Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Work address: 4650 Sunset Blvd, Los Angeles, CA 90027, Cell phone: 312-405-4393.
| | - Jilayne Smith
- Pediatric Nurse Practitioner, Pediatric Blood and Marrow Transplant and Cellular Therapy, Children's Hospital of Colorado, Work Address: 13123 E. 16th Ave, Aurora, CO 80045.
| | - Kimberly Powers
- Pediatric Nurse Practitioner, Pediatric Stem Cell Transplantation and Cellular Therapy Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Work address: 225 E Chicago Ave, Chicago, IL 60611.
| | - Melody Hellsten
- Associate Director Texas Children's Cancer and Hematology Centers Palliative Care Program, Texas Children's Hospital, Work Address: 6701 Fannin St, Houston, TX 77030.
| | - Paula Murray
- Biostatistician, Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Work address: 4650 Sunset Blvd, Los Angeles, CA 90027
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4
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West KB, Plevinsky JM, Amaral S, Laskin B, Lefkowitz DS. Predicting psychosocial risk in pediatric kidney transplantation: An exploratory cluster analysis of a revised Pediatric Transplant Rating Instrument. Pediatr Transplant 2023; 27:e14454. [PMID: 36518059 DOI: 10.1111/petr.14454] [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: 05/22/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Pediatric Transplant Rating Instrument (P-TRI) is a 17-item scale developed to assess psychosocial risk factors for poor outcomes after solid organ transplantation. Research has identified the limitations of the original instrument and proposed revisions to improve clinical utility. This project examined patterns of risk in children being evaluated for kidney transplant using a revised P-TRI. METHODS A multidisciplinary kidney transplant team revised the P-TRI. A social worker and a psychologist collaboratively completed the modified instrument for 37 children after the psychosocial pretransplant evaluation. Electronic medical records were reviewed for transplant status (transplanted, active waitlist, inactive) 1 year later. Exploratory cluster analyses and chi-square tests examined patterns of risk and correlates with cluster membership. RESULTS Three clusters were identified. The high-risk group (29.7%) had difficulties with medication and appointment adherence, strained relationships with the medical team, and the presence of parent psychiatric history. The medium-risk group (35.1%) had difficulties with parent knowledge, financial strain, and risk factors for medication nonadherence. The low-risk group (35.1%) demonstrated no difficulties with adherence or financial strain. Clusters were prospectively associated with transplant status, such that those in the high-risk group were less likely to be transplanted within 1 year post-evaluation. CONCLUSIONS The revised P-TRI demonstrated good construct validity as risk level appeared to be associated with transplant listing status 1 year post-evaluation. These results suggest that standardized pretransplant psychosocial risk assessment tools may have value in optimizing transplant access if they can be paired with targeted, multidisciplinary interventions to address concerns early in the transplant process.
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Affiliation(s)
- Kara B West
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jill M Plevinsky
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sandra Amaral
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin Laskin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Debra S Lefkowitz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Beckmann NB, Dietrich MS, Hooke MC, Gilmer MJ, Akard TF. Parental Posttraumatic Growth After Pediatric Hematopoietic Stem Cell Transplant. J Hosp Palliat Nurs 2021; 23:331-338. [PMID: 34185727 DOI: 10.1097/njh.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known about the development of posttraumatic growth among parents of children with serious advanced disease. The purpose of this study is to describe parental posttraumatic growth 100 days after pediatric stem cell transplant. This is a cross-sectional, descriptive study of 24 parents, approximately 100 days after their children received stem cell transplant. Participants reported environmental, personal, and disease characteristics and completed measures of distress, coping, rumination, and posttraumatic growth. Evidence of parental posttraumatic growth was described in each of 5 dimensions (relating to others, new possibilities, personal strength, spiritual change, and appreciation of life). Posttraumatic growth was positively associated with parental distress, disengagement coping, and rumination measures (r = 0.44-0.47, P < .05). Appreciation of life demonstrated the strongest associations with distress and rumination (r = 0.53-0.61, P < .01). Curvilinear relationships were observed for the association of distress, disengagement coping, and involuntary engagement with posttraumatic growth (P < .05). Study results highlight opportunities for palliative care nurses and clinicians to facilitate opportunities to support parent posttraumatic growth during treatment for children's advanced disease.
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Liu YM, Jaing TH, Wen YC, Chen SH, Weng PY, Lin L, Wu CL. Health-related quality of life predicts length of hospital stay and survival rates for pediatric patients receiving allogeneic hematopoietic cell transplantation. Qual Life Res 2021; 30:3421-3430. [PMID: 34018123 DOI: 10.1007/s11136-021-02887-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We examined the association between health-related quality of life (HRQoL) of pediatric patients during hospitalization for allogeneic hematopoietic cell transplantation (HCT) and length of hospital stay, and 1-year survival. METHODS Primary family caregivers were proxy-assessors for the Pediatric Quality of Life (PedsQL) Stem Cell Transplant Module at three time points: 5-days pre-HCT (T0); 14-days post-HCT (engraftment, T1); and 1-week before hospital discharge (T2). Cox regression analyses determined predictors of the overall 1-year survival after allogeneic HCT. RESULTS Thirty-nine eligible caregivers completed all assessments. The mean age of the pediatric patients was 9.07 years (SD = 5.2). PedsQL Stem Cell Transplant Module scores decreased from 71.33 (SD = 13.26) at T0 to 55.41(SD = 13.05) at T1 (p < 0.001) and increased to 68.46 (SD = 13.97) at T2 (p < 0.001). There was no significant difference between scores at T0 and T2. Longer length of hospital stay was associated with children who were younger and had greater relative changes in scores on the caregiver-proxy PedsQL Stem Cell Transplant Module from T0 to T1. PedsQL Stem Cell Transplant Module scores ≥ 58.07 at T2 were associated with higher 1-year survival rates (Hazard Ratio = 0.12, 95% Confidence Interval = 0.02-0.78; p = 0.03). CONCLUSION Our findings suggest that assessment of HRQoL during early HCT can add prognostic value beyond demographic and HCT factors. Understanding the HRQoL status during hospitalization for HCT could help identify pediatric patients with low prospects of 1-year survival in order to provide support interventions to improve HRQoL and survival rates.
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Affiliation(s)
- Ying-Mei Liu
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- , No. 261, Wen-Hwa 1st Road, Guishan District, Taoyuan, Taiwan.
| | - Tang-Her Jaing
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Yin Weng
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lin Lin
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Chia-Ling Wu
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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7
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Patient-reported outcomes in survivors of childhood hematologic malignancies with hematopoietic stem cell transplant. Blood 2021; 135:1847-1858. [PMID: 32243495 DOI: 10.1182/blood.2019003858] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/05/2020] [Indexed: 12/22/2022] Open
Abstract
Patient-reported outcomes among survivors of pediatric hematopoietic stem cell transplant (HSCT) are understudied. We compared symptom prevalence, health-related quality of life (HRQOL), and risk factors in adult survivors of childhood hematologic malignancies treated with HSCT to those treated with conventional therapy and noncancer controls. Survivors of childhood hematologic malignancies (HSCT N = 112 [70% allogeneic, 30% autologous]; conventionally treated N = 1106) and noncancer controls (N = 242) from the St. Jude Lifetime Cohort Study completed surveys assessing 10 symptom domains and SF-36 HRQOL summary scores. Chronic health conditions (CHCs) were validated by clinical assessment. Multivariable logistic regression reveals that compared with noncancer controls, HSCT survivors endorsed a significantly higher symptom prevalence in sensation (OR = 4.7, 95% confidence interval [CI], 2.6-8.4), motor/movement (OR = 4.3, 95% CI, 1.6-11.0), pulmonary (OR = 4.6, 95% CI, 1.8-11.8), and memory domains (OR = 4.8, 95% CI, 2.5-9.2), and poorer physical HRQOL (OR = 6.9, 95% CI, 2.8-17.0). HSCT and conventionally treated survivors had a similar prevalence of all symptom domains and HRQOL (all P > .05); however, HSCT survivors had a significantly higher cumulative prevalence for specific symptoms: double vision (P = .04), very dry eyes (P < .0001), and trouble seeing when wearing glasses (P < .0001). Occurrence of organ-specific CHCs, instead of transplant receipt, was significantly associated with a higher prevalence of all symptom domains (all P < .05) in adult survivors of childhood cancer, except for pain and anxiety domains. This study found that patient-reported outcomes were equally impaired between HSCT and conventionally treated survivors, but poorer in both groups compared with noncancer controls. Poor patient-reported outcomes in all survivors of childhood hematologic malignancies correlated with the presence of CHCs, whether treated with conventional therapy or HSCT.
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Chardon ML, Canter KS, Pai ALH, Peugh JL, Madan-Swain A, Vega G, Joffe NE, Kazak AE. The impact of pediatric hematopoietic stem cell transplant timing and psychosocial factors on family and caregiver adjustment. Pediatr Blood Cancer 2020; 67:e28552. [PMID: 32881326 DOI: 10.1002/pbc.28552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The impact of pediatric hematopoietic stem cell transplant (HCT) on family functioning varies, but little is known about how the timing of HCT in children's treatment course contributes to this variability. This study examines how preexisting child, sibling, and family problems, the length of time between diagnosis to HCT, and children's age at HCT are associated with family and caregiver functioning. PROCEDURE Caregivers (n = 140) of children (≤18 years old) scheduled to undergo their first HCT completed the Psychological Assessment Tool-HCT and the Impact on Family Scale. Treatment information was extracted from electronic medical records. A bootstrapped multivariate path analysis was used to test the hypotheses. RESULTS More preexisting family problems related to greater caregiver perceived negative impact of their child's HCT across family and caregiver functioning domains. Less time between diagnosis and HCT was associated with greater caregiver personal strain, particularly for those with younger children undergoing HCT. Younger child age at HCT was also associated with a larger negative impact on family social functioning. CONCLUSIONS Families with preexisting problems are the most at-risk for experiencing negative impacts related to their child's HCT. The timing of a child's HCT within their treatment course and the child's age during HCT may impact families' social functioning and caregiver adjustment. Screening families for preexisting family problems, particularly for families with young children or who are abruptly learning of their child's need for an HCT, may assist providers in identifying families who would benefit from earlier or more intensive psychosocial support.
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Affiliation(s)
- Marie L Chardon
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kimberly S Canter
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Orlando, Florida.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ahna L H Pai
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James L Peugh
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Avi Madan-Swain
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabriela Vega
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Orlando, Florida
| | - Naomi E Joffe
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Anne E Kazak
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Orlando, Florida.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania
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West CH, Dusome DL, Winsor J, Rallison LB. Falling Down the Rabbit Hole: Child and Family Experiences of Pediatric Hematopoietic Stem Cell Transplant. QUALITATIVE HEALTH RESEARCH 2020; 30:1125-1138. [PMID: 32249699 PMCID: PMC7252601 DOI: 10.1177/1049732320912410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pediatric hematopoietic stem cell transplant (HSCT) is an intensive treatment that can be life-threatening. All family members experience distress. We conducted a grounded theory study using a family systems-expressive arts framework to develop a theoretical understanding of the family experience of HSCT. Six families (15 family members) participated in two interviews, drew an image, and were guided through a "dialoguing with images" process. Participants did not always perceive HSCT as an experience they had lived as a family and were surprised to hear other family members' experiences. While one mother drew, she suddenly understood it was not only her ill child, but the entire family who had "fallen down the rabbit hole." The family experience of HSCT is described across (a) the pre-HSCT trajectory, (b) family fragmentation (hospitalization), and (c) family reintegration. We identified a critical need for targeted family intervention during the transition into HSCT, throughout and following hospitalization.
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Affiliation(s)
| | - Debra L. Dusome
- Brandon University (Winnipeg site), Winnipeg,
Manitoba, Canada
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10
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Gomes IM, Lacerda MR, Hermann AP, Rodrigues JAP, Zatoni DCP, Tonin L. Care performed by family caregivers of children submitted to hematopoietic stem cell transplantation. Rev Lat Am Enfermagem 2019; 27:e3120. [PMID: 30698219 PMCID: PMC6336401 DOI: 10.1590/1518-8345.2298-3120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/25/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to know the care provided by family caregivers of children submitted to hematopoietic stem cell transplantation. METHOD the Grounded Theory was used as methodology. The study comprised four sample groups, comprising 36 caregivers. Data were collected by semi-structured interviews and analyzed according to the coding proposed by Strauss and Corbin in three phases: open, axial and selective. RESULTS eight propositions were identified for the care provided to the child in the researched context, namely administering medications; attention to cleaning issues; care with water and food intake; care with the body; experiencing protective isolation; addressing the child's need for emotional support; addressing the child's self-care; and facing complications. CONCLUSION the different aspects in which the caregiver acts in the care of the child were understood. Such care equips the health team to elaborate measures for guidance and preparation of home care that are effective and directed to the needs of the patient and their family. The understanding of the care that they accomplish enables the caregiver a greater understanding of their role, as well as of the decisions they will make by their being under treatment.
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Affiliation(s)
| | - Maria Ribeiro Lacerda
- Universidade Federal do Paraná, Departamento de Enfermagem e Terapia Ocupacional, Curitiba, PR, Brazil
| | - Ana Paula Hermann
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brazil
| | | | | | - Luana Tonin
- Universidade Federal do Paraná, Departamento de Enfermagem e Terapia Ocupacional, Curitiba, PR, Brazil
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11
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Donnelly C, Cunningham N, Jones JT, Ji L, Brunner HI, Kashikar-Zuck S. Fatigue and depression predict reduced health-related quality of life in childhood-onset lupus. Lupus 2018; 27:124-133. [PMID: 28662595 PMCID: PMC5537044 DOI: 10.1177/0961203317716317] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to identify risk factors for persistently reduced health-related quality of life in childhood-onset lupus and describe a risk profile for persistently reduced health-related quality of life. At a tertiary rheumatology clinic, 50 childhood onset lupus patients were assessed twice, approximately six months apart. Measures of disease activity and patient-reported measures of health-related quality of life, pain, depressive symptoms, anxiety and disability were collected at each visit. At visits 1 and 2, respectively, clinically relevant fatigue was present in 66% and 56% of patients; clinically significant depressive symptoms in 26% and 24%; and clinically significant anxiety in 34% and 28%. Poorer health-related quality of life at follow-up was significantly predicted by higher fatigue and depressive symptoms at the initial visit. Using clinically relevant cut-offs for fatigue and depressive symptoms, patients were assigned to Low ( n = 27) or High Risk ( n = 23) groups. A profile of significantly greater pain, anxiety and coping difficulties was seen in the High Risk group. Routine assessment of fatigue and mood symptoms in youth with childhood-onset lupus could be helpful in identifying those at risk for persistently poor health-related quality of life. Integration of behavioral interventions to address fatigue and mood symptoms into medical care for such patients may be beneficial, but more research in this area is needed.
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Affiliation(s)
- Catherine Donnelly
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati Medical Center, Cincinnati, OH
| | - Natoshia Cunningham
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jordan T Jones
- Department of Pediatrics, University of Missouri-Kansas City, Children’s Mercy Kansas City, Kansas City, MO
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Li Ji
- Peking Union Medical College Hospital, Beijing, China
| | - Hermine I Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, University of Missouri-Kansas City, Children’s Mercy Kansas City, Kansas City, MO
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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