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Strauss AC, Marquardt N, Oldenburg J, Pieper CC, Attenberger U, Hmida J, Rommelspacher C, Koob S, Strauss AC. Self-conducted sonographic monitoring of the knee in patients with haemophilia-A feasibility study. Haemophilia 2024. [PMID: 38825768 DOI: 10.1111/hae.15056] [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: 01/10/2024] [Revised: 03/30/2024] [Accepted: 04/16/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION/AIM To evaluate whether patients with haemophilia (PwH) can be enabled to perform ultrasonography (US) of their knees without supervision according to the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) protocol and whether they would be able to recognize pathologies. METHODS Five PwH (mean age 29.6 years, range 20-48 years) were taught the use of a portable US device and the HEAD-US protocol. Subsequently, the patients performed US unsupervised at home three times a week for a total of 6 weeks with a reteaching after 2 weeks. All images were checked for mapping of the landmarks defined in the HEAD-US protocol by a radiologist. In a final test after the completion of the self-sonography period, participants were asked to identify scanning plane and potential pathology from US images of other PwH. RESULTS On the images of the self-performed scans, 82.7% of the possible anatomic landmarks could be identified and 67.5% of the requested images were unobjectionable, depicting 100% of the required landmarks. There was a highly significant improvement in image quality following reteaching after 2 weeks (74.80 ± 36.88% vs. 88.31 ± 19.87%, p < .001). In the final test, the participants identified the right scanning plane in 85.0% and they correctly identified pathology in 90.0% of images. CONCLUSION Appropriately trained PwH can perform the HEAD-US protocol of their knee with high quality and are capable to identify pathologic findings on these standardized images. Asynchronous tele-sonography could enable early therapy adjustment and thereby possibly reduce costs.
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Affiliation(s)
- Anna Christina Strauss
- Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| | - Natascha Marquardt
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| | - Jamil Hmida
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | | | - Sebastian Koob
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
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Obeidat HM, Habashneh MH, Dwairej DA, Obeidat AH, Al-Oran HM. The lived experience of mothers of children with haemophilia in Jordan: A phenomenological study. Haemophilia 2023; 29:1226-1233. [PMID: 37428628 DOI: 10.1111/hae.14820] [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: 12/20/2022] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Haemophilia is an inherited bleeding disorder. Mothers of children with haemophilia experience stress, anxiety and different types of burdens that affect their life negatively. OBJECTIVES This study aimed to explore the lived experience of mothers of children with haemophilia. METHODS A descriptive phenomenological design was utilized. The participants were selected purposively from the Jordanian Association for Thalassemia and Hemophilia. Data saturation was achieved by interviewing 20 mothers. RESULTS Five themes emerged: (1) the challenges related to the diagnosis, the availability and administration of the clotting factors, and the occurrence of the bleeding emergency; (2) physical, social, psychological and financial burden; (3) fear of child death and disability; (4) stigmatization; and (5) lack of educational and medical support. CONCLUSION Mothers of children with haemophilia suffer from physical, psychological and social consequences. Healthcare providers should carry out educational sessions regarding the importance of support for the family and throughout the life of the child.
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Cutica I, Mortarino M, Garagiola I, Pravettoni G, Peyvandi F. Psychological and cognitive factors involved in decision-making process of haemophilia carriers in reproductive choices. Haemophilia 2023; 29:1313-1319. [PMID: 37548114 DOI: 10.1111/hae.14836] [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: 04/16/2023] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Haemophilia carriers (HCs) face a multitude of psychological challenges, mainly linked to the possibility of having an affected child. Important reproductive decisions such as opting for pre-implantation genetic testing, or choosing prenatal diagnosis and then whether to continue or interrupt pregnancy in case of affected male fetus, have to be taken into consideration. Notwithstanding, the role of psychological characteristics on such decision-making process needs further investigation. AIM The aim of this study was to investigate whether HCs' beliefs and emotions about haemophilia and cognitive factors such as decision-making style, risk perception, coping strategies in response to stress, and need for cognitive closure might modulate HCs' reproductive decisions. METHODS Participants were interviewed about their beliefs and emotions on haemophilia and filled an on-line standardized questionnaire on cognitive variables. Sixty HCs participated in this study. RESULTS Results show that HCs with high distress for haemophilia given by negative childhood experiences for one or more family member illness and by high concern for their children's health, and with psychological traits characterized by logical (versus emotional) reasoning, active coping style and high need for certainty, tend to choose diagnostic prenatal tests over routine pregnancy analysis. CONCLUSION This study highlighted the influence of negative early-life experience with haemophilia and of several cognitive factors in HCs choice of prenatal test.
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Affiliation(s)
- Ilaria Cutica
- Department of Oncology and Hematoncology, University of Milan, Milan, Italy
| | - Mimosa Mortarino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Isabella Garagiola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hematoncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Liu Z, Feng J, Fang Y, Cheng Y, Li S. Barriers to prophylactic treatment among patients with haemophilia A in Shandong Province, China: a qualitative study. Orphanet J Rare Dis 2023; 18:226. [PMID: 37537616 PMCID: PMC10398971 DOI: 10.1186/s13023-023-02838-8] [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: 07/31/2022] [Accepted: 07/21/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Haemophilia A is a rare, hereditary haemorrhagic disease that manifests as induced spontaneous bleeding and leads to disability or premature death in severe cases. Prophylactic treatment is optimal for patients to prevent uncontrolled bleeding and reduce the severity of the injury. However, little is known about the use of prophylactic treatment among patients with haemophilia A in China, especially barriers that predispose them to low or non-adherence. In this study, we explore the barriers to the prophylactic treatment of patients with haemophilia A. METHOD We used personal interviews and focus groups to collect the data and analysed the data through thematic analysis. Purposive sampling was employed to recruit our participants. We continued recruiting participants until data saturation was reached from the thematic analysis. Ultimately, we obtained 37 participants, among whom 19 participated in personal interviews and 18 participated in focus groups (i.e., 3 focus groups with 6 participants each). RESULTS Three themes and nine subthemes were identified from the thematic analysis. Nine subthemes (i.e., perceived barriers) emerged from the analysis, which were further clustered into three themes: (1) poor primary health care, (2) inadequate financial support, and (3) a lack of patient-centred care. CONCLUSION The findings presented in this descriptive qualitative study offer a unique view of Chinese patients with haemophilia A and their barriers to prophylactic treatment. Our findings not only provide an in-depth understanding of barriers to prophylactic treatment encountered by Chinese patients with haemophilia A but also address the urgent need to strengthen primary care, provide adequate financial support, and establish patient-centred care for these suffering patients.
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Affiliation(s)
- Ziyu Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Centre for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Junchao Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Centre for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Yunhai Fang
- Shandong Blood Center, Shandong Haemophilia Treatment Center, Jinan, China
| | - Yan Cheng
- Shandong Blood Center, Shandong Haemophilia Treatment Center, Jinan, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Centre for Health Preference Research, Shandong University, Jinan, 250012, China.
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von der Lippe C, Neteland I, Feragen KB. Children with a rare congenital genetic disorder: a systematic review of parent experiences. Orphanet J Rare Dis 2022; 17:375. [PMID: 36253830 PMCID: PMC9575260 DOI: 10.1186/s13023-022-02525-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for a child with a chronic disease may be demanding and stressful. When a child has a rare condition, the impact of care on parents is amplified due to the rarity of the diagnosis. In order to address the lack of generalized and synthesized knowledge regarding parents' experiences of having a child with a rare genetic disorder, and give a holistic picture of these experiences, a systematic review of the available qualitative research was conducted. METHODS We performed a systematic review, including qualitative studies on parents of children with rare genetic disorders, published between 2000 and 2020. RESULTS The review included 33 qualitative studies. Findings were synthesized and categorized according to three main themes: Parents' experiences with health care, Responsibilities and challenges, and Factors promoting positive experiences in parents. The findings demonstrate that parents of children with rare genetic disorders share many common challenges, despite evident differences across conditions. CONCLUSION Coordinated care, and a more holistic approach in the follow up of children with rare genetic disorders is needed. International collaboration on research, diagnostics, producing scientific correct and understandable information available for health care professionals and lay people should be prioritized.
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Affiliation(s)
- Charlotte von der Lippe
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, P.B. 4950, 0424, Nydalen, Oslo, Norway.
| | - Ingrid Neteland
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, P.B. 4950, 0424, Nydalen, Oslo, Norway
| | - Kristin Billaud Feragen
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, P.B. 4950, 0424, Nydalen, Oslo, Norway
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Vasquez-Loarte TC, Lucas TL, Harris-Wai J, Bowen DJ. Beliefs and Values About Gene Therapy and In-Utero Gene Editing in Patients with Hemophilia and Their Relatives. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:633-642. [PMID: 32794073 DOI: 10.1007/s40271-020-00442-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM Hemophilia is an inherited disease for which current treatment is noncurative. While gene therapy and gene editing are being researched, we do not know how the hemophilia community perceives them. Herein, we explore the beliefs and values regarding these new therapies in patients with hemophilia and their relatives. METHODS This qualitative study used phone-based semi-structured interviews on 21 adult English-speaking patients with hemophilia A or B and their parents across the United States during March to July 2019. The study was advertised through different chapters of the Hemophilia Foundation. The interview guide included questions about participants' prior experience with hemophilia, and included two case scenarios about the use of gene therapy and in utero gene editing, after which participants were asked about their opinions, beliefs, and values on each scenario. We used a grounded theory approach and identified the main themes using an inductive process. RESULTS We interviewed 21 participants-12 patients and 9 mothers. Most of them had or were related to a patient with severe disease. The main themes discussed were related to efficacy, safety and financial concerns and insurance coverage for both gene therapy and in utero gene editing. Patients and their parents had expected outcomes in terms of durability of therapy and impact on emotional health and lifestyle changes in the long term. Gene therapy was more accepted among patients with severe and uncontrolled disease. In-utero gene editing was not completely accepted because of safety and ethical issues. CONCLUSION Patients with severe hemophilia perceive gene therapy as a potential cure, while gene editing was more controversial. Patients still have questions that remain to be answered regarding safety and efficacy that should be assessed with long-term follow up studies.
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Affiliation(s)
| | - Tiffany Lin Lucas
- Division of Hematology/Oncology, Department of Pediatrics, University of California San Francisco, 550 16th Street Box 0434, San Francisco, CA, USA.
| | - Julie Harris-Wai
- Institute for Health and Aging, University of California San Francisco, San Francisco, CA, USA
| | - Deborah J Bowen
- Public Health Genetics, University of Washington, Seattle, WA, USA
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Hemophilia carriers: quality of life and management at different life stages. Blood Coagul Fibrinolysis 2021; 31:S12-S14. [PMID: 33351496 DOI: 10.1097/mbc.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The carrier testing, genetic counseling and prenatal diagnosis have become an integrated part of the comprehensive care for hemophilia, but quality of life and management of carriers frequently remain suboptimal. It is paramount to evaluate the physical and psycho-social impact of them as problematic physical, psychological and social situations are not uncommon. There are to instruct them about their hemorrhagic possible symptoms and condition for offering solutions that meet their needs and help them enjoy a satisfactory quality of life in all life stages.
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ADHERENCE TO PROPHYLAXIS IN RELATION TO QUALITY OF LIFE AND ANXIETY LEVEL IN TURKISH PATIENTS WITH SEVERE HAEMOPHILIA A. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2020. [DOI: 10.33457/ijhsrp.738665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Punt MC, Aalders TH, Bloemenkamp KWM, Driessens MHE, Fischer K, Schrijvers MH, van Galen KPM. The experiences and attitudes of hemophilia carriers around pregnancy: A qualitative systematic review. J Thromb Haemost 2020; 18:1626-1636. [PMID: 32271985 PMCID: PMC7383726 DOI: 10.1111/jth.14825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/05/2020] [Accepted: 04/01/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hemophilia carriers (HCs) face specific psychosocial challenges related to pregnancy, caused by their inherited bleeding disorder. Optimal support from healthcare providers can only be realized by exploring medical and psychological healthcare requirements. OBJECTIVE To review all published evidence on the experiences and attitudes of HCs regarding reproductive decision-making, prenatal diagnosis, pregnancy, childbirth, and puerperium to provide an accessible overview of this information for health care providers. STUDY SELECTION Cochrane library, PubMed/MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for original qualitative data. Two authors performed study selection, risk-of-bias assessment, data extraction, and data analysis through meta-summary. The extracted themes were discussed within the research team. FINDINGS Fifteen studies with an overall moderate quality were included. The following findings were identified: (a) Quality of life of family members with hemophilia influences reproductive decision-making; (b) Genetic counselling is generally considered useful; (c) The development of a specialized carrier clinic is considered valuable; (d) HCs describe prenatal diagnosis as beneficial yet psychosocially challenging; and (e) noninvasive prenatal diagnosis and preimplantation genetic diagnosis are predominantly considered beneficial. These findings are limited by the overall moderate quality of included studies and the possibly partly outdated results in the current era of hemophilia treatment. CONCLUSIONS Available qualitative literature on HCs around pregnancy focuses on genetic counselling and prenatal diagnosis. Future studies are needed on the experiences and needs of HCs through pregnancy and puerperium as well as in light of emerging hemophilia diagnosis and treatment options.
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Affiliation(s)
- Marieke C. Punt
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Tanja H. Aalders
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Kitty W. M. Bloemenkamp
- Department of ObstetricsBirth Centre Wilhelmina’s Children HospitalDivision Woman and BabyUniversity Medical Centre UtrechtUniversity of UtrechtUtrechtThe Netherlands
| | | | - Kathelijn Fischer
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Marlies H. Schrijvers
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
- Bachelor of NursingUniversity of Applied SciencesUtrechtThe Netherlands
| | - Karin P. M. van Galen
- Van CreveldkliniekUniversity Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
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10
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Mattis S, Barry V, Taylor N, Lynch ME, Tatum K, Whitten S, Kempton CL. Disease-related distress among adults with haemophilia: A qualitative study. Haemophilia 2019; 25:988-995. [PMID: 31577383 DOI: 10.1111/hae.13850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Distress related to disease burden has been defined and described among people with chronic diseases including diabetes and cancer. In these populations, disease-specific distress is associated with health outcomes. Haemophilia-related distress is less understood. AIM To identify qualitative features of haemophilia-related distress among affected adults to ultimately inform the creation of a measurement tool. METHODS Adults with haemophilia A or B associated with a large haemophilia treatment centre in the south-eastern U.S. were recruited to participate in this qualitative study. Fifteen participants completed semi-structured telephone interviews. Interviews lasted 1-2 hours and explored experiences of distress related to various aspects of haemophilia. Interviews were audio taped, transcribed and coded using NVIVO, software for organizing, managing and analysing qualitative data. Coding was deductive and inductive, and the analysis was thematic. RESULTS Haemophilia-related distress was broadly related to feelings of isolation and vulnerability which incorporated health system factors, physical functioning, caretaker roles and psychological considerations. Specific features associated with haemophilia-related distress included lack of trust in the knowledge of haemophilia and care provided by staff in community healthcare settings, concerns about the future such as health insurance access and ageing/disability, long-standing feelings of being different from others and feeling like an outsider, treatment burdens and fear of acute bleeds. Protective factors included supportive relationships with family, friends and haemophilia care teams through which participants received practical and emotional support. CONCLUSION Features of haemophilia-related distress were identified. Results will facilitate distress measurement and intervention efforts to reduce distress in adults with haemophilia.
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Affiliation(s)
- Shanna Mattis
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Vaughn Barry
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Natalie Taylor
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mary Ellen Lynch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Katharine Tatum
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie Whitten
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christine L Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Myrin Westesson L, Sparud‐Lundin C, Baghaei F, Khair K, Mackensen S, Acuña Mora M, Wallengren C. Burden on parents of children with haemophilia: The impact of sociodemographic and child's medical condition. J Clin Nurs 2019; 28:4077-4086. [DOI: 10.1111/jocn.15003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/17/2019] [Accepted: 06/30/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Linda Myrin Westesson
- Sahlgrenska University Hospital Gothenburg Sweden
- Institute of Health and Care Sciences The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Carina Sparud‐Lundin
- Institute of Health and Care Sciences The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | | | - Kate Khair
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Trust London UK
| | - Sylvia Mackensen
- Department of Medical Psychology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Mariela Acuña Mora
- Institute of Health and Care Sciences The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Public Health and Primary Care KU Leuven Leuven Belgium
| | - Catarina Wallengren
- Institute of Health and Care Sciences The Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Centre for Person‐Centred Care (GPCC) University of Gothenburg Gothenburg Sweden
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von Mackensen S, Myrin Westesson L, Kavakli K, Klukowska A, Escuriola C, Uitslager N, Santoro C, Holland M, Khair K. The impact of psychosocial determinants on caregivers’ burden of children with haemophilia (results of the BBC study). Haemophilia 2019; 25:424-432. [DOI: 10.1111/hae.13684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Sylvia von Mackensen
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Linda Myrin Westesson
- Department of Medicine/Haematology and Coagulation Disorders, Coagulation Centre Sahlgrenska University Hospital Gothenburg Sweden
| | | | - Anna Klukowska
- Department of Paediatrics, Haematology Oncology Warsaw Medical University Warsaw Poland
| | | | - Nanda Uitslager
- Division of Internal Medicine and Dermatology, Van Creveldkliniek University Medical Center Utrecht Utrecht The Netherlands
| | | | | | - Kate Khair
- Centre for Outcomes and Experience Research in Childhood Health Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Trust London UK
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Boardman FK, Hale R, Gohel R, Young PJ. Preventing lives affected by hemophilia: A mixed methods study of the views of adults with hemophilia and their families toward genetic screening. Mol Genet Genomic Med 2019; 7:e618. [PMID: 30838796 PMCID: PMC6503017 DOI: 10.1002/mgg3.618] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/11/2019] [Accepted: 02/06/2019] [Indexed: 11/20/2022] Open
Abstract
Background Genomic sequencing technologies have made the possibility of population screening for whole panels of genetic disorders more feasible than ever before. As one of the most common single gene disorders affecting the UK population, hemophilia is an attractive candidate to include on such screening panels. However, very little is known about views toward genetic screening amongst people with hemophilia or their family members, despite the potential for a wide range of impacts on them. Methods Twenty‐two in‐depth qualitative interviews were undertaken to explore the views of adults with hemophilia and their family members, recruited through the Haemophilia Society UK. These interviews were used to develop a survey, the Haemophilia Screening Survey (UK), which was distributed in paper and online format through the support group, receiving 327 returns between January and June 2018. Results Fifty‐seven per cent of the sample supported preconception carrier screening of the population for hemophilia, and 59% supported prenatal carrier screening. Key reasons for support included a desire to reduce pregnancy terminations and increase awareness of hemophilia. Despite support for screening however, 90% of the sample disagreed with pregnancy terminations for hemophilia. Conclusions Families and adults living with hemophilia are more supportive of screening for information and preparation purposes than to prevent boys with hemophilia from being born. A distinction was made between preventing the disease and preventing the lives of people with it, with support shown for the use of screening to achieve the former, but not at the expense of the latter.
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Affiliation(s)
| | - Rachel Hale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Raksha Gohel
- School of Life Sciences, University of Warwick, Coventry, UK
| | - Philip J Young
- School of Life Sciences, University of Warwick, Coventry, UK
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14
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Myrin Westesson L, Wallengren C, Baghaei F, Sparud-Lundin C. Reaching Independence Through Forced Learning: Learning Processes and Illness Management in Parents of Children Affected by Hemophilia. QUALITATIVE HEALTH RESEARCH 2018; 28:2142-2154. [PMID: 30066606 DOI: 10.1177/1049732318789631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hemophilia is a complex condition to manage, especially for parents to newly diagnosed children. This grounded theory study explores parents' learning processes and illness management in daily life during the first year after the start of their child's treatment. Using a longitudinal qualitative design, eight parents of four children were interviewed repeatedly during 12 to 14 months. The core category, reaching independence through forced learning, reflected the parents' learning process and their experiences of the challenges during the first year after start of treatment. Incentives for learning were characterized by a longing to reach independence and regain control of one's life situation. The emerging key incentive for learning was a desire to become independent of health care professionals. Early home treatment reduced the impact of the illness, and by supporting parents in different ways during the learning process, health care professionals can promote the parents' trajectory toward independency.
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Affiliation(s)
| | - Catarina Wallengren
- 2 Institute of Health and Care Sciences, the Sahlgrenska Academy at University of Gothenburg, Sweden
- 3 Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| | | | - Carina Sparud-Lundin
- 2 Institute of Health and Care Sciences, the Sahlgrenska Academy at University of Gothenburg, Sweden
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15
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Schleicher C, Heine S, Graf N, von Mackensen S, Eichler H. Feasibility and Results of a Mobile Haemophilia Outpatient Care Pilot Project. Hamostaseologie 2018; 38:129-140. [DOI: 10.1055/s-0038-1654721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Introduction Regular visits at haemophilia treatment centres (HTCs) in rural regions are often dependent on the access to a private car due to lack of or limited availability of public means. Therefore, a mobile haemophilia outpatient care (MHOC) concept providing home visits to haemophilia patients has been developed by the Saarland HTC, which is located in a rural German region.
Methods Haemophilia patients and their parents were home visited at least twice (baseline, follow-up) by trained medical staff. Socio-demographic and clinical data were collected and interviews were performed asking the patients and parents about their needs and expectations towards such a MHOC.
Results Seventy-nine patients were enrolled (56 adults, 23 children), 62.0% severely affected, 48.1% on prophylaxis, with a mean age of 37.4 ± 16.4 years (17–78) and 9.8 ± 4.2 years (3–16), respectively. Median travel distance to the HTC was 43.5 km (3–200). Note that 92.4% considered an intense binding to the HTC and a MHOC concept as ‘rather/very important’ (88.6%). They expected from a MHOC to provide consulting and educating activities, support in elderhood issues and treatment. For 35.4%, a MHOC could currently provide additional support, mainly due to patient's immobility and need of consultancy. They mainly used services in terms of consultancy in social–legal affairs and support in contacting authorities.
Conclusion The results of this study support the hypothesis that a MHOC concept is a needful supplement in haemophilia comprehensive care and will improve the challenging haemophilia treatment, especially for those with limited access to HTCs or with disabilities.
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Affiliation(s)
- Christian Schleicher
- Institute of Clinical Hemostaseology and Transfusion Medicine/European Hemophilia Comprehensive Care Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Sabine Heine
- Department for Pediatric Oncology and Hematology/European Hemophilia Comprehensive Care Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Norbert Graf
- Department for Pediatric Oncology and Hematology/European Hemophilia Comprehensive Care Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Sylvia von Mackensen
- Department for Medical Psychology, University Medical Center Hamburg–Eppendorf, University of Hamburg, Hamburg, Germany
| | - Hermann Eichler
- Institute of Clinical Hemostaseology and Transfusion Medicine/European Hemophilia Comprehensive Care Center, Saarland University Hospital, Homburg/Saar, Germany
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16
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Keenan KF, Finnie RM, Simpson WG, McKee L, Dean J, Miedzybrodzka Z. Parents' views of genetic testing and treatment of familial hypercholesterolemia in children: a qualitative study. J Community Genet 2018; 10:129-141. [PMID: 29949065 PMCID: PMC6325044 DOI: 10.1007/s12687-018-0373-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/01/2018] [Indexed: 01/06/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a serious inherited disorder, which greatly increases individuals’ risk of cardiovascular disease (CVD) in adult life. However, medical treatment and lifestyle adjustments can fully restore life expectancy. Whilst European guidance advises that where there is a known family mutation genetic testing is undertaken in early childhood, the majority of the at-risk population remain untested and undiagnosed. To date, only a small number of studies have explored parents’ and children’s experiences of testing and treatment for FH, and little is known about interactions between health professionals, parents, and children in clinic settings. In this study, in-depth interviews were undertaken with parents who had attended a genetics and/or lipid clinic for FH with their children (n = 17). A thematic analysis revealed four main themes: undertaking early prevention, postponing treatment, parental concerns, and the importance of the wider family context. The majority of parents supported genetic testing for FH in childhood. However, although some were very supportive of following early treatment recommendations, others expressed reluctance. Importantly, some parents were concerned that inappropriate information had been shared with their children and wished that more time had been given to discuss how, when, and what to tell in advance. Future research is needed to explore the long-term outcomes for children who undertake genetic testing and early treatment for FH and to trial interventions to improve the engagement, follow-up, and support of children who are at risk, or diagnosed, with this disorder.
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Affiliation(s)
- Karen Forrest Keenan
- Epidemiology Group, University of Aberdeen, First Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK. .,Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.
| | - Robert M Finnie
- Department of Medicine/Care of the Elderly, St. Johns Hospital, Howdon Road West, Livingston, UK.,Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William G Simpson
- Department of Clinical Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Lorna McKee
- Health Services Research Unit, University of Aberdeen, Third Floor Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - John Dean
- Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.,Department of Medical Genetics, Ashgrove House, NHS Grampian, Aberdeen, UK
| | - Zosia Miedzybrodzka
- Medical Genetics Group, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, UK.,Department of Medical Genetics, Ashgrove House, NHS Grampian, Aberdeen, UK
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17
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McLintock C. Women with bleeding disorders: Clinical and psychological issues. Haemophilia 2018; 24 Suppl 6:22-28. [DOI: 10.1111/hae.13501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
- C. McLintock
- Auckland City Hospital; National Women's Health; Auckland New Zealand
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18
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Peng J, Yang H, Fu G, Zhao X, Li X, Chen F. A study of the stressors and coping behaviors of parents of Chinese hemophilic children. J Child Health Care 2017; 21:212-221. [PMID: 29119803 DOI: 10.1177/1367493517705736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To understand the stressors experienced by parents of hemophiliac children in China and the coping behaviors utilized, semi-structured interviews were conducted with parents of 158 Chinese hemophiliac children. We administered the Coping Health Inventory for Parents to determine coping behaviors. Parents' main stressors were in the domains of children's illness and physical condition, economic problems, and so on. Parents engaged in various positive coping behaviors to manage these stressors. The helpfulness of these coping behaviors in maintaining a normal family life differed significantly by parents' education and income ( p < .01). Parents of hemophilic children in China face numerous stressors but engage in a number of coping behaviors to manage these stressors. While treating hemophilic children, Chinese medical workers should guide parents to adopt such positive coping behaviors.
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Affiliation(s)
- Jie Peng
- 1 Department of Hematology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Hongbin Yang
- 1 Department of Hematology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Gan Fu
- 1 Department of Hematology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xielan Zhao
- 1 Department of Hematology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Xiaolin Li
- 1 Department of Hematology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Fangping Chen
- 1 Department of Hematology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
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"It was a lot Tougher than I Thought It would be". A Qualitative Study on the Changing Nature of Being a Hemophilia Carrier. J Genet Couns 2017; 26:1324-1332. [PMID: 28547664 DOI: 10.1007/s10897-017-0112-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/09/2017] [Indexed: 12/17/2022]
Abstract
Studies on carriers of genetic disorders mainly focus on the process of genetic testing and reproductive choices, and less on how psychosocial aspects of being a carrier change over time. Our study sought to understand more about the psychosocial aspects of hemophilia carrier status, and thereby improve counseling aiming to advance carriers' quality of life and well-being. We analyzed 16 in-depth interviews from women who were carriers of hemophilia and had a son with hemophilia. Three themes emerged: Guilt and sorrow across generations; the choices and future consequences of genetic testing; and preparing to have a child with hemophilia. Experience with being a hemophilia carrier is a process that changes over time while feelings of guilt and sorrow run across generations. The carrier status may create "mothers-in-waiting" living at risk of having a sick child or not. The women think they are prepared to have a son with hemophilia, but experience more sadness than they expect when a son is diagnosed. Our findings suggest that health professionals, especially clinical geneticists and genetic counselors, carriers, families and patient organizations need to be aware that women's experiences of being a carrier of hemophilia changes during the biographical life course. The women may benefit from several rounds of genetic counseling at different stages of life.
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