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Velarde-García JF, Güeita-Rodríguez J, Jiménez-Antona C, García-Bravo C, Aledo-Serrano Á, Gómez-Sánchez SM, Palacios-Ceña D. The impact of developmental and epileptic encephalopathies on families: a qualitative study. Eur J Pediatr 2024:10.1007/s00431-024-05677-2. [PMID: 38965081 DOI: 10.1007/s00431-024-05677-2] [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: 03/31/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/06/2024]
Abstract
Developmental and epileptic encephalopathies (DEEs) cause disability and dependence affecting both children and the family. The aim of the study was to describe the perspective of parents of children with DEEs regarding the impact of the disease on the family. We carried out a qualitative study based on the interpretivist paradigm. Twenty-one participants were selected using purposive sampling. Parents of children with DEEs of SCN1A, KCNQ2, CDKL5, PCDH19, and GNAO1 variants were included. In-depth interviews and researcher notes were used for data collection. A thematic analysis was performed on the data. Three themes were identified in the results: (a) Assuming conflicts and changes within the couple, causing them to distance themselves, reducing their time and intimacy and leading them to reconsider having more children; (b) impact of the disorder on siblings and grandparents, where siblings perceived DEE as a burden in their lives, felt neglected, and needed to grow and mature alone; conversely, the grandparents suffered for their grandchildren and the parents, in addition to perceiving that their health worsened, and (c) reconciling the care of the child with family life and work; this led the parents to share tasks, abandon or reduce working hours and ask for help.Conclusions: Caring for a child with DEE can result in neglect of social, psychological, emotional, recreational, educational, or occupational needs and obligations that ultimately impact all family members. What is Known: • Children with DEE may develop seizures and experience developmental and cognitive problems. • Caring for a child with DEE has a social and psychological impact on the entire family. Caring for a child with DEE has a social and psychological impact on the entire family. What is New: • Within the couple, there are tensions due to a lack of time, which could be alleviated by alternating childcare duties. • It is necessary to implement programs that address the physical and mental needs of the couple, as well as cater to the needs of siblings and alleviate the suffering of grandparents.
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Affiliation(s)
- Juan Francisco Velarde-García
- Red Cross Nursing School, Universidad Autónoma de Madrid, Madrid, Spain
- Research Nursing Group of Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Alcorcón, Madrid, Spain
| | - Javier Güeita-Rodríguez
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Alcorcón, Madrid, Spain.
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Carmen Jiménez-Antona
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Alcorcón, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Cristina García-Bravo
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Alcorcón, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Ángel Aledo-Serrano
- Epilepsy and Neurogenetics Program, Vithas Hospital Group, Vithas Madrid La Milagrosa University Hospital, Madrid, Spain
| | - Stella Maris Gómez-Sánchez
- Research Group, GAMDES of Universidad Rey Juan Carlos, Madrid, Spain
- Department of Basic Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Domingo Palacios-Ceña
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Alcorcón, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Wilkie DJ, Telisnor G, Powell-Roach K, Rangel AP, Greenlee AL, Ezenwa MO, Gallo AM, Black LV, Gomes de Siqueira A, Dyal BW, Kalyanaraman S, Yao Y. CHOICES for sickle cell reproductive health: A protocol of a randomized preconception intervention model for a single gene disorder. PLoS One 2023; 18:e0294907. [PMID: 38060589 PMCID: PMC10703323 DOI: 10.1371/journal.pone.0294907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
Our long-term goal is to foster genetically informed reproductive health knowledge and behaviors among young adults with sickle cell disease (SCD) or sickle cell trait (SCT) with a web-based, tailored, multimedia intervention called CHOICES. CHOICES is designed to help young adults with SCD or SCT preconception to gain knowledge of genetic inheritance, specify their reproductive health intentions (their parenting plan), and engage in reproductive health behaviors concordant with their parenting plan. In a previous study, we found high acceptability of both the e-Book (usual care control) and CHOICES interventions. We also found sustained (24 months), significant effects on knowledge but not on behavior, most likely because half of the recruited group was not at risk for their children inheriting SCD. Hence, we propose an adequately powered randomized controlled trial with the CHOICES intervention and an e-Book control to compare their effects on genetic inheritance knowledge and at-risk reproductive health behaviors (immediate posttest and at 6, 12, 18, and 24 months). We will conduct subgroup analyses to provide insight into the baseline knowledge and behavior as well as the intervention effects in different demographic or acceptability groups. Given the scalability and low cost of CHOICES, if proved to be effective, it can reach the affected population at low cost.
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Affiliation(s)
- Diana J. Wilkie
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | - Guettchina Telisnor
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | - Keesha Powell-Roach
- College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Andrea P. Rangel
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | - Amelia L. Greenlee
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | - Miriam O. Ezenwa
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | - Agatha M. Gallo
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | - L. Vandy Black
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | | | - Brenda W. Dyal
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | - Sriram Kalyanaraman
- College of Journalism and Communications, University of Florida, Gainesville, Florida, United States of America
| | - Yingwei Yao
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
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3
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Alsalman M, Alhamoud H, Alabdullah Z, Alsleem R, Almarzooq Z, Alsalem F, Alsulaiman A, Albeladi A, Alsalman Z. Sickle Cell Disease Knowledge and Reproductive Decisions: A Saudi Cross-Sectional Study. Patient Prefer Adherence 2023; 17:761-767. [PMID: 36974077 PMCID: PMC10039637 DOI: 10.2147/ppa.s404811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Background and Aim Sickle cell disease (SCD) is an autosomal recessive disorder. Decisions following premarital screening results might be influenced by several factors. Thus, this study aims to assess the knowledge and beliefs toward SCD and reproductive decisions. Material and Methods A cross-sectional study was conducted among adults in the eastern province of Saudi Arabia. Data was collected using a web-based questionnaire. Participants were divided into two groups based on their knowledge scores. Results A total of 390 participants were recruited with a mean age of 28.6 years. The majority (90.5%) of participants had general knowledge about the disease mode of inheritance however, 66.9% had poor knowledge about the disease overall. Regarding knowledge level, there was no statistically significant difference between the non-healthy group (diseased and carrier) and healthy participants (P=0.304). Moreover, the participants' decisions about choosing future partners were more likely to be affected among those with prior knowledge about the disease (p=0.008). However, 152 (91.6%) male participants with prior knowledge would change their decision about selecting a future partner compared to 225 (92.4%) female participants. Regarding reproduction, only 38.5% of participants were aware of in vitro fertilization (IVF) as an assistive reproductive technology. Furthermore, female participants believed that IVF is a way to have healthy babies and would consider it despite the cost more than male participants (p=0.0001, p=0.007 respectively). Conclusion SCD is an inherited disease with economic, physical, and psychological burdens. However, curative options are costly, and hence, prevention is key. Therefore, healthcare decision-makers should consider implementing policies to minimize the financial burden that may still affect society despite the availability of free medical care. This study warrants extensive community-based education programs that may contribute toward cost savings. It also highlights the importance of premarital counselling for disease and carrier people including alternative reproduction options.
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Affiliation(s)
- Mortadah Alsalman
- Department of Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Hassan Alhamoud
- Department of Medicine, King Fahad Hospital, Al Hofuf, Saudi Arabia
| | - Zainab Alabdullah
- Department of Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Raghad Alsleem
- Department of Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Zainab Almarzooq
- Department of Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Fatemah Alsalem
- Department of Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | | | | | - Zaenb Alsalman
- Departments of Family and Community Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
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Pecker LH, Oteng-Ntim E, Nero A, Lanzkron S, Christianson MS, Woolford T, Meacham LR, Mishkin AD. Expecting more: the case for incorporating fertility services into comprehensive sickle cell disease care. Lancet Haematol 2023; 10:e225-e234. [PMID: 36708736 DOI: 10.1016/s2352-3026(22)00353-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 01/27/2023]
Abstract
Assisted reproductive technologies (ART) are not yet systematically available to people with sickle cell disease or their parents. Fertility care for these groups requires addressing sickle cell disease-associated infertility risks, fertility preservation options, pregnancy possibilities and outcomes, and, when needed, infertility treatment. People with a chance of having a child with sickle cell disease can use in-vitro fertilisation with preimplantation genetic testing to conceive a child unaffected by sickle cell disease. Also, parents of children with sickle cell disease can use this technology to identify embryos to become potential future matched sibling donors for stem cell transplant. In the USA, disparities in fertility care for the sickle cell disease community are especially stark. Universal screening of newborn babies' identifies sickle cell disease and sickle cell trait, guidelines direct preconception genetic carrier screening, and standard-of-care fertility preserving options exist. However, potentially transformative treatments and cures for patients with sickle cell disease are not used due to iatrogenic infertility concerns. In diversely resourced care settings, obstacles to providing fertility care to people affected by sickle cell disease persist. In this Viewpoint, we contend that fertility care should be incorporated into the comprehensive care model for sickle cell disease, supporting alignment of treatment goals with reproductive life plans and delivering on the promise of individualised high-quality care for people with sickle cell disease and their families. We consider the obligation to provide fertility care in light of medical evidence, with acknowledgment of formidable obstacles to optimising care, and powerful historical and ethical considerations.
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Affiliation(s)
- Lydia H Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Eugene Oteng-Ntim
- Women's Health Academic Centre, King's College London, London, UK; Women's Services, Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Alecia Nero
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sophie Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mindy S Christianson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Reproductive Endocrinology & Infertility, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Teonna Woolford
- Sickle Cell Reproductive Health Education Directive, Washington, DC, USA
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center Children's Healthcare of Atlanta; Division of Hematology & Oncology, Department of Pediatrics Emory University, Atlanta, GA, USA
| | - Adrienne D Mishkin
- Blood and Marrow Transplantation and Cell Therapy Program, Division of Hematology & Oncology and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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Benedetti DJ, Marron JM, Thomas SM, Brown AEC, Pyke-Grimm KA, Johnson LM, Unguru Y, Kodish E. The role of ethicists in pediatric hematology/oncology: Current status and future needs. Pediatr Blood Cancer 2023; 70:e30132. [PMID: 36495529 DOI: 10.1002/pbc.30132] [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: 09/18/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022]
Abstract
As pediatric hematology/oncology (PHO) becomes more complex and sub-subspecialized, dedicated PHO ethicists have emerged as sub-subspecialists focused on addressing ethical issues encountered in clinical and research practices. PHO physicians and other clinicians with advanced training in bioethics contribute to the field through ethics research, education, and ethics consultation services. Furthermore, there exists a newer generation of PHO trainees interested in bioethics. This review details the experiences of current PHO ethicists, providing a blueprint for future educational, research and service activities to strengthen the trajectory of the burgeoning sub-subspecialty of PHO ethics. Creating an American Society of Pediatric Hematology/Oncology (ASPHO) ethics Special Interest Group, enhancing clinical ethics education for pediatric hematologists/oncologists (PHOs), developing multi-institutional research collaborations, and increasing attention to ethical issues germane to nonmalignant hematology will serve the interests of the entire field of PHO, enhancing the care of PHO patients and careers of PHOs.
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Affiliation(s)
- Daniel J Benedetti
- Division of Pediatric Hematology/Oncology, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan M Marron
- Division of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Amy E Caruso Brown
- Division of Pediatric Hematology/Oncology, and Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Kimberly A Pyke-Grimm
- Department of Nursing Research and Evidence-Based Practice, Stanford Children's Health and Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Liza-Marie Johnson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, Maryland, USA.,Johns Hopkins University Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Eric Kodish
- Departments of Pediatrics, Oncology, and Bioethics, Cleveland Clinic Children's and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio, USA
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6
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Pecker LH, Nero A, Christianson M. No crystal stair: supporting fertility care and the pursuit of pregnancy in women with sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:459-466. [PMID: 36485154 PMCID: PMC9821326 DOI: 10.1182/hematology.2022000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Growing recognition that the ovary is an end organ in sickle cell disease (SCD), advances in SCD treatment and cure, and innovations in assisted reproductive technologies invite progressive challenges in fertility care for women with SCD. The reproductive life span of women with SCD may be reduced because ovarian reserve declines more rapidly in people with SCD compared to unaffected people. Some young women have diminished ovarian reserve, a risk factor for infertility. Referrals for fertility preservation may be offered and anticipatory guidance about when to seek infertility care provided. For a subset of people with SCD, this information is also applicable when pursuing in vitro fertilization with preimplantation genetic testing to avoid implantation of an embryo with SCD. Here we explore the dimensions of SCD-related fertility care illustrated by the case of a 28-year-old woman with hemoglobin SS disease who initially presented for a hematology consultation for preconception counseling. This case highlights the complexity of preconception SCD management and care and the need to partner with patients to help align pregnancy hopes with SCD treatment and the many associated uncertainties.
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Affiliation(s)
- Lydia H. Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, MD
- Correspondence Lydia H. Pecker, 720 Rutland Ave, Ross Bldg 1025, Johns Hopkins University School of Medicine, Baltimore, MD 21205; e-mail:
| | - Alecia Nero
- Division of Hematology-Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Mindy Christianson
- Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, MD
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7
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Abstract
This overview of reproductive and sexual health care concerns for people with sickle cell disease (SCD) addresses clinical concerns that can be complex and are inherently multidisciplinary. Clinicians must be prepared to initiate reproductive health care discussions, as these intimate concerns may not be volunteered by patients. SCD is associated with delayed onset of puberty, sickle pain during menstruation, disease-specific contraceptive considerations, high-risk pregnancy, priapism, erectile dysfunction, and offspring who inherit a hemoglobinopathy trait from affected parents. Reproductive health considerations are underrecognized, undertreated, and understudied. They need attention in primary care and specialty SCD, urology, and obstetrics and gynecology clinics.
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Acceptable, hopeful, and useful: development and mixed-method evaluation of an educational tool about reproductive options for people with sickle cell disease or trait. J Assist Reprod Genet 2022; 39:183-193. [PMID: 34806131 PMCID: PMC8866599 DOI: 10.1007/s10815-021-02358-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/12/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE People with sickle cell disease (SCD) or trait have many reproductive options, some of which decrease the chance of passing SCD to children, including in vitro fertilization with preimplantation genetic testing (IVF + PGT). Few are aware of these options, and educational materials are needed. This study aimed to develop an accessible, non-directive patient education material about reproductive options for those with SCD or trait via a process that incorporated stakeholders from the SCD community. METHODS Multidisciplinary stakeholders guided development and revision of a novel pamphlet. Researchers applied health literacy scales to measure pamphlet understandability. We interviewed nine patients with SCD and six multidisciplinary clinicians to evaluate the pamphlet. Interviews were recorded, transcribed, and coded by a five-member team who developed a codebook and proposed themes that were revised by all research team members. Feedback was incorporated into a revised pamphlet. RESULTS A two-page pamphlet describing reproductive options for people with SCD including IVF + PGT was acceptable to key stakeholders, including people with SCD. Material about this complex topic met health literacy standards, including being written at a 5th grade level. Patients reported feeling hopeful after reviewing the pamphlet, and participants considered the pamphlet useful, clear, and appropriate for distribution in clinics and online. CONCLUSIONS Though awareness of reproductive options for those with SCD or trait is low, patients and providers find a novel pamphlet about this topic acceptable and useful. Educational materials about complex topics including IVF + PGT can be written at a level understandable to the average American.
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Aldossary DS, Black V, Ezenwa MO, Gallo AM, Johnson-Mallard VM, Eades NT, Oguntoye AO, Yao Y, Wilkie DJ. Characteristics associated with the perceived likelihood to become parents among young adults with sickle cell disease or sickle cell trait in the USA. J Genet Couns 2021; 31:689-697. [PMID: 34826361 PMCID: PMC9142167 DOI: 10.1002/jgc4.1535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/08/2022]
Abstract
Individuals with sickle cell disease (SCD) and individuals with sickle cell trait (SCT) have different health trajectories, but it is unknown whether sociodemographic and clinical characteristics are associated with their likelihood to be a parent. The purpose of this study was to examine the sociodemographic and clinical characteristics associated with perceived likelihood-to-parent among a cohort of young adults with SCD or SCT in the USA. The participants were 234 young adults (82 males, 152 females) who had either SCD (n = 138) or SCT (n = 96). The average age was 25.9 years (SD = 4.9), and most participants (87%) were single. Study participants completed the likelihood-to-parent item (0-4 scale) included in the valid and reliable Sickle Cell Reproductive Health Knowledge Parenting Intent and Behavior Questionnaire (SCKnowIQ). The mean likelihood-to-parent score was M = 2.3 (SD = 1.1) and 41% indicated that they were 'very' or 'extremely' likely to be a parent. Bivariate analysis showed that likelihood-to-parent was associated with the participant's sickle cell genotype (p = .03), age (p = .003), educational level (p = .04), income (p = .01), employment (p = .04), number of children (p < .001), health insurance (p = .02), and influenced by others (p < .001). In multiple regression analysis, participants reported higher likelihood-to-parent scores if they had at most 2 children (p = .03), higher income (p = .03), had no insurance (p = .01), and reported higher levels of being influenced by others (p = .001). Additional research is needed to confirm these findings in larger representative samples with more young adult males and to understand the likelihood to become parents over time by implementing longitudinal studies in the SCD and SCT populations. Such research is needed to guide appropriate education and genetic counseling for reproductive decision-making among young adults with SCD or SCT.
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Affiliation(s)
- Dalal S Aldossary
- Department of Nursing Fundamentals, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Vandy Black
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Agatha M Gallo
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Nyema T Eades
- Office of Student Affairs, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Anne O Oguntoye
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
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10
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Pecker LH, Sharma D, Nero A, Paidas MJ, Ware RE, James AH, Smith-Whitley K. Knowledge gaps in reproductive and sexual health in girls and women with sickle cell disease. Br J Haematol 2021; 194:970-979. [PMID: 34231198 PMCID: PMC8448913 DOI: 10.1111/bjh.17658] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 02/02/2023]
Abstract
There is an immediate need to address long-standing questions about the reproductive health of girls and women with sickle cell disease (SCD). There are many SCD-related reproductive risks and uncertainties across girls' and women's reproductive life span, with particularly outstanding concerns about menstruation, contraception, fertility and pregnancy. Extant literature addressing women's reproductive health topics is mostly descriptive; there are few high-quality interventional studies. In 2020, the Centers for Disease Control and Prevention and the Foundation for Women and Girls with Blood Disorders convened an expert panel to assess the knowledge gaps in women's reproductive health in SCD. The panel identified significant limitations to clinical care due to the need for research. The panel also identified prominent barriers to research and care. In this report, we frame these issues, providing a roadmap for investigators, funding agencies, and policy makers to advance care for girls and women with SCD.
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Affiliation(s)
- Lydia H. Pecker
- Johns Hopkins University School of Medicine, Division of Hematology, Department of Medicine & Gynecology & Obstetrics, Baltimore MD
| | - Deva Sharma
- Vanderbilt University Medical Center, Divisions of Transfusion Medicine and Hematology
| | - Alecia Nero
- Department of Medicine, Division of Hematology/Oncology, University of Texas Southwestern
| | - Michael J. Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine
| | - Russell E. Ware
- Division of Pediatric Hematology, Department of Pediatrics, Cincinnati Children’s Hospital
| | - Andra H. James
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Department of Medicine, Division of Hematology, Duke University, Durham, NC
| | - Kim Smith-Whitley
- Division of Hematology, The Children’s Hospital of Philadelphia, Philadelphia, PA
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Specialist physicians' referral behavior regarding preimplantation genetic testing for single-gene disorders: Is there room to grow? F S Rep 2021; 2:215-223. [PMID: 34278357 PMCID: PMC8267388 DOI: 10.1016/j.xfre.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022] Open
Abstract
Objective To assess whether primary care specialists’ demographics, specialty, and knowledge of preimplantation genetic testing for monogenic disorders (PGT-M) influence their practice patterns. Design Cross-sectional survey study. Setting Academic medical center. Patient(s) Not applicable. Intervention(s) None. Main Outcome Measure(s) Objective PGT-M knowledge, subjective comfort with PGT-related topics, PGT care practices (discussions/referrals), and PGT-M implementation barriers. Result(s) Our survey had 145 respondents: 65 obstetrician/gynecologists, 36 internists, and 44 pediatricians. Overall, 88% believed that patients at a risk of passing on genetic disorders should be provided PGT-M information. However, few discussed PGT-M with their patients (24%) or referred them for testing (23%). Over half (63%) believed that the lack of physician knowledge was a barrier to PGT use. In terms of subjective comfort with PGT, only 1 in 5 physicians felt familiar enough with the topic to answer patient questions. There were higher odds of discussing (odds ratio, 3.21; 95% confidence interval, 1.75–5.87) or referring for PGT (odds ratio, 2.52; 95% confidence interval, 1.41–4.51) for each additional 0.5 correct answers to PGT knowledge-related questions. The odds of referring patients for PGT-M were the highest among obstetrician/gynecologists compared with those among the internists and pediatricians. Conclusion(s) Physician specialty and PGT knowledge were associated with PGT-M care delivery practices. Although most specialists believed in equipping at-risk patients with PGT-M information, <1 in 4 discussed or referred patients for PGT. The low levels of PGT-related care among providers may be owed to inadequate knowledge of and comfort with the topic. An opportunity to promote greater understanding of PGT-M among primary care specialists exists and can in turn improve the use of referrals to PGT-M services.
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Sharma A, Bhakta N, Johnson LM. Germline Gene Editing for Sickle Cell Disease. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:46-49. [PMID: 32804058 DOI: 10.1080/15265161.2020.1781970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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