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Torun T, Çavuşoğlu H, Doğru D. The application of the self-care deficit nursing theory in adolescents with cystic fibrosis: A randomized controlled study. J Pediatr Nurs 2024; 77:96-105. [PMID: 38490107 DOI: 10.1016/j.pedn.2024.03.011] [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: 09/15/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The present study evaluates the effects of the application of Self-Care Deficit Nursing Theory (SCDNT) on the self-care knowledge and skills in adolescents with Cystic Fibrosis. DESIGN AND METHODS This randomized controlled study included 30 adolescents who were equally divided into the intervention and control groups. The data were collected by using the Sociodemographic Data Form and the Self-Care Knowledge and Skills Evaluation Forms for Adolescents with Cystic Fibrosis. A total of seven home visits were conducted with the adolescents in the intervention group, during which individualized care plans were applied based on the Self-Care Deficit Nursing Theory. The self-care needs of the adolescents in the control group were identified based on data collected during two home visits conducted at the onset of the study and after 4.5 months. RESULTS As a result of the application of nursing interventions based on the SCDNT, a statistically significant increase was noted in the self-care knowledge and skills of the adolescents in the intervention group (p < 0.05). Additionally, after the interventions based on SCDNT, the need of adolescents for nursing interventions decreased significantly over time in all adolescents in the intervention group (p < 0.05). CONCLUSIONS The application of nursing interventions based on the SCDNT was effective in enhancing the self-care knowledge and skills of adolescents with Cystic Fibrosis. PRACTICE IMPLICATIONS Nurses can benefit from Orem's Self-Care Deficit Nursing Theory in the design and application of the individualized care of adolescents with Cystic Fibrosis to improve their self-care practices.
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Affiliation(s)
- Tuğçe Torun
- Pediatric Nursing Department, Faculty of Nursing, Hacettepe University, Turkey.
| | - Hicran Çavuşoğlu
- Head of Pediatric Nursing Department, Faculty of Nursing, Hacettepe University, Turkey
| | - Deniz Doğru
- Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Turkey
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Kow S, Rieger B, Morse K, Keens T, Wu S. The positive impact of journaling on adolescents with cystic fibrosis. Pediatr Pulmonol 2024; 59:63-71. [PMID: 37772647 DOI: 10.1002/ppul.26708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) often have psychological difficulties on top of their medically complex care, such as anxiety, depression, and medical mistrust. These have been shown to be associated with worse adherence, pulmonary function test results, and other health outcomes. In this pilot trial, we implemented a journaling program based on narrative therapy methodology to improve mental and physical health outcomes for individuals with CF. METHODS Eight adolescents aged 12-17 with a confirmed diagnosis of CF followed in a single center CF clinic were emailed weekly journaling prompts that explored topics like treatment adherence, feeling different with CF, anxiety, depression, and interpersonal relationships. Subjects completed surveys about their experience with the writing assignment and measures of wellness including the Pediatric Symptom Checklist (PSC-17) and baseline health data was collected from the electronic medical records. RESULTS The average score for the PSC-17 decreased by 5.5 points, and fell to less than 28 (mean 23.5, SD 12.2), which is the cutoff for screening positive for behavioral or emotional problems. Participants reported the study was enjoyable and had improvement in feelings of anxiety/depression. 100% of participants responded "Strongly Agree" to the statement "I recommend other people with CF to write about the topics from this study." CONCLUSIONS The journaling intervention for individuals with CF was feasible and well received. Initial results show improvement in PSC-17 and other well-being measures. Further studies are needed to evaluate the impact of journaling on mental health and disease outcomes.
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Affiliation(s)
- Sean Kow
- Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Brenda Rieger
- Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Kimberly Morse
- Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Thomas Keens
- Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Susan Wu
- Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
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Yamaguchi M, Honda J, Fukui M. Effects of Parental Involvement on Glycemic Control in Adolescents With Type 1 Diabetes Mellitus: A Scoping Review. JOURNAL OF FAMILY NURSING 2023; 29:382-394. [PMID: 37211777 DOI: 10.1177/10748407231171842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is typically diagnosed in pediatric patients. Transitioning from supported management in childhood to self-management in adolescence is an important step. Parental psychosocial influence is a possible factor in adolescents' disease control. This review summarized the effects of parental involvement on glycemic control in adolescents with T1DM by focusing on hemoglobin A1c (HgbAIc). A scoping review per the Guidance for Systematic Scoping Reviews was conducted with the following inclusion criteria: (a) studies in English, (b) focused on adolescents with T1DM, (c) outcomes included HgbAIc, and (d) focused on parental influence of children with T1DM. Of 476 articles, 14 were included. The study outcomes were classified based on direct or indirect influence. "Parental support for adherence" and "parental conflict" significantly affected HgbAIc control. This study provides current evidence on parental influence on glycemic control in adolescents.
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Affiliation(s)
| | | | - Minae Fukui
- Mukogawa Women's University, Nishinomiya, Japan
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Dawson S, Rodham K, Taylor J, Dewar J, Wildman M. "I think most people feel like healthcare professionals tell them to take their treatments and judge them for not taking them": reflexive thematic analysis of the views of adults with cystic fibrosis on how treatment adherence is discussed in healthcare. Psychol Health 2023:1-23. [PMID: 37667520 DOI: 10.1080/08870446.2023.2254318] [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: 01/10/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Previous research exploring patient-practitioner communication in relation to adherence in cystic fibrosis (CF) is limited. This UK study explored the views of adults with CF on how treatment adherence (related to all CF treatments) is discussed in routine CF care. METHODS 12 White British adults (ten females; aged 20-37 years; mean 30.1 years) with CF participated in semi-structured interviews. RESULTS Three overarching themes were developed through reflexive thematic analysis: (1) 'The power of language'; (2) 'Healthcare professionals do not recognise the importance of context'; and (3) '"Admitting" non-adherence is difficult'. The way in which adherence is discussed in adult CF care is viewed as paternalistic and infantilising. Participants reported that healthcare professionals do not always consider the desire to balance treatment-taking with living a normal life. Unwelcome responses from healthcare professionals, and the inability to accurately self-report the amount of treatment taken made it difficult to 'admit' non-adherence. CONCLUSIONS A culture change is needed in CF care such that people who struggle to take their treatments are not labelled as disobedient, wilfully disobeying orders from healthcare professionals in positions of authority. Instead, an open, honest, non-judgemental approach, as recommended by healthcare agencies for over a decade, should be adopted.
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Affiliation(s)
- Sophie Dawson
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Karen Rodham
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
- Institute of Psychology, Business and Human Sciences, University of Chichester, Chichester, UK
| | - Jennifer Taylor
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Jane Dewar
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Martin Wildman
- Sheffield Adult Cystic Fibrosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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South K, Smaldone A, Sadeghi H, Piane V, Kowal R, Wei L, George M. Parent and adolescent perceptions of cystic fibrosis management responsibility: A mixed-methods study. Pediatr Pulmonol 2023; 58:2340-2351. [PMID: 37232332 PMCID: PMC10524381 DOI: 10.1002/ppul.26494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Adolescents with cystic fibrosis (CF) and their parents must navigate changing roles and responsibilities within the family including transfer of disease management responsibilities. AIM/OBJECTIVE The aim of this qualitative study was to explore how families share and transfer CF management responsibility from the perspectives of adolescents with CF and their parents. METHODS Guided by qualitative descriptive methodology, we purposively sampled adolescent/parent dyads. Participants completed two surveys measuring family responsibility (Family Responsibility Questionnaire [FRQ]) and transition readiness (Transition Readiness Assessment Questionnaire [TRAQ]) We conducted semistructured video or phone interviews, used a codebook to guide team coding and analyzed qualitative data using both content analysis and dyadic interview analysis. RESULTS Thirty participants (15 dyads) enrolled (7% Black; 33% Latina/o; 40% female; adolescent age 14.4 ± 2 years; 66% prescribed highly effective modulator therapy; 80% of parents were mothers). Parent FRQ and TRAQ scores were significantly higher than their adolescent indicating differing perceptions of responsibility and transition readiness. We inductively identified four themes: (1) CF management is a delicate balance (CF management is a routine which is easily disrupted), (2) Growing up and parenting under extraordinary circumstances (the burden of CF weighs on families as they navigate adolescence), (3) Differing Perceptions of risk and responsibility (adolescent and parent perceptions of treatment responsibility and the risks of nonadherence do not always align), and (4) Balancing independence and protection (families must weigh the benefits and risks of allowing adolescents increased independence). CONCLUSIONS Adolescents and parents demonstrated differing perceptions of CF management responsibility, which may be related to a lack of communication between family members about this topic. To help facilitate alignment of parent and adolescent expectations, discussion of family roles and responsibility for CF management should begin early during the transition process and be discussed regularly during clinic visits.
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Affiliation(s)
- Katherine South
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
| | - Arlene Smaldone
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
| | - Hossein Sadeghi
- Columbia University Irving Medical School, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY, 10032
| | - Victoria Piane
- Columbia University Irving Medical School, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY, 10032
| | - Rebecca Kowal
- Columbia University Irving Medical School, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY, 10032
| | - Leanna Wei
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
| | - Maureen George
- Columbia University School of Nursing, 560 West 168 Street, New York, NY, 10032
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Spitaletta G, Biagioli V, Greco F, Mascolo R, Liburdi A, Manzi G, Gawronski O, Ricci R, Tiozzo E, Vellone E, Grimaldi Capitello T, Salata M, Raponi M, Dall’Oglio I. Self-care in children and young people with complex chronic conditions: a qualitative study using Emotional Text Mining. Front Pediatr 2023; 11:1170268. [PMID: 37576150 PMCID: PMC10420086 DOI: 10.3389/fped.2023.1170268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives To explore: (1) self-care behaviors in children and young people (range: 6 months-24 years) with complex chronic conditions, characterized by the diagnosis of a severe chronic condition, substantial family-identified needs, functional limitations associated with technology dependence, and intensive use of healthcare services; (2) the contribution to self-care of family members and other persons involved in the child's health and daily life context (e.g., health professionals and teachers), and (3) the principal factors that might have influenced the self-care process associated with developmental age. Methods A qualitative descriptive study was conducted in an Italian academic tertiary pediatric hospital between September 2020 and May 2021. Overall, 25 focus groups and 7 online interviews were conducted via videoconferencing. Textual data were analyzed using Emotional Text Mining to identify three levels of communication: the factors, the main themes (clusters), and the sub-themes. Results A total of 104 participants were enrolled, including 27 patients with complex chronic conditions (12 males, mean age = 11.1 ± 4.40), 33 parents, 6 siblings, 33 health professionals, and 5 teachers. Participants described the process of self-care through four main factors: "self-care", "external settings", "family", and "management". Five clusters (themes) were identified: (1) Self-care management (device; consulting); (2) Shift of agency (influencing factors; parents; school); (3) Self-care support (normal life and personal development; multidisciplinary support); (4) Daily self-care maintenance/monitoring; (5) Treatment adherence. Self-care management was mostly relevant for parents of children aged between 6 months and 3 years. Conclusion The self-care process varies according to the needs related to the specific developmental age and the evolution of the clinical condition over time. The contribution of the family, health professionals, and social networks is fundamental for adequate self-care. To help families manage the unstable condition of their children at home, it is necessary to strengthen support networks implement home care, and ensure continuity of care.
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Affiliation(s)
- Giuseppina Spitaletta
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Greco
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Rachele Mascolo
- Pediatric Semi-Intensive Care Area/Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Annachiara Liburdi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Manzi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Michele Salata
- Paediatric Palliative Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Immacolata Dall’Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Killey J, Simons M, Prescott S, Kimble R, Tyack Z. Becoming Experts in Their Own Treatment: Child and Caregiver Engagement With Burn Scar Treatments. QUALITATIVE HEALTH RESEARCH 2023; 33:496-508. [PMID: 36942444 DOI: 10.1177/10497323231161997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Children who experience a severe burn injury not only require acute medical care but may also need ongoing rehabilitation. To mitigate the potential long-term consequences of scarring and the impact of scarring on their everyday lives, children may be expected to use a variety of time-consuming and multi-component non-invasive scar treatments (such as pressure garments and silicone gels). These treatments may pose unique challenges for children and their caregivers. With limited research previously addressing how Australian children navigate the use of scar treatments at home, this study aimed to develop a grounded theory of children and their caregivers' engagement with non-invasive burn scar treatments. Using a constructivist grounded theory approach, interviews were completed with 20 caregivers and 7 children, and a theory of children and their caregivers becoming experts in the use of non-invasive burn scar treatments was developed. Through persistence and flexibility, they continued to develop expertise. Engaging with scar treatments was an evolving process over time for children with burns and their caregivers. Theoretical categories identified included 'making it work', 'finding the balance' and 'seeking reassurance' and highlighted the remarkable strengths and adaptability of children and their caregivers. Through trial and error, children and their caregivers developed their own unique strategies for engaging with scar treatments. These insightful results may inform the development of interventions to support children and their caregivers' day-to-day engagement with non-invasive burn scar treatments and guide health professionals recommending these treatments.
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Affiliation(s)
- Jessica Killey
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, QLD, Australia
| | - Megan Simons
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, QLD, Australia
- Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Queensland, QLD, Australia
| | - Sarah Prescott
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, QLD, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, QLD, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, QLD, Australia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, QLD, Australia
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Dawson S, Girling CJ, Cowap L, Clark-Carter D. Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 3:CD013766. [PMID: 36989170 PMCID: PMC10054300 DOI: 10.1002/14651858.cd013766.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Adherence to treatment, including inhaled therapies, is low in people with cystic fibrosis (CF). Although psychological interventions for improving adherence to inhaled therapies in people with CF have been developed, no previous published systematic review has evaluated the evidence for efficacy of these interventions. OBJECTIVES The primary objective of the review was to assess the efficacy of psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (CF). The secondary objective was to establish the most effective components, or behaviour change techniques (BCTs), used in these interventions. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, which is compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched databases (PubMed; PsycINFO; EBSCO; Scopus; OpenGrey), trials registries (World Health Organization International Clinical Trials Registry Platform; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov), and the reference lists of relevant articles and reviews, with no restrictions on language, year or publication status. Date of search: 7 August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different types of psychological interventions for improving adherence to inhaled therapies in people with CF of any age, or comparing psychological interventions with usual care. We included quasi-RCTs if we could reasonably assume that the baseline characteristics were similar in both groups. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and completed data extraction, risk of bias assessments, and BCT coding (using the BCT Taxonomy v1) for all included trials. We resolved any discrepancies by discussion, or by consultation with a third review author as necessary. We assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 10 trials (1642 participants) in the review (children and adolescents in four trials; adults in five trials; and children and adults in one trial). Nine trials compared a psychological intervention with usual care; we could combine data from some of these in a number of quantitative analyses. One trial compared a psychological intervention with an active comparator (education plus problem-solving (EPS)). We identified five ongoing trials. Psychological interventions were generally multi-component and complex, containing an average of 9.6 BCTs (range 1 to 28). The two most commonly used BCTs included 'problem-solving' and 'instruction on how to perform the behaviour'. Interventions varied in their type, content and mode of delivery. They included a problem-solving intervention; a paper-based self-management workbook; a telehealth intervention; a group training programme; a digital intervention comprising medication reminders and lung function self-monitoring; a life-coaching intervention; a motivational interviewing (MI) intervention; a brief MI intervention (behaviour change counselling); and a digital intervention combined with behaviour change sessions. Intervention duration ranged from 10 weeks to 12 months. Assessment time points ranged from six to eight weeks up to 23 months. Psychological interventions compared with usual care We report data here for the 'over six months and up to 12 months' time point. We found that psychological interventions probably improve adherence to inhaled therapies (primary outcome) in people with CF compared with usual care (mean difference (MD) 9.5, 95% confidence interval (CI) 8.60 to 10.40; 1 study, 588 participants; moderate-certainty evidence). There was no evidence of a difference between groups in our second primary outcome, treatment-related adverse events: anxiety (MD 0.30, 95% CI -0.40 to 1.00; 1 study, 535 participants), or depression (MD -0.10, 95% CI -0.80 to 0.60; 1 study, 534 participants), although this was low-certainty evidence. For our secondary outcomes, there was no evidence of a difference between groups in terms of lung function (forced expiratory volume in one second (FEV1) % predicted MD 1.40, 95% CI -0.20 to 3.00; 1 study, 556 participants; moderate-certainty evidence); number of pulmonary exacerbations (adjusted rate ratio 0.96, 95% CI 0.83 to 1.11; 1 study, 607 participants; moderate-certainty evidence); or respiratory symptoms (MD 0.70, 95% CI -2.40 to 3.80; 1 study, 534 participants; low-certainty evidence). However, psychological interventions may improve treatment burden (MD 3.90, 95% CI 1.20 to 6.60; 1 study, 539 participants; low-certainty evidence). The overall certainty of the evidence ranged from low to moderate across these outcomes. Reasons for downgrading included indirectness (current evidence included adults only whereas our review question was broader and focused on people of any age) and lack of blinding of outcome assessors. Psychological interventions compared with an active comparator For this comparison the overall certainty of evidence was very low, based on one trial (n = 128) comparing an MI intervention to EPS for 12 months. We are uncertain whether an MI intervention, compared with EPS, improves adherence to inhaled therapies, lung function, or quality of life in people with CF, or whether there is an effect on pulmonary exacerbations. The included trial for this comparison did not report on treatment-related adverse events (anxiety and depression). We downgraded all reported outcomes due to small participant numbers, indirectness (trials included only adults), and unclear risk of bias (e.g. selection and attrition bias). AUTHORS' CONCLUSIONS Due to the limited quantity of trials included in this review, as well as the clinical and methodological heterogeneity, it was not possible to identify an overall intervention effect using meta-analysis. Some moderate-certainty evidence suggests that psychological interventions (compared with usual care) probably improve adherence to inhaled therapies in people with CF, without increasing treatment-related adverse events, anxiety and depression (low-certainty evidence). In future review updates (with ongoing trial results included), we hope to be able to establish the most effective BCTs (or 'active ingredients') of interventions for improving adherence to inhaled therapies in people with CF. Wherever possible, investigators should make use of the most objective measures of adherence available (e.g. data-logging nebulisers) to accurately determine intervention effects. Outcome reporting needs to be improved to enable combining or separation of measures as appropriate. Likewise, trial reporting needs to include details of intervention content (e.g. BCTs used); duration; intensity; and fidelity. Large trials with a longer follow-up period (e.g. 12 months) are needed in children with CF. Additionally, more research is needed to determine how to support adherence in 'under-served' CF populations.
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Affiliation(s)
- Sophie Dawson
- Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Carla-Jane Girling
- Sheffield Clinical Trials Research Unit, ScHARR, University of Sheffield, Innovation Centre, Sheffield, UK
| | - Lisa Cowap
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - David Clark-Carter
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
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Sayegh CS, Iverson E, Newman C, Tanaka D, Olshansky EF, Wijaya C, Belzer M. Designing an mHealth Roadmap for the Journey to Self-Management: A Qualitative Study with Adolescents and Young Adults Living with Chronic Illness. Chronic Illn 2023; 19:65-80. [PMID: 34904870 DOI: 10.1177/17423953211067436] [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] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Adolescents and young adults (AYA) with chronic illnesses often struggle with illness self-management. The objective of this study is to understand how AYA with various chronic illnesses develop self-management skills and which mobile health (mHealth) strategies they believe could be helpful. METHODS Semi-structured interviews were conducted with patients, between 16 to 20 years old, living with at least one chronic illness (N = 19), between 2018 and 2019 in Los Angeles, CA. Three coders completed thematic coding to understand how AYA develop and maintain self-management skills, to inform the development of mHealth interventions appropriate across a variety of chronic conditions. RESULTS Results suggest that AYA develop self-management skills through several strategies, including (1) getting organized, (2) making it work for me and (3) keeping the right mentality. AYA described developing these strategies through: (1) receiving social support, (2) accessing helpful tools and technologies, and (3) going through a maturation process. They provided recommendations for mHealth intervention developers. DISCUSSION The results suggest that an appealing mHealth intervention could support AYA patients in proactively acquiring self-management skills and prevent having to rely on trial and error or uneven access to guidance and support. Interventions should be responsive to individual technology preferences and practices.
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Affiliation(s)
- Caitlin S Sayegh
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,USC University Center for Excellence in Developmental Disabilities, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ellen Iverson
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Clarissa Newman
- Department of Population and Public Health Sciences, 12223University of Southern California, Los Angeles, California, USA
| | - Diane Tanaka
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ellen F Olshansky
- 115162Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA.,Sue & Bill Gross School of Nursing, 8788University of California Irvine, Los Angeles, California, USA
| | - Clarisa Wijaya
- Department of Psychology, 5116University of Southern California, Los Angeles, California, USA
| | - Marvin Belzer
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
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10
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Fairweather N, Jones FW. Facilitators and barriers to empowerment in children and young people with cystic fibrosis: a meta-synthesis of the qualitative literature. Disabil Rehabil 2022; 44:7767-7780. [PMID: 34802345 DOI: 10.1080/09638288.2021.2003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Patient empowerment may be particularly important in children and young people (CYP) with CF, due to high treatment burden and limited peer support opportunities. This review aimed to meta-synthesize the qualitative literature pertaining to empowerment in CYP with CF. MATERIALS AND METHODS This work was guided by the ENTREQ framework, with a search strategy based on the SPIDER framework. A systematic search of PsycInfo, Medline, CINAHL and ASSIA databases was conducted. Identified studies were quality assessed and data analysed using thematic synthesis. PROSPERO registration: CRD42019154014. RESULTS Seventeen studies met inclusion criteria, though none explicitly explored empowerment. Thematic synthesis identified six analytic themes: relational support, information and understanding and feeling heard and respected appeared to facilitate empowerment, while prejudices and assumptions were identified as potential barriers. Mastery and competence and Navigating being different appeared to be components of empowerment. CONCLUSIONS The findings provide an initial understanding of patient empowerment in CYP with CF. Potential clinical implications include the need for more CYP-friendly information, more shared decision making and more opportunities to experience mastery. The need for further research is highlighted, particularly relating to developmental influences and factors unique to CF, which are not adequately addressed in existing patient empowerment models.Implications for rehabilitationEmpowerment in children and young people with cystic fibrosis can be facilitated by supportive and respectful relationships with family, friends and clinical teams, that enable them to feel heard and understood.It can be further supported by providing developmentally appropriate information and opportunities for children and young people to experience mastery and competency in typical childhood activities.Prejudices and assumptions about the capabilities of children and young people with CF, even when based in good intentions, can act as a barrier to empowerment.Empowerment can shape (and be shaped by) the way the children and young people navigate differences associated with living with CF.
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Affiliation(s)
- Naomi Fairweather
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, Kent, UK
| | - Fergal W Jones
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, Kent, UK
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11
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Holland LR, Hilton J, Cookson K, Heinsch M, Gilligan C, Wark P. Understanding motivation for Australian adolescents and young adults with cystic fibrosis: Modifiable factors to support self-management. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2712-e2723. [PMID: 34997788 DOI: 10.1111/hsc.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/07/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Cystic fibrosis (CF) is Australia's most common life limiting genetic condition, characterised by declining health and quality of life (QoL) over time. Despite improvements in treatment, there remains no cure. Adolescents and young adults (AYAs) with CF experience broad impacts to psychosocial functioning and QoL, as well as major transitions in care, all at a time of significant developmental change. The importance of developmentally tailored approaches to youth health care and self-management for young people with CF are well understood. However, to date, models of youth specific self-management have been lacking and motivation for young people with CF has not been well explored. This qualitative study, based on a social constructionist epistemological framework, addresses this gap. A total of 21 AYAs aged 15-30 years were recruited through one paediatric and one adult Australian CF centre. Demographic, clinical and distress data were captured to describe health complexity. Semi-structured interviews were audio-recorded, transcribed and analysed using thematic analysis. Participants were representative of Australian AYAs with CF by demography and clinical status. Alarmingly, over a third reported clinically significant distress. Two themes emerged. The first Identified impacts to motivation and self-management resulting from the challenges of managing CF, life and care. These included time and competing priorities, changing health statis, mental health, social factors, unmet needs and health system complexity. The second identified factors that support motivation including: achievement, meaning and purpose; consequence avoidance; and accountability. These results illustrate the importance of AYA specific, theoretically founded, holistic self-management models which extend beyond current theoretical approaches that aim to understand behaviour change or address barriers, in isolation from motivation. Improved approaches to care based on these findings are essential to foster positive behavioural change, support self-management and foster the best health outcomes for young people living with CF.
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Affiliation(s)
- Lucy Ruth Holland
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jodi Hilton
- Department of Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Kim Cookson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Milena Heinsch
- School of Medicine and Public Health & Behavioural Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Conor Gilligan
- School of Medicine and Public Health & Behavioural Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter Wark
- Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
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12
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South K, George M, Sadeghi H, Piane V, Smaldone A. Moving up: Healthcare transition experiences of adolescents and young adults with cystic fibrosis. J Pediatr Nurs 2022; 65:116-123. [PMID: 35367087 PMCID: PMC9246909 DOI: 10.1016/j.pedn.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The experience of healthcare transition from pediatric to adult care in cystic fibrosis (CF) remains poorly understood, particularly among racially and ethnically diverse adolescents and young adults (AYAs) with CF. The objective of this qualitative study was to explore the perspectives of a diverse sample of AYAs with CF at one urban academic medical center regarding healthcare transition. DESIGN AND METHODS Guided by qualitative descriptive methodology, we purposively selected AYAs who represented the pre and post transition experience: some AYAs had experienced the transition preparation program CF R.I.S.E. Demographic information and responsibility for self-management behaviors were collected using an online survey. Semi-structured video interviews were conducted following an iterative interview guide. A codebook directed inductive coding. QSR NVivo Version 12 software was used to organize the data. RESULTS 12 AYAs with CF were enrolled (25% female, 25% Black AYA, 33% Hispanic/Latina/o AYA, 50% White AYA; mean age 20.8 years). Three themes were identified: independent care of the whole self, preparing for change and the unknown and transition experiences vary. CONCLUSIONS Not all participants experienced a smooth transition. Participants identified suggestions for the development of transition preparation interventions, specifically around involving AYAs in transition decisions and beginning transition preparation early in adolescence. PRACTICE IMPLICATIONS Participants expressed uncertainty about transition when they felt little control over the process or lacked sufficient information about adult care. Therefore, comprehensive early transition preparation for all AYAs with CF with a focus on involving AYAs in transition decisions is recommended.
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Affiliation(s)
- Katherine South
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America.
| | - Maureen George
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America
| | - Hossein Sadeghi
- Columbia University Irving Medical Center, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY 10032, United States of America
| | - Victoria Piane
- Columbia University Irving Medical Center, Division of Pediatric Pulmonology and Sleep Medicine, 3959 Broadway, New York, NY 10032, United States of America
| | - Arlene Smaldone
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, United States of America
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13
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Volpi S, Carnovale V, Colombo C, Raia V, Blasi F, Pappagallo G. Use of mucoactive agents in cystic fibrosis: A consensus survey of Italian specialists. Health Sci Rep 2022; 5:e604. [PMID: 35677472 PMCID: PMC9169509 DOI: 10.1002/hsr2.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background The goal of mucoactive therapies in cystic fibrosis (CF) is to enhance sputum clearance and to reduce a progressive decline in lung function over the patient's lifetime. We aimed to investigate the level of consensus among specialists from Italian CF Centers on appropriateness of therapeutic use of dornase alfa (rhDNase) for CF patients. Method A consensus on appropriate prescribing in CF mucoactive agents was appraised by an online Delphi method, based on a panel of 27 pulmonologists, coordinated by a Scientific Committee of six experts in medical care of patients with CF. Results Full or very high consensus was reached on several issues related to therapeutic use of dornase alfa for CF patients in clinical practice. Conclusions The consensus reached on a number of topics regarding use of mucoactive agents in patients with CF can help guide clinicians in daily practice based on expert experience and define the most appropriate therapeutic strategy for the individual patient.
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Affiliation(s)
- Sonia Volpi
- Cystic Fibrosis Center Azienda Ospedialiera Universitaria Integrata Verona Italy
| | - Vincenzo Carnovale
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Cystic Fibrosis Center Milan Italy
| | - Carla Colombo
- Department of Translational Medical Science, Cystic Fibrosis Centre, Adult Unit University “Federico II” Naples Italy
| | - Valeria Raia
- Section of Pediatrics, Department of Translational Medical Sciences “University Federico II” Naples Italy
| | - Francesco Blasi
- Department of Internal Medicine Respiratory Unit and Adult Cystic Fibrosis Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano Milan Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
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14
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Taheri L, Mirlashari J, Modaresi M, Pederson A. Cough in adolescent with cystic fibrosis, from nightmare to COVID-19 stigma: A qualitative thematic analysis. J Pediatr Nurs 2022; 64:119-125. [PMID: 35279332 PMCID: PMC8906655 DOI: 10.1016/j.pedn.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Cough is part of the daily life of patients with Cystic fibrosis (CF) and its most common symptom. This study explored the experiences of adolescents with CF in Iran during the COVID-19 pandemic in relation to their cough. DESIGN AND METHODS In this qualitative study, we conducted 32 semi-structured interviews with 21 adolescents with CF. We analyzed the data thematically. RESULTS We identified three main themes among adolescents with CF in relation to coughing: 1. Cough is a permanent companion; 2. Coughing raises fear of double stigma; 3. Patients' individualized coping strategies to deal with coughing. Participants complained that cough interrupted daily tasks and sleep, drew unwanted attention in public places, and elicited questions about whether they were COVID-19 patients or substance users-both highly stigmatized identities. CONCLUSION Although coughing is a protective mechanism for CF patients, frequent coughing often causes major challenges, particularly during the COVID pandemic, when people were acutely sensitive and aware about coughing. During the COVID-19 pandemic, in addition to taking care of themselves and managing the disease, CF patients therefore had to also overcome issues related to social stigma and isolation. PRACTICE IMPLICATIONS Healthcare workers play an important role in increasing public awareness about CF and its symptoms, including cough. During the pandemic, healthcare workers can help reduce the stigma of coughing through public education. Healthcare workers can actively communicate with patients to identify severe and ineffective cases of cough due to exacerbation of the disease and refer them to a specialist.
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Affiliation(s)
- Leila Taheri
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jila Mirlashari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Department of OBGYN, Women's Health Research Institute, University of British Columbia, Vancouver, Canada.
| | - Mohammadreza Modaresi
- Pediatric Pulmonary Disease and Sleep Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran; Cystic Fibrosis research center, Iran CF Foundation (ICFF), Tehran, Iran.
| | - Ann Pederson
- Population Health School of Population and Public health, University of British Columbia, British Columbia, Canada.
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Singh J, Towns S, Jayasuriya G, Hunt S, Simonds S, Boyton C, Middleton A, Kench A, Pandit C, Keatley LR, Chien J, Bishop J, Song Y, Robinson P, Selvadurai H, Middleton PG, Fitzgerald DA. Transition to adult care in cystic fibrosis: The challenges and the structure. Paediatr Respir Rev 2022; 41:23-29. [PMID: 32917516 DOI: 10.1016/j.prrv.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Abstract
In developed countries, it is projected that there will be a 70% increase in the number of adults living with Cystic Fibrosis (CF) between 2010 and 2025. This shift in demographics highlights the importance of high-quality transition programmes with developmentally appropriate integrated health care services as the individual moves through adolescence to adulthood. Adolescents living with CF face additional and unique challenges that may have long-term impacts on their health, quality of life and life-expectancy. CF specific issues around socially challenging symptoms, body image, reproductive health and treatment burden differentiate people with CF from their peers and require clinicians to identify and address these issues during the transition process. This review provides an overview of the health, developmental and psychosocial challenges faced by individuals with CF, their guardians and health care teams considering the fundamental components and tools that are required to build a transition programme that can be tailored to suit individual CF clinics.
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Affiliation(s)
- Jagdev Singh
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Susan Towns
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Adolescent Medicine, Sydney Children's Hospital Network, Australia
| | - Geshani Jayasuriya
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, Sydney, NSW, Australia; Department of Adolescent Medicine, Sydney Children's Hospital Network, Australia
| | - Sharon Hunt
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sharon Simonds
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Christie Boyton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anna Middleton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Andrea Kench
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Chetan Pandit
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Lucy R Keatley
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Jimmy Chien
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, NSW, Australia
| | - Jennifer Bishop
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Yang Song
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, NSW, Australia
| | - Paul Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Peter G Middleton
- Department of Adolescent Medicine, Sydney Children's Hospital Network, Australia; Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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16
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Rowbotham NJ, Daniels TE. Airway clearance and exercise for people with cystic fibrosis: Balancing longevity with life. Pediatr Pulmonol 2022; 57 Suppl 1:S50-S59. [PMID: 34672434 DOI: 10.1002/ppul.25734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 11/05/2022]
Abstract
Airway clearance has been an integral part of cystic fibrosis (CF) care for almost as long as CF has been identified as a condition. From diagnosis as a neonate through to end-of-life care, airway clearance is an everyday aspect of life, adding a considerable treatment burden to the lives of people with CF. There are many different techniques used for airway clearance which have evolved over time with an aim to improve effectiveness, support adherence and, more recently, to consider the impact of burden. A popular thought is whether airway clearance could be replaced by exercise. With new precision therapies in the form of CFTR modulators available, the CF landscape is rapidly changing, raising the question of whether certain treatments are needed at all. Depending on factors such as CFTR mutation, age, and pre-existing lung damage before starting a CFTR modulator, individuals with CF may need different levels of intensity and type of maintenance treatment. Precision medicine is likely to lead to the need for increased precision and individualized management around other maintenance therapies such as airway clearance.
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Affiliation(s)
- Nicola J Rowbotham
- Evidence Based Child Health Group, University of Nottingham, Nottingham, UK
| | - Tracey E Daniels
- York Hull Adult Cystic Fibrosis Centre, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.,School of Science, Technology and Health, York St John University, York, UK
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17
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Lumley E, Drabble SJ, Scott A, Wildman MJ, O’Cathain A. Objective Nebuliser Adherence Data as "Proof" of Adherence in the Management of Cystic Fibrosis: A Qualitative Interview Study. Patient Prefer Adherence 2022; 16:771-780. [PMID: 35370406 PMCID: PMC8965329 DOI: 10.2147/ppa.s353434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Low adherence to medication via nebulisers is linked to poor clinical outcomes for people with Cystic Fibrosis (PWCF). Advances in technology allow electronic monitoring of nebuliser usage and feedback of objective adherence data to PWCF and clinical teams caring for them. CFHealthHub is a new intervention that collects and displays objective adherence data in easy-to-read formats with the aim of improving nebuliser adherence and health. There is little understanding of how objective adherence data is perceived by PWCF and healthcare professionals (HCPs). PATIENTS AND METHODS A qualitative study using semi-structured interviews with 22 PWCF and 31 HCPs who had used the CFHealthHub intervention. RESULTS Objective adherence data was welcomed by the majority of PWCF in the sample, and HCP delivering the intervention, because the data allowed PWCF to reflect on patterns of adherence or non-adherence. Ease of use and characteristics of data display were important, particularly the use of a "traffic light" system to allow PWCF to easily see if they were meeting their adherence targets. For PWCF objective adherence data was used as "proof to self", offering reassurance to high adherers, and a wake-up call to those with lower levels of adherence. It could also provide 'proof to others' where PWCF had higher levels of adherence than HCP or family members believed. The data could sometimes change HCP perceptions of PWCF's identities as poor adherers. Where adherence was not high, data was used to facilitate honest discussions between PWCF and HCPs about how to increase adherence. HCPs perceived that it was important to use the data positively to motivate, rather than criticise, PWCF. CONCLUSION Objective nebuliser adherence data in CFHealthHub can offer proof of adherence to PWCF and HCPs. It is important to use it constructively to facilitate discussions on how to improve adherence.
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Affiliation(s)
- Elizabeth Lumley
- Health and Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
- Correspondence: Elizabeth Lumley, Health and Care Research Unit, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK, Tel +44 114 2224294, Email
| | - Sarah J Drabble
- Health and Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anne Scott
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Martin J Wildman
- Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alicia O’Cathain
- Health and Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Valero-Moreno S, Lacomba-Trejo L, Montoya-Castilla I, Pérez-Marín M. Is mHealth a useful therapy for improving physical or emotional health in adolescents with cystic fibrosis? A systematic review. CURRENT PSYCHOLOGY 2021; 42:1-14. [PMID: 34840486 PMCID: PMC8610788 DOI: 10.1007/s12144-021-02452-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
Cystic fibrosis (CF) is a rare disease that severely compromises health and interferes with the lives of those who suffer from it and is especially challenging in adolescence. The use of tools such as MHealth may benefit the physical and psychological health of adolescents with CF. Therefore, this study aims to examine the benefits of MHealth in adolescents with CF through a systematic review. A search of the scientific literature following the PRISMA guidelines was conducted in the ProQuest Central, PubMed, Web Of Science, Embase and ínDICE databases, resulting in 186 studies, of which seven were selected (based on inclusion and exclusion criteria). Two blinded evaluators conducted the searches, the selection and data extraction process and the quality evaluation of the studies. The agreement between evaluators was excellent in all cases (Kappa ranged from .78 to .96). 214 pediatric CF patients (61.71% female) participated in the final analysis. The mean age was 12.76 years. The studies evaluated different types of mHealth tools, with greater homogeneity in the independent and dependent variables. The quality of the studies analyzed was poor, since these had small samples selected for convenience, conducted non-experimental and low-quality designs, recorded few variables, and their statistical analyses were not sufficiently robust. Further research is needed in this field, improving research designs and considering physical and psychological adjustment variables, as well as patients and family members in the process of health improvement.
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Affiliation(s)
- Selene Valero-Moreno
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain
| | - Laura Lacomba-Trejo
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibánez, 21, 46010 Valencia, Spain
| | - Inmaculada Montoya-Castilla
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibánez, 21, 46010 Valencia, Spain
| | - Marian Pérez-Marín
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibánez, 21, 46010 Valencia, Spain
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Lynn C, Lyons E, Muther E. Delivery of cystic fibrosis psychosocial care across developmental stages. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.1993228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Courtney Lynn
- Department of Psychiatry, University of Colorado School of Medicine
- Children’s Hospital Colorado, Pediatric Mental Health Institute
| | - Emma Lyons
- Children’s Hospital Colorado, Pediatric Mental Health Institute
| | - Emily Muther
- Department of Psychiatry, University of Colorado School of Medicine
- Children’s Hospital Colorado, Pediatric Mental Health Institute
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20
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Verkleij M, Appelman I, Altenburg J, Twisk J, Quittner AL, Haarman E. Anxiety and depression in Dutch patients with primary ciliary dyskinesia and their caregivers: associations with health-related quality of life. ERJ Open Res 2021; 7:00274-2021. [PMID: 34708110 PMCID: PMC8542938 DOI: 10.1183/23120541.00274-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background Primary ciliary dyskinesia (PCD) might be a risk factor for the development of anxiety and depression. This study investigated the associations between anxiety, depression and health-related quality of life (HRQoL) in individuals with PCD and their caregivers. Methods Children, adolescents and adults with PCD and their caregivers were invited to participate in a mental health screening programme. During regular yearly outpatient visits, measures of anxiety (GAD-7), depression (PHQ-9), HRQoL (QOL-PCD), lung function (forced expiratory volume in 1 s (FEV1)) and body mass index (BMI)) were collected and associations of anxiety, depression and HRQoL were estimated. Results A total of 103 individuals participated in the mental health screening programme. Elevated levels of anxiety (scores ≥10 on GAD-7) were found in 6% of adults (n=33), 14% of children (n=7), 6% of adolescents (n=17) and 20% of caregivers (n=46, 52% of mothers). Elevated depression levels (scores ≥10 on PHQ-9) were found in 18% of adults, 14% of children, 6% of adolescents and 11% of caregivers. Anxiety and depression were associated with scales on the QOL-PCD. Mothers reported higher anxiety scores than fathers (30% versus 9%, p=0.03). A strong negative relationship was found between depression in caregivers and physical functioning (QOL-PCD) of the child. Anxiety and depression were not significantly associated with anxiety/depression in their child. Conclusion This is the first study investigating anxiety and depression in individuals with PCD and their caregivers. Our results revealed elevated levels of anxiety and depression, which were associated with worse HRQoL. These results suggest the need for psychological support in PCD. Individuals with PCD and their caregivers are at risk of developing symptoms of anxiety and depression, which are associated with worse HRQoL. There is an urgent need for psychological care in PCD, especially in adults with PCD and caregivers.https://bit.ly/3rmbgc9
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Affiliation(s)
- Marieke Verkleij
- Dept of Pediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Iris Appelman
- Dept of Pediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Josje Altenburg
- Dept of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jos Twisk
- Dept of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Eric Haarman
- Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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21
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Perkins RC, Gross R, Regan K, Bishay L, Sawicki GS. Perceptions of Social Media Use to Augment Health Care Among Adolescents and Young Adults With Cystic Fibrosis: Survey Study. JMIR Pediatr Parent 2021; 4:e25014. [PMID: 34232121 PMCID: PMC8406102 DOI: 10.2196/25014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/02/2021] [Accepted: 07/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND For individuals with cystic fibrosis (CF), adolescence and young adulthood are times of significant vulnerability and have been associated with clinical and psychosocial challenges. Social media may offer innovative care delivery solutions to address these challenges. OBJECTIVE This study explored motivations and attitudes regarding current social media use and preferences for a social media platform in a sample of adolescents and young adults (AYA) with CF. METHODS A cross-sectional survey was administered to 50 AYA with CF followed at a large pediatric-adult CF center. The survey included questions regarding social media platform utilization, attitudes toward general and CF-specific online activities, and preferences for a CF-specific care delivery platform. RESULTS YouTube, Snapchat, and Instagram were the most commonly used social media platforms. AYA with CF do not report routinely using social media for health-related information acquisition, social support, or help with adherence. However, their perceptions of social media utilization and preferences for platform development suggest interest in doing so in the future. CONCLUSIONS AYA with CF use social media and expressed interest in the development of a social media platform. Platform development will allow for gaps in health care delivery to be addressed by improving social support and adherence while augmenting current methods of health information acquisition.
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Affiliation(s)
- Ryan C Perkins
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Rachel Gross
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Kayla Regan
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Lara Bishay
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, United States
| | - Gregory S Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States
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22
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Fairweather NH, Jones FW, Harris SA, Deiros Collado M, Shayle A. Thriving alongside cystic fibrosis: Developing a grounded theory of empowerment in children and young people with cystic fibrosis during key life transitions. Child Care Health Dev 2021; 47:484-493. [PMID: 33638555 DOI: 10.1111/cch.12860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/21/2020] [Accepted: 02/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although the importance of patient empowerment is increasingly recognized, little is known about empowerment in children and young people (CYP) with long-term conditions. Empowerment may be particularly important in CYP with cystic fibrosis (CF) due to high treatment burden and limited opportunities for peer support. METHODS A Grounded Theory method was employed to develop a preliminary theory of empowerment in CYP with CF. Seven CYP with CF, five parents and four professionals were interviewed. RESULTS AND CONCLUSIONS The emerging model suggests that 'thriving alongside CF' may be supported by interactions between 'having a team' and 'taking charge and having a voice', leading to 'being able to just be a child', that 'concealing self' may get in the way of 'thriving alongside CF' and that these processes occur within wider medical and developmental contexts. Study limitations, clinical and research implications are discussed.
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Affiliation(s)
- Naomi H Fairweather
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, UK.,Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Fergal W Jones
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, UK.,Sussex Partnership NHS Foundation Trust, Sussex, UK
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23
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Hill SV, Johnson J, Rahman F, Dauria EF, Mugavero M, Matthews LT, Simpson T, Elopre L. Exploring adults as support persons for improved pre-exposure prophylaxis for HIV use among select adolescents and young adults in the Deep South. PLoS One 2021; 16:e0248858. [PMID: 33740005 PMCID: PMC7978356 DOI: 10.1371/journal.pone.0248858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Pre-exposure prophylaxis for HIV (PrEP) is an effective yet underutilized biomedical tool for adolescents and young adults' (AYA) HIV prevention due to barriers such as PrEP adherence. We assessed HIV prevention knowledge, attitudes and beliefs from adults who self-identified as a primary support person to an AYA. METHODS We surveyed AYA primary support persons at an academic hospital. Univariate and multivariate regression analyses were completed to identify factors associated with the belief AYAs engaging in HIV-associated behaviors should use PrEP and willingness to support AYAs on PrEP. RESULTS 200 primary support persons completed the survey. Participants were predominately female (77%) and black (56%). Nearly all primary support persons believed AYAs engaging in HIV-associated behaviors should take PrEP (94%) and 98% would support an AYA taking PrEP via transportation to appointments, assistance with refilling prescriptions, medication reminders, or encouragement. CONCLUSIONS Primary support persons are willing to support AYAs using PrEP.
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Affiliation(s)
- Samantha V Hill
- Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Jarvis Johnson
- Division of Infectious Diseases, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Fazlur Rahman
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Emily F Dauria
- Division of Infant, Child and Adolescent Psychiatry, The University of California San Francisco, San Francisco, California, United States of America
| | - Michael Mugavero
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Lynn T Matthews
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Tina Simpson
- Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States of America
| | - Latesha Elopre
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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24
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Glenn TW, Riekert KA, Roter D, Eakin MN, Pruette CS, Brady TM, Mendley SR, Tuchman S, Fivush BA, Eaton CK. Engagement and Affective Communication During Pediatric Nephrology Clinic Visits: Associations with Medication Adherence. PATIENT EDUCATION AND COUNSELING 2021; 104:578-584. [PMID: 32948401 PMCID: PMC7933303 DOI: 10.1016/j.pec.2020.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate whether engagement and affective communication among adolescents and young adults (AYAs) with chronic kidney disease (CKD), caregivers, and pediatric nephrology providers during outpatient clinic visits predicts antihypertensive medication adherence. METHODS AYAs (n = 60, M age = 15.4 years, SD = 2.7, 40% female, 43% African American/Black) and caregivers (n = 60, 73% female) attended audio-recorded clinic visits with pediatric nephrologists (n = 12, 75% female). Recordings were analyzed using global affect ratings of the Roter Interactional Analysis System. Antihypertensive medication adherence was monitored electronically before and after clinic visits. A linear regression model evaluated associations between affect ratings and post-visit adherence. RESULTS AYAs took 84% of doses (SD = 20%) pre-visit and 82% of doses (SD = 24%) post-visit. Higher AYA engagement (β = 0.03, p = .01) and the absence of provider negative affect (β=-0.15, p = .04) were associated with higher post-visit adherence, controlling for pre-visit adherence, AYA sex, age, and race, and clustered by provider. CONCLUSIONS Post-visit adherence was higher when AYAs were rated as more engaged and providers as less negative. PRACTICE IMPLICATIONS AYAs with lower engagement may benefit from further adherence assessment. Communication strategies designed to more actively engage AYAs in their care and diminish provider conveyance of negative affect during clinic visits may positively influence adherence among AYAs with CKD.
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Affiliation(s)
- Trevor W Glenn
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Kristin A Riekert
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Debra Roter
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Michelle N Eakin
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Cozumel S Pruette
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Tammy M Brady
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Susan R Mendley
- University of Maryland School of Medicine, Baltimore MD - 655 W Baltimore St S, Baltimore, MD, 21201, USA.
| | - Shamir Tuchman
- Children's National Medical Center, Washington DC - 110 Irving St NW, Washington, DC, 20010, USA.
| | - Barbara A Fivush
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Cyd K Eaton
- Johns Hopkins University School of Medicine, Baltimore MD - 733 N Broadway, Baltimore, MD, 21205, USA.
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25
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Arden MA, Hutchings M, Whelan P, Drabble SJ, Beever D, Bradley JM, Hind D, Ainsworth J, Maguire C, Cantrill H, O'Cathain A, Wildman M. Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub. Pilot Feasibility Stud 2021; 7:1. [PMID: 33390191 PMCID: PMC7780635 DOI: 10.1186/s40814-020-00739-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-limiting genetic condition in which daily therapies to maintain lung health are critical, yet treatment adherence is low. Previous interventions to increase adherence have been largely unsuccessful and this is likely due to a lack of focus on behavioural evidence and theory alongside input from people with CF. This intervention is based on a digital platform that collects and displays objective nebuliser adherence data. The purpose of this paper is to identify the specific components of an intervention to increase and maintain adherence to nebuliser treatments in adults with CF with a focus on reducing effort and treatment burden. METHODS Intervention development was informed by the Behaviour Change Wheel (BCW) and person-based approach (PBA). A multidisciplinary team conducted qualitative research to inform a needs analysis, selected, and refined intervention components and methods of delivery, mapped adherence-related barriers and facilitators, associated intervention functions and behaviour change techniques, and utilised iterative feedback to develop and refine content and processes. RESULTS Results indicated that people with CF need to understand their treatment, be able to monitor adherence, have treatment goals and feedback and confidence in their ability to adhere, have a treatment plan to develop habits for treatment, and be able to solve problems around treatment adherence. Behaviour change techniques were selected to address each of these needs and were incorporated into the digital intervention developed iteratively, alongside a manual and training for health professionals. Feedback from people with CF and clinicians helped to refine the intervention which could be tailored to individual patient needs. CONCLUSIONS The intervention development process is underpinned by a strong theoretical framework and evidence base and was developed by a multidisciplinary team with a range of skills and expertise integrated with substantial input from patients and clinicians. This multifaceted development strategy has ensured that the intervention is usable and acceptable to people with CF and clinicians, providing the best chance of success in supporting people with CF with different needs to increase and maintain their adherence. The intervention is being tested in a randomised controlled trial across 19 UK sites.
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Affiliation(s)
- M A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, 2.03a Heart of the Campus, Collegiate Crescent Campus, Sheffield, S10 2BQ, UK.
| | - M Hutchings
- Sheffield Adult Cystic Fibrosis Unit Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - P Whelan
- Health eResearch Centre-Farr Institute, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9GB, UK
| | - S J Drabble
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - D Beever
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - J M Bradley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - D Hind
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - J Ainsworth
- Health eResearch Centre-Farr Institute, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9GB, UK
| | - C Maguire
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - H Cantrill
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - A O'Cathain
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - M Wildman
- Sheffield Adult Cystic Fibrosis Unit Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
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26
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Montero-Ruiz A, Fuentes LA, Pérez Ruiz E, García-Agua Soler N, Rius-Diaz F, Caro Aguilera P, Pérez Frías J, Martín-Montañez E. Effects of music therapy as an adjunct to chest physiotherapy in children with cystic fibrosis: A randomized controlled trial. PLoS One 2020; 15:e0241334. [PMID: 33125399 PMCID: PMC7598495 DOI: 10.1371/journal.pone.0241334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/12/2020] [Indexed: 11/18/2022] Open
Abstract
Airway clearance therapy (ACT) is considered an important approach to improve airway clearance in children with cystic fibrosis (CF). Daily ACT administration requires substantial commitments of time and energy that complicate ACT and reduce its benefits. It is crucial to establish ACT as a positive routine. Music therapy (MT) is an aspect of integrative strategies to ameliorate the psycho-emotional consequences of chronic diseases, and a MT intervention could help children with CF between the ages of 2 and 17 develop a positive response. The aim of this randomized controlled trial was to evaluate the effects of specifically composed and recorded instrumental music as an adjunct to ACT. We compared the use of specifically composed music (Treated Group, TG), music that the patient liked (Placebo Group, PG), and no music (Control Group, CG) during the usual ACT routine in children with CF aged from 2 to 17. The primary outcomes, i.e., enjoyment and perception of time, were evaluated via validated questionnaires. The secondary outcome, i.e., efficiency, was evaluated in terms of avoided healthcare resources. Enjoyment increased after the use of the specifically composed music (children +0.9 units/parents +1.7 units; p<0.05) compared to enjoyment with no music (0 units) and familiar music (+0.5 units). Perception of time was 11.1 min (±3.9) less than the actual time in the TG (p<0.05), 3.9 min (±4.2) more than the actual time in the PG and unchanged in the CG. The potential cost saving related to respiratory exacerbations was €6,704.87, while the cost increased to €33,524.35 in the CG and to €13,409.74 in the PG. In conclusion, the specifically composed, played and compiled instrumental recorded music is an effective adjunct to ACT to establish a positive response and is an efficient option in terms of avoided costs. Trial registered as ISRCTN11161411. ISRCTN registry (www.isrctn.com).
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Affiliation(s)
- Alberto Montero-Ruiz
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga, Facultad de Medicina, Málaga, Spain
- Consejería de Educación, Junta de Andalucía, Delegación Territorial de Málaga, Málaga, Spain
| | - Laura A. Fuentes
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga, Facultad de Medicina, Málaga, Spain
| | - Estela Pérez Ruiz
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga, Facultad de Medicina, Málaga, Spain
- Hospital Regional Universitario de Málaga, Sección de Neumología Pediátrica, Málaga, Spain
| | - Nuria García-Agua Soler
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga, Facultad de Medicina, Málaga, Spain
| | - Francisca Rius-Diaz
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Facultad de Medicina, Málaga, Spain
| | - Pilar Caro Aguilera
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga, Facultad de Medicina, Málaga, Spain
- Hospital Regional Universitario de Málaga, Sección de Neumología Pediátrica, Málaga, Spain
| | - Javier Pérez Frías
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga, Facultad de Medicina, Málaga, Spain
- Hospital Regional Universitario de Málaga, Sección de Neumología Pediátrica, Málaga, Spain
- * E-mail: (EM-M); (JPF)
| | - Elisa Martín-Montañez
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga, Facultad de Medicina, Málaga, Spain
- * E-mail: (EM-M); (JPF)
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27
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Dawson S, Cowap L, Clark-Carter D, Girling CJ. Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sophie Dawson
- Wolfson Cystic Fibrosis Centre; Nottingham University Hospitals NHS Trust; Nottingham UK
- Staffordshire Centre for Psychological Research, School of Life Sciences & Education; Staffordshire University; Stoke-on-Trent UK
| | - Lisa Cowap
- Staffordshire Centre for Psychological Research, School of Life Sciences & Education; Staffordshire University; Stoke-on-Trent UK
| | - David Clark-Carter
- Staffordshire Centre for Psychological Research, School of Life Sciences & Education; Staffordshire University; Stoke-on-Trent UK
| | - Carla-Jane Girling
- Sheffield Clinical Trials Research Unit, ScHARR; University of Sheffield, Innovation Centre; Sheffield UK
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28
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Drabble SJ, O'Cathain A, Scott AJ, Arden MA, Keating S, Hutchings M, Maguire C, Wildman M. Mechanisms of Action of a Web-Based Intervention With Health Professional Support to Increase Adherence to Nebulizer Treatments in Adults With Cystic Fibrosis: Qualitative Interview Study. J Med Internet Res 2020; 22:e16782. [PMID: 32697197 PMCID: PMC7576463 DOI: 10.2196/16782] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/14/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023] Open
Abstract
Background Adherence to nebulizer treatments in adults with cystic fibrosis (CF) is often low. A new complex intervention to help adults with CF increase their adherence to nebulizer treatments was tested in a pilot randomized controlled trial (RCT) in 2 UK CF centers. Patients used a nebulizer with electronic monitoring capabilities that transferred data automatically to a digital platform (CFHealthHub) to monitor adherence over time and to a tailored website to display graphs of adherence data and educational and problem-solving information about adherence. A trained interventionist helped patients identify ways to increase their adherence. Objective This study aims to explore the mechanisms of action underpinning the intervention. Methods A qualitative interview study was conducted concurrently with a pilot RCT. In total, 25 semistructured interviews were conducted with 3 interventionists at 2 time points, 14 patients in the intervention arm of the trial, and 5 members of the multidisciplinary teams offering wider care to patients. A framework approach was used for the analysis. Results The intervention was informed by a theoretical framework of behavior change. There was evidence of the expected behavior change mechanisms of action. There was also evidence of additional mechanisms of action associated with effective telehealth interventions for self-management support: relationships, visibility, and fit. Patients described how building a relationship with the interventionist through face-to-face visits with someone who cared about them and their progress helped them to consider ways of increasing adherence to medication. Rather than seeing the visibility of adherence data to clinicians as problematic, patients found this motivating, particularly if they received praise about progress made. The intervention was tailored to individuals, but there were challenges in how the intervention fitted into some patients’ busy lives when delivered through a desktop computer. Conclusions The mechanisms of action associated with effective telehealth interventions for self-management operated within this new intervention. The intervention was modified to strengthen mechanisms of action based on these findings, for example, delivery through an app accessed via mobile phones and then tested in an RCT in 19 UK CF centers. Trial Registration International Standard Randomized Controlled Trial Number 13076797; http://www.isrctn.com/ISRCTN13076797
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Affiliation(s)
- Sarah J Drabble
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Alexander J Scott
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, United Kingdom
| | - Samuel Keating
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Marlene Hutchings
- Sheffield Adult CF Centre, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Chin Maguire
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Martin Wildman
- Sheffield Adult CF Centre, Sheffield Teaching Hospitals, Sheffield, United Kingdom
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29
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Graziano S, Spanò B, Majo F, Righelli D, Vincenzina L, Quittner A, Tabarini P. Rates of depression and anxiety in Italian patients with cystic fibrosis and parent caregivers: Implementation of the Mental Health Guidelines. Respir Med 2020; 172:106147. [PMID: 32961510 DOI: 10.1016/j.rmed.2020.106147] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Individuals with chronic respiratory conditions are at-risk for depression and anxiety. In the largest mental health screening study of over 6000 people with cystic fibrosis (CF) and 4000 parent caregivers (TIDES, 2014), rates of symptomatology were two to three times higher than in the general population. International guidelines recommend annual screening of mental health. This is the first study to implement these guidelines in one of the largest CF Centers in Italy. METHODS All individuals with CF, 12 and older (n = 167) and caregivers of children with CF (n = 186), birth to 18, were screened. Health outcome data were also collected (i.e FEV1, BMI, pulmonary exacerbations, CF-related diabetes). Prevalence data and associations between psychological symptoms and health outcomes were examined. RESULTS A high percentage of patients and parent caregivers reported scored above the clinical cut-off for depression and anxiety (37%-48% of adolescents, 45%-46% of adults, 49%-66% of mothers and fathers). Most scores fell in the mild range, however, over 30% were in the moderate to severe range. Elevations in depression and anxiety were correlated. Adolescents who had more pulmonary exacerbations reported higher anxiety. Adults with recent events of hemoptysis reported higher symptoms of depression. CONCLUSIONS Symptoms of depression and anxiety were elevated in both individuals with CF and parents. Implementation of mental health screening was critical for identifying those in need of psychological interventions. These results strongly suggest that mental health should be integrated into physical health care for those with complex, chronic respiratory conditions, including COPD, PCD.
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Affiliation(s)
- Sonia Graziano
- Unit of Clinical Psychology, Bambino Gesù Pediatric Hospital, Rome, IT.
| | - Barbara Spanò
- Neuroimaging Laboratory, Fondazione Santa Lucia, Rome, IT
| | - Fabio Majo
- Cystic Fibrosis Unit, Department of Pediatrics, Bambino Gesù Pediatric Hospital, Rome, IT
| | - Dario Righelli
- Istituto per le Applicazioni del Calcolo Mauro Picone, Consiglio Nazionale delle Ricerche Sezione di Napoli, Naples, IT
| | - Lucidi Vincenzina
- Cystic Fibrosis Unit, Department of Pediatrics, Bambino Gesù Pediatric Hospital, Rome, IT
| | | | - Paola Tabarini
- Unit of Clinical Psychology, Bambino Gesù Pediatric Hospital, Rome, IT
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30
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Eaton CK, Beachy S, McLean KA, Nicolais CJ, Bernstein R, Sáez-Clarke E, Quittner AL, Riekert KA. Misunderstandings, misperceptions, and missed opportunities: Perspectives on adherence barriers from people with CF, caregivers, and CF team members. PATIENT EDUCATION AND COUNSELING 2020; 103:1587-1594. [PMID: 32098744 DOI: 10.1016/j.pec.2020.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/24/2020] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify differences in perspectives of people with cystic fibrosis (PwCF) and caregivers versus healthcare providers on adherence barriers. Mismatched perspectives may lead to miscommunication and missed opportunities to reduce barriers and improve CF outcomes. METHODS PwCF, caregivers, and CF providers completed audio-taped, semi-structured interviews about adherence barriers. Interviews were transcribed and coded for themes. Themes were reviewed to identify when PwCF-caregiver perspectives differed from providers'. RESULTS Participants included 14 adolescents with CF (mean age = 15.89 years, 64 % female, 71 % Caucasian), 14 adults with CF (mean age = 30.03 years, 64 % female, 57 % Caucasian), 29 caregivers (76 % female; 72 % Caucasian), and 42 providers. Four barriers were identified that could generate miscommunication between PwCF-caregivers and providers: Tired = Fatigued/Sleepy versus Tired = Burnout, Vacation and Travel, Knowledge and Skills About CF Regimen, and Daily Habits or Routines. PwCF and caregivers used similar words as providers, but conceptualized barriers differently. PwCF and caregivers discussed barriers pragmatically, however, providers viewed certain barriers more abstractly or unidimensionally, or did not discuss them. CONCLUSIONS PwCF-caregivers and providers may not align in how they discuss barriers, which may contribute to miscommunication about adherence challenges. PRACTICE IMPLICATIONS Patient-centered communication strategies may enhance providers' understandings of PwCF-caregiver perspectives on barriers and facilitate adherence interventions.
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Affiliation(s)
- Cyd K Eaton
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA.
| | - Sara Beachy
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
| | - Katherine A McLean
- Rush University Medical Center, Department of Pediatrics, Chicago, IL, USA
| | | | - Ruth Bernstein
- University of Miami, Department of Psychology, Coral Gables, FL, 33124, USA
| | | | | | - Kristin A Riekert
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA
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31
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Bonfim BS, Melo Filho VMD, Fontenelle FM, Souza EL. TREATMENT ADHERENCE AMONG CHILDREN AND ADOLESCENTS IN A CYSTIC FIBROSIS REFERENCE CENTER. REVISTA PAULISTA DE PEDIATRIA 2020; 38:e2018338. [PMID: 32520296 PMCID: PMC7274532 DOI: 10.1590/1984-0462/2020/38/2018338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/12/2019] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the level of self-referenced treatment adherence (TA) and its
association with clinical and sociodemographic variables in patients with
cystic fibrosis assisted at a reference center, as well as compare the level
of self-referenced TA with that presumed by the multidisciplinary team. Methods: This is a cross-sectional study that included children and adolescents aged
between 0-20 years with cystic fibrosis. Adolescents older than 14 years or
their guardians, when younger than 14 years old, were interviewed using a
standardized questionnaire. Professionals from the multidisciplinary clinic
filled out another form with their impressions of the patients’ TA. Clinical
and laboratory data were obtained in the medical records. The TA was
considered satisfactory if the total adherence index (TAI) was equal or
higher than 80%. Results: 53 patients were included with a median age of 112 months. The mean TAI was
83.2%. The mean TAIs for dornase alfa, pancreatic enzymes, continued use of
inhaled tobramycin, vitamins supplements, nutritional supplements and
dietary orientation was respectively: 86.1; 96.6; 78.6; 88.1; 51.8 and 78%.
Children younger than 14 years presented better TA (p=0.021). The
correlation between the self-referenced TA and the one presumed by the
multidisciplinary team ranged from 0,117 to 0.402, being higher for
Psychology and Nutrition professionals. Conclusions: The TAI was high particularly among children younger than 14 years. There
was a positive correlation between the self-referenced TA and the one
presumed by the Psychology (p=0.032) and the nutrition (p=0.012)
professionals.
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Cooley L, Hudson J, Potter E, Raymond KF, George C, Georgiopoulos AM. Clinical communication preferences in cystic fibrosis and strategies to optimize care. Pediatr Pulmonol 2020; 55:948-958. [PMID: 31977168 DOI: 10.1002/ppul.24655] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The importance of optimizing communication between clinicians and individuals and families living with cystic fibrosis (CF) about daily care, adherence, and related psychosocial concerns is well documented. The purpose of this study was to gain an understanding of interpersonal communication experiences and preferences among individuals and families living with CF as they engage with the clinical team. The study also aimed to reveal opportunities for enhancing future interpersonal communication practices. METHODS Five U.S. CF care centers participated in the following activities: (a) On-site observation of clinic interactions during outpatient visits; (b) On-site 1:1 interviews with individuals living with CF, their family members, and CF clinicians; (d) Focus groups conducted in person with CF care team members; (d) Focus groups conducted virtually with adults and family members with CF. Content analysis of transcripts and constant comparative methods were used to identify emergent themes. RESULTS Four themes related to participants' needs and preferences for clinic interactions emerged during analysis: (a) eliciting psychosocial concerns, (b) addressing childhood development and transitions, (c) negotiating agendas and sharing decisions, and (d) educating to enhance CF conversations. CONCLUSION CF clinicians and individuals and families living with CF expressed the need for resources and training to engage in better conversations with each other. Participants identified areas of high priority, including working together around social, psychological, and economic challenges, preparation for transition to adulthood, and sustaining daily care. Findings point to the value of developing advanced communication skills that foster trust-building, negotiating agendas, active listening, and collaborative goal-setting.
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Affiliation(s)
- Laura Cooley
- Division of Education and Outreach, Academy of Communication in Healthcare, Lexington, Kentucky
| | - Janella Hudson
- Division of Education and Outreach, Academy of Communication in Healthcare, Lexington, Kentucky
| | - Eileen Potter
- Department of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Katherine F Raymond
- Partnerships for Sustaining Daily Care, The Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Cynthia George
- Partnerships for Sustaining Daily Care, The Cystic Fibrosis Foundation, Bethesda, Maryland
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Martin R, Arden M, Porritt J, Wildman M, Naughton F. Investigating the Temporal Relationships between Symptoms and Nebuliser Adherence in People with Cystic Fibrosis: A Series of N-of-1 Observations. Healthcare (Basel) 2020; 8:healthcare8010022. [PMID: 31972991 PMCID: PMC7151352 DOI: 10.3390/healthcare8010022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 12/12/2022] Open
Abstract
Treatment adherence in adults with cystic fibrosis (CF) is poor. One of the reasons identified for lack of adherence to nebulised treatments is that patients may not experience any immediate relief in their symptoms or notice changes as a result of taking their treatment, thus many report that they do not perceive there to be consequences of non adherence. The aim of the study was to investigate the temporal relationships between symptoms and adherence to nebulised treatments in adults with CF using an N-of-1 observational design. Six participants were recruited for a six-week period during which time they completed a daily online respiratory symptom questionnaire. Adherence to treatment was measured throughout the duration of the study using an eTrack® nebuliser that logged date and time of treatments taken. Data generated from each participant was analysed separately. There were significant relationships between pain and adherence for three participants, tiredness and adherence for one participant and cough and adherence for one participant. For all of these findings, the symptom and adherence were experienced on the same day. Extending the monitoring period beyond six weeks may provide increased insight into the complex relationship between symptoms and adherence in CF.
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Affiliation(s)
- Rosie Martin
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
- Correspondence:
| | - Madelynne Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
| | - Jenny Porritt
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK;
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Muther EF, Butcher JL, Riekert KA. Understanding Treatment Adherence in Cystic Fibrosis: Challenges and Opportunities. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hoefnagels JW, Kars MC, Fischer K, Schutgens REG, Schrijvers LH. The Perspectives of Adolescents and Young Adults on Adherence to Prophylaxis in Hemophilia: A Qualitative Study. Patient Prefer Adherence 2020; 14:163-171. [PMID: 32158199 PMCID: PMC6986248 DOI: 10.2147/ppa.s232393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/05/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Adolescents and young adults (AYAs) with severe hemophilia use prophylaxis that requires a high level of adherence. The present study aimed to explore the underlying reason for adherence and non-adherence to prophylaxis in hemophilia from the perspective of AYAs. PATIENTS AND METHODS A qualitative study in Dutch AYAs with hemophilia (14-25 years) using prophylaxis was executed. Focus group interviews and individual interviews were recorded, transcribed, coded and analyzed using an iterative process. Member checking in three respondents was used to validate the potential model. RESULTS A total of 21 interviews were performed. Parental support decreased when AYAs gained more treatment responsibilities, which resulted in a higher risk for non-adherence. AYAs were weighing their potential bleeding risk per activity based on the wish to do what they prefer while also wanting to simultaneously feel safe. When bleeding with low impact on their daily life occurred, or when bleeding remained absent, AYAs felt safe and the perceived need for prophylaxis decreased. CONCLUSION The level of treatment responsibility per AYA and estimated risks per activity were the two main underlying reasons for (non-)adherence. CLINICAL IMPLICATIONS We suggest using a conversation technique to discuss adherence, especially during bleeding assessment visits.
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Affiliation(s)
- JW Hoefnagels
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
- Correspondence: JW Hoefnagels Van Creveldkliniek, Division Internal Medicine and Dermatology, University Medical Center Utrecht, Room C01.409, PO Box 85500, Utrecht3508, GA, the NetherlandsTel +31 88 75 584 50Fax +31 88755438 Email
| | - MC Kars
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K Fischer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
| | - REG Schutgens
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
| | - LH Schrijvers
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
- Institute of Nursing Studies, University of Applied Sciences, Utrecht, the Netherlands
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Drabble SJ, O’Cathain A, Arden MA, Hutchings M, Beever D, Wildman M. When Is Forgetting Not Forgetting? A Discursive Analysis of Differences in Forgetting Talk Between Adults With Cystic Fibrosis With Different Levels of Adherence to Nebulizer Treatments. QUALITATIVE HEALTH RESEARCH 2019; 29:2119-2131. [PMID: 31303116 PMCID: PMC7322938 DOI: 10.1177/1049732319856580] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Forgetting is often cited as a reason why people struggle to adhere to treatments for chronic conditions. Interventions have tried to improve forgetting behavior using reminders. We used a discursive psychological approach to explore differences in how high and low adherers constructed forgetting their nebulizer treatments for cystic fibrosis. Interviews were conducted with 18 adults from a cystic fibrosis center in the United Kingdom. High adherers constructed forgetting treatments as occasional lapses in automaticity and temporary lapses in memory that they found easy to repair. Low adherers utilized forgetting to normalize more consistent nonadherence to treatments. However, it is important to contextualize forgetting as a discursive resource that helped these participants to negotiate moral discourses around adherence to treatment that reminder interventions cannot address; we therefore recommend a more behavioral, patient-focused, theory-driven approach to intervention development.
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Affiliation(s)
| | | | | | | | - Daniel Beever
- The University of Sheffield, Sheffield,
United Kingdom
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Davies G, Rowbotham NJ, Smith S, Elliot ZC, Gathercole K, Rayner O, Leighton PA, Herbert S, Duff AJ, Chandran S, Daniels T, Nash EF, Smyth AR. Characterising burden of treatment in cystic fibrosis to identify priority areas for clinical trials. J Cyst Fibros 2019; 19:499-502. [PMID: 31735561 DOI: 10.1016/j.jcf.2019.10.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/26/2019] [Accepted: 10/29/2019] [Indexed: 11/24/2022]
Abstract
In a recent James Lind Alliance Priority Setting Partnership in cystic fibrosis (CF) the top priority clinical research question was: "What are effective ways of simplifying the treatment burden of people with CF?" We aimed to summarise the lived experience of treatment burden and suggest research themes aimed at reducing it. An online questionnaire was co-produced and responses subjected to quantitative and thematic analysis. 941 survey responses were received (641 from lay community). People with CF reported a median of 10 (interquartile range: 6-15) current treatments. Seven main themes relating to simplifying treatment burden were identified. Treatment burden is high, extending beyond time taken to perform routine daily treatments, with impact varying according to person-specific factors. Approaches to communication, support, evaluation of current treatments, service set-up, and treatment logistics (obtaining/administration) contribute to burden, offering scope for evaluation in clinical trials or service improvement.
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Affiliation(s)
- Gwyneth Davies
- Respiratory, Critical Care and Anaesthesia Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Nicola J Rowbotham
- Evidence Based Child Health Group, University of Nottingham, Nottingham, United Kingdom
| | - Sherie Smith
- Evidence Based Child Health Group, University of Nottingham, Nottingham, United Kingdom
| | - Zoe C Elliot
- Parent of Children with CF, Nottingham, United Kingdom
| | - Katie Gathercole
- University of Leeds, Leeds, United Kingdom; Person with CF, Leeds, United Kingdom
| | - Oli Rayner
- Person with CF, Plymouth, United Kingdom
| | - Paul A Leighton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom
| | - Sophie Herbert
- Evidence Based Child Health Group, University of Nottingham, Nottingham, United Kingdom
| | | | - Suja Chandran
- Paediatric CF Service, Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Tracey Daniels
- Department of Physiotherapy, York Hull Adult CF Unit, York Teaching Hospital NHS Foundation Trust, York, United Kingdom
| | - Edward F Nash
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alan R Smyth
- Evidence Based Child Health Group, University of Nottingham, Nottingham, United Kingdom
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Dunbar P, Hall M, Gay JC, Hoover C, Markham JL, Bettenhausen JL, Perrin JM, Kuhlthau KA, Crossman M, Garrity B, Berry JG. Hospital Readmission of Adolescents and Young Adults With Complex Chronic Disease. JAMA Netw Open 2019; 2:e197613. [PMID: 31339547 PMCID: PMC6659144 DOI: 10.1001/jamanetworkopen.2019.7613] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Adolescents and young adults (AYA) who have complex chronic disease (CCD) are a growing population that requires hospitalization to treat severe, acute health problems. These patients may have increased risk of readmission as demands on their self-management increase and as they transfer care from pediatric to adult health care practitioners. OBJECTIVE To assess variation across CCDs in the likelihood of readmission for AYA with increasing age. DESIGN, SETTING, AND PARTICIPANTS Retrospective 1-year cross-sectional study of the 2014 Agency for Healthcare Research and Quality Nationwide Readmissions Database for all US hospitals. Participants were 215 580 hospitalized individuals aged 15 to 30 years with cystic fibrosis (n = 15 213), type 1 diabetes (n = 86 853), inflammatory bowel disease (n = 48 073), spina bifida (n = 7819), and sickle cell anemia (n = 57 622) from January 1, 2014, to December 1, 2014. EXPOSURES Increasing age at index admission. MAIN OUTCOMES AND MEASURES Unplanned 30-day hospital readmission. Readmission odds were compared by patients' ages in 2-year epochs (with age 15-16 years as the reference) using logistic regression, accounting for confounding patient characteristics and data clustering by hospital. RESULTS Of 215 580 participants, 115 982 (53.8%) were female; the median (interquartile range) age was 24 (20-27) years. Across CCDs, multimorbidity was common; the percentages of index hospitalizations with 4 or more coexisting conditions ranged from to 33.4% for inflammatory bowel disease to 74.2% for spina bifida. Thirty-day hospital readmission rates varied significantly across CCDs: 20.2% (cystic fibrosis), 19.8% (inflammatory bowel disease), 20.4% (spina bifida), 22.5% (type 1 diabetes), and 34.6% (sickle cell anemia). As age increased from 15 to 30 years, unadjusted, 30-day, unplanned hospital readmission rates increased significantly for all 5 CCD cohorts. In multivariable analysis, age trends in the adjusted odds of readmission varied across CCDs. For example, for AYA who had cystic fibrosis, the adjusted odds of readmission increased to 1.9 (95% CI, 1.5-2.3) by age 21 years and remained elevated through age 30 years. For AYA who had type 1 diabetes, the adjusted odds of readmission peaked at ages 23 to 24 years (odds ratio, 2.3; 95% CI, 2.1-2.6) and then declined through age 30 years. CONCLUSIONS AND RELEVANCE These findings suggest that hospitalized AYA who have CCDs have high rates of multimorbidity and 30-day readmission. The adjusted odds of readmission for AYA varied significantly across CCDs with increasing age. Further attention is needed to hospital discharge care, self-management, and prevention of readmission in AYA with CCD.
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Affiliation(s)
- Peter Dunbar
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matt Hall
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City School of Medicine, Kansas City
- Children’s Hospital Association, Lenexa, Kansas
| | - James C. Gay
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jessica L. Markham
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City School of Medicine, Kansas City
| | - Jessica L. Bettenhausen
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City School of Medicine, Kansas City
| | - James M. Perrin
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Karen A. Kuhlthau
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Morgan Crossman
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Brigid Garrity
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay G. Berry
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Lerch MF, Thrane SE. Adolescents with chronic illness and the transition to self-management: A systematic review. J Adolesc 2019; 72:152-161. [PMID: 30903932 DOI: 10.1016/j.adolescence.2019.02.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 02/11/2019] [Accepted: 02/24/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Chronic illness effects one in ten adolescents worldwide. Adolescence involves a desire for autonomy from parental control and the necessity to transition care from parent to child. This review investigates the transition to adolescent self-management of chronic illness treatment behaviors in the context of parent-adolescent relationships. METHODS A systematic search of PubMed, CINAHL, and Web of Science was conducted from earliest database records to early June 2017. Articles were included if they focused on adolescents, addressed illness self-management, discussed the parent-adolescent relationship, and were published in English. Articles were excluded if the chronic illness was a mental health condition, included children younger than 10 years of age, or lacked peer review. RESULTS Nine studies met inclusion criteria. Outcomes included challenges to adolescent self-management, nature of the parent-adolescent relationship, illness representation, perceptions of adolescent self-efficacy in compliance, medical decision making, laboratory measures, and adolescent self-management competence. Across diagnoses, parents who were available to monitor, be a resource, collaborate with their adolescent, and engage in ongoing dialogue were key in the successful transition to autonomous illness management. CONCLUSIONS There is a paucity of research addressing the experiences of adolescents in becoming experts in their own care.
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Affiliation(s)
- Matthew F Lerch
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Susan E Thrane
- College of Nursing, The Ohio State University, 322 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, United States.
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Arden MA, Drabble S, O'Cathain A, Hutchings M, Wildman M. Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework. Br J Health Psychol 2019; 24:357-380. [PMID: 30825258 PMCID: PMC6519271 DOI: 10.1111/bjhp.12357] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 02/04/2019] [Indexed: 12/21/2022]
Abstract
Objectives Adherence to nebulizer treatment in adults with Cystic Fibrosis (CF) is poor, and interventions are needed. This research aimed to identify the factors affecting nebulizer adherence using the Theoretical Domains Framework (TDF) and to compare these for participants with different levels of adherence. Design Data‐prompted interviews using the TDF. Methods Eighteen semi‐structured interviews were conducted with adults with CF during which objectively measured adherence data were discussed. Framework analysis was used to code the data into TDF domains, and inductive qualitative content analysis was used to code different beliefs and experiences. Aspects of the TDF that differed between participants with different adherence levels were explored. Results Factors influencing adherence to treatment included all 14 domains of the TDF, 10 of which appeared to vary by adherence level: Skills; Memory and decision‐making; and Behavioural regulation; Environmental context and resources; Social influences; Beliefs about consequences; Beliefs about capability; Reinforcement; Social role and identify; Intentions; Optimism; and Emotions. Conclusions This study is the first to use objectively measured adherence data in a data‐prompted interview using the TDF framework to systematically assess the full range of factors potentially influencing adherence. The results highlighted that interventions need to consider issues of capability, opportunity, and motivation. Interventions that challenge dysfunctional beliefs about adherence and which support the development of routines or habits and problem‐solving may be particularly useful for adults with CF. Statement of contribution What is already known? Adherence to medication in adults with cystic fibrosis is poor. Previous research has identified a range of contributing factors in relation to subjective reports of adherence. There is a wide discrepancy between self‐reported adherence and objectively measured adherence.
What this study adds A data‐prompted interview using objectively measured adherence data enabled the systematic assessment of potential factors that could be targeted in an intervention to increase adherence. There were some differences in the factors that were identified by high and low adherers. There is not one‐size fits all intervention for adherence to medication in cystic fibrosis.
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Affiliation(s)
- Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology (CeBSAP), Sheffield Hallam University, UK
| | - Sarah Drabble
- School of Health and Related Research (ScHARR), University of Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, UK
| | | | - Martin Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, UK.,Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
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Nicolais CJ, Bernstein R, Saez-Flores E, McLean KA, Riekert KA, Quittner AL. Identifying Factors that Facilitate Treatment Adherence in Cystic Fibrosis: Qualitative Analyses of Interviews with Parents and Adolescents. J Clin Psychol Med Settings 2019; 26:530-540. [DOI: 10.1007/s10880-018-9598-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Longacre M, Grande S, Hager A, Montan M, Bergquist RP, Martensson M, Kotzbauer G. Clinical Adoption of mHealth Technology to Support Pediatric Cystic Fibrosis Care in Sweden: Qualitative Case Study. JMIR Pediatr Parent 2018; 1:e11080. [PMID: 31518297 PMCID: PMC6715072 DOI: 10.2196/11080] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/25/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have potential to improve self-management and care co-ordination of pediatric chronic diseases requiring complex care, such as cystic fibrosis (CF). Barriers to implementation include the lack of support and infrastructure to use mHealth in the clinical microsystem. Coproducing mHealth technology with patients, clinicians, and designers may increase the likelihood of successful integration into the clinical setting. OBJECTIVE This study explored the development, adoption, and integration of a new, co-produced mHealth platform (Genia) for the management of pediatric CF in Sweden. METHODS A retrospective, qualitative case study approach was used. The case was defined as the process of introducing and using Genia at the Pediatric Cystic Fibrosis Center at Skåne University Hospital in Lund, Sweden. Data sources included interviews, presentations, meeting notes, and other archival documents created between 2014 and 2017. To be included, data sources must have described or reflected upon the Genia adoption process. Iterative content analysis of data source materials was conducted by 2 qualitatively trained researchers to derive themes characterizing the mHealth clinical adoption process. RESULTS In total, 4 core themes characterized successful clinical integration of Genia in Lund: cultural readiness to use mHealth; use of weekly huddles to foster momentum and rapid iteration; engagement in incremental "Genia Talk" to motivate patient adoption; and co-design approach toward pediatric chronic care. CONCLUSIONS Principles of quality improvement, relational co-ordination, user-centered design, and coproduction can facilitate the integration of mHealth technology into clinical care systems for pediatric CF care.
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Affiliation(s)
- Meghan Longacre
- The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Stuart Grande
- The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | | | | | | | - Maria Martensson
- Lund Pediatric Cystic Fibrosis Center, Skane University Hospital, Lund, Sweden
| | - Greg Kotzbauer
- The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
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Coyne I, Malone H, Chubb E, While AE. Transition from paediatric to adult healthcare for young people with cystic fibrosis: Parents' information needs. J Child Health Care 2018; 22:646-657. [PMID: 29618237 DOI: 10.1177/1367493518768448] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parents of young people with cystic fibrosis (YPWCF) play an important role during the transition from paediatric to adult health services. There is limited evidence on parental information needs and the extent to which they are met. An online survey was conducted targeting a finite population of 190 parents of YPWCF in Ireland. Fifty-nine parents responded (31% response rate). Parents reported the need for more general preparation and timing of the transfer, more information regarding the differences between adult and child health services and how their child will self-manage his/her illness in the future. Most parents received information on the timing of transfer and new healthcare providers but reported being insufficiently informed about their legal status relating to medical confidentiality for their adult child and community resources available for their child after transition to adult health services. The findings highlight the importance of information and preparation for caregivers as well as young people to promote successful transition to adult healthcare. Providing parents with clear information and anticipatory guidance are simple changes in practice that may lead to improvements in transition experiences.
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Affiliation(s)
- Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Helen Malone
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Emma Chubb
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Alison E While
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Implementing the International Committee on Mental Health in Cystic Fibrosis (ICMH) guidelines: Screening accuracy and referral-treatment pathways. J Cyst Fibros 2018; 17:821-827. [DOI: 10.1016/j.jcf.2018.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 11/23/2022]
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Everhart RS, Molitor SJ, Wentz D, Schmidt HJ, Schechter MS. Identifying and Integrating Parent Priorities for Psychosocial Support Services in a Pediatric Cystic Fibrosis Clinic. J Clin Psychol Med Settings 2018; 26:235-241. [PMID: 30368723 DOI: 10.1007/s10880-018-9588-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Engaging parents early in the development of psychosocial support programs in cystic fibrosis (CF) clinics may enable services and care team recommendations to be tailored appropriately. This pilot study identified psychosocial priorities of parents of children with CF related to treatment adherence, parent/child mental health, and CF-related communication. Forty parents of children with CF (2 months to 17 years) completed an anonymous 17-item survey during routine clinic visits that assessed priorities related to psychosocial services. Elements of a quality improvement framework were used to develop the survey and determine recommendations based on findings. Parents reported the most interest in support related to improving adherence to respiratory therapies and helping children complete treatments independently. Other priority areas included services that helped children cope with feelings of isolation or abnormality due to CF and strategies to improve communication with the care team. Additionally, the majority of families indicated that they preferred receiving psychosocial services during routine clinic visits, followed by periodic parent workshops. Based on survey results, the psychosocial team at our center developed a survey/response model (e.g., roundtables, workshops) that may serve useful for other CF care teams as they identify the priorities of parents and adapt to their needs.
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Affiliation(s)
- Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA.
| | - Stephen J Molitor
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
| | - Dena Wentz
- Division of Pulmonary Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - H Joel Schmidt
- Division of Pulmonary Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Michael S Schechter
- Division of Pulmonary Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
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Bowmer G, Sowerby C, Duff A. Transition and transfer of young people with cystic fibrosis to adult care. Nurs Child Young People 2018; 30:34-39. [PMID: 30088702 DOI: 10.7748/ncyp.2018.e1080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 11/09/2022]
Abstract
Treatment for cystic fibrosis (CF) remains arduous and time-consuming, with young people in particular struggling to balance these demands with living a 'normal' life. Transferring to adult services is an important milestone that should be preceded by a gradual process of empowerment. This service evaluation aimed to explore the views of young people with CF before their transfer to adult care and to co-produce revisions to the transition and transfer programme. A total of 37 participants, aged 11-17 years, completed questionnaires during routine clinic visits with 81% expressing good knowledge of CF and treatment, and 59% reporting that they undertook their own treatment. Only 40% had seen a doctor alone for part of their clinic visit, 64% supported recruitment of a youth worker and 48% viewed dedicated adolescent clinics as beneficial. Participants expressed overall satisfaction with their care, however, improvements were suggested. Based on these suggestions, funding was secured for a youth worker, 'transition' clinics were established with children's and adult CF team members, and doctors started seeing young people on their own for part of the clinic visit from age 13 years.
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Affiliation(s)
- Grace Bowmer
- Paediatric Psychology Service, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Carol Sowerby
- Regional Paediatric CF Unit, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Alistair Duff
- Department of Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, England
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Spitzer N, Legare TB, Patel P, Toselli N, Livingston F. The Prevalence and Effect of Comorbid Cystic Fibrosis and Attention Deficit Hyperactivity Disorders on Hospitalizations: A Retrospective Analysis. Cureus 2018; 10:e3048. [PMID: 30397565 PMCID: PMC6207276 DOI: 10.7759/cureus.3048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: The prevalence of attention-deficit/hyperactivity disorder (ADHD) in pediatric cystic fibrosis (CF) patients is comparable to the general population, but the effects of ADHD on CF treatment and the outcomes have been minimally investigated. Methods: Two cohorts were retrospectively reviewed, pediatric patients with comorbid CF/ADHD and patients with CF only. Each patient with CF/ADHD was age and sex-matched to a CF-only patient based on their most recent pulmonary office visit. Each patient was reviewed for forced expiratory volume in one-second percent predicted (FEV1%pred), body mass index (BMI) percentile, and hospitalizations for one year prior to the last pulmonary visit. Results: A total of 624 patients with CF were identified, with 52 having co-morbid CF/ADHD (8.3%). Of those identified, 46 met inclusion criteria and were analyzed in the CF/ADHD cohort. The mean total hospital admissions between the CF/ADHD cohort and the CF-only cohort were not statistically significant (2.22 vs 1.834, p=.467). The difference between the BMI percentiles was not statistically significant (48.634 vs 38.634, p=.135). The difference between FEV1%pred was statistically significant at 84% for the CF/ADHD group and 74% for the CF-only group (p=.042). Conclusion: The difference in total hospital admissions between the CF/ADHD cohort and the CF-only cohort did not reach statistical significance, but the study was underpowered. There was a significant difference between FEV1%pred between the two groups, in favor of the comorbid CF/ADHD population. More research is needed to further evaluate the effects of a comorbid ADHD diagnosis on outcomes in the CF pediatric population.
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Affiliation(s)
- Nicole Spitzer
- Ophthalmology, University of Central Florida College of Medicine, Orlando, USA
| | - Timothy B Legare
- Surgery, University of Central Florida College of Medicine, Orlando, USA
| | - Priyanshi Patel
- Pediatrics, University of Central Florida College of Medicine, Orlando, USA
| | - Nicholas Toselli
- Miscellaneous, University of Central Florida College of Medicine, Orlando, USA
| | - Floyd Livingston
- Pediatric Pulmonology, Nemours Children's Hospital, Orlando, USA
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48
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Treatment compliance in cystic fibrosis patients with chronic Pseudomonas aeruginosa infection treated with tobramycin inhalation powder: The FREE study. Respir Med 2018; 138:88-94. [DOI: 10.1016/j.rmed.2018.03.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/08/2017] [Accepted: 03/30/2018] [Indexed: 11/18/2022]
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Greenwood J, Schwarz C, Sommerwerck U, Nash EF, Tamm M, Cao W, Mastoridis P, Debonnett L, Hamed K. Ease of use of tobramycin inhalation powder compared with nebulized tobramycin and colistimethate sodium: a crossover study in cystic fibrosis patients with pulmonary Pseudomonas aeruginosa infection. Ther Adv Respir Dis 2018; 11:249-260. [PMID: 28614995 PMCID: PMC5933634 DOI: 10.1177/1753465817710596] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: This study assessed the ease of use of tobramycin inhalation powder (TIP)
administered via T-326 inhaler versus
tobramycin inhalation solution (TIS) and colistimethate sodium (COLI), both
administered via nebulizers, for the treatment of chronic
pulmonary Pseudomonas aeruginosa infection in patients with
cystic fibrosis (CF). Methods: A real-world, open-label, crossover, interventional phase IV study was
conducted in CF patients aged ⩾6 years with forced expiratory volume in 1
second (FEV1) ⩾25% to ⩽90% predicted. Patients were assigned to
one of the three treatment arms in Cycle 1; all patients received TIP in
Cycle 2. Each cycle consisted of 28 days on and 28 days off the
treatment. Results: A total of 60 patients [mean (standard deviation) age, 27.6 (8.4) years] were
allocated to three treatment arms [TIS/TIP (n = 14);
COLI/TIP (n = 28); TIP/TIP (n = 18)] in
Cycle 1. The mean total administration time, which included device setup and
cleaning, in Cycle 1 versus Cycle 2 for TIS/TIP, COLI/TIP,
and TIP/TIP arms were 37.0 versus 5.0 min, 16.4
versus 3.8 min, and 4.2 versus 3.4
min, respectively. The difference in mean total administration time was
significantly shorter in Cycle 2 than in Cycle 1 for TIS/TIP
(p = 0.0112) and COLI/TIP (p = 0.0016)
arms. Overall, 12 patients were found to have contaminated devices across
the two treatment cycles. In the TIP/TIP arm, no contamination of the T-326
inhaler was observed in either cycle. Treatment satisfaction, assessed by
the Treatment Satisfaction Questionnaire for Medication and ACCEPT®
questionnaire, was better overall for TIP compared with TIS and COLI. There
were no unexpected adverse events and most were mild or moderate in
intensity. Conclusion: The T-326 inhaler used to deliver TIP was easy to use, required shorter total
administration time, and was much less frequently contaminated than the
nebulizers. The safety findings observed for TIP were generally consistent
with its established safety profile.
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Affiliation(s)
- James Greenwood
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, UK
| | - Carsten Schwarz
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Centre Berlin, Charité-University Medicine Berlin, Berlin, Germany
| | - Urte Sommerwerck
- Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Edward F Nash
- West Midlands Adult Cystic Fibrosis Centre, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Michael Tamm
- Clinic of Pneumology and Respiratory Cell Research, University Hospital, Basel, Switzerland
| | - Weihua Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936-1080, USA
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Shakkottai A, Kaciroti N, Kasmikha L, Nasr SZ. Impact of home spirometry on medication adherence among adolescents with cystic fibrosis. Pediatr Pulmonol 2018; 53:431-436. [PMID: 29457700 DOI: 10.1002/ppul.23950] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/21/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Medication adherence among adolescents with cystic fibrosis (CF) is often suboptimal and this has significant impact on their health and quality of life. The purpose of the study was to evaluate the impact of frequent home pulmonary function (PFT) monitoring on medication adherence among adolescents with CF. HYPOTHESIS We hypothesized that weekly home PFT monitoring will improve adherence while not significantly adding to the treatment burden. METHODS Individuals aged 12-21 years with CF were provided a spirometer to measure PFTs weekly for 1 year. Results were reviewed weekly via telephone. PFT data were downloaded from the device during quarterly clinic visits. Adherence was calculated from prescription refill data and compared to the previous year. Perceptions of treatment burden were assessed using the CF questionnaire-revised (CFQ-R) quality of life measure. Health outcome measures including nutritional status and PFTs from clinic were collected for the study period and the year prior. RESULTS Thirty-nine subjects participated in the study. Mean age was 15.89 ± 2.18 years and 54% were female. Mean adherence to weekly spirometry monitoring was 59.47 ± 24.60%. Values generated on the device showed good correlation with those obtained in clinic. Mean medication possession ratio (MPR) was 60% in the previous year and 65% during the study (P = 0.04). Mean treatment burden scaled score on the CFQ-R was 68 at enrollment and 66 at study completion (P = 0.14). CONCLUSIONS Frequent home PFT monitoring is feasible in CF adolescents and could successfully improve medication adherence without significantly impacting treatment burden.
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Affiliation(s)
| | - Niko Kaciroti
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Lauren Kasmikha
- Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan
| | - Samya Z Nasr
- Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan
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