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Arslan Şahbaz EE, Cankurtaran Ö. Evaluation of coping strategies of parents of children with cystic fibrosis. SOCIAL WORK IN HEALTH CARE 2024; 63:349-369. [PMID: 38477619 DOI: 10.1080/00981389.2024.2324858] [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: 01/10/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
This cross-sectional quantitative study was conducted to evaluate the coping strategies of parents of children with cystic fibrosis. The research sample is the parents (n: 112) who presented to Thoracic Medicine Department at Hacettepe University Pediatric Hospital between 3 April 2021 - 28 May 2021 and volunteered to participate in the study. Sociodemographic Data Form and Coping Orientation to Problems Experienced Inventory (COPE Inventory) were used in the collection of data. The study examined coping strategies according to children's characteristics such as age, sex, education, and parents' independent variables such as employment status, income status, number of individuals and children in the family, communication with other families, social and financial support. Data were analyzed using Mann-Whitney and Kruskal-Wallis tests. Research findings show that religious coping was the most frequently preferred coping strategy, and behavioral disengagement was the least commonly used coping strategy. Emotion-Focused Coping Strategies were also commonly used. Social work interventions and strategies play an important role in helping parents to adopt positive coping strategies and improve their skills.
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Affiliation(s)
- Elif Ezgi Arslan Şahbaz
- Department of Social Work, Institute of Health Sciences, Faculty of Health, Ankara University, Ankara, Turkey
| | - Özlem Cankurtaran
- Department of Social Work, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
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2
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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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3
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Georgiopoulos AM, Christon LM, Filigno SS, Mueller A, Prieur MG, Boat TF, Smith BA. Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention. Pediatr Pulmonol 2021; 56 Suppl 1:S107-S122. [PMID: 32706527 DOI: 10.1002/ppul.24977] [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: 05/01/2020] [Accepted: 07/20/2020] [Indexed: 01/04/2023]
Abstract
This is the second of two companion papers that examine the emotional wellness of children with cystic fibrosis (CF) during the early years of life, defined here as the period between birth and age 12. Both papers promote optimal mental health and well-being, with an emphasis on early identification and intervention. The first paper explores child and family resilience. Here, we discuss strategies for pediatric CF teams to provide routine, systematic mental health assessment, anticipatory guidance, brief intervention, and triage to evidence-based treatment when needed, while addressing barriers to accessing care. Many mental health conditions emerge before the age of 12, with the potential for lifelong effects on individuals, their families, and society. Living with a chronic illness such as CF can further increase the risk of mental health concerns and, in a bidirectional manner, their consequences for the quality of life, sustaining daily care, and health outcomes. There has been a significant focus in recent years on the mental health and wellness of adolescents and adults with CF, but less attention to specifics of depression and anxiety in younger children, or to other common pediatric comorbidities including trauma, developmental disorders such as attention-deficit/hyperactivity disorder or autism spectrum disorder, and oppositional behavior. Given the availability of psychometrically sound screening instruments and effective interventions, routinely addressing the mental health of children with CF and their families is feasible to integrate within multidisciplinary CF care, allowing for a personalized approach respecting individual needs, values, and goals.
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Affiliation(s)
| | - Lillian M Christon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Stephanie S Filigno
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy Mueller
- Departments of Pulmonology and Social Work Services, Hartford Hospital, Hartford, Connecticut
| | - Mary G Prieur
- Departments of Psychiatry and Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Thomas F Boat
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Beth A Smith
- Departments of Psychiatry and Pediatrics, University at Buffalo--The State University of New York, Buffalo, New York
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4
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Del Corral T, La Touche R, Cebrià I Iranzo MÀ, Olmos R, Blanco-Royano F, López-de-Uralde-Villanueva I. Development and Validation of the AdT-Physio Scale: A Tool to Assess Adherence and Perception of Physical Therapist Intervention in Patients With Cystic Fibrosis. Phys Ther 2020; 100:2063-2074. [PMID: 32754747 DOI: 10.1093/ptj/pzaa136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/28/2019] [Accepted: 06/22/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a scale to measure patient adherence to physical therapist intervention and to report psychometric properties in patients with cystic fibrosis (CF). METHODS This observational, multicenter, qualitative, and cross-sectional study was divided into 2 phases: development of scale items (content validity) and assessment of psychometric properties (construct validity, reliability, and convergent/discriminant validity). Recruited were 121 patients with CF (aged ≥16 years). Sociodemographic characteristics, lung function testing, Coping with Stress Self-Efficacy, brief Coping Orientation to Problems Experienced inventory, and the scale of Adherence to Treatment of Physiotherapy (AdT-Physio) scale were evaluated. RESULTS The final version of the AdT-Physio scale consists of 15 items distributed across 2 subscales: compliance and beliefs about treatment/therapist. The scale showed high internal consistency (Cronbach α = .897; 95% CI = 0.868-0.922) and subscales above 0.800. The 2-factor confirmatory factor analysis model fitted the data reasonably well: χ2 (76) = 111.96, comparative fit index = 0.982, Tucker-Lewis index = 0.978, root mean square error of approximation = 0.063, 95% CI = 0.036 to 0.086, and weighted root mean square residual = 0.720. No floor or ceiling effects were identified. There was a positive, significant, and moderate-low magnitude correlation with the total Coping Orientation to Problems Experienced inventory (r = .360) and Coping with Stress Self-Efficacy subscale efficacy expectations scores (r = .304). For discriminant validity, there was a positive, significant, and moderate correlation between the total and the age of the patients (r = .354). CONCLUSIONS The AdT-Physio scale is psychometrically valid and reliable for use in the clinic for the assessment of adherence to physical therapy in patients with CF. IMPACT Ultimately, the authors propose this documentary instrument to assess the evaluation of the therapeutic alliance in a valid and objective manner. The AdT-Physio scale provides us with a greater degree of understanding of the problems behind noncompliance with treatment to advance person-centered decisions in physical therapy and thereby enhance the effectiveness of care.
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Affiliation(s)
- Tamara Del Corral
- Department of Physiotherapy, Faculty of Health Sciences; and Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences, Centre for Advanced University Studies La Salle, Autonomous University of Madrid, Madrid, Spain
| | - Roy La Touche
- Department of Physiotherapy, Faculty of Health Sciences, Center for Advanced Studies, LaSalle University, Madrid, Autonomous University of Madrid, Calle la Salle, 10, 28023, Madrid, Spain; and Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences, Centre for Advanced University Studies La Salle, Autonomous University of Madrid
| | - Maria Àngels Cebrià I Iranzo
- Department of Physiotherapy, University of Valencia, and University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Ricardo Olmos
- Department of Social Psychology and Methodology, Autonomous University of Madrid, Madrid, Spain
| | - Fernando Blanco-Royano
- Training Institute of Masseur-Kinesitherapists, the Health Renaissance, Hôpital de la Musse, Saint Sébastien de Morsent, France. At the time of the study, Mr Blanco-Royano was affiliated with Department of Nursing and Physiotherapy, Faculty of Medicine, CEU-San Pablo University, Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
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Murphy C, Miller VA. Concurrent and Longitudinal Associations among Parenting Style, Responsibility, and Adherence in Youth with Cystic Fibrosis. CHILDRENS HEALTH CARE 2020; 49:153-167. [PMID: 32742054 DOI: 10.1080/02739615.2019.1616295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In an effort to identify pathways for improvements in clinical monitoring and intervention, the current study investigated the role that parenting style plays in treatment adherence and responsibility for youth with CF. Participants (n = 50) completed questionnaires related to treatment adherence, treatment responsibility, and parenting style at baseline and at a two year follow up visit. Aspects of parenting style (e.g., warmth, autonomy support) were related to youth adherence and responsibility in cross-sectional and prospective analyses. These data suggest that aspects of parenting may be important targets of interventions to promote treatment adherence in youth with CF.
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Affiliation(s)
- Christina Murphy
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Victoria A Miller
- Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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6
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Psihogios AM, Fellmeth H, Schwartz LA, Barakat LP. Family Functioning and Medical Adherence Across Children and Adolescents With Chronic Health Conditions: A Meta-Analysis. J Pediatr Psychol 2020; 44:84-97. [PMID: 29982694 DOI: 10.1093/jpepsy/jsy044] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/03/2018] [Indexed: 12/16/2022] Open
Abstract
Objectives A meta-analysis examined family functioning and medical adherence in children and adolescents with chronic health conditions. Family functioning was evaluated at the level of the family unit, as well as parent-child interactions. Methods We conducted literature searches using PubMed, PsycINFO, SCOPUS, Web of Science, and Cochrane. After reviewing 764 articles, 62 studies met eligibility criteria. Pearson's r correlations were the effect size of interest. We conducted both omnibus and domain-specific (e.g., family conflict, cohesion) meta-analyses. Meta-regressions examined whether relevant covariates related to the magnitude of the effect. Results The omnibus meta-analysis showed that family functioning was significantly related to medical adherence across a variety of pediatric chronic health conditions. Lower family conflict, greater family cohesion, greater family flexibility, more positive communication, and better family problem-solving were each associated with better adherence. There were no significant differences in the magnitude of the omnibus effect based on child age, measurement features (subjective vs. objective or bioassay adherence; family unit vs. parent-child interactions), or study quality. Conclusions Consistent with social-ecological frameworks, findings supported links between family functioning and medical adherence. This study highlights several limitations of the extant research, including absence of a guiding theoretical framework and several methodological weaknesses. We offer clinical and research recommendations for enhancing scientific understanding and promotion of adherence within the family context.
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Affiliation(s)
| | | | - Lisa A Schwartz
- The Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
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7
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Georgiopoulos AM. Starting early: An international focus on mental health in children living with cystic fibrosis. Pediatr Pulmonol 2020; 55:267-269. [PMID: 31682329 DOI: 10.1002/ppul.24560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/20/2019] [Indexed: 01/24/2023]
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8
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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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9
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Behrhorst KL, Everhart RS, Schechter MS. Mental Health in Cystic Fibrosis. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_21] [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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10
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Cave L, Milnes LJ. The lived experience of adults with cystic fibrosis: what they would tell their younger selves about the gut. J Hum Nutr Diet 2019; 33:151-158. [PMID: 31763740 PMCID: PMC7079059 DOI: 10.1111/jhn.12703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Little is known about adults’ experience of living with cystic fibrosis (CF) specifically in relation to the gut. However, their unique perspectives may be meaningful to children with CF and inform the understanding and practice of dietitians. The present study aimed to explore adults’ lived experience of the CF gut and how they learnt to manage the gut as they were growing up. Methods Semi‐structured interviews were conducted with adult inpatients (n = 10). Interviews were audio‐recorded, transcribed verbatim and accounts analysed using interpretative phenomenological analysis. Results Three super‐ordinate themes were identified: taking Creon, the learning process and this much I (now) know. Participants accounts of how CF affects the gut predominantly focused on taking Creon (pancreatin, Mylan). Various strategies were employed for coping with peer responses to taking Creon at school. Several participants reached adulthood before they understood and/or accepted that taking Creon consistently needed to be normal for them. Knowledge and understanding developed over time, with ‘CF experience’ and was shaped by family, CF care teams and other children with CF. All had unmet information needs when growing up. Having key explanations earlier, to make connections between eating, taking Creon, gaining weight and growth, did or would have helped most participants. Participants urged children to be assertive, ask questions and not only be involved in managing their diet and gut, but also begin to take control of this aspect of their CF. Conclusions Supporting development of knowledge, skills and confidence to manage diet and the gut needs to be integral to care throughout childhood.
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Affiliation(s)
- L Cave
- Children's Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - L J Milnes
- School of Healthcare, University of Leeds, Leeds, UK
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Barker MM, Beresford B, Bland M, Fraser LK. Prevalence and Incidence of Anxiety and Depression Among Children, Adolescents, and Young Adults With Life-Limiting Conditions: A Systematic Review and Meta-analysis. JAMA Pediatr 2019; 173:835-844. [PMID: 31282938 PMCID: PMC6618774 DOI: 10.1001/jamapediatrics.2019.1712] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Children, adolescents, and young adults with life-limiting conditions experience various challenges that may make them more vulnerable to mental health problems, such as anxiety and depression. However, the prevalence and incidence of anxiety and depression among this population appears to be unknown. OBJECTIVE To conduct a systematic review and meta-analysis to estimate the prevalence and/or incidence of anxiety and depression in children, adolescents, and young adults with life-limiting conditions. DATA SOURCES Searches of MEDLINE (PubMed), PsycInfo, and Embase were conducted to identify studies published between January 2000 and January 2018. STUDY SELECTION Studies were eligible for this review if they provided primary data of anxiety or depression prevalence and/or incidence, included participants aged 5 to 25 years with a life-limiting condition, were conducted in an Organisation for Economic Co-operation and Development country, and were available in English. DATA EXTRACTION AND SYNTHESIS Random-effects meta-analyses were generated to provide anxiety and depression prevalence estimates. Meta-regression was conducted to analyze associations between study characteristics and each prevalence estimate. MAIN OUTCOMES AND MEASURES Prevalence of anxiety and depression. RESULTS A total of 14 866 nonduplicate articles were screened, of which 37 were included in the review. Of these, 19 studies reported anxiety prevalence, and 36 studies reported depression prevalence. The mean (range) age of participants was 15.4 (6-25) years. The meta-analysis of anxiety prevalence (n = 4547 participants) generated a pooled prevalence estimate of 19.1% (95% CI, 14.1%-24.6%). Meta-regression analysis found statistically significant differences in anxiety prevalence by assessment tool; diagnostic interviews were associated with higher anxiety prevalence (28.5% [95% CI, 13.2%-46.8%]) than self-reported or parent-reported measures (14.9% [95% CI, 10.9%-19.4%]). The depression meta-analysis (n = 5934 participants) found a pooled prevalence estimate of 14.3% (95% CI, 10.5%-18.6%). Meta-regression analysis revealed statistically significant differences in depression prevalence by the mean age of the sample (β = 0.02 [95% CI, 0.01-0.03]; P = .001). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, the prevalence of anxiety and depression among children, adolescents, and young adults with life-limiting conditions was high, highlighting the need for increased psychological assessment and monitoring. Further research is required to determine the prevalence and incidence of anxiety and depression in a larger sample of children, adolescents, and young adults with a broader range of life-limiting conditions.
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Affiliation(s)
- Mary M. Barker
- Department of Health Sciences, University of York, Heslington, York, United Kingdom,Martin House Research Centre, University of York, York, United Kingdom
| | - Bryony Beresford
- Martin House Research Centre, University of York, York, United Kingdom,Social Policy Research Unit, University of York, York, United Kingdom
| | - Martin Bland
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - Lorna K. Fraser
- Department of Health Sciences, University of York, Heslington, York, United Kingdom,Martin House Research Centre, University of York, York, United Kingdom
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12
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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] [MESH Headings] [Grants] [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 UniversityUK
| | - Sarah Drabble
- School of Health and Related Research (ScHARR)University of SheffieldUK
| | - Alicia O'Cathain
- School of Health and Related Research (ScHARR)University of SheffieldUK
| | | | - Martin Wildman
- School of Health and Related Research (ScHARR)University of SheffieldUK
- Sheffield Adult CF CentreNorthern General HospitalSheffieldUK
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13
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Question 12: What do you consider when discussing treatment adherence in patients with Cystic Fibrosis? Paediatr Respir Rev 2018. [PMID: 28625493 DOI: 10.1016/j.prrv.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Faint NR, Staton JM, Stick SM, Foster JM, Schultz A. Investigating self-efficacy, disease knowledge and adherence to treatment in adolescents with cystic fibrosis. J Paediatr Child Health 2017; 53:488-493. [PMID: 28186386 DOI: 10.1111/jpc.13458] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/05/2016] [Accepted: 10/28/2016] [Indexed: 12/27/2022]
Abstract
AIM Patient adherence is integral to the effectiveness of prescribed treatment, and is associated with beneficial disease outcomes, yet in adolescents with cystic fibrosis, adherence is often sub-optimal. Multiple factors may contribute to treatment adherence, including disease knowledge and self-efficacy. In adolescents with cystic fibrosis: (i) to compare the disease knowledge of adolescents and their parents before transition to adult care; (ii) to determine the relationship between disease knowledge (adolescent, parent) and adherence; and (iii) to evaluate self-efficacy and its association with disease knowledge and adherence. METHODS Adolescents with cystic fibrosis and their parents were recruited from a tertiary children's hospital. Disease knowledge and self-efficacy was assessed using the Knowledge of Disease Management-CF and General Self-Efficacy Scales respectively. Using pharmacy records, medication possession ratio was calculated to measure treatment adherence in the preceding year. RESULTS Thirty-nine adolescent (aged 12-17 (median 14) years) and parent pairs were recruited. Adherence to hypertonic saline, but not other medications, was significantly associated with disease knowledge in adolescents (r 2 = 0.40, P = 0.029). Mean (SD) adolescent self-efficacy was 30.8 (4.0), and not associated with disease knowledge or adherence. Mean (SD) disease knowledge was less in adolescents than parents (55 (16)% and 72 (14)% respectively, P < 0.001). CONCLUSION Disease knowledge is sub-optimal in adolescents with cystic fibrosis, even in the 2 years immediately before transition to adult care. Given that adherence with some treatments has been associated with disease knowledge our results suggest the need for educational interventions in adolescents with cystic fibrosis to optimise self-management and health outcomes.
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Affiliation(s)
- Nicholas R Faint
- The University of Notre Dame, Perth, Western Australia, Australia
| | - Janelle M Staton
- The University of Notre Dame, Perth, Western Australia, Australia
| | - Stephen M Stick
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children and Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Juliet M Foster
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - André Schultz
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children and Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Paediatric and Child Health, University of Western Australia, Perth, Western Australia, Australia
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15
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Hamed K, Conti V, Tian H, Loefroth E. Adherence to tobramycin inhaled powder vs inhaled solution in patients with cystic fibrosis: analysis of US insurance claims data. Patient Prefer Adherence 2017; 11:831-838. [PMID: 28490864 PMCID: PMC5414718 DOI: 10.2147/ppa.s134759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Tobramycin inhalation powder (TIP), the first dry-powder inhaled antibiotic for pulmonary Pseudomonas aeruginosa infection, is associated with reduced treatment burden, increased patient satisfaction, and higher self-reported adherence for cystic fibrosis (CF) patients. We compared adherence in CF patients newly treated with TIP with those newly treated with the traditional tobramycin inhalation solution (TIS), using US insurance claims data. PATIENTS AND METHODS From the Truven MarketScan® database, we identified CF patients chronically infected with P. aeruginosa who had been prescribed TIP between May 1, 2013 to December 31, 2014, or TIS between September 1, 2010 to April 30, 2012 with at least 12 months of continuous medical and pharmacy benefits prior to and following prescription. TIP and TIS adherence levels were assessed. RESULTS A total of 145 eligible patients were identified for the TIP cohort and 306 for the TIS cohort. Significant differences in age distribution (25.0 vs 21.9 years for TIP vs TIS, respectively, P=0.017), type of health plan (P=0.014), employment status (72.4% vs 63.4% of TIP vs TIS patients in full-time employment, P=0.008), and some comorbidities were observed between the two cohorts. Although a univariate analysis found no significant differences between TIP and TIS (odds ratio [OR] 1.411, 95% confidence interval [CI] 0.949-2.098), TIP was moderately associated with higher adherence levels compared with TIS in a multivariable analysis, once various demographic and clinical characteristics were adjusted for. These included geographic location (OR: 1.566, CI: 1.016-2.413) and certain comorbidities. CONCLUSION This study of US patient data supports previous findings that TIP is associated with better adherence compared with TIS; however, further studies will be required to fully elucidate differences in adherence between TIP and TIS.
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Affiliation(s)
- Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
- Correspondence: Kamal Hamed, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936, USA, Tel +1 862 778 4780, Email
| | | | - Hengfeng Tian
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Leeman J, Crandell JL, Lee A, Bai J, Sandelowski M, Knafl K. Family Functioning and the Well-Being of Children With Chronic Conditions: A Meta-Analysis. Res Nurs Health 2016; 39:229-43. [PMID: 27128982 DOI: 10.1002/nur.21725] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/11/2022]
Abstract
For children with chronic conditions, well-being is closely related to how well their families function. Most prior research syntheses on family functioning and child well-being have focused on children with a single condition, thereby limiting the potential to aggregate and build on what is known across conditions. To address this challenge, research reports were reviewed and meta-analyses conducted of findings on the relationship between family functioning and child well-being across a range of chronic physical conditions. The sample was derived from a larger systematic review study that included 1,028 reports published between January 1, 2000 and March 31, 2014. The current review includes 53 studies in which a relationship between family functioning and child well-being was analyzed using one of four family measures: Family Adaptability and Cohesion Evaluation Scales, Family Environment Scale, Family Relationship Index, or Family Assessment Device. Most studies were cross-sectional and observational (n = 43, 81%). The most frequently studied conditions were diabetes, cancer, sickle cell disease, and asthma. In 37 studies, findings were sufficiently comparable to conduct meta-analyses. Significant correlations were identified between children's psychological health and seven of nine dimensions of family functioning. Significant correlations also were found between dimensions of family functioning and children's problem behaviors, social competence, quality of life, and, to a lesser extent, adherence and physical health. Of the family dimensions, cohesion and conflict were associated most strongly with child outcomes. Understanding the specific family variables, such as conflict, linked to varied child outcomes is key for intervention development. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jennifer Leeman
- Assistant Professor, School of Nursing, University of North Carolina, 5004 Carrington Hall, CB 7460, Chapel Hill, NC, 27599-7460
| | - Jamie L Crandell
- Assistant Professor, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Anna Lee
- Doctoral Candidate, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Jinbing Bai
- Doctoral Candidate, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Margarete Sandelowski
- Cary C. Boshamer Distinguished Professor, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Kathleen Knafl
- Frances Hill Fox Distinguished Professor, School of Nursing, University of North Carolina, Chapel Hill, NC
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Bodnár R, Mészáros Á, Oláh M, Ágh T. Inhaled antibiotics for the treatment of chronic Pseudomonas aeruginosa infection in cystic fibrosis patients: challenges to treatment adherence and strategies to improve outcomes. Patient Prefer Adherence 2016; 10:183-93. [PMID: 26937178 PMCID: PMC4762437 DOI: 10.2147/ppa.s53653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Inhaled antibiotics (ABs) are recommended for use in the therapy of chronic Pseudomonas aeruginosa infection in patients with cystic fibrosis (CF). The aim of this systematic literature review was to identify level of adherence to inhaled ABs and to determine predictors and consequences of nonadherence in CF. METHODS A systematic literature search of English-language articles was conducted in April 2015 using Medline and Embase. No publication date limit was applied. The literature screening was conducted by two independent reviewers. All of the included studies were assessed for quality. RESULTS The search yielded 193 publications, of which ten met the inclusion criteria and underwent data extraction. Seven studies focused on inhaled tobramycin, one on inhaled colistimethate, one on inhaled levofloxacin, and one on inhaled aztreonam lysine. Medication adherence to inhaled ABs was analyzed by pharmacy refill history, daily phone diary, parent and child self-reports, vials counting, or electronic monitoring. In randomized controlled trials (n=3), proportion of adherent patients (>75%-80% of required doses taken) ranged from 86% to 97%; in prospective cohort studies (n=3), adherence rates ranged between 36% and 92%, and in retrospective studies (n=4) it ranged between 60% and 70%. The adherence to inhaled ABs in CF was found to be associated with the complexity of treatment, time of drug administration, age of patients, treatment burden (adverse events, taste), and patient satisfaction. CONCLUSION The high diversity of adherence data was because of the different study designs (randomized controlled trials vs real-world studies) and the lack of a commonly accepted consensus on the definition of adherence in the reviewed articles. Routine adherence monitoring during CF care, discussing the possible reasons of suboptimal adherence with the patient, and changing treatment regimens on the basis of patient burden can individualize CF therapy for patients and may improve the level of adherence.
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Affiliation(s)
- Réka Bodnár
- Department of Pediatric Pulmonology, Heim Pál Children’s Hospital, Budapest, Hungary
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
- Correspondence: Réka Bodnár, Department of Pediatric Pulmonology, Heim Pál Children’s Hospital, Üllői Street 86, 1089 Budapest, Hungary, Tel +36 1 459 9100, Fax +36 1 459 9100, Email
| | - Ágnes Mészáros
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Máté Oláh
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary
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Clinical and Sociodemographic Factors Associated With Attention-Deficit/Hyperactivity Disorder in Patients With Cystic Fibrosis. PSYCHOSOMATICS 2015; 56:495-503. [DOI: 10.1016/j.psym.2014.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 11/20/2022]
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Leeman J, Sandelowski M, Havill NL, Knafl K. Parent-to-Child Transition in Managing Cystic Fibrosis: A Research Synthesis. JOURNAL OF FAMILY THEORY & REVIEW 2015; 7:167-183. [PMID: 26279680 PMCID: PMC4532343 DOI: 10.1111/jftr.12070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Although parents and children must adhere to five primary treatments for cystic fibrosis (CF), and their roles transition over time, the scope of CF studies often has been limited to one treatment regimen or to children within a specified age range. The purpose of this mixed research synthesis study is to integrate findings from qualitative and quantitative studies addressing the transition of CF management from parent to child, as well as factors related to adherence across treatments and over time. An existing grounded theory was used as a framework to synthesize findings in 17 reports from 16 studies. The results confirm the theory and posit three additional factors that may influence parent-to-child transition of care management.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill
| | | | - Nancy L Havill
- School of Nursing, University of North Carolina at Chapel Hill
| | - Kathleen Knafl
- School of Nursing, University of North Carolina at Chapel Hill
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Goodfellow NA, Hawwa AF, Reid AJ, Horne R, Shields MD, McElnay JC. Adherence to treatment in children and adolescents with cystic fibrosis: a cross-sectional, multi-method study investigating the influence of beliefs about treatment and parental depressive symptoms. BMC Pulm Med 2015; 15:43. [PMID: 25927329 PMCID: PMC4417214 DOI: 10.1186/s12890-015-0038-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 04/15/2015] [Indexed: 11/12/2022] Open
Abstract
Background Adherence to treatment is often reported to be low in children with cystic fibrosis. Adherence in cystic fibrosis is an important research area and more research is needed to better understand family barriers to adherence in order for clinicians to provide appropriate intervention. The aim of this study was to evaluate adherence to enzyme supplements, vitamins and chest physiotherapy in children with cystic fibrosis and to determine if any modifiable risk factors are associated with adherence. Methods A sample of 100 children (≤18 years) with cystic fibrosis (44 male; median [range] 10.1 [0.2-18.6] years) and their parents were recruited to the study from the Northern Ireland Paediatric Cystic Fibrosis Centre. Adherence to enzyme supplements, vitamins and chest physiotherapy was assessed using a multi-method approach including; Medication Adherence Report Scale, pharmacy prescription refill data and general practitioner prescription issue data. Beliefs about treatments were assessed using refined versions of the Beliefs about Medicines Questionnaire-specific. Parental depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results Using the multi-method approach 72% of children were classified as low-adherers to enzyme supplements, 59% low-adherers to vitamins and 49% low-adherers to chest physiotherapy. Variations in adherence were observed between measurement methods, treatments and respondents. Parental necessity beliefs and child age were significant independent predictors of child adherence to enzyme supplements and chest physiotherapy, but parental depressive symptoms were not found to be predictive of adherence. Conclusions Child age and parental beliefs about treatments should be taken into account by clinicians when addressing adherence at routine clinic appointments. Low adherence is more likely to occur in older children, whereas, better adherence to cystic fibrosis therapies is more likely in children whose parents strongly believe the treatments are necessary. The necessity of treatments should be reinforced regularly to both parents and children. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0038-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicola A Goodfellow
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Ahmed F Hawwa
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK. .,Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK.
| | - Alastair Jm Reid
- Northern Ireland Paediatric Cystic Fibrosis Centre, Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE, UK.
| | - Rob Horne
- UCL School of Pharmacy, BMA House, Tavistock Square, London, WC1H 9JP, UK.
| | - Michael D Shields
- Centre for Infection and Immunity, Queen's University Belfast, Belfast, UK. .,Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE, UK.
| | - James C McElnay
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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Hogan A, Bonney MA, Brien JA, Karamy R, Aslani P. Factors affecting nebulised medicine adherence in adult patients with cystic fibrosis: a qualitative study. Int J Clin Pharm 2014; 37:86-93. [PMID: 25432693 DOI: 10.1007/s11096-014-0043-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/19/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nebulised medicines contribute to the high treatment burden experienced by patients with cystic fibrosis (CF). OBJECTIVES This study explored experiences of adult patients with CF when using nebulised medicines, factors impacting on their adherence to nebulised therapy and strategies they used to facilitate adherence. SETTING Community setting, in Sydney, Australia. METHODS Ten patients with CF were recruited through a CF patient organisation. Semi-structured face-to-face interviews were conducted, addressing the study objectives. Interviews were audio-recorded, transcribed verbatim and content analysed for anticipated and emergent themes. MAIN OUTCOME MEASURE Experiences with using nebulised medicines; and barriers and facilitators of adherence to nebulised medicines. RESULTS Participants' age ranged from 22 to 45 years, with half being male. Four broad themes (with more specific sub-themes) were identified from the interviews: experiences with using nebulised medicines (cleaning nebuliser, time taken to use nebuliser medicine, flexibility in use of nebuliser); feelings about using nebulised medicines (necessary/important, dislike, part of life); factors impacting non-adherence (time consuming therapy, side effects/effects of medicine, work/social demands, lack of perceived importance); factors and strategies facilitating adherence (perceived medicine importance, habit/routine, support, health benefits, technology/medicine dose form, timetabling). CONCLUSIONS Nebulised therapy for cystic fibrosis patients takes a substantial amount of time, with patients trying to alter their routine to incorporate nebulising into their daily lives. However there are still many factors that lead to low adherence, including work/social demands and travelling. Patients balance the necessity for nebulised therapy against the barriers, and engage in intentional non-adherence at times. Future strategies and resources should target and address specific factors identified by patients with CF as being important and impacting their adherence to nebulised medicines.
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Affiliation(s)
- Alice Hogan
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, Broadway, NSW, 2006, Australia
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22
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Platten MJ, Newman E, Quayle E. Self-esteem and its relationship to mental health and quality of life in adults with cystic fibrosis. J Clin Psychol Med Settings 2014; 20:392-9. [PMID: 23264083 DOI: 10.1007/s10880-012-9346-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Research from the general population indicates an important role for self-esteem in mental health, but limited research in this area exists in the cystic fibrosis (CF) literature. This study aimed to explore the predictive value of self-esteem and health-related quality of life (HRQoL) in mental health symptoms in adults with CF. Seventy-four participants, recruited online, completed the Clinical Outcomes in Routine Evaluation-Outcome Measure 34 (CORE-OM), Rosenberg Self-esteem Scale and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Comparably high levels of self-esteem were found, but HRQoL was lower than previous research. Thirty percent of participants scored within the clinical range for mental health difficulty. Hierarchical regression, controlling for gender, explored the value of four CFQ-R subscales (physical, social, emotional and role functioning) and self-esteem in predicting CORE-OM total score. Gender accounted for 8.2% of the variance in mental health scores while the five independent variables accounted for a further 73.0% of variance. Of the five variables, CFQ-R emotional functioning and self-esteem were significant predictors of mental health symptoms. Results are discussed in relation to clinical implications and potential uses for internet technologies to promote socialisation.
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Affiliation(s)
- Melanie Jane Platten
- Department of Psychological Services and Research, Dumfries & Galloway NHS Health Board, Nithbank, Dumfries, DG1 2SA, Scotland, UK.
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Duff AJA, Abbott J, Cowperthwaite C, Sumner C, Hurley MA, Quittner A. Depression and anxiety in adolescents and adults with cystic fibrosis in the UK: a cross-sectional study. J Cyst Fibros 2014; 13:745-53. [PMID: 24642184 DOI: 10.1016/j.jcf.2014.02.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/03/2014] [Accepted: 02/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The International Depression/anxiety Epidemiological Study (TIDES) in the UK aimed: (i) to establish the prevalence of anxiety and depression amongst people with CF compared to a normative sample; (ii) to establish the association between mood, demographic and clinical variables; and (iii) to provide guidance for specialist-referral decision-making. METHODS Patients (≥12years) completed the Hospital Anxiety and Depression Scale (HADS). CF-HADS scores, expressed as percentiles, were compared with a normative sample. Multiple-regression analysis explored associations between demographic, clinical and mood variables. RESULTS Thirty-nine CF centres recruited 2065 patients. Adults with CF were similar in terms of anxiety and depression to the general population. Adolescents with CF were less anxious and depressed. For adult patients, older age, unemployment for health reasons and poor lung function were associated with disordered mood. Gender-specific CF-percentile scores were calculated. CONCLUSION Surveillance, with attention to gender and risk factors is advocated. This work provides unique benchmark scores to aid referral decision-making.
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Affiliation(s)
- Alistair J A Duff
- Regional Paediatric CF Unit, Leeds Teaching Hospitals NHS Trust, Ward 25 A Floor, Clarendon Wing, Leeds General Infirmary, Leeds LS2 9NS, UK; Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK.
| | - Janice Abbott
- School of Psychology, University of Central Lancashire, Preston, UK.
| | | | - Clare Sumner
- Adult Cystic Fibrosis Unit, Liverpool Heart & Chest Hospital, Liverpool, UK.
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Abstract
Nonadherence to inhaled therapies is a major problem in the treatment of cystic fibrosis that can influence lung function and health outcomes. Potential contributors to nonadherence have been identified, including demographic and psychosocial factors, time and convenience of inhaled therapy, and treatment beliefs. Additional research is clearly needed to clarify the contributors and to determine which interventions and technological advances will enhance adherence to inhaled therapies in patients with cystic fibrosis. Nurses and allied health professionals are ideally positioned to assist patients and families with adherence to inhaled therapies through monitoring, communication, and education about the available therapies and their proper use. This review briefly summarizes the available evidence about contributors to nonadherence, potential interventions, novel delivery devices for inhaled therapies, and opportunities for additional research.
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Affiliation(s)
- Paula Lomas
- Nurse Coordinator, Adult Cystic Fibrosis Center, Morristown Medical Center, Morristown, NJ 07962, USA
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25
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Tluczek A, Laxova A, Grieve A, Heun A, Brown RL, Rock MJ, Gershan WM, Farrell PM. Long-term follow-up of cystic fibrosis newborn screening: psychosocial functioning of adolescents and young adults. J Cyst Fibros 2013; 13:227-34. [PMID: 24157354 DOI: 10.1016/j.jcf.2013.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/30/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term psychosocial outcomes of cystic fibrosis (CF) patients diagnosed through newborn screening remain unknown. METHODS This cross-sectional study compared three groups of youths (16 to 22 years): CF patients diagnosed through NBS (CF-NBS, n = 13), CF patients diagnosed through standard practice (CF-SP, n = 26) and healthy peers (H, n = 42), plus 72 of their parents. We hypothesized that adolescent psychological functioning would be mediated by parent depression and quality of parent-child communication and cohesiveness. RESULTS A path analysis showed significantly more depression among CF-NBS group parents (p = .006-.008). Parent-child cohesiveness was related to communication (p < .001). Cohesiveness and communication were associated with youth Internalizing Problems (p = .037, p = .009), Emotional Symptoms (p = 0.018, p = 0.022), and Personal Adjustment (communication only, p = 0.009). Parent depression was related to youth Personal Adjustment (p = 0.022). CONCLUSIONS CF patients report psychosocial function similar to healthy peers. Parents of children diagnosed with CF through NBS may be at risk for depressive symptoms when their children reach adolescence.
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Affiliation(s)
- Audrey Tluczek
- University of Wisconsin, School of Nursing, Madison, WI, United States; University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States.
| | - Anita Laxova
- University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States
| | - Adam Grieve
- University of Wisconsin, School of Medicine and Public Health, Department of Psychiatry, Madison, WI, United States
| | - Anne Heun
- Iowa Health Des Moines, Blank Children's Hospital and John Stoddard Cancer Center, Des Moines, IA, United States
| | - Roger L Brown
- University of Wisconsin, School of Nursing, Madison, WI, United States
| | - Michael J Rock
- University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States
| | - William M Gershan
- University of Utah, School of Medicine, Department of Pediatrics, Salt Lake City, UT, United States
| | - Philip M Farrell
- University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States
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McCormick King ML, Mee LL, Gutierrez-Colina AM, Eaton CK, Lee JL, Blount RL. Emotional Functioning, Barriers, and Medication Adherence in Pediatric Transplant Recipients. J Pediatr Psychol 2013; 39:283-93. [DOI: 10.1093/jpepsy/jst074] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Sandelowski M, Leeman J, Knafl K, Crandell JL. Text-in-context: a method for extracting findings in mixed-methods mixed research synthesis studies. J Adv Nurs 2013; 69:1428-37. [PMID: 22924808 PMCID: PMC3535067 DOI: 10.1111/jan.12000] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2012] [Indexed: 10/28/2022]
Abstract
AIM Our purpose in this paper is to propose a new method for extracting findings from research reports included in mixed-methods mixed research synthesis studies. BACKGROUND International initiatives in the domains of systematic review and evidence synthesis have been focused on broadening the conceptualization of evidence, increased methodological inclusiveness and the production of evidence syntheses that will be accessible to and usable by a wider range of consumers. Initiatives in the general mixed-methods research field have been focused on developing truly integrative approaches to data analysis and interpretation. DATA SOURCE The data extraction challenges described here were encountered, and the method proposed for addressing these challenges was developed, in the first year of the ongoing (2011-2016) study: Mixed-Methods Synthesis of Research on Childhood Chronic Conditions and Family. DISCUSSION To preserve the text-in-context of findings in research reports, we describe a method whereby findings are transformed into portable statements that anchor results to relevant information about sample, source of information, time, comparative reference point, magnitude and significance and study-specific conceptions of phenomena. IMPLICATIONS FOR NURSING The data extraction method featured here was developed specifically to accommodate mixed-methods mixed research synthesis studies conducted in nursing and other health sciences, but reviewers might find it useful in other kinds of research synthesis studies. CONCLUSION This data extraction method itself constitutes a type of integration to preserve the methodological context of findings when statements are read individually and in comparison to each other.
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Affiliation(s)
- Margarete Sandelowski
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA.
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Abstract
PURPOSE OF REVIEW Treatment nonadherence is a common problem, yet adherence to treatments is important for the successful management of cystic fibrosis (CF). Previous work has concentrated on rates of adherence in children and adults using self-report questionnaires. Recent studies have employed new measurement methods and evaluated various treatment components. It is important to understand the factors that impede and facilitate adherence in order that research and clinical practice can improve adherence rates. RECENT FINDINGS There is a high perceived treatment burden in CF. Rates of adherence vary according to the treatment and the measurement method. Reasons for nonadherence are numerous. Even with technology designed to reduce treatment time, adherence to nebulized antibiotics is still poor. Nonadherence is a particular issue in adolescence and there is evidence that girls are less adherent than boys, leading to poorer lung function. Patients who have a cohesive and balanced family life may be better able to incorporate CF treatments. Treatment beliefs and the perception of treatment effectiveness are important determinants of adherence. SUMMARY Research needs to move forward to understand how to help patients to improve their adherence and to assist healthcare professionals in supporting them. There is a consensus that tailored interventions are essential. In addition, it is important to understand adherence behaviours over time in order to recognize specific periods during a person's life when adherence is more difficult to achieve.
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Engelen MP, Schroder R, Van der Hoorn K, Deutz NE, Com G. Use of body mass index percentile to identify fat-free mass depletion in children with cystic fibrosis. Clin Nutr 2012; 31:927-33. [DOI: 10.1016/j.clnu.2012.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 04/20/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
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Besier T, Goldbeck L. Anxiety and depression in adolescents with CF and their caregivers. J Cyst Fibros 2011; 10:435-42. [DOI: 10.1016/j.jcf.2011.06.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 06/05/2011] [Accepted: 06/28/2011] [Indexed: 11/28/2022]
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Abstract
Cystic fibrosis (CF) is a multisystemic life-limiting genetic disorder, primarily affecting respiratory functioning. Most patients with CF are diagnosed by 2 years of age, and the current median predicted survival rate is 37.4 years old, with 95% of patients dying from complications related to pulmonary infection. Given the chronic, progressive, and disabling nature of CF, multiple treatments are prescribed, most on a daily basis. Thus, this illness requires children, with the aid of their families, to adopt multiple health-related behaviors in addition to managing more typical developmental demands. The morbidity and mortality factors pose cognitive, emotional, and behavioral challenges for many children with CF and their families. This article applies a developmental perspective to describing the psychosocial factors affecting psychological adjustment and health-related behaviors relevant to infants, preschool and school-age children, and adolescents with CF. Topics particularly pertinent to developmental periods and medical milestones are noted, with clinical implications highlighted.
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Affiliation(s)
- Michelle M Ernst
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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Besier T, Born A, Henrich G, Hinz A, Quittner AL, Goldbeck L. Anxiety, depression, and life satisfaction in parents caring for children with cystic fibrosis. Pediatr Pulmonol 2011; 46:672-82. [PMID: 21384564 DOI: 10.1002/ppul.21423] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 12/27/2010] [Accepted: 12/27/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the prevalence of symptoms of anxiety and depression and the extent of life satisfaction in parents caring for children with cystic fibrosis (CF) in Germany. METHODS The study included 650 caregivers of 564 children with CF ages 0-17, who completed the Hospital Anxiety Depression Scale (HADS), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Questions on Life Satisfaction (FLZ(M) ). RESULTS More than one-third (37.2%) of parents showed elevated levels of anxious symptoms, compared to 18.9% of a population sample (P≤0.001) and significantly more parents reported elevated levels of depressive symptoms compared to a community sample (28% vs. 21%, P=0.01). Higher levels of anxious and depressive symptoms were associated with lower life satisfaction (P<0.001). CONCLUSIONS High levels of anxious and depressive symptoms among parents of children with CF suggested that annual symptom screening is warranted. This will facilitate identification of those at risk and provide referrals and intervention for those who are in need of it.
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Affiliation(s)
- Tanja Besier
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhoevelstrasse 5, Ulm, Germany.
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Georgiopoulos AM, Hua LL. The Diagnosis and Treatment of Attention Deficit-Hyperactivity Disorder in Children and Adolescents with Cystic Fibrosis: A Retrospective Study. PSYCHOSOMATICS 2011; 52:160-6. [DOI: 10.1016/j.psym.2010.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 07/26/2010] [Indexed: 10/14/2022]
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Modi AC, Driscoll KA, Montag-Leifling K, Acton JD. Screening for symptoms of depression and anxiety in adolescents and young adults with cystic fibrosis. Pediatr Pulmonol 2011; 46:153-9. [PMID: 21259449 PMCID: PMC3462584 DOI: 10.1002/ppul.21334] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 07/06/2010] [Accepted: 07/07/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although studies have assessed symptoms of depression and anxiety in individuals with cystic fibrosis (CF), few have been conducted since the advent of new medical treatments (e.g., nebulized antibiotics, ThAIRpy Vest). Study objectives were to: (1) document symptoms of depression and anxiety for adolescents and young adults with CF and compare with normative values, (2) examine the associations among depressive/anxiety symptoms and gender, age, lung function, and body mass index, and (3) determine the relations between adolescent and caregiver symptoms of depression and anxiety. METHODS Patients and caregivers completed the Hospital Anxiety and Depression Scale (HADS) anytime (e.g., beginning or end) during routine CF clinic appointments. RESULTS Participants included 59 adolescents/young adults with CF (M(age) = 15.8 years, 54% female, 98% Caucasian, M(FEV1% predicted) = 84.6) and caregivers of 40 adolescents. Although symptom scores were in the normative range for patients with CF (M(Depression) = 2.27 and M(Anxiety) = 5.59), 3% and 32% exhibited clinically elevated symptoms of depression and anxiety, respectively. Symptoms of depression and anxiety were significantly associated with age (r = 0.28, 0.36). Symptoms of depression and anxiety were also positively correlated (r = 0.48). Females endorsed higher anxiety symptoms than males. While adolescent and caregiver anxiety scores were not related, higher caregiver depressive symptoms were associated with older patient age and worse lung function. CONCLUSIONS Data from the current study suggest low levels of depressive symptoms and substantial levels of anxiety symptoms in adolescents and young adults with CF. Consistent with prior literature, depressive symptoms appear higher in older patients and are significantly associated with anxiety symptoms. Caregiver symptomology appears to be more affected by an adolescent's health status, suggesting a need to screen caregivers when health begins to decline.
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Affiliation(s)
- Avani C Modi
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA.
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Casier A, Goubert L, Theunis M, Huse D, De Baets F, Matthys D, Crombez G. Acceptance and well-being in adolescents and young adults with cystic fibrosis: a prospective study. J Pediatr Psychol 2011; 36:476-87. [PMID: 21208979 DOI: 10.1093/jpepsy/jsq111] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To prospectively investigate the role of acceptance in well-being in adolescents and young adults with cystic fibrosis (CF). METHOD A total of 40 adolescents and young adults with CF (ages 14-22 years) completed questionnaires assessing acceptance, anxiety and depressive symptoms, physical functioning, role functioning, emotional functioning, and social functioning. After 6 months, 28 of them completed the questionnaires on anxiety and depressive symptoms, physical functioning, role functioning, emotional functioning, and social functioning a second time. RESULTS More acceptance (Time 1) was related to less depressive symptoms (Time 1 and 2), and to better role, emotional, and social functioning (Time 1). CONCLUSIONS Results indicate that accepting the limitations imposed by chronic disease and readjusting life goals may have a positive effect upon well-being in adolescents and young adults with CF. Further research is needed to clarify whether acceptance-based interventions are useful in promoting well-being in adolescents and young adults with CF.
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Affiliation(s)
- Annabelle Casier
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium.
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Bregnballe V, Schiøtz PO, Boisen KA, Pressler T, Thastum M. Barriers to adherence in adolescents and young adults with cystic fibrosis: a questionnaire study in young patients and their parents. Patient Prefer Adherence 2011; 5:507-15. [PMID: 22114464 PMCID: PMC3218111 DOI: 10.2147/ppa.s25308] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Treatment adherence is crucial in patients with cystic fibrosis, but poor adherence is a problem, especially during adolescence. Identification of barriers to treatment adherence and a better understanding of how context shapes barriers is of great importance in the disease. Adolescent reports of barriers to adherence have been studied, but studies of their parents' experience of such barriers have not yet been carried out. The aim of the present study was to explore barriers to treatment adherence identified by young patients with cystic fibrosis and by their parents. METHODS A questionnaire survey of a cohort of young Danish patients with cystic fibrosis aged 14-25 years and their parents was undertaken. RESULTS Barriers to treatment adherence were reported by 60% of the patients and by 62% of their parents. Patients and parents agreed that the three most common barriers encountered were lack of time, forgetfulness, and unwillingness to take medication in public. We found a significant positive correlation between reported number of barriers and perceived treatment burden. We also found a statistically significant relationship between the reported number of barriers and treatment adherence. A significant association was found between the number of barriers and the reactions of adolescents/young adults and those of their mothers and fathers, and between the number of barriers and the way the family communicated about cystic fibrosis. CONCLUSION The present study showed that the majority of adolescents with cystic fibrosis and their parents experienced barriers to treatment adherence. Agreement between adolescents and their parents regarding the level and types of barriers indicates an opportunity for close cooperation between adolescents, their parents, and health care professionals in overcoming adolescent adherence problems.
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Affiliation(s)
- Vibeke Bregnballe
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
- Correspondence: Vibeke Bregnballe, Department of Pediatrics, Aarhus University Hospital, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark, Tel +45 6169 9001, Fax +45 8949 6790, Email
| | | | - Kirsten A Boisen
- Centre of Adolescent Medicine, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Tacjana Pressler
- Cystic Fibrosis Centre, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Mikael Thastum
- Department of Psychology, University of Aarhus, Aarhus, Denmark
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Goldbeck L, Besier T, Hinz A, Singer S, Quittner AL. Prevalence of Symptoms of Anxiety and Depression in German Patients With Cystic Fibrosis. Chest 2010; 138:929-36. [DOI: 10.1378/chest.09-2940] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Smith BA, Modi AC, Quittner AL, Wood BL. Depressive symptoms in children with cystic fibrosis and parents and its effects on adherence to airway clearance. Pediatr Pulmonol 2010; 45:756-63. [PMID: 20597082 DOI: 10.1002/ppul.21238] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Little is currently known about the co-morbidity of depression and cystic fibrosis (CF) and there is currently no empirical research on the effects of depressive symptoms on adherence in children and adolescents with CF. The primary aim of this study was to evaluate the extent of depressive symptoms in children and adolescents with CF and their parents, and determine whether depressive symptoms in the child and/or parent was associated with adherence to airway clearance. We also evaluated whether children's perceptions of relational security with a parent were associated with adherence to airway clearance. METHODS Participants included 39 children with CF ages 7-17 years and their primary caregivers. Depressive symptoms were measured with the Children's Depression Inventory (CDI) and the Center for Epidemiological Studies-Depression Scale (CES-D). The Relatedness Questionnaire assessed the quality of parent-child relational security. Adherence to airway clearance was measured using the daily phone diary (DPD), an empirically validated adherence measure for youth with CF. RESULTS Rates of depressive symptoms were elevated in children with CF and their parents (29% for children; 35% for mothers; 23% for fathers). Child depressive symptoms were significantly associated with lower rates of adherence to airway clearance, after controlling for demographic variables (r = -0.34, P = 0.02). Child depressive symptoms were associated with worse perceptions of parental relationships (t(35) = 3.2; P = 0.002) and the quality of this relationship was also related to worse adherence (r = 0.42, P = 0.005). CONCLUSIONS A large percentage of youth with CF and their parents reported elevated symptoms of depression. Children scoring in the depressed range on a standardized screening measure and those with less secure parent-child relationships were at greatest risk for poor adherence. Thus, depressive symptoms and family relationships are appropriate targets for adherence promotion interventions, which may ultimately improve health outcomes.
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Affiliation(s)
- Beth A Smith
- Division of Child and Adolescent Psychiatry, State University of New York at Buffalo, Buffalo, New York 14222, USA.
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Abstract
Cystic fibrosis (CF) is a multisystemic life-limiting genetic disorder, primarily affecting respiratory functioning. Most patients with CF are diagnosed by 2 years of age, and the current median predicted survival rate is 37.4 years old, with 95% of patients dying from complications related to pulmonary infection. Given the chronic, progressive, and disabling nature of CF, multiple treatments are prescribed, most on a daily basis. Thus, this illness requires children, with the aid of their families, to adopt multiple health-related behaviors in addition to managing more typical developmental demands. The morbidity and mortality factors pose cognitive, emotional, and behavioral challenges for many children with CF and their families. This article applies a developmental perspective to describing the psychosocial factors affecting psychological adjustment and health-related behaviors relevant to infants, preschool and school-age children, and adolescents with CF. Topics particularly pertinent to developmental periods and medical milestones are noted, with clinical implications highlighted.
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Affiliation(s)
- Michelle M. Ernst
- Assistant Professor, Division of Behavioral Medicine and Clinical Psychology,Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mark C. Johnson
- Assistant Professor, Division of Child and Adolescent Psychiatry,Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lori J. Stark
- Professor, Division of Behavioral Medicine and Clinical Psychology,Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Modi AC, Cassedy AE, Quittner AL, Accurso F, Sontag M, Koenig JM, Ittenbach RF. Trajectories of adherence to airway clearance therapy for patients with cystic fibrosis. J Pediatr Psychol 2010; 35:1028-37. [PMID: 20304772 DOI: 10.1093/jpepsy/jsq015] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Although cross-sectional studies have demonstrated poor adherence to airway clearance therapy (ACT) for patients with cystic fibrosis (CF), no studies have identified longitudinal patterns of adherence. The objective was to characterize and identify predictors of ACT adherence trajectories for individuals with CF. METHODS Secondary data analyses were conducted for a randomized clinical trial examining differences in three ACTs. Participants (n = 153; M = 14.3 years, 55% male, 86% Caucasian, baseline FEV(1)% predicted: M = 86.7)/primary caregivers completed Daily Phone Diaries, an empirically supported adherence measure, every 4 months. RESULTS Group-based trajectory modeling revealed the best-fitting solution was a three-group model: low-adherence (14%), medium-adherence (49%), and high-adherence (37%) groups. ACT type was the only significant predictor of adherence trajectories. DISCUSSION Three trajectories of adherence to ACT for patients with CF were found. With the identification of trajectories, adherence interventions can be targeted for the subgroup at highest risk in order to prevent poor health outcomes.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
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Wu YP, Aylward BS, Steele RG. Associations between internalizing symptoms and trajectories of medication adherence among pediatric renal and liver transplant recipients. J Pediatr Psychol 2010; 35:1016-27. [PMID: 20231258 DOI: 10.1093/jpepsy/jsq014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine medication adherence trajectories posttransplantation and the association between adherence trajectories and self-reported internalizing symptoms in a pediatric population. METHODS Multilevel modeling was used to examine internalizing symptoms and longitudinal medication adherence, as assessed by electronic monitoring, among 55 children and adolescents who received liver or kidney transplantation. RESULTS Medication adherence generally declined over the study assessment window, and higher levels of anxiety were associated with higher and more stable patterns of medication adherence. CONCLUSIONS Anxiety may be an important factor to consider when assessing and intervening with posttransplantation medication adherence. Future research should consider the potential reactivity effects of adherence monitoring, as well as individual and family behaviors associated with anxiety that may influence adherence.
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Affiliation(s)
- Yelena P Wu
- University of Kansas, Lawrence, KS 66047, USA
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