"Where Does it Come from?" Experiences Among Survivors and Parents of Children with Retinoblastoma in Kenya

Development and preliminary evaluation of a genetics education booklet for retinoblastoma

BACKGROUND

Parents and survivors of retinoblastoma often hold misconceptions about the disease and desire more extensive and detailed information about its genetic nature. The aim of this study was to co-develop and evaluate a genetic education booklet for retinoblastoma.

METHODS

A human-centered design approach was employed, in which the study team consulted with clinician and patient knowledge user groups to design, produce, and refine an educational booklet. Over three phases of consultation, the study team met with each knowledge user group to review booklet prototypes and collect feedback for its further refinement. A preliminary evaluation using quantitative and qualitative methods was completed with six mothers of children with retinoblastoma.

RESULTS

The iterative, phased design process produced an educational booklet rich in images and stories, with complex genetic topics described in simplified terms. The preliminary evaluation showed an average improvement in knowledge between pre- and post-test questionnaire of 10%. Participants were satisfied with content and comprehensiveness of the information included in the booklet.

CONCLUSION

A novel educational tool for families affected by retinoblastoma was developed through collaboration with health care and patient knowledge users. Preliminary evaluation results indicate it is feasible to implement and study the booklet in a prospective, pragmatic trial to evaluate its efficacy.

Late effects of childhood cancer survivors in Africa: A scoping review

INTRODUCTION

The number of children surviving cancer in Africa is increasing. Knowledge about late effects of survivors is lacking. Our study maps literature regarding late effects of childhood cancer survivors in Africa.

METHODS

Scoping review was performed following JBI-guidelines. Systematic literature search was conducted in: Medline, Embase, African Index Medicus, Web of Science, Scopus, Psycinfo. Titles and abstracts were screened by two reviewers, followed by full-text analysis by the lead reviewer.

RESULTS

Sixty-eight studies were included for content analysis. Studies originated from 10 of 54 African countries. Most studies had retrospective study design, 2-5 years follow-up, solely chemotherapy as treatment modality, Egypt as country of origin. Fifty-three studies described physical, and seventeen studies described psychosocial late effects.

CONCLUSION

Literature concerning late effects is available from a limited number of African countries. Psychosocial domain lacks attention compared to the physical domain. More countries should report on this topic to prevent, identify and monitor late effects.

Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality services

Despite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. We found that quality of services for children is substandard across both health and social systems. Health systems have deficits in care competence (eg, diagnosis and management), system competence (eg, timeliness, continuity, and referral), user experience (eg, respect and usability), service provision for common and serious conditions (eg, cancer, trauma, and mental health), and service offerings for adolescents. Education and social services for child health are limited by low funding and poor coordination with other sectors. Structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems. Additional research is needed on health needs across the life course, health system performance for children and families, and large-scale evaluation of promising health and social programmes.

Opportunities and barriers for genetic service delivery in Kenya from a health personnel perspective

Genetic counselling and testing are essential health services for the management of heritable diseases. However, in low-and-middle income countries like Kenya, genetic counsellors are not yet a licenced profession, and there is limited availability of and access to genetic testing. This study aimed to uncover opportunities and barriers for genetic service delivery in the Kenyan healthcare system from the perspectives of those who provide genetic testing and/or genetic counselling. Participants included Kenyan health personnel who deliver genetic services. This was a qualitative study that collected data via semi-structured one-on-one interviews and analyzed it using inductive thematic analysis. Participant demographics and characteristics of clinical genetic service provision were collected using a survey and results summarized using descriptive statistics. Themes revealed during analysis were compared to the clinical characteristics of genetic service provision to inform the opportunities and barriers. Fifteen interviews were conducted in total. Thematic analysis indicated that participants believed that the barriers facing genetic service delivery were linked to three themes: (1) education and training, (2) costs, and (3) counselling challenges. The opportunities for genetic service delivery were linked to four themes: (1) demand, (2) education and training, (3) encouraging a multidisciplinary approach to care, and (4) enhancing laboratory infrastructure. These findings are crucial for the development of a national evidence-informed and culturally appropriate model for genetic service delivery.

The family's adaptation process to their child's hospitalization in an Intensive Care Unit

OBJECTIVE

To learn about the adaptation process of family members when experiencing their child's hospitalization in an Intensive Care Unit.

METHOD

A qualitative, descriptive and exploratory study conducted at the Pediatrics Unit with family members of children from the Pediatric Intensive Care Unit. The thematic analysis technique was used.

RESULTS

Thirteen (13) family members, 12 mothers and one father participated. The following categories emerged from the results: Family impact on children's hospitalization in a Pediatric Intensive Care Unit and Mechanisms for adapting family members to hospitalization in a Pediatric Intensive Care Unit.

CONCLUSION

The mechanisms adopted by the family in the process of adapting the child to admission to the Pediatric Intensive Care Unit were: positive thinking, understanding the treatment and the operation of the unit. Health professionals can offer strategies to the family in order to make hospitalization less traumatic, making it possible to share experiences and expand the knowledge of those involved.

Parent Knowledge of Screening and Genetic Testing in Retinoblastoma

PURPOSE

To evaluate parent knowledge of screening and genetic testing for retinoblastoma and its potential correlation with demographics, clinical features, and socioeconomical factors.

METHODS

It was a cross-sectional study conducted at the ocular oncology unit of a tertiary ophthalmic center in Southern China. A face-to-face interview was administered to parents of retinoblastoma children during hospitalization. Parent knowledge was assessed using the sum score of a 7-item questionnaire. Demographics and socioeconomic status were collected from the interview, and clinical data were retrieved from the medical records.

RESULTS

A total of 126 parents of retinoblastoma children were included. Parents accurately answered 66.7% to 84.9% of each item in the questionnaire. Only 37 (29.4%) parents correctly answered all 7 questions. Parent knowledge was positively correlated with education, but it was not associated with patients' laterality, sex, or household income. Physicians and the Internet were the major sources of parental health-related information. During the median follow-up of 492 days, 13 (61.9%) of 21 patients in the full-score group without genetic testing at baseline actually conducted testing during follow-up compared to 29 of 67 (43.3%) in the less-than-full-score group (P=0.136).

CONCLUSION

Overall parent knowledge about retinoblastoma screening and genetic testing was moderate. Higher education was associated with greater parent knowledge. Future studies should validate our findings in other populations, especially in those with different cultural background and healthcare systems.

Children's and adolescents' experiences of healthcare professionals: scoping review protocol

BACKGROUND

Children and adolescents form a distinct patient group, whose experiences are relatively under-represented in research. Surveys have shown that healthcare professionals (HCPs) do not always communicate with them well, leaving children and adolescents under-involved and unsure who to ask when concerned. Recent qualitative studies have recognised that HCPs have a major influence on children's and adolescents' experiences, where poorer interactions can lead to fear, missed appointments and potentially a worse clinical outcome. Little is known about how children and adolescents experience the HCPs who play such an integral role in their healthcare. This review aims to explore children's and adolescents' lived experience of HCPs, so that a deeper understanding of the interactions between them can equip HCPs to provide care that better aligns with patients' needs.

METHOD

This study will use scoping review methodology to map the existing published literature comprehensively and systematically, following a six-step framework. It will extract children's and adolescents' experiences, in the form of direct quotations, and thematically analyse them. The consultation exercise with children and adolescents will gather additional insights. Findings will consist of descriptions of each theme along with exemplar quotations and consultation comments.

DISCUSSION

This scoping review is unique, as it will present children's and adolescents' lived experiences of HCPs, from synthesis of their direct quotations. Findings will assist HCPs to tailor their interpersonal skills to meet patients' needs so that better healthcare can be provided. This study will have implications for clinical educators, policy makers and guideline developers and provide suggestions for further research.

SYSTEMATIC REVIEW REGISTRATION

Not registered.

Paroxysmal Kinesigenic Dyskinesia: First Molecularly Confirmed Case from Africa

Background

Paroxysmal kinesigenic dyskinesia (PKD) is a movement disorder, with an excellent response to carbamazepine treatment. It has been described in various populations, but not yet in an African population.

Case report

In a patient who reported to clinic with side effects of carbamazepine, PRRT2 gene screening was performed based on a clinical history compatible with PKD. A common PRRT2 mutation was identified in this patient, hereby the first genetically confirmed PRRT2-associated PKD in Africa.

Discussion

Reporting genetic confirmation of an unusual movement disorder from an equally unusual location shows the wide geographical distribution of PRRT2-associated disease. It also illustrates recognizability of this treatable disorder where the easiest accessible diagnostic tool is neurological history and examination.

Parental coping with retinoblastoma diagnosis

OBJECTIVE

To characterize coping and distress among parents of children with retinoblastoma, and to uncover their association with perceived health literacy, self-efficacy, and social support.

METHODS

This was a cross-sectional study performed in the retinoblastoma clinics of Beijing Children's Hospital, Jilin Eye Hospital and Changchun Hospital in China. Parents of children with retinoblastoma (n = 104) completed a print Mandarin language questionnaire consisting of four sections: (i) demographic information, (ii) mini-mental adjustment to cancer scale, (iii) hospital anxiety and depression scale, and (iv) perceived health literacy, self-efficacy, and social support scales. Scores were tabulated for each measure and analyzed by bivariate correlation.

RESULTS

Moderate anxiety affected 59.2% of parents, and 77.7% experienced low, moderate, or high levels of depression. Combined anxiety and depression was positively correlated with helplessness/hopelessness (R = 0.42, p < .01) and anxious preoccupation (R = 0.247, p < .05), and negatively correlated with perceived self-efficacy (R = -0.228, p < .05). Perceived social support from a partner was negatively correlated with depression (R = -0.207, p < .05) and helplessness/hopelessness (R = -0.271, p < .01).

CONCLUSIONS

Knowledge of how parents cope with their child's cancer diagnosis can help healthcare teams understand how best to support their psychosocial needs.