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The role of parental health and distress in assessing children’s health status. Qual Life Res 2022; 31:3403-3412. [PMID: 35876948 PMCID: PMC9587925 DOI: 10.1007/s11136-022-03186-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/24/2022]
Abstract
Purpose The purpose of the study was to examine the contributions of parents’ health and distress to parent’s and children’s assessments of children’s health. Methods We used baseline data from a longitudinal study of 364 children (ages 4–12) about to undergo surgery and their parents in a Southern California pediatric hospital. We used the 20-item child self-reported CHRIS 2.0 general health and the parallel parent-reported measure of the child’s health, along with a measure of parental distress about the child’s health were administered in the perioperative period. Other measures included parents’ physical and mental health, quality of life, distress over their child’s health, and number and extent of other health problems of the child and siblings. Results On average, parents’ reports about the child were consistently and statistically significantly higher than children’s self-reports across all sub-dimensions of the CHRIS 2.0 measure. Parents’ personal health was positively associated with their reports of the child’s health. More distressed parents were closer to the child’s self-reports, but reported poorer personal health. Conclusion Parent–child differences in this study of young children’s health were related to parental distress. Exploring the nature of the gap between parents and children in assessments of children’s health could improve effective clinical management for the child and enhance family-centered pediatric care. Future studies are needed to assess the generalizability of CHRIS 2.0 to other health settings and conditions and to other racial/ethnic groups. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03186-z.
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Significant improvement of child physical and emotional functioning after familial haploidentical stem cell transplant. Bone Marrow Transplant 2022; 57:586-592. [PMID: 35110690 DOI: 10.1038/s41409-022-01584-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Abstract
Allogeneic stem cell transplantation (AlloSCT) represents the only curative therapy for sickle cell disease (SCD). However, limited availability of matched related donors and suboptimal outcomes following AlloSCT with unrelated donors has led to investigation of alternative donors. Among children with high-risk SCD, we evaluated health-related quality of life (HRQoL) impact in the two years following familial haploidentical SCT. HRQoL was collected from parent and child raters, using the Child Health Ratings Inventories Generic measure and haploidentical SCT-specific module. Repeated measures models were fit to assess HRQoL changes over time and by rater. Nineteen children (mean age 12.9 yrs [standard deviation, 5.3]; 63% male) and their parents were included. There were no differences in the 2-yr trajectories of child physical or emotional functioning (EF) by rater. Child physical functioning and EF scores were significantly lower at day +45 than baseline, but scores recovered by day +180. There was significant improvement in EF (p = 0.03) at 2 yrs vs baseline. A similar pattern of scores over time was seen for parent ratings of child's global HRQoL. Despite treatment intensity in the initial months following AlloSCT, patient scores recovered or exceeded baseline scores at two years. This trial is registered at clinicaltrials.gov (NCT01461837).
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Killien EY, Loftis LL, Clark JD, Muszynski JA, Rissmiller BJ, Singleton MN, White BR, Zimmerman JJ, Maddux AB, Pinto NP, Fink EL, Watson RS, Smith M, Ringwood M, Graham RJ. Health-related quality of life outcome measures for children surviving critical care: a scoping review. Qual Life Res 2021; 30:3383-3394. [PMID: 34185224 PMCID: PMC9116894 DOI: 10.1007/s11136-021-02928-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Health-related quality of life (HRQL) has been identified as one of the core outcomes most important to assess following pediatric critical care, yet there are no data on the use of HRQL in pediatric critical care research. We aimed to determine the HRQL instruments most commonly used to assess children surviving critical care and describe study methodology, patient populations, and instrument characteristics to identify areas of deficiency and guide investigators conducting HRQL research. METHODS We queried PubMed, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Registry for studies evaluating pediatric critical care survivors published 1970-2017. We used dual review for article selection and data extraction. RESULTS Of 60,349 citations, 66 articles met inclusion criteria. The majority of studies were observational (89.4%) and assessed HRQL at one post-discharge time-point (86.4%), and only 10.6% of studies included a baseline assessment. Time to the first follow-up assessment ranged from 1 month to 10 years post-hospitalization (median 3 years, IQR 0.5-6). For 26 prospective studies, the median follow-up time was 0.5 years [IQR 0.25-1]. Parent/guardian proxy-reporting was used in 83.3% of studies. Fifteen HRQL instruments were employed, with four used in >5% of articles: the Health Utility Index (n = 22 articles), the Pediatric Quality of Life Inventory (n = 17), the Child Health Questionnaire (n = 16), and the 36-Item Short Form Survey (n = 9). CONCLUSION HRQL assessment in pediatric critical care research has been centered around four instruments, though existing literature is limited by minimal longitudinal follow-up and infrequent assessment of baseline HRQL.
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Affiliation(s)
- Elizabeth Y Killien
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, FA 2.112, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Laura L Loftis
- Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Jonna D Clark
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, FA 2.112, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Jennifer A Muszynski
- Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian J Rissmiller
- Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Marcy N Singleton
- Pediatric Critical Care, Children's Hospital At Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Benjamin R White
- Pediatric Critical Care Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Jerry J Zimmerman
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, FA 2.112, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Aline B Maddux
- Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Neethi P Pinto
- Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - R Scott Watson
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, FA 2.112, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - McKenna Smith
- Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Melissa Ringwood
- Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert J Graham
- Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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Kaplan SH, Fortier MA, Shaughnessy M, Maurer E, Vivero-Montemayor M, Masague SG, Hayes D, Stern HS, Dai M, Kain ZN. Development and initial validation of self-report measures of general health, preoperative anxiety, and postoperative pain in young children using computer-administered animation. Paediatr Anaesth 2021; 31:150-159. [PMID: 33174313 DOI: 10.1111/pan.14068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 10/06/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND For young children, existing measures of children's health-related quality of life must be parent-reported or interviewer-administered for those who cannot read or complete measures independently. Parents' and childrens' reports about the child's health have been shown to disagree. AIMS (a) To test the reliability and validity of an animated, computer-administered Child Health Rating Inventories (CHRIS2.0) among children aged 4-12 undergoing surgery; and (b) to develop and test two CHRIS measures of preoperative anxiety and postoperative pain management. METHODS We conducted a longitudinal cohort study of a diverse group of 542 children aged 4-12 undergoing surgery. We compared the CHRIS measures to Pediatric Quality of Life Inventory (PedsQL), the Functional Disabilities Inventory (FDI), State-Trait Anxiety Inventory for children (STAI-CH), and the Parent Postoperative Pain Measure (PPPM). RESULTS Factor analyses supported the construct validity of the 12-item general physical health and the 8-item mental health CHRIS scales, as well as a composite 20-item scale, and the CHRIS preoperative anxiety and postoperative pain scales. Internal consistency reliability for all CHRIS scales exceeded the standard for group comparisons (Cronbach's α ≥0.70). The CHRIS general health composite was significantly correlated with composite PedsQL and FDI (r = 0.28, P < .001 and r = 0.43, P < .001, respectively). The CHRIS peri-operative anxiety measure was significantly correlated with the STAI-CH (r = 0.44, P < .001), as was the CHRIS postoperative pain scale with the PPPM (r = 0.52, P < .001). CONCLUSIONS The CHRIS measures were reliable and valid in this diverse sample of young children (4-12). Because CHRIS measures are self-administered, scored in real time, and run on multiple different platforms, this approach provides a feasible method for the collection of health-related quality of life in young children and those with limited literacy. Our data indicate that this approach is psychometrically sound and has the potential for adding the child's voice to pediatric outcomes.
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Affiliation(s)
- Sherrie H Kaplan
- Health Policy Research Institute, University of California, Irvine, CA, USA
| | - Michelle A Fortier
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | | | - Eva Maurer
- Health Policy Research Institute, University of California, Irvine, CA, USA
| | | | - Sergio Gago Masague
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA, USA
| | - Dylan Hayes
- Independent animation consultant, Providence, RI, USA
| | - Hal S Stern
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA, USA
| | - Maozhu Dai
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA, USA
| | - Zeev N Kain
- Health Policy Research Institute, University of California, Irvine, CA, USA.,Department of Anesthesiology & Perioperative Care, University of California, Irvine, CA, USA
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Lin JK, Lerman BJ, Barnes JI, Boursiquot BC, Tan YJ, Robinson AQL, Davis KL, Owens DK, Goldhaber-Fiebert JD. Cost Effectiveness of Chimeric Antigen Receptor T-Cell Therapy in Relapsed or Refractory Pediatric B-Cell Acute Lymphoblastic Leukemia. J Clin Oncol 2018; 36:3192-3202. [PMID: 30212291 DOI: 10.1200/jco.2018.79.0642] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The anti-CD19 chimeric antigen receptor T-cell therapy tisagenlecleucel was recently approved to treat relapsed or refractory pediatric acute lymphoblastic leukemia. With a one-time infusion cost of $475,000, tisagenlecleucel is currently the most expensive oncologic therapy. We aimed to determine whether tisagenlecleucel is cost effective compared with currently available treatments. METHODS Markov modeling was used to evaluate tisagenlecleucel in pediatric relapsed or refractory acute lymphoblastic leukemia from a US health payer perspective over a lifetime horizon. The model was informed by recent multicenter, single-arm clinical trials. Tisagenlecleucel (under a range of plausible long-term effectiveness) was compared with blinatumomab, clofarabine combination therapy (clofarabine, etoposide, and cyclophosphamide), and clofarabine monotherapy. Scenario and probabilistic sensitivity analyses were used to explore uncertainty. Main outcomes were life-years, discounted lifetime costs, discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (3% discount rate). RESULTS With an assumption of a 40% 5-year relapse-free survival rate, tisagenlecleucel increased life expectancies by 12.1 years and cost $61,000/QALY gained. However, at a 20% 5-year relapse-free survival rate, life-expectancies were more modest (3.8 years) and expensive ($151,000/QALY gained). At a 0% 5-year relapse-free survival rate and with use as a bridge to transplant, tisagenlecleucel increased life expectancies by 5.7 years and cost $184,000/QALY gained. Reduction of the price of tisagenlecleucel to $200,000 or $350,000 would allow it to meet a $100,000/QALY or $150,000/QALY willingness-to-pay threshold in all scenarios. CONCLUSION The long-term effectiveness of tisagenlecleucel is a critical but uncertain determinant of its cost effectiveness. At its current price, tisagenlecleucel represents reasonable value if it can keep a substantial fraction of patients in remission without transplantation; however, if all patients ultimately require a transplantation to remain in remission, it will not be cost effective at generally accepted thresholds. Price reductions would favorably influence cost effectiveness even if long-term clinical outcomes are modest.
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Affiliation(s)
- John K Lin
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Benjamin J Lerman
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - James I Barnes
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Brian C Boursiquot
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Yuan Jin Tan
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Alex Q L Robinson
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Kara L Davis
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Douglas K Owens
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Jeremy D Goldhaber-Fiebert
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
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Rodday AM, Terrin N, Leslie LK, Graham RJ, Parsons SK. Understanding the Relationship Between Child Health-Related Quality of Life and Parent Emotional Functioning in Pediatric Hematopoietic Stem Cell Transplant. J Pediatr Psychol 2018; 42:804-814. [PMID: 28369555 DOI: 10.1093/jpepsy/jsx047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/09/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Explore interrelationships between domains of child health-related quality of life (HRQL) and parent emotional functioning using parent-proxy and child report in the context of hematopoietic stem cell transplant (HSCT). Methods Data on 258 parent-child dyads were used from two longitudinal studies. Domains of HRQL included physical, emotional, and role functioning, and HSCT-related worry. We used structural equation modeling to model the outcome of parent emotional functioning using primary and alternative conceptual models. Results Parent-proxy raters reported lower child HRQL than child raters. Structural equation models demonstrated relationships between child emotional functioning, child HSCT-related worry, and parent emotional functioning, with some differences by raters. Conclusions Relationships between child HRQL and parent emotional functioning within the context of HSCT are complex. To optimize the child's health outcomes, providing psychosocial support for children and their families may be necessary, especially for those experiencing distress or facing treatment complications.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.,Department of Medicine, Tufts University
| | - Norma Terrin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.,Department of Medicine, Tufts University
| | - Laurel K Leslie
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.,American Board of Pediatrics, Chapel Hill, NC
| | - Robert J Graham
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital.,Department of Anesthesia, Harvard Medical School
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.,Department of Medicine, Tufts University
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7
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Rodday AM, Graham RJ, Weidner RA, Rothrock NE, Dewalt DA, Parsons SK. Leveraging pediatric PROMIS item banks to assess physical functioning in children at risk for severe functional loss. J Patient Rep Outcomes 2017; 1:10. [PMID: 29757321 PMCID: PMC5934938 DOI: 10.1186/s41687-017-0011-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 09/04/2017] [Indexed: 01/22/2023] Open
Abstract
Background Pediatric neuromuscular illnesses often result in decreased health-related quality of life (HRQL), notably in physical functioning. Generic HRQL measures have been developed for use in general populations, but may not adequately assess patients with severe functional loss. To address this measurement gap, we created two custom parent-proxy physical functioning short forms for use among children at risk for low levels of functioning, using pediatric Patient Reported Outcomes Measurement Information System (PROMIS) item banks for Upper Extremity and Mobility. Methods Two custom short forms from PROMIS Upper Extremity (13 items) and Mobility (13 items) parent-proxy item banks were created and administered to parents of children (ages 5 - 22 years) enrolled in an integrated care program for management of chronic respiratory insufficiency, largely due to neuromuscular illnesses. Standardized PROMIS T-scores have a mean of 50 (SD = 10); higher scores indicate better functioning. Physicians rated clinical severity. Single proxy-rated items on mental and physical health from the Child Health Rating Inventories (CHRIs) global health scale were completed by parents. Psychometric properties, including known groups comparisons, were explored. Results Fifty-seven parents completed the parent-proxy custom PROMIS short forms. The mean Upper Extremity T-score was 21 (SD = 13); the mean Mobility T-score was 22 (SD = 11). Some participants scored at the measurement floor; two items on assistive devices did not perform well in this sample and were excluded from the Mobility T-score. Known groups comparisons showed that those with lower clinical severity had better median Upper Extremity (22 vs. 14, p < 0.001) and Mobility (28 vs. 16, p = 0.004) function than those with worse clinical severity. Both Upper Extremity and Mobility T-scores were higher in the subgroups defined by better physical and mental health, as measured by the CHRIs. Conclusions Upper Extremity and Mobility T-scores were nearly three standard deviations below the PROMIS pediatric calibration population mean. Preliminary psychometrics demonstrated the potential to more accurately measure lower physical functioning using items from PROMIS item banks. However, some participants scored at the measurement floor despite targeting items at the lower end of the scale. Further short form refinement, enrichment of the item banks, and larger-scale field testing are needed.
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Affiliation(s)
- Angie Mae Rodday
- 1Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, 800 Washington St, Box 345, Boston, MA 02111 USA
| | - Robert J Graham
- 2Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Department of Anesthesia, Harvard Medical School, 300 Longwood Avenue, Bader 629, Boston, MA 02115 USA
| | - Ruth Ann Weidner
- 3Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 345, Boston, MA 02111 USA
| | - Nan E Rothrock
- 4Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine625, North Michigan Avenue, Suite 2700, Chicago, IL 60611 USA
| | - Darren A Dewalt
- 5Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, 5041 Old Clinic Building, CB 7110, Chapel Hill, NC 27599 USA
| | - Susan K Parsons
- 6Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, 800 Washington St, Box 345, Boston, MA 02111 USA
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8
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Rodday AM, Graham RJ, Weidner RA, Terrin N, Leslie LK, Parsons SK. Predicting Health Care Utilization for Children With Respiratory Insufficiency Using Parent-Proxy Ratings of Children's Health-Related Quality of Life. J Pediatr Health Care 2017. [PMID: 28629924 PMCID: PMC5653401 DOI: 10.1016/j.pedhc.2017.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Children with chronic respiratory insufficiency and mechanical ventilation often experience acute illnesses requiring unscheduled hospitalizations. Health-related quality of life (HRQL) may predict future health care utilization. METHODS Participants were 30 days to 22 years old with chronic respiratory insufficiency (N = 120). Parent-proxies completed global HRQL and general health measures. Outcomes were total health care (emergency department, outpatient, inpatient) and inpatient days over 6 months. Adjusted negative binomial regression estimated the effects of global HRQL and general health on utilization. RESULTS Three quarters of children had any utilization; 32% had hospitalizations. Children with poor/fair global HRQL had 3.7 times more health care days than those with very good/excellent global HRQL. Children with poor/fair global HRQL had 6.3 times more inpatient days than those with very good/excellent global HRQL. Similar relationships existed between general health and utilization. DISCUSSION HRQL was associated with health care and inpatient days. Clinical teams can use HRQL as a marker for utilization risk, enabling potentially earlier intervention, better outcomes, and lower costs.
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9
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Utilizing trauma admissions as an opportunity to identify developmental and behavioral concerns. Am J Surg 2017; 214:661-665. [DOI: 10.1016/j.amjsurg.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/01/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022]
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10
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Beckmann NB, Miller WP, Dietrich MS, Orchard PJ. Quality of life among boys with adrenoleukodystrophy following hematopoietic stem cell transplant. Child Neuropsychol 2017; 24:986-998. [DOI: 10.1080/09297049.2017.1380176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Nicole B. Beckmann
- University of Minnesota Masonic Children’s Hospital, Pediatric Blood & Marrow Transplantation, Minneapolis, MN, USA
- Vanderbilt University Schools of Medicine, Nashville, TN, USA
| | - Weston P. Miller
- University of Minnesota Medical School, Department of Pediatrics, Division of Blood & Marrow Transplantation, Minneapolis, MN, USA
| | - Mary S. Dietrich
- Vanderbilt University Schools of Medicine and Nursing, Nashville, TN, USA
| | - Paul J. Orchard
- University of Minnesota Medical School, Department of Pediatrics, Division of Blood & Marrow Transplantation, Minneapolis, MN, USA
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Ullrich CK, Rodday AM, Bingen KM, Kupst MJ, Patel SK, Syrjala KL, Harris LL, Recklitis CJ, Chang G, Guinan EC, Terrin N, Tighiouart H, Phipps S, Parsons SK. Three sides to a story: Child, parent, and nurse perspectives on the child's experience during hematopoietic stem cell transplantation. Cancer 2017; 123:3159-3166. [PMID: 28387946 DOI: 10.1002/cncr.30723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The experience of children undergoing hematopoietic stem cell transplantation (HSCT), including the ways in which different participants (ie, children, parents, and nurses) contribute to the overall picture of a child's experience, is poorly characterized. This study evaluated parent, child, and nurse perspectives on the experience of children during HSCT and factors contributing to interrater differences. METHODS Participants were enrolled in a multicenter, prospective study evaluating child and parent health-related quality of life over the year after HSCT. Children (n = 165) and their parents and nurses completed the Behavioral, Affective, and Somatic Experiences Scale (BASES) at baseline (before/during conditioning), 7 days after the stem cell infusion (day+7), and 21 days after the stem cell infusion (day+21). The BASES domains included Somatic Distress, Mood Disturbance, Cooperation, and Getting Along. Higher scores indicated more distress/impairment. Repeated measures models by domain assessed differences by raters and changes over time and identified other factors associated with raters' scores. RESULTS Completion rates were high (≥73% across times and raters). Multivariate models revealed significant time-rater interactions, which varied by domain. For example, parent-rated Somatic Distress scores increased from baseline to day+7 and remained elevated at day+21 (P < .001); children's scores were lower than parents' scores across time points. Nurses' baseline scores were lower than parents' baseline scores, although by day+21 they were similar. Older child age was associated with higher Somatic Distress and Mood Disturbance scores. Worse parent emotional functioning was associated with lower scores across raters and domains except for Cooperation. CONCLUSIONS Multirater assessments are highly feasible during HSCT. Ratings differ by several factors; considering ratings in light of such factors may deepen our understanding of the child's experience. Cancer 2017;123:3159-66. © 2017 American Cancer Society.
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Affiliation(s)
- Christina K Ullrich
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Kristin M Bingen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sunita K Patel
- Department of Population Sciences, City of Hope Medical Center, Duarte, California.,Department of Supportive Care Medicine, City of Hope Medical Center, Duarte, California
| | - Karen L Syrjala
- Department of Biobehavioral Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lynnette L Harris
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Christopher J Recklitis
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Grace Chang
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Eva C Guinan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Norma Terrin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.,Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
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12
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Nuss SL, Wilson ME. Health-Related Quality of Life Following Hematopoietic Stem Cell Transplant During Childhood. J Pediatr Oncol Nurs 2016; 24:106-15. [PMID: 17332424 DOI: 10.1177/1043454206296033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study is to examine the self-reported and parent-reported health-related quality of life (HRQoL) of children (age < 19 years) who received a hematopoietic (bone marrow, cord blood, or peripheral blood) stem cell transplant (SCT) at the University of Nebraska Medical Center (UNMC). A total of 35 families participated: 31 SCT recipients, 35 mothers, and 28 fathers. Mean scores were 73.6 child, 71.2 mothers, and 76.2 fathers (range of 0-100, with high scores indicating better HRQoL). No significant overall HRQoL difference between parent and child were reported. Mothers reported significantly lower physical functioning (F 2,23 = 3.509, P = .041) compared to child (P = .041) and fathers (P = .025). Older age at time of transplant was associated with higher procedural anxiety according to child (r = .498, P = .005) and mothers (r = .466, P = .008). Older age at time of transplant was associated with less worry according to fathers (r = -.589, P = .002). Overall, SCT recipients and their parents report moderately high HRQoL.
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13
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Graham RJ, Rodday AM, Weidner RA, Parsons SK. The Impact on Family of Pediatric Chronic Respiratory Failure in the Home. J Pediatr 2016; 175:40-6. [PMID: 27289498 DOI: 10.1016/j.jpeds.2016.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/15/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the family impact of managing severe, chronic respiratory failure (CRF) at home. Better understanding will inform parental counseling and serve as a point of reference for interventions. STUDY DESIGN Families of children with CRF completed the Impact on Family Scale (IFS) and Consumer Assessment of Healthcare Providers and Systems. Using multivariable linear regression, we assessed the relationship between IFS and family, clinical, and utilization characteristics. RESULTS A total of 118 parents (60%) completed the IFS; 114 parents (58%) completed all measures. The 15-item IFS mean total score was 40 (SD = 10) with a possible range of 15-60 (greater scores indicate more impact). Modeling identified a negative association with parent emotional functioning, parent-rated child health, and private insurance only (compared with both private/public), and other family characteristics (eg, parental education, marital status, and income) were not associated with IFS scores. CONCLUSION Families of children with CRF are greatly impacted by their child's health. In contrast to other children with special health care needs, family characteristics were not associated with IFS scores, excluding insurance type. These results may reflect more uniform demands and stressors related to CRF. Future research should identify interventions to attenuate the impact of CRF.
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Affiliation(s)
- Robert J Graham
- Division of Critical Care, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Angie Mae Rodday
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA; Tufts University School of Medicine, Boston, MA
| | - Ruth Ann Weidner
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA
| | - Susan K Parsons
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA; Tufts University School of Medicine, Boston, MA
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14
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Parent Outlook: How Parents View the Road Ahead as They Embark on Hematopoietic Stem Cell Transplantation for Their Child. Biol Blood Marrow Transplant 2015; 22:104-11. [PMID: 26348891 DOI: 10.1016/j.bbmt.2015.08.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/23/2015] [Indexed: 11/22/2022]
Abstract
Pediatric hematopoietic stem cell transplantation (HSCT) offers cure for high-risk malignancies and other conditions, but carries a risk of complications. Parental outlook regarding their child's transplantation course and future health has been largely unexplored. This report presents the Parent Outlook Scale, describes its properties, and examines the outlook of parents embarking on their child's transplantation course and the associated variables. Parents of children scheduled to undergo HSCT (n = 363) at 8 US transplantation centers completed the Parent Outlook Scale, comprising 4 items assessing frequency of the parent's thoughts about the potential difficulty of the child's transplantation (Transplant Difficult subscale) and worsened health (Health Worse subscale). Item responses were rated on a 5-point Likert scale (ranging from "none" to "all of the time") and, along with scale/subscale scores, transformed to 100-point scales, with higher scores connoting greater thought frequency. Psychometrics were explored. Multivariable models identified personal and clinical characteristics associated with scale and subscale scores. The Parent Outlook Scale (α = 0.75) and subscales were found to have sound psychometric properties. Factor loading supported the single scale with 2 subscales representing distinct aspects of overall outlook. Mean scores (Parent Outlook, 52.5 ± 21.7; Transplant Difficult, 64.4 ± 25.6; Health Worse, 40.7 ± 25.7) revealed variability within and across scale/subscales. Significantly different mean subscale scores (P < .001) indicated more frequent Transplant Difficult thoughts than Health Worse thoughts. Clinical factors (solid tumor diagnosis and unrelated donor transplant) and a parent factor (worse emotional functioning) were associated with higher scale and subscale scores. Our findings show that the outlook of parents embarking on their child's HSCT course is varied and not solely a product of clinical factors readily apparent to clinicians. Referring and transplantation clinicians should create opportunities to explore with parents their perspectives and concerns before and during the course of HSCT.
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15
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Lee SJ, Wolff D, Kitko C, Koreth J, Inamoto Y, Jagasia M, Pidala J, Olivieri A, Martin PJ, Przepiorka D, Pusic I, Dignan F, Mitchell SA, Lawitschka A, Jacobsohn D, Hall AM, Flowers MED, Schultz KR, Vogelsang G, Pavletic S. Measuring therapeutic response in chronic graft-versus-host disease. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: IV. The 2014 Response Criteria Working Group report. Biol Blood Marrow Transplant 2015; 21:984-99. [PMID: 25796139 PMCID: PMC4744804 DOI: 10.1016/j.bbmt.2015.02.025] [Citation(s) in RCA: 263] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 12/17/2022]
Abstract
In 2005, the National Institutes of Health (NIH) Chronic Graft-versus-Host Disease (GVHD) Consensus Response Criteria Working Group recommended several measures to document serial evaluations of chronic GVHD organ involvement. Provisional definitions of complete response, partial response, and progression were proposed for each organ and for overall outcome. Based on publications over the last 9 years, the 2014 Working Group has updated its recommendations for measures and interpretation of organ and overall responses. Major changes include elimination of several clinical parameters from the determination of response, updates to or addition of new organ scales to assess response, and the recognition that progression excludes minimal, clinically insignificant worsening that does not usually warrant a change in therapy. The response definitions have been revised to reflect these changes and are expected to enhance reliability and practical utility of these measures in clinical trials. Clarification is provided about response assessment after the addition of topical or organ-targeted treatment. Ancillary measures are strongly encouraged in clinical trials. Areas suggested for additional research include criteria to identify irreversible organ damage and validation of the modified response criteria, including in the pediatric population.
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Affiliation(s)
- Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel Wolff
- Department of Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Carrie Kitko
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - John Koreth
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Madan Jagasia
- Division of Hematology-Oncology, Vanderbilt University, Nashville, Tennessee
| | - Joseph Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Attilio Olivieri
- Department of Clinical and Molecular Sciences, University of Ancona, Ancona, Italy
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Donna Przepiorka
- US Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland
| | - Iskra Pusic
- Department of Medicine, Washington University, St. Louis, Missouri
| | - Fiona Dignan
- Department of Clinical Haematology, University of Manchester, Manchester, United Kingdom
| | - Sandra A Mitchell
- Outcomes Research Branch, National Cancer Institute, Bethesda, Maryland
| | - Anita Lawitschka
- Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - David Jacobsohn
- Division of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Anne M Hall
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kirk R Schultz
- BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | | | - Steven Pavletic
- Outcomes Research Branch, National Cancer Institute, Bethesda, Maryland.
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16
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Heinze KE, Rodday AM, Nolan MT, Bingen K, Kupst MJ, Patel SK, Syrjala K, Harris L, Recklitis C, Schwartz L, Davies S, Guinan EC, Noll R, Chang G, Parsons SK. The impact of pediatric blood and marrow transplant on parents: introduction of the parent impact scale. Health Qual Life Outcomes 2015; 13:46. [PMID: 25890070 PMCID: PMC4408604 DOI: 10.1186/s12955-015-0240-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents often experience stress-related complications when their child requires blood and marrow transplant (BMT). Previous studies have described the emotional toll BMT places on parents during the acute phase of care and within the context of clinical complications. In this paper we introduce the Parent Impact Scale (PARimpact), designed to capture physical and emotional challenges of the child's health on the parent. The primary aim of this paper is to examine psychometric properties of PARimpact, and the secondary aim is to explore factors associated with PARimpact scores for further hypothesis generation. METHODS This analysis used a merged dataset of two longitudinal studies. Accompanying parents (n = 363) of children undergoing BMT were surveyed up to six times from pre-BMT baseline to one year after their child's BMT. For this analysis, pre-BMT baseline responses to PARimpact were used to examine the factor structure with Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA). Construct validity was assessed, and multivariable regression was used to examine relationships between PARimpact and BMT clinical variables. RESULTS PCA and EFA revealed a one-factor solution with acceptable item loading; Cronbach's α was 0.83 at baseline. Hypothesized differences in known groups were detected for BMT complications with significantly higher PARimpact scores for those with vs. without each complication. In the adjusted multivariable regression models, acute graft versus host disease (b = 5.3; p = 0.03), end organ toxicity (b = 5.9; p < 0.01), and systemic infection (b = 9.1; p < 0.01) were associated with significantly higher mean PARimpact scores in the first 3 months following transplant. After the first 3 months to 1 year post BMT, systemic infection was associated with increased mean PARimpact scores (b = 19.2; p < 0.01). CONCLUSIONS Initial results suggest that the PARimpact is valid and reliable. Our finding that clinical complications increase the impact of BMT on the caretaking parent indicates the need for BMT healthcare professionals to identify these events and help parents navigate the BMT course. Clinical application of the PARimpact scale should be considered to identify high-risk families and provide targeted interventions to augment care.
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Affiliation(s)
- Katherine E Heinze
- Johns Hopkins University School of Nursing, 525 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Angie Mae Rodday
- Tufts Medical Center, 800 Washington Street #345, Boston, MA, 02111, USA.
| | - Marie T Nolan
- Johns Hopkins University School of Nursing, 525 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Kristin Bingen
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Mary Jo Kupst
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Sunita K Patel
- City of Hope, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
| | - Karen Syrjala
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA.
| | - Lynnette Harris
- Baylor College of Medicine, One Baylor Plaza, Baylor, TX, 77030, USA.
| | | | - Lisa Schwartz
- University of Pennsylvania School of Medicine, 3501 Civic Center Boulevard CTRB 10311, Philadelphia, PA, 19104, USA.
| | - Stella Davies
- Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA.
| | - Eva C Guinan
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Robert Noll
- Children's Hospital of Pittsburgh of PUMC, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
| | - Grace Chang
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA.
| | - Susan K Parsons
- Tufts Medical Center, 800 Washington Street #345, Boston, MA, 02111, USA.
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17
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Pennarola BW, Rodday AM, Bingen K, Schwartz LA, Patel SK, Syrjala KL, Mayer DK, Ratichek SJ, Guinan EC, Kupst MJ, Hibbard JH, Parsons SK. Changing factors associated with parent activation after pediatric hematopoietic stem cell transplant. Support Care Cancer 2014; 23:1997-2006. [PMID: 25519755 DOI: 10.1007/s00520-014-2544-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 11/30/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify factors associated with parent activation in parents of children undergoing pediatric hematopoietic stem cell transplant (HSCT) in the 6 months following HSCT, and to address if their association with parent activation changes over time. METHODS Measures for this analysis, including the Parent-Patient Activation Measure (Parent-PAM), were completed by parents (N = 198) prior to their child's HSCT preparative regimen and again at 6 months post-HSCT. Clinical data were also collected. A repeated measures model was built to estimate the association between clinical and demographic factors and parent well-being on Parent-PAM scores. Interactions with time were considered to test for changing effects over time. RESULTS Throughout the HSCT course, older parent age was associated with lower Parent-PAM scores (β = -0.29, p = 0.02) and never being married was associated with higher scores (versus married, β = 12.27, p = 0.03). While higher parent emotional functioning scores were not associated with activation at baseline, they were important at 6 months (baseline, β = -0.002, p = 0.96; interaction, β = 0.14, p = 0.03). At baseline, longer duration of illness was associated with increased activation, but this effect diminished with time (baseline, β = 3.29, p = 0.0002; interaction, β = -2.40, p = 0.02). Activation levels dropped for parents of children who went from private to public insurance (baseline, β = 2.95, p = 0.53; interaction, β = -13.82, p = 0.004). Clinical events did not affect Parent-PAM scores. CONCLUSIONS Our findings reveal important changes in the factors associated with parent activation in the first 6 months after pediatric HSCT. These findings may reflect the emotional and financial toll of pediatric HSCT on parent activation.
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Affiliation(s)
- Brian W Pennarola
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA,
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18
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Wiener L, Baird K, Crum C, Powers K, Carpenter P, Baker KS, MacMillan ML, Nemecek E, Lai JS, Mitchell SA, Jacobsohn DA. Child and parent perspectives of the chronic graft-versus-host disease (cGVHD) symptom experience: a concept elicitation study. Support Care Cancer 2014; 22:295-305. [PMID: 24077685 DOI: 10.1007/s00520-013-1957-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/27/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Chronic graft-versus-host disease (cGVHD) is a significant cause of mortality and morbidity after allogeneic hematopoietic cell transplant and is associated with a wide range of distressing symptoms. A pediatric measure of cGVHD-related symptoms is needed to advance clinical research. Our aim was to elicit descriptions of the cGVHD symptom experience directly from children and to compare the specific language used by children to describe their symptoms and the comprehension of symptom concepts across the developmental spectrum. METHODS We used qualitative methods to identify the phrases, terms, and constructs that children (ages 5–8 [n =8], 9–12 [n =8], and 13–17 [n =8]) with cGVHD employ when describing their symptoms. The symptom experience of each participant was determined through individual interviews with each participant and parent (5–7 year olds were interviewed together with a parent). Medical practitioners with experience in evaluating cGVHD performed clinical assessments of each participant. RESULTS Pediatric transplant survivors and their parents identified a wide range of bothersome cGVHD symptoms, and common concepts and terminologies to describe these experiences emerged. Overall concordance between patient and parent reports was moderate (70–75 %). No consistent pattern of child under- or over-reporting in comparison to the parent report was observed. CONCLUSION These study results identify concepts and vocabulary to inform item generation for a new pediatric self-report measure of cGVHD symptoms for use in clinical research. The findings also confirm the prevalence and nature of symptom distress in pediatric patients with cGVHD and support implementation of systematic approaches to symptom assessment and intervention in routine clinical practice.
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19
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Graham RJ, Rodday AM, Parsons SK. Family-centered assessment and function for children with chronic mechanical respiratory support. J Pediatr Health Care 2014; 28:295-304. [PMID: 23942254 DOI: 10.1016/j.pedhc.2013.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/18/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The purpose of this study was to assess health-related quality of life (HRQL) when managing severe, chronic respiratory insufficiency (CRI) at home. METHODS Families enrolled in a comprehensive program for CRI completed the Child Health Ratings Inventories with (a) parent-proxy ratings of the child's HRQL and (b) the parent's own HRQL. Psychometrics and known groups comparisons were reported. Linear regressions models assessed the effect of the parent's HRQL on proxy ratings. RESULTS Eighty-six parents (67%) completed the measures. The child global HRQL score was low (63.1, SD = 24.9), although ratings of "family life" were higher (73.8, SD = 26.5). The parent global HRQL and emotional functioning (EF) scores were low, despite preserved physical and role function. Having a child with a congenital versus an acquired disability was associated with higher parental EF (p = .004). Higher parental EF correlated with a higher global child HRQL (p < .001). DISCUSSION Families of children with CRI experience reduced HRQL. The Child Health Ratings Inventories is a valid tool for this assessment, identifying emotional distress and potential gaps in support.
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Bagheri Z, Jafari P, Tashakor E, Kouhpayeh A, Riazi H. Assessing whether measurement invariance of the KIDSCREEN-27 across child-parent dyad depends on the child gender: a multiple group confirmatory factor analysis. Glob J Health Sci 2014; 6:142-53. [PMID: 25169000 PMCID: PMC4825500 DOI: 10.5539/gjhs.v6n5p142] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 04/22/2014] [Indexed: 11/25/2022] Open
Abstract
This study aims to assess the measurement invariance (MI) of the KIDSCREEN-27 questionnaire across girl-parent and boy-parent dyad to clarify how child gender affects the agreement between children’s and parents’ perception of the meaning of the items in the questionnaire. The child self-reports and parent proxy-reports of the KIDSCREEN-27 were completed by 1061 child-parent dyad. Multiple group categorical confirmatory factor analysis (MGCCFA) was applied to assess MI. The non-invariant items across girl-parent dyad were mostly detected in the psychological well-being and the social support and peers domains. Moreover, the boys and their parents differed mainly in the autonomy and parent relation domain. Detecting different non-invariant items across the girl-parent dyad compared to the boy-parent dyad underlines the importance of taking the child’s gender into account when assessing measurement invariance between children and their parents and consequently deciding about children’s physical, psychological or social well-being from the parents’ viewpoint.
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Affiliation(s)
| | - Peyman Jafari
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran.
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Morris C, Janssens A, Allard A, Thompson Coon J, Shilling V, Tomlinson R, Williams J, Fellowes A, Rogers M, Allen K, Beresford B, Green C, Jenkinson C, Tennant A, Logan S. Informing the NHS Outcomes Framework: evaluating meaningful health outcomes for children with neurodisability using multiple methods including systematic review, qualitative research, Delphi survey and consensus meeting. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02150] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BackgroundThe identification of suitable outcome measures will improve the evaluation of integrated NHS care for the large number of children affected by neurodisability, and has the potential to encourage the provision of more appropriate and effective health care. This research sought to appraise the potential of patient-reported outcome measures (PROMs) for children and young people with neurodisability.AimThis research aimed (i) to identify key outcomes of health care for children with neurodisability, beyond morbidity and mortality, from the perspectives of children, parents and professionals; (ii) to critically appraise existing generic multidimensional PROMs; and (iii) to examine whether or not the key outcomes might be measured by existing PROMs. We also sought agreement on a definition of neurodisability.MethodsData were gathered in three main ways, (i) a systematic review identified eligible generic multidimensional PROMs and peer-reviewed studies evaluating psychometric performance using English-language questionnaires. Studies were appraised for methodological quality and psychometric performance was appraised using standard criteria. (ii) Focus groups and interviews with children and young people with neurodisability, and separately with parents, sought to identify important outcomes of NHS care, and their feedback on example PROM questionnaires. (iii) An online Delphi survey was conducted with a multidisciplinary sample of health professionals to seek agreement on appropriate NHS outcomes. In addition, we convened a consensus meeting with a small nominal group of young people, parents and professionals; the group sought agreement on a core set of important health outcomes.ResultsFrom the systematic review, we identified 126 papers that reported eligible evidence regarding the psychometric performance of 25 PROMs. Evidence of psychometric robustness was more favourable for a small number of PROMs: KIDSCREEN (generic), DISABKIDS (chronic-generic) and Child Health Utility 9D (preference-based measure). The Pediatric Quality of Life Inventory and KINDL offer both self-report and a proxy report version for a range of age bands, but evidence of their psychometric performance was weaker. Evidence was lacking in one or more respects for all candidate PROMs, in both general populations and those with neurodisability. Proxy reporting was found generally to be poorly correlated with self-report. Focus groups and interviews included 54 children and young people, and 53 parents. The more important health outcomes were felt to be communication, emotional well-being, pain, mobility, independence/self-care, worry/mental health, social activities and sleep. In addition, parents of children with intellectual impairment identified behaviour, toileting and safety as important outcomes. Participants suggested problems with the face validity of example PROM questionnaires for measuring NHS care. In the Delphi survey, 276 clinicians from a wide range of professions contributed to at least one of four rounds. Professionals rated pain, hearing, seeing, sleep, toileting, mobility and communication as key goals for the NHS but also identified treating neurological symptoms as important. Professionals in the Delphi survey and parents working with the research team agreed a proposed definition for neurodisability. The consensus meeting confirmed overlap between the outcomes identified as important by young people, parents and professionals, but not complete agreement.ConclusionsThere was agreement between young people, parents and professionals regarding a core suite of more important health outcomes: communication, emotional well-being, pain, mobility, independence/self-care, worry/mental health, social activities and sleep. In addition, behaviour, toileting and safety were identified as important by parents. This research suggests that it would be appropriate to measure these constructs using PROMs to assess health care. None of the candidate PROMs in the review adequately captures all of the identified constructs, and there is inadequate evidence that candidate PROMs are psychometrically robust for use across children with neurodisability. Further consultation with young people, families and professionals is warranted to support the use of PROMs to measure NHS outcomes. Research to test potential PROMs with different age groups and conditions would be valuable.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Astrid Janssens
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Amanda Allard
- Council for Disabled Children, National Children’s Bureau, London, UK
| | | | - Valerie Shilling
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Richard Tomlinson
- Department of Child Health, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Jane Williams
- Department of Child Health and Paediatrics, Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Fellowes
- Council for Disabled Children, National Children’s Bureau, London, UK
| | - Morwenna Rogers
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Karen Allen
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Colin Green
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Alan Tennant
- Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
| | - Stuart Logan
- University of Exeter Medical School, University of Exeter, Exeter, UK
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Dennett KV, Tracy S, Oliver Taylor L, Zurakowski D, Chen C. Prenatally-counseled congenital diaphragmatic hernia parents exhibit positive well-being before and after surgical repair. J Pediatr Surg 2014; 49:700-5. [PMID: 24851751 DOI: 10.1016/j.jpedsurg.2014.02.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 02/13/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this paper was to examine the effect of prenatal counseling in the Advanced Fetal Care Center (AFCC) on the well-being of parents of infants with congenital diaphragmatic hernia (CDH). METHODS From 2008 through 2012, 26 mothers and fathers of surgically repaired CDH patients who received prenatal counseling at our institution, and 15 who received no prenatal counseling, each completed the Short-Form 36 version 1 (SF-36v1) at the appropriate time points: prenatal, two weeks, and six months post-surgery. RESULTS Parents in both groups did not differ by demographic characteristics. Patients who received prenatal counseling had significantly longer ventilatory time and length of stay (LOS) in the ICU and in the hospital compared to those who did not receive prenatal counseling (all P<.01). Mothers and fathers had similar SF-36v1 mental and physical component summary (MCS, PCS) post-surgery scores when compared by counseling status. Prenatal MCS scores for mothers and fathers (47 vs. 41; P=.24) were similar to those at six months post-surgery (47 vs. 47; P=.90). CONCLUSIONS When hospital LOS was controlled between groups stratified by AFCC counseling status, MCS scores were comparable prenatally and were sustained at six months post-surgery for both parents. These findings may reflect the support services parents received beginning in the prenatal period.
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Affiliation(s)
- Kate V Dennett
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Sarah Tracy
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | | | - David Zurakowski
- Department of Anesthesia, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Catherine Chen
- Department of Surgery, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Parsons SK, Tighiouart H, Terrin N. Assessment of health-related quality of life in pediatric hematopoietic stem cell transplant recipients: progress, challenges and future directions. Expert Rev Pharmacoecon Outcomes Res 2013; 13:217-25. [PMID: 23570432 DOI: 10.1586/erp.13.11] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article provides an overview of health-related quality of life (HRQoL) assessments in pediatric hematopoietic stem cell transplants, focusing on the relationship between child and parent proxy ratings of the child's HRQoL and how measurement of HRQoL may be incorporated into clinical decision-making. Parent and child ratings of the child's health may be affected differently by unequal access to and incongruent understanding of available information, as well as the effect of age difference on interpretation. In particular, parents and children may experience the impact of clinical events on HRQoL very differently. The recent US Federal emphasis on 'patient-centeredness' has helped fuel the development and application of more clinically functional and low-burden HRQoL measures. Future work in pediatric hematopoietic stem cell transplants must seek to capture the experiences and perceptions of all those involved.
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Affiliation(s)
- Susan K Parsons
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
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Joint models for predicting transplant-related mortality from quality of life data. Qual Life Res 2013; 24:31-9. [PMID: 24129669 DOI: 10.1007/s11136-013-0550-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 02/03/2023]
Abstract
PURPOSE To test whether longitudinally measured health-related quality of life (HRQL) predicts transplant-related mortality (TRM) in pediatric hematopoietic stem cell transplant (HSCT). METHODS The predictors of interest were emotional functioning, physical functioning, role functioning, and global HRQL, as rated by the parent about the child up to 6 times over 12 months of follow-up and measured by the Child Health Ratings Inventories. We used joint models, specifically shared parameter models, with time to TRM as the outcome of interest and other causes of mortality as a competing risk, via the JM software package in R. Choosing shared parameter models instead of standard survival models, such as Cox models with time-dependent covariates, enabled us to address measurement error in the HRQL trajectories and appropriately handle missing data. The nonlinear trajectories for each HRQL domain were modeled by random spline functions. The survival submodels were adjusted for baseline patient, family, and transplant characteristics. RESULTS Hazard ratios per one-half standard deviation difference in emotional, physical, and role functioning, and global HRQL were 0.61 (95 % CI 0.46-0.81; p < 0.001), 0.70 (0.51-0.96; p = 0.03), 0.54 (0.34-0.85; p = 0.007), and 0.57 (0.41-0.79; p < 0.001), respectively. CONCLUSIONS HRQL trajectories were predictive of TRM in pediatric HSCT, even after adjusting the survival outcome for baseline characteristics.
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Rodday AM, Terrin N, Parsons SK. Measuring global health-related quality of life in children undergoing hematopoietic stem cell transplant: a longitudinal study. Health Qual Life Outcomes 2013; 11:26. [PMID: 23442200 PMCID: PMC3644228 DOI: 10.1186/1477-7525-11-26] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 02/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric health-related quality of life (HRQL) measures explore multiple domains of HRQL. To ease administration, burden, and implementation, we created a 7-item unidimensional global HRQL scale for children. This paper evaluates the psychometric properties of the global HRQL scale in children undergoing hematopoietic stem cell transplant (HSCT) and describes the trajectory of global HRQL scores over the 12-month course following HSCT. METHODS As part of two longitudinal HSCT studies, HRQL was collected on 312 parent-child dyads using the Child Health Ratings Inventories. Parents of children aged 5-18 completed the pediatric global HRQL scale about their child and 117 adolescents completed the scale themselves. Psychometric properties were compared across both raters. Two repeated measures models were built to describe trajectories of (1) global HRQL for all children based on parent proxy report and (2) global HRQL for adolescents based on adolescent self-report and parent proxy report. RESULTS Internal consistency reliability was high for parent proxy report and adolescent self-report (Cronbach's alpha 0.9, 0.8, respectively). Unidimensionality was verified using principal components analysis. Both models indicated decreased global HRQL in the presence of early complications related to HSCT and Model 1 further indicated decreased HRQL in the presence of later complications. Model 2 showed that parent proxies reported lower global HRQL scores than adolescent self-report. CONCLUSIONS This study has demonstrated the unidimensionality and strong psychometric properties of a 7-item global HRQL scale in a sample of children undergoing HSCT. Despite its brevity, scale scores vary in clinically meaningful ways. Future applications of this scale are encouraged.
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Affiliation(s)
- Angie Mae Rodday
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Graduate Program in Clinical and Translational Science, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Norma Terrin
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Susan K Parsons
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
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Dennett KV, Tracy S, Zurakowski D, Calvert CE, Chen C. Impact on family of management strategies for perforated appendicitis in children. J Pediatr Surg 2012; 47:1900-6. [PMID: 23084204 DOI: 10.1016/j.jpedsurg.2012.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/04/2012] [Accepted: 06/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to examine the impact on the family of immediate appendectomy compared with initial nonoperative management for perforated appendicitis in children. METHODS Sixty-six prospectively identified families of children with perforated appendicitis completed a daily activity journal and the Impact on Family Scale at presentation and at completion of therapy. RESULTS There were no significant differences in postoperative surgical site infections or number of missed school or employment days between the immediate appendectomy group (n = 40) and the initial nonoperative management group (n = 26). Impact on Family Scale total scores decreased over time for both groups, but this improvement over time was significant only in the initial nonoperative management group (P < .01). CONCLUSIONS Immediate appendectomy or initial nonoperative management can effectively manage perforated appendicitis in children with no statistically significant differences in the number of missed school or employment days. Greater improvements in family impact are associated with initial nonoperative management as measured by the Impact on Family Scale at completion of therapy.
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Affiliation(s)
- Kate V Dennett
- Department of Surgery, Children's Hospital Boston, Boston, MA 02115, USA
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Kelly MJ, Pennarola BW, Rodday AM, Parsons SK. Health-related quality of life (HRQL) in children with sickle cell disease and thalassemia following hematopoietic stem cell transplant (HSCT). Pediatr Blood Cancer 2012; 59:725-31. [PMID: 22183952 PMCID: PMC3319491 DOI: 10.1002/pbc.24036] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/14/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND Little is known regarding the health-related quality of life (HRQL) trajectory of children with sickle cell disease or thalassemia ("hemoglobinopathies") following hematopoietic stem cell transplantation (HSCT). PROCEDURES We serially evaluated the HRQL of 13 children with hemoglobinopathies who received HSCT during two prospective multi-center studies using the Child Health Ratings Inventories (CHRIs). The HRQL scores among children with hemoglobinopathies, as reported separately by the children and their parents were compared using repeated measures models to scores of a comparison group of children receiving HSCT for malignancies or severe aplastic anemia. RESULTS The sample included 13 children with hemoglobinopathies (median age: 8 years, range 5-18) and 268 children in the comparison group (median age: 11 years, range 5-18). There were similar rates of early infection, chronic graft versus host disease, and all-cause mortality between the two groups. There was no significant difference in recovery to baseline scores for physical, emotional, and role functioning by 3 months for either group. Children with hemoglobinopathies had higher HRQL scores for physical (beta = 12, se = 5.5, P = 0.01) and baseline emotional functioning (beta = 11.6, se = 5.5, P = 0.03) than the comparison group. For all domains for both groups, parent reports demonstrated a nadir at 45 days with recovery to baseline by 3 months following transplant. Children's ratings were higher than those of their parents in both diagnostic groups. CONCLUSIONS Children with hemoglobinopathies had higher physical and emotional functioning scores prior to HSCT and experienced a similar pattern of recovery to their baseline functioning by 3 months post-HSCT when compared to children receiving HSCT for acquired conditions.
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Affiliation(s)
- Michael J. Kelly
- The Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center,Division of Pediatric Hematology Oncology, The Floating Hospital for Children at Tufts Medical Center,Department of Pediatrics (MJK and SKP) and Medicine (SKP), Tufts University School of Medicine,Correspondence should be addressed to: Michael Kelly, MD, MPH, Tufts Medical Center, Division of Pediatric Hematology Oncology, Box #14, 800 Washington St., Boston, MA 02111, 617-636-8636, 617-636-8351 (fax),
| | - Brian W. Pennarola
- The Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
| | - Angie Mae Rodday
- The Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
| | - Susan K. Parsons
- The Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center,Division of Pediatric Hematology Oncology, The Floating Hospital for Children at Tufts Medical Center,Department of Pediatrics (MJK and SKP) and Medicine (SKP), Tufts University School of Medicine
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Castellino SM, Tooze JA, Flowers L, Hill DF, McMullen KP, Shaw EG, Parsons SK. Toxicity and efficacy of the acetylcholinesterase (AChe) inhibitor donepezil in childhood brain tumor survivors: a pilot study. Pediatr Blood Cancer 2012; 59:540-7. [PMID: 22238217 PMCID: PMC3345166 DOI: 10.1002/pbc.24078] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 12/21/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neurocognitive deficits are a recognized late effect of curative brain tumor therapy. We evaluated the feasibility, tolerance, and impact of a pilot pharmacologic intervention with the acetylcholinesterase (AChe) inhibitor, donepezil, in pediatric brain tumor (BT) survivors at risk for neurocognitive dysfunction. PROCEDURE A single institution open-label pilot study was conducted in childhood BT survivors: ≥1 year from cancer treatment; and who received >23.5 Gy cranial radiation therapy (RT). Toxicity, adherence and neurocognitive outcomes were evaluated at baseline and serially during 24 weeks of donepezil, and following a 12-week washout period off drug. RESULTS From a pool of subjects, 13 were successfully contacted and screened, and 11 met all eligibility criteria to initiate donepezil at a median of 4.7 (1.9-11.9) years from RT. Seventy-two percent of patients completed the 24-week drug study visit. Despite transient gastrointestinal toxicity (vomiting and diarrhea) in 30% of patients there was no weight loss on donepezil. Significant improvement in performance was noted at 24 weeks on the Dellis-Kaplan Executive Function (D-KEF) Tower test (P < 0.001), the Wide Range Assessment of Memory and Learning, 2nd Edition (WRAML-2) Visual memory (P = 0.007), and the Number/Letter task (P = 0.018). CONCLUSIONS Donepezil was well tolerated among childhood BT survivors who had received substantial prior therapy. Based on improved executive function and memory performance in this pilot trial, a randomized placebo controlled trial of this pharmacologic agent is warranted to fully evaluate its efficacy in remediating neurocognitive dysfunction.
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Affiliation(s)
| | - Janet A. Tooze
- Wake Forest University Health Sciences, Department of Public Health Sciences
| | - Lynn Flowers
- Wake Forest University Health Sciences, Department of Neurology
| | - Debbie F. Hill
- Wake Forest University Health Sciences, Department of Public Health Sciences
| | - Kevin P. McMullen
- Wake Forest University Health Sciences, Department of Radiation Oncology
| | - Edward G. Shaw
- Wake Forest University Health Sciences, Department of Radiation Oncology
| | - Susan K. Parsons
- Tufts University School of Medicine, Boston, MA,Tufts Medical Center, Boston, MA
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Parental emotional functioning declines with occurrence of clinical complications in pediatric hematopoietic stem cell transplant. Support Care Cancer 2012; 21:687-95. [PMID: 22936494 DOI: 10.1007/s00520-012-1566-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 08/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Parents' stress levels are high prior to their child's hematopoietic stem cell transplant (HSCT) and during transplant hospitalization, usually abating after discharge. Nevertheless, a subgroup of parents continues to experience frequent anxiety and mood disruption, the causes of which are not well understood. The purpose of this study was to assess whether clinical complications of HSCT could explain variation in parents' recovery of emotional functioning. METHODS Pediatric HSCT recipients (n = 165) aged 5-18 and their parents were followed over the first year post-transplant. Health-related quality of life assessments and medical chart reviews were performed at each time period (baseline, 45 days, 3, 6, and 12 months). We tested the association between clinical complications [acute and chronic graft versus host disease (aGVHD and cGVHD), organ toxicity, and infection] and longitudinally measured parental emotional functioning, as assessed by the Child Health-Ratings Inventories. The models used maximum likelihood estimation with repeated measures. RESULTS In adjusted analyses covering the early time period (45 days and 3 months), aGVHD grade ≥2, intermediate or poor organ toxicity, and systemic infection were associated with decreases in mean parental emotional functioning of 5.2 (p = 0.086), 5.8 (p = 0.052), and 5.1 (p = 0.023) points, respectively. In the later time period (6 and 12 months), systemic infection was associated with a decrease of 20 points (p < 0.0001). cGVHD was not significantly associated. CONCLUSIONS When children experience clinical complications after HSCT, parental emotional functioning can be impacted. Intervening at critical junctures could mitigate potential negative consequences for parents and their children.
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Performance of the parent emotional functioning (PREMO) screener in parents of children undergoing hematopoietic stem cell transplantation. Qual Life Res 2012; 22:1427-33. [PMID: 22836377 DOI: 10.1007/s11136-012-0240-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Parents of children undergoing hematopoietic stem cell transplantation (HSCT) may face emotional distress while managing intense treatments with uncertain outcomes. We evaluated a brief parental emotional functioning (PREMO) screener from a health-related quality of life instrument to identify parental emotional distress, as measured by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). METHODS As part of a longitudinal pediatric HSCT study, parents (N = 165) completed the Child Health Ratings Inventories, which contain the 7-item PREMO screener. Some parents (n = 117) also completed SCID modules for Anxiety, Mood, and Adjustment disorders at baseline and/or 12 months. A composite outcome was created for threshold or subthreshold levels of any of these disorders. Receiver operating characteristic (ROC) analysis assessed how the PREMO screener predicted emotional distress as measured by the SCID. A prediction model was then built. RESULTS Fifty-two percent of parents completing the SCID had an Axis I disorder at baseline, while 41 % had an Axis I disorder at 12 months. The area under the ROC curve was 0.75 for the PREMO screener and 0.81 for the prediction model. CONCLUSIONS The PREMO screener may identify parents with, or at risk for, emotional distress and facilitate further evaluation and intervention.
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Dennett KV, Tracy S, Fisher S, Charron G, Zurakowski D, Calvert CE, Chen C. Treatment of perforated appendicitis in children: what is the cost? J Pediatr Surg 2012; 47:1177-84. [PMID: 22703790 DOI: 10.1016/j.jpedsurg.2012.03.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 03/06/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE We compared direct hospital costs and indirect costs to the family associated with immediate appendectomy or initial nonoperative management for perforated appendicitis in children. METHODS From June 2009 through May 2010, 61 prospectively identified families completed a cost diary, documenting the numbers of missed school days for the child and missed employment days for the adult caregiver(s) over the treatment course. Hospital costs were obtained from hospital financial databases. Mann-Whitney U tests and Fisher exact tests were used to compare outcome measures for each treatment strategy. RESULTS Patients treated by initial nonoperative management had a significantly longer median length of stay (9 days vs 7 days, P = .02) and a significantly greater median total hospital cost per patient ($31,349 vs $21,323, P = .01) when compared with those treated by immediate appendectomy. There was no significant difference in median number of missed school days (9 days vs 10 days, P = .23) or missed employment days for adult caregiver(s) (5 days vs 7 days, P = .18) between treatment strategies. CONCLUSIONS Patients with perforated appendicitis treated by initial nonoperative management had a greater length of stay and a significantly greater total hospital cost but were not burdened by significantly greater indirect costs compared with those treated by immediate appendectomy.
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Affiliation(s)
- Kate V Dennett
- Department of Surgery, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
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Rodday AM, Pedowitz EJ, Mayer DK, Ratichek SJ, Given CW, Parsons SK. Parental caregiving of children prior to hematopoietic stem cell transplant. Res Nurs Health 2012; 35:328-39. [PMID: 22549793 DOI: 10.1002/nur.21485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2012] [Indexed: 11/11/2022]
Abstract
Using the Caregiver Reaction Assessment (CRA), we assessed positive reactions and burdens of the caregiving experience among parental caregivers (n = 189) of children scheduled to undergo hematopoietic stem cell transplant. Although widely used in non-parental caregivers, the CRA has not been used in parents of pediatric patients. Reliability (Cronbach's alpha: .72-.81 vs. .63) and concurrent validity (correlation: .41-.61 vs. .28) were higher for negatively framed than positively framed subscales. Results indicate that the caregiving experience is complex. The parents experienced high caregiver's esteem and moderate family support, but also negative impacts on finances and schedule, and to a lesser degree, health. Compared to non-parental caregivers, parental caregivers experienced higher esteem and more impact on finances and schedule.
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Bingen K, Kent MW, Rodday AM, Ratichek SJ, Kupst MJ, Parsons SK. Children's Coping With Hematopoietic Stem Cell Transplant Stressors: Results From the Journeys to Recovery Study. CHILDRENS HEALTH CARE 2012. [DOI: 10.1080/02739615.2012.656551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pennarola BW, Rodday AM, Mayer DK, Ratichek SJ, Davies SM, Syrjala KL, Patel S, Bingen K, Kupst MJ, Schwartz L, Guinan EC, Hibbard JH, Parsons SK. Factors associated with parental activation in pediatric hematopoietic stem cell transplant. Med Care Res Rev 2011; 69:194-214. [PMID: 22203645 DOI: 10.1177/1077558711431460] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient activation, the extension of self-efficacy into self-management, is an essential component of effective chronic care. In pediatric populations, caregiver activation is also needed for proper disease management. This study investigates the relationships between parental activation and other characteristics of parent-child dyads (N = 198) presenting for pediatric hematopoietic stem cell transplant. Parental activation concerning their child's health was assessed using the Parent Patient Activation Measure (Parent-PAM), a modified version of the well-validated Patient Activation Measure (PAM). Using hierarchical linear regression and following the Belsky process model for determining parenting behaviors, a multivariate model was created for parental activation on behalf of their child that showed that the parent's age, rating of their own general health, self-activation, and duration of the child's illness were significantly related to Parent-PAM score. Our findings characterize a potentially distinct form of activation in a parent-child cohort preparing for a demanding clinical course.
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Parsons SK, Phipps S, Sung L, Baker KS, Pulsipher MA, Ness KK. NCI, NHLBI/PBMTC First International Conference on Late Effects after Pediatric Hematopoietic Cell Transplantation: health-related quality of life, functional, and neurocognitive outcomes. Biol Blood Marrow Transplant 2011; 18:162-71. [PMID: 22155139 DOI: 10.1016/j.bbmt.2011.12.501] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/05/2011] [Indexed: 01/24/2023]
Abstract
The purpose of this manuscript is to summarize issues relevant to health-related quality of life (HRQL), physical function, and neurocognitive function for survivors of pediatric hematopoietic stem cell transplantation (HCT). The physiologic and psychological demands of HCT and its sequelae have the potential to substantially alter HRQL. When compared with research on adult HCT recipients, research in pediatric HRQL following HCT has lagged considerably. Initially, this lag was because of limited validated questionnaires, small numbers of affected patients, and a general lack of salience for the topic relative to traditional endpoints, such as transplant-related toxicity and potential mortality. The percentage of childhood HCT survivors with physical disability ranges from 7% to 17% in studies where the outcome was based on clinician or self-report measures, to over 40% in studies where the outcome was based on a directly measured physical performance task. Direct and comprehensive measures of physical performance may help further clarify the proportion of individuals who have subclinical problems amenable to intervention before apparent functional loss becomes a problem. There is a need to include longer term survivors in such an assessment. In terms of neurocognitive function, the majority of reports demonstrate relatively good function in survivors. However, it is clear that little or no data on outcomes beyond 5 years posttransplant have been obtained, and clinicians working with this population remain concerned regarding the cognitive functions of these survivors. Research focused on these domains should attempt to better understand the prevalence of the problem using child self-report and direct measurements of function, standardize measurement methods, and tools across trials, obtain longer term evaluations and begin to consider interventional trials.
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Affiliation(s)
- Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
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Taylor RM, Wray J, Gibson F. Measuring quality of life in children and young people after transplantation: methodological considerations. Pediatr Transplant 2010; 14:445-58. [PMID: 20345615 DOI: 10.1111/j.1399-3046.2010.01316.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The measurement of QoL has become an important area for research in paediatric transplantation over the past 15 yr. While much of this work remains descriptive and exploratory, advances in treatment and the trend towards outcomes being patient centred and not just survival based suggest the measurement of QoL will be of far more importance and relevance in the future. In this discussion article, we will outline some of the issues that need to be considered when embarking on a QoL study. The aim of our account is not to be prescriptive, rather to present researchers and clinicians with questions and possible solutions to help increase the scientific robustness of future studies. We have included summary tables of instruments that are currently available as a resource for those wanting to evaluate QoL in paediatric transplantation.
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Affiliation(s)
- Rachel M Taylor
- Department of Children's Nursing, Faculty of Health and Social Care, London South Bank University, and Great Ormond STreet Hospital for Children NHS Trust, London, UK.
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Klassen AF, Strohm SJ, Maurice-Stam H, Grootenhuis MA. Quality of life questionnaires for children with cancer and childhood cancer survivors: a review of the development of available measures. Support Care Cancer 2009; 18:1207-17. [DOI: 10.1007/s00520-009-0751-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
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Longitudinal health-related quality of life outcomes and related factors after pediatric SCT. Bone Marrow Transplant 2009; 44:249-56. [PMID: 19234504 DOI: 10.1038/bmt.2009.24] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Our purpose was to investigate longitudinally health-related quality of life (HRQOL) outcomes and related factors up to 2 years post-pediatric SCT. A total of 99 mothers of patients, aged 1.5-17 years, completed two standardized HRQOL questionnaires, generic and disease specific (DS), about the child, and reported on their own symptoms of depression and family function pre-SCT, 12 and 24 months post-SCT. Clinical (diagnosis, radiation), child (age) and family (maternal depression) information was also obtained. Significant improvement in physical and psychosocial HRQOL from pre-SCT to 1 or 2 years post-SCT was reported. Survivors of ALL were reported to have poorer physical and psychosocial HRQOL than survivors of solid tumors on the DS measure. Maternal depression was negatively associated with physical and psychosocial HRQOL. Maternal education (higher) at pre-SCT predicted improvements in physical domains 2 years post-SCT; mother's age (older) and child's age (younger) also predicted improvements of physical and emotional HRQOL. We conclude that survivors of pediatric SCT improved physical and psychosocial HRQOL by 1 and 2 years post-SCT. Older survivors whose mothers are younger and distressed, with lower education at SCT have compromised HRQOL compared to other survivors. This study has important implications for the care of SCT survivors and their families.
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Health-related quality of life in survivors of BMT for paediatric malignancy: a systematic review of the literature. Bone Marrow Transplant 2008; 42:73-82. [DOI: 10.1038/bmt.2008.156] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND/PURPOSE We hypothesized that long-term impact on the family of survivors of congenital diaphragmatic hernia (CDH) would vary based on the child's current clinical problems and clinical severity, family income, insurance, and out-of-pocket expenses. METHODS Parents of a retrospective cohort of 53 CDH survivors who underwent repair at Children's Hospital Boston in Massachusetts from 1991 through 1999 completed the Impact on Family Scale (IFS), the Child Health Ratings Inventories General Health Module Parent Report, a rating of their child's clinical severity, an inventory of current clinical problems, and family demographics. Statistical tests of the primary outcome, the IFS total score, were performed. RESULTS Survivors of CDH had a median age of 8 years. Most families had private insurance (78%) and annual income levels higher than the federal poverty level (96%). The IFS total score was correlated with child's clinical severity (r = 0.71, P < .001) and was worse among families of children with current clinical problems (P = .01), families with public insurance (P = .01), and those with out-of-pocket expenses of at least $500 (P = .002). Regression analysis identified the independent effect of clinical severity on family impact (P < .001). CONCLUSION Family impact is profound and long-standing at a median of 8 years after surgery for a subset of CDH survivors with more severe conditions and current clinical problems.
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O'Leary TE, Diller L, Recklitis CJ. The effects of response bias on self-reported quality of life among childhood cancer survivors. Qual Life Res 2007; 16:1211-20. [PMID: 17624814 DOI: 10.1007/s11136-007-9231-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 05/23/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies of long-term adjustment in childhood cancer survivors (CCS) report very positive outcomes, while other studies find significant adjustment problems. These inconsistencies have prompted some investigators to suggest survivors may be biased responders, prone to underreporting on self-report measures. This study tested the hypothesis that CCS are elevated on self-deception response bias (SDRB), and that SDRB is associated with higher ratings of quality-of-life (QOL). METHODS One hundred and seven adult (mean age = 31.85) survivors of childhood cancers completed a demographic questionnaire, Short Form-12 (SF-12), Functional Assessment of Cancer Therapy-General (FACT-G), and Self-Deception Enhancement scale (SDE), an SDRB measure. RESULTS Survivors' QOL scores were similar to normative groups, but they evidenced much higher levels of response bias. SDE scores were significantly correlated with the FACT-G, and SF-12 Mental Health (but not Physical Health) scores even after accounting for demographic and treatment-related variables. CONCLUSIONS CCS show a biased response style, indicating a systematic tendency to deny difficulties on QOL measures. This may complicate QOL studies by inflating survivors' reports of their socio-emotional functioning. Understanding how response bias develops may help us learn more about cancer survivors' adaptation to illness, and the effects of the illness experience on their perceptions of QOL.
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Chen C, Jeruss S, Chapman JS, Terrin N, Tighiouart H, Glassman E, Wilson JM, Parsons SK. Long-term functional impact of congenital diaphragmatic hernia repair on children. J Pediatr Surg 2007; 42:657-65. [PMID: 17448762 DOI: 10.1016/j.jpedsurg.2006.12.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND/PURPOSE Congenital diaphragmatic hernia (CDH) is a malformation requiring neonatal surgical repair with in-hospital survival rates above 90%. We examined the long-term functional impact of CDH repair on a cross-sectional cohort of survivors. METHODS A cohort of 53 CDH families participated in this study. Functional impact was evaluated with parent report of the Functional Status IIR and the Child Health Ratings Inventories General Health Module. Parents also provided a clinical severity score, the child's medical history, and family demographic information. The primary outcome was the effect of medical morbidity on the Functional Status IIR total score. RESULTS Congenital diaphragmatic hernia survivors had a median age of 8 years; 50% were in third grade or above. Sixty-six percent had major medical issues at hospital discharge, whereas 48% had current clinical problems. Functional Status IIR total score was strongly correlated with child's clinical severity (r = -0.65; P < .0001) and was lower among children with ongoing medical morbidity, denoting worse functioning (P = .01). Child Health Ratings Inventories General Health Module scores followed a similar pattern. CONCLUSIONS A subset of long-term CDH survivors continues to have ongoing clinical problems a median of 8 years after surgery, translating to lower functional status. Affected children and their families may benefit from prospective identification and ongoing interventions.
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Affiliation(s)
- Catherine Chen
- Department of Surgery, Children's Hospital, Boston, MA 02115, USA.
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Cremeens J, Eiser C, Blades M. Factors influencing agreement between child self-report and parent proxy-reports on the Pediatric Quality of Life Inventory 4.0 (PedsQL) generic core scales. Health Qual Life Outcomes 2006; 4:58. [PMID: 16942613 PMCID: PMC1564004 DOI: 10.1186/1477-7525-4-58] [Citation(s) in RCA: 280] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 08/30/2006] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND In situations where children are unable or unwilling to respond for themselves, measurement of quality of life (QOL) is often obtained by parent proxy-report. However the relationship between child self and parent proxy-reports has been shown to be poor in some circumstances. Additionally the most appropriate statistical method for comparing ratings between child and parent proxy-reports has not been clearly established. The objectives of this study were to assess the: 1) agreement between child and parent proxy-reports on an established child QOL measure (the PedsQL) using two different statistical methods; 2) effect of chronological age and domain type on agreement between children's and parents' reports on the PedsQL; 3) relationship between parents' own well-being and their ratings of their child's QOL. METHODS One hundred and forty-nine healthy children (5.5 - 6.5, 6.5 - 7.5, and 7.5 - 8.5 years) completed the PedsQL. One hundred and three of their parents completed these measures in relation to their child, and a measure of their own QOL (SF-36). RESULTS Consistency between child and parent proxy-reports on the PedsQL was low, with Intra-Class correlation coefficients ranging from 0.02 to 0.23. Correlations were higher for the oldest age group for Total Score and Psychosocial Health domains, and for the Physical Health domain in the youngest age group. Statistically significant median differences were found between child and parent-reports on all subscales of the PedsQL. The largest median differences were found for the two older age groups. Statistically significant correlations were found between parents' own QOL and their proxy-reports of child QOL across the total sample and within the middle age group. CONCLUSION Intra-Class correlation coefficients and median difference testing can provide different information on the relationship between parent proxy-reports and child self-reports. Our findings suggest that differences in the levels of parent-child agreement previously reported may be an artefact of the statistical method used. In addition, levels of agreement can be affected by child age, domains investigated, and parents' own QOL. Further studies are needed to establish the optimal predictors of levels of parent-child agreement.
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Affiliation(s)
- Joanne Cremeens
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Mark Blades
- Department of Psychology, University of Sheffield, UK
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Pavletic SZ, Martin P, Lee SJ, Mitchell S, Jacobsohn D, Cowen EW, Turner ML, Akpek G, Gilman A, McDonald G, Schubert M, Berger A, Bross P, Chien JW, Couriel D, Dunn JP, Fall-Dickson J, Farrell A, Flowers MED, Greinix H, Hirschfeld S, Gerber L, Kim S, Knobler R, Lachenbruch PA, Miller FW, Mittleman B, Papadopoulos E, Parsons SK, Przepiorka D, Robinson M, Ward M, Reeve B, Rider LG, Shulman H, Schultz KR, Weisdorf D, Vogelsang GB. Measuring therapeutic response in chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. Response Criteria Working Group report. Biol Blood Marrow Transplant 2006; 12:252-66. [PMID: 16503494 DOI: 10.1016/j.bbmt.2006.01.008] [Citation(s) in RCA: 321] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 01/18/2006] [Indexed: 02/08/2023]
Abstract
The lack of standardized criteria for quantitative measurement of therapeutic response in clinical trials poses a major obstacle for the development of new agents in chronic graft-versus-host disease (GVHD). This consensus document was developed to address several objectives for response criteria to be used in chronic GVHD-related clinical trials. The proposed measures should be practical for use both by transplantation and nontransplantation medical providers, adaptable for use in adults and in children, and focused on the most important chronic GVHD manifestations. The measures should also give preference to quantitative, rather than semiquantitative, measures; capture information regarding signs, symptoms, and function separately from each other; and use validated scales whenever possible to demonstrate improved patient outcomes and meet requirements for regulatory approval of novel agents. Based on these criteria, we propose a set of measures to be considered for use in clinical trials, and forms for data collection are provided (). Measures should be made at 3-month intervals and whenever major changes are made in treatment. Provisional definitions of complete response, partial response, and progression are proposed for each organ and for overall outcomes. The proposed response criteria are based on current expert consensus opinion and are intended to improve consistency in the conduct and reporting of chronic GVHD trials, but their use remains to be demonstrated in practice.
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Affiliation(s)
- Steven Z Pavletic
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1203, USA.
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Cremeens J, Eiser C, Blades M. Characteristics of Health-related Self-report Measures for Children Aged Three to Eight Years: A Review of the Literature. Qual Life Res 2006; 15:739-54. [PMID: 16688506 DOI: 10.1007/s11136-005-4184-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2005] [Indexed: 11/30/2022]
Abstract
AIMS To review and make recommendations about the format and quality of health-related self-report measures for children aged 3-8 years. METHODS Literature searches used to identify measures of QOL, self-esteem, self-concept and mental health. The format (i.e., scale type, presentation style) and quality (i.e., item generation, reliability, validity, responsiveness) of measures were compared and evaluated. RESULTS Fifty three measures were identified: QOL (n = 25, 47%), self-esteem/concept (n = 15, 28%), mental health (n = 13, 25%). Likert scales were used most frequently to represent response choices (n = 34, 64%). The authors of 11 (21%) measures provided justification for their scale choice. Items were most commonly presented in written format (n = 24, 45%). Item content was generated from the respondent population in only 21 (40%) measures. Twenty-seven (51%) measures reported internal reliability between 0.70 and 0.90, and 12 (23%) reported reproducibility in this range. Although validity was reported for 48 (91%) measures, evidence for three or more aspects occurred for only 9 (17%). Eleven (21%) measures evidenced responsiveness to change. CONCLUSION Authors should provide clearer evidence for reliability and responsiveness. Newly developed instruments need to meet established standards, and further studies should assess the impact of scale and presentation types on the psychometrics of measures.
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Affiliation(s)
- Joanne Cremeens
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
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Parsons SK, Shih MC, Duhamel KN, Ostroff J, Mayer DK, Austin J, Martini DR, Williams SE, Mee L, Sexson S, Kaplan SH, Redd WH, Manne S. Maternal Perspectives on Children’s Health-Related Quality of Life During the First Year After Pediatric Hematopoietic Stem Cell Transplant. J Pediatr Psychol 2005; 31:1100-15. [PMID: 16150874 DOI: 10.1093/jpepsy/jsj078] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess the longitudinal health-related quality of life (HRQL) of children receiving hematopoietic stem cell transplantation (HSCT). METHODS Mothers (N = 160) of HSCT recipients aged 5-20 at six US transplant centers completed the Child Health Ratings Inventories (CHRIs), the Disease Impairment Inventory (DSII)-HSCT module, and the Short Form (SF)-36 at baseline, 3, 6, and 12 months. RESULTS HRQL domain scores at baseline varied by recipient age and program site. Longitudinal data over the first year post-HSCT revealed lowest functioning at baseline and 3 months, with largest improvement in functioning between the 3 and 6-months assessments and continued improvement from 6 to 12 months. Recipients of unrelated donor transplants had steepest declines in functioning at 3 months and great HSCT-specific issues at 3 and 6 months. Among children who survived the first year, functioning at 12 months was similar across transplant types and surpassed baseline scores. Children who did not survive the first year exhibited deterioration in HRQL in the months before death and trajectories were strikingly different than for survivors. CONCLUSIONS This study offers the first glimpse of the 12-month trajectory of HRQL following pediatric HSCT from mothers' perspectives. This study also highlights the importance of and approaches to addressing missing data in longitudinal research.
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Affiliation(s)
- Susan K Parsons
- Center on Child and Family Outcomes, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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