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Kamat S, Kondapalli S, Syed S, Price G, Danias G, Gorbenko K, Cantor J, Valera P, Shah AK, Akiyama MJ. Access to Hepatitis C Treatment during and after Incarceration in New Jersey, United States: A Qualitative Study. Life (Basel) 2023; 13:life13041033. [PMID: 37109562 PMCID: PMC10146294 DOI: 10.3390/life13041033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Despite effective antiviral therapy for hepatitis C virus (HCV), people who are incarcerated and those returning to the community face challenges in obtaining HCV treatment. We aimed to explore facilitators and barriers to HCV treatment during and after incarceration. From July-November 2020 and June-July 2021, we conducted 27 semi-structured interviews with residents who were formerly incarcerated in jail or prison. The interviews were audio-recorded and professionally transcribed. We used descriptive statistics to characterize the study sample and analyzed qualitative data thematically using an iterative process. Participants included five women and 22 men who self-identified as White (n = 14), Latinx (n = 8), and Black (n = 5). During incarceration, a key facilitator was having sufficient time to complete HCV treatment, and the corresponding barrier was delaying treatment initiation. After incarceration, a key facilitator was connecting with reentry programs (e.g., halfway house or rehabilitation program) that coordinated the treatment logistics and provided support with culturally sensitive staff. Barriers included a lack of insurance coverage and higher-ranking priorities (e.g., managing more immediate reentry challenges such as other comorbidities, employment, housing, and legal issues), low perceived risk of harm related to HCV, and active substance use. Incarceration and reentry pose distinct facilitators and challenges to accessing HCV treatment. These findings signal the need for interventions to improve engagement in HCV care both during and after incarceration to assist in closing the gap of untreated people living with HCV.
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Affiliation(s)
- Samir Kamat
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Shumayl Syed
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gabrielle Price
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - George Danias
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ksenia Gorbenko
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Institute for Healthcare Delivery Science, Mount Sinai Health System, New York, NY 10016, USA
| | - Joel Cantor
- Center for State Health Policy, Rutgers University, New Brunswick, NJ 08901, USA
| | - Pamela Valera
- Department of Urban-Global Public Health, Rutgers University School of Public Health, Newark, NJ 07102, USA
- Community Health Justice Lab, Newark, NJ 07107, USA
| | - Aakash K Shah
- Department of Emergency Medicine, Department of Psychiatry and Behavioral Health, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Matthew J Akiyama
- Department of Medicine, Divisions of General Internal Medicine and Infectious Disease, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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2
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Donaldson SR, Radley A, Dillon JF. Future destinations and social inclusion scoping review: how people cured of hepatitis C (HCV) using direct- acting antiviral drugs progress in a new HCV-free world. Subst Abuse Treat Prev Policy 2022; 17:45. [PMID: 35676732 PMCID: PMC9178822 DOI: 10.1186/s13011-022-00475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There has been a paradigm shift in the treatment of Hepatitis C (HCV) from the interferon-era to direct-acting antiviral (DAA) drugs. Cure of HCV for the key risk group, those with a history of injecting drug use, may provide a range of benefits to an individual's quality of life that can be additional to that of a clinical cure. The interferon-era provided evidence that cure of HCV can be a turning point for those who use drugs, supporting a recovery journey. There remains a question if DAAs can provide the same opportunity. METHODS We employed a scoping review methodology to consider the additional non-clinical benefits that HCV cure may provide. We used the theoretical construct of recovery capital to consider how these benefits may support a recovery journey in the DAA-era. RESULTS Our search provided 2095 articles, from which 35 were included in the analysis. We developed a thematic synthesis of the non-clinical outcomes identified based on the four over-arching themes of recovery capital: physical, cultural, social and human capital. Our review suggests that identity change is a constituent part of each of the recovery capital domains in relation to HCV treatment. CONCLUSION We identified Social Identity Model Of Recovery (SIMOR) as a mechanism through which DAAs may provide non-clinical outcomes to increase recovery capital domains. Further research is required to develop an understanding of the impact a cure of HCV with DAAs may have on identity, overall health and wellbeing and social inclusion to support recovery journeys.
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Affiliation(s)
- Sarah R Donaldson
- School of Medicine, University of Dundee, Dundee, DD1 9SY, UK.
- NHS Tayside, Dundee, DD1 9SY, UK.
| | - Andrew Radley
- School of Medicine, University of Dundee, Dundee, DD1 9SY, UK
- NHS Tayside, Dundee, DD1 9SY, UK
| | - John F Dillon
- School of Medicine, University of Dundee, Dundee, DD1 9SY, UK
- NHS Tayside, Dundee, DD1 9SY, UK
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3
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Gray-Renfrew A, Kimbell B, Finucane A. Emotional experience of people with advanced liver disease: Secondary data analysis. Chronic Illn 2020; 16:284-295. [PMID: 30286621 DOI: 10.1177/1742395318803668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Patients with advanced liver disease live mainly in the community with treatment of complications provided for in-hospital. The illness trajectory of advanced liver disease is uncertain and most do not have access to end of life care. Gaps in knowledge and understanding of the patient experience of this condition have been identified. METHODS Secondary analysis of 15 transcripts from in-depth interviews with people with advanced liver disease collected as part of a previous longitudinal study on the experience of liver disease. Transcripts were thematically analysed for emotional content. RESULTS Fear, anger, sadness and guilt clearly featured in the person's experience of advanced liver disease. Certain causal factors were identified as provoking these emotional responses, including shock of diagnosis, uncertainty concerning illness, lack of coordinated care, worrying symptoms and sudden death. Humour emerged as a coping mechanism. CONCLUSION People living with advanced liver disease experience distressing emotions. It is helpful for clinicians, nurses and other healthcare support staff to have an appreciation of the person's emotional concerns in order to provide holistic care typical of a palliative approach.
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Affiliation(s)
| | - Barbara Kimbell
- Primary Palliative Care Research Group, Centre for Population Health Sciences, University of Edinburgh, Scotland, UK
| | - Anne Finucane
- Marie Curie Hospice Edinburgh, Usher Institute, University of Edinburgh, Scotland, UK
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4
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Serumondo J, Penkunas MJ, Niyikora J, Ngwije A, Kiromera A, Musabeyezu E, Umutesi J, Umuraza S, Musengimana G, Nsanzimana S. Patient and healthcare provider experiences of hepatitis C treatment with direct-acting antivirals in Rwanda: a qualitative exploration of barriers and facilitators. BMC Public Health 2020; 20:946. [PMID: 32546216 PMCID: PMC7298738 DOI: 10.1186/s12889-020-09000-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Direct-acting antivirals (DAAs) are increasingly accessible to patients with hepatitis C (HCV) worldwide and are being introduced through national health systems in sub-Saharan Africa. DAAs are highly efficacious when tested in controlled trials, yet patients treated outside of study settings often encounter challenges in completing the full treatment and follow-up sequence. Little information is available on the influences of successful DAA implementation in sub-Saharan Africa. This qualitative study explored the individual- and system-level barriers and enablers of DAA treatment in Rwanda between March 2015 and November 2017. METHODS Face-to-face interviews were conducted with 39 patients who initiated care at one of four referral hospitals initially offering DAAs. Ten healthcare providers who managed HCV treatment participated in face-to-face interviews to examine system-level barriers and facilitators. Interview data were analyzed using a general inductive approach in alignment with the a priori objective of identifying barriers and facilitators of HCV care. RESULTS Barriers to successful treatment included patients' lack of knowledge surrounding HCV and its treatment; financial burdens associated with paying for medication, laboratory testing, and transportation; the cumbersome nature of the care pathway; the relative inaccessibility of diagnostics technology; and heavy workloads of healthcare providers accompanied by a need for additional HCV-specific training. Patients and healthcare providers were highly aligned on individual- and system-level barriers to care. The positive patient-provider relationship, strong support from community and family members, lack of stigma, and mild side effect profile of DAAs all positively influenced patients' engagement in treatment. CONCLUSIONS Several interrelated factors acted as barriers and facilitators to DAA treatment in Rwanda. Patients' and healthcare providers' perceptions were in agreement, suggesting that the impeding and enabling factors were well understood by both groups. These results can be used to enact evidence-informed interventions to help maximize the impact of DAAs as Rwanda moves towards HCV elimination.
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Affiliation(s)
| | | | | | - Alida Ngwije
- Clinton Health Access Initiative (CHAI), Kigali, Rwanda
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5
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Rashidi A, Higgs P, Carruthers S. Aboriginal people with chronic HCV: The role of community health nurses for improving health-related quality of life. Collegian 2020. [DOI: 10.1016/j.colegn.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Garvey CM, Jones R. The role of stigma and trauma in hepatitis C virus treatment in veterans: Applying the common-sense model. Public Health Nurs 2019; 36:829-835. [PMID: 31583773 DOI: 10.1111/phn.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/19/2019] [Accepted: 08/28/2019] [Indexed: 01/16/2023]
Abstract
Hepatitis C Virus (HCV), a blood borne pathogen capable of causing severe liver disease, disproportionately affects veterans in the United States. While there are antiviral medications to treat HCV, stigma and trauma in this population may lead to avoidance of care. Those veterans who do undergo treatment have certain illness representations about HCV and its treatment. They undergo treatment even while facing stigma and trauma. The Common-Sense Model may be useful in elucidating how such representations, when matched to an appropriate illness prototype, may inform an action plan of how to respond to HCV. An exploration of the illness representations among veterans with HCV, and the effects of stigma and trauma on these representations, may help to explain how they exercise the choice to undergo treatment and may inform interventions to encourage treatment in veterans who have yet to do so.
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Affiliation(s)
- Casey M Garvey
- School of Nursing, Northeastern University, Boston, Massachusetts
| | - Rachel Jones
- School of Nursing, Northeastern University, Boston, Massachusetts
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7
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Goutzamanis S, Doyle J, Higgs P, Hellard M. Improving hepatitis C direct-acting antiviral access and uptake: A role for patient-reported outcomes and lived experience. J Viral Hepat 2019; 26:218-223. [PMID: 30315689 DOI: 10.1111/jvh.13020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 12/12/2022]
Abstract
Hepatitis C virus contributes to substantial and growing mortality and morbidity. Fortunately, the advent of highly effective interferon-free direct-acting antiviral (DAA) medications and new diagnostic tests has the potential to dramatically alter the epidemiologic trajectory of hepatitis C, particularly for "hard-to-reach" populations. Treatment advances and cure will also likely alter the individual experience of living with hepatitis C. However, it is not yet known in what capacity. This paper provides an overview of the population-level impact of DAA treatment, highlighting the need to further our understanding of the impact of treatment on behaviour, health and wellbeing through lived experience and more sensitive patient-reported outcome measures.
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Affiliation(s)
- Stelliana Goutzamanis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joseph Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
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8
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Valizadeh L, Zamanzadeh V, Zabihi A, Negarandeh R, Jafarian Amiri SR. Qualitative study on the experiences of hepatitis B carriers in coping with the disease. Jpn J Nurs Sci 2018; 16:194-201. [PMID: 30088344 DOI: 10.1111/jjns.12229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 11/23/2017] [Accepted: 05/29/2018] [Indexed: 12/28/2022]
Abstract
AIM Hepatitis is a systemic infection that causes restrictions in the life of many patients due to its chronic nature and it necessitates the use of coping strategies to improve the quality of life. This study aims to demonstrate the experiences of hepatitis B carriers in coping with the disease. METHODS The present study was conducted by using a qualitative content analysis. The data were collected through 18 unstructured and in-depth interviews from 2014 to 2016 at medical centers, a gastrointestinal and liver diseases research center in the cities of Babol and Amol (northern Iran) and Tabriz (north-western Iran) with patients infected with hepatitis B. The study was carried out by using purposive sampling. RESULTS The data analysis led to the extraction of the main theme, "attempting an active expansion of interactions," and its three subthemes, including: "denial of the disease," "protecting oneself or others," and "coping with the disease." CONCLUSION Patients with hepatitis B use different strategies to cope with this disease. In order for patients to properly face the disease and to live with minimum challenges and limitations, they need to be suitably understood and supported. Therefore, consideration of education and consultation programs regarding the different aspects of this disease is urgent.
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Affiliation(s)
- Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Zabihi
- Department of Nursing, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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9
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Valery PC, Clark PJ, McPhail SM, Rahman T, Hayward K, Martin J, Horsfall L, Volk ML, Skoien R, Powell E. Exploratory study into the unmet supportive needs of people diagnosed with cirrhosis in Queensland, Australia. Intern Med J 2017; 47:429-435. [PMID: 28145084 DOI: 10.1111/imj.13380] [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: 07/12/2016] [Revised: 10/09/2016] [Accepted: 01/20/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Many patients with cirrhosis follow complex medication and dietary regimens, and those with decompensated cirrhosis suffer debilitating complications. These factors impact activities of daily living and quality of life. AIMS To explore the concerns and challenges of people with cirrhosis and their use of support services and to also describe health professionals' (HP) perspectives of patients' concerns. METHODS This is a cross-sectional study at a tertiary liver clinic involving 50 patients and 54 HP. Data were collected using structured questionnaires. The study includes patients' report of their challenges/problems now that they have cirrhosis ('patient-volunteered concerns') and HP' report of patients' concerns. Both also ranked a list of 10 potential concerns. RESULTS Patients were, on average, 58 years old (SD = 10.2), mostly male (78%), Caucasian (86%) and with compensated cirrhosis (60%). The patients' most common volunteered concerns related to managing symptoms, emotional issues and disease. Most ranked 'developing liver cancer' (79%), 'losing ability to do daily tasks for yourself' (76%), 'fear of dying' (64%) and 'fear of the unknown' (64%) as priority concerns. Regarding the use of support services, 24% of patients had accessed a dietician, 20% a pharmacist and 18% a psychologist. From the HP' perspective, the patients' most significant challenges related to managing disease (65%) and symptoms (48%), access to healthcare (56%) and information/knowledge (48%). CONCLUSIONS Our findings demonstrate that cirrhosis (its symptoms, complications and treatment) is associated with significant concerns for patients. The discrepancies between the views of HP and patients suggest that we may not be measuring or addressing patients' needs appropriately.
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Affiliation(s)
- Patricia C Valery
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Paul J Clark
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Tony Rahman
- Prince Charles Hospital, Metro North Health, Brisbane, Queensland, Australia
| | - Kelly Hayward
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jennifer Martin
- School of Medicine and Public Health, University of Newcastle, New Castle, New South Wales, Australia.,Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Leigh Horsfall
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The Centre for Liver Disease Research, University of Queensland, Brisbane, Queensland, Australia
| | - Michael L Volk
- Loma Linda University Medical Center, Loma Linda University, Loma Linda, California, USA
| | - Richard Skoien
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Powell
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The Centre for Liver Disease Research, University of Queensland, Brisbane, Queensland, Australia
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10
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Whiteley D, Whittaker A, Elliott L, Cunningham-Burley S. Hepatitis C in a new therapeutic era: Recontextualising the lived experience. J Clin Nurs 2017; 27:2729-2739. [PMID: 28960567 DOI: 10.1111/jocn.14083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/28/2023]
Abstract
AIMS AND OBJECTIVES To explore the experience of adults living with hepatitis C in a new era of interferon-free treatment. BACKGROUND Hepatitis C is a leading cause of morbidity and mortality worldwide, posing a significant challenge to global public health. Historically, the treatment of hepatitis C was poorly efficacious and highly demanding; however, more effective and tolerable therapies have become available in high-income nations in recent years. This is the first study to explore how these significant developments in the treatment of hepatitis C may have influenced the experience of those living with the virus, and their understanding of the disease. DESIGN A qualitative study underpinned by social phenomenological theory. METHODS Data were generated through semi-structured interviews with a purposive sample of 20 hepatitis C positive adults living in a large city in Scotland. RESULTS Thematic analysis identified three overriding themes. "Positioning hepatitis C" illustrated how the disease was understood within wider sociocultural, medical and politico-economic contexts. "Beyond a physical burden" emphasised the emotional aspect of infection, and "a new uncertainty" revealed participants' cautious response to the advances in hepatitis C therapy. CONCLUSIONS Interthematic discourse portrayed the new era of hepatitis C treatment as holding little sway over constructions of the illness, as narratives resonated with previous studies. Such unmoving "lay" understandings of hepatitis C may pose potential barriers to the new therapeutic era from reaching its full potential. RELEVANCE TO CLINICAL PRACTICE How people living with the virus perceive and understand hepatitis C can have an adverse impact on their engagement with care and treatment. Whilst global medical discourse eulogises the arrival of a new era of therapy, there remain significant challenges for nurses engaging those with hepatitis C in therapeutic pathways.
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Affiliation(s)
- David Whiteley
- Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,Substance Misuse Directorate, NHS Lothian, Astley Ainslie Hospital, Edinburgh, UK
| | - Anne Whittaker
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,Substance Misuse Directorate, NHS Lothian, Astley Ainslie Hospital, Edinburgh, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sarah Cunningham-Burley
- School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
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11
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Living with Hepatitis C Virus: A Systematic Review and Narrative Synthesis of Qualitative Literature. Can J Gastroenterol Hepatol 2017; 2017:3268650. [PMID: 28529936 PMCID: PMC5424189 DOI: 10.1155/2017/3268650] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/20/2017] [Indexed: 02/07/2023] Open
Abstract
Background and Aims. The lived experience of HCV has not been well documented in the literature. The aim of this systematic review was to understand the experiences of living with Hepatitis C Virus (HCV). Methods. Five databases were searched from inception until January 19, 2015. Studies were included if they focused on adults diagnosed with HCV; reported experience living with HCV; and described original research. Results. 46 studies were included. Studies found that participants had reduced quality of life due to physical symptoms. Due to physical symptoms and discrimination, many participants switched to part-time work or quit their jobs. Many individuals reported negative experiences with the healthcare system; themes of feeling unsupported, not having adequate information, and not feeling involved in decisions were reported. Stigma significantly impacted those living with HCV. Conclusions. Published literature indicates that those with HCV often feel stigmatized and unsupported in their care, relationships, and work environments, while simultaneously coping with physical and psychological symptoms. This synthesis points to areas where greater education, compassion, and patient-centered healthcare could improve the experience of people living with HCV.
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12
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Abstract
It is now a full decade since Paylor and Orgel (2004) called for social work to 'wake up' to hepatitis C (HCV). In that time, a small but significant body of social research has developed which has highlighted the far-reaching social consequences of living with HCV. Using this as a foundation, Paylor and Mack (2010) expanded arguments on the role of social work and identified specific areas where social work might become involved, arguing that the profession is uniquely placed and skilled, to respond and provide support. This article draws on qualitative in-depth interviews with twenty-one people who (had) lived with HCV in the UK, to strengthen and broaden the argument that social work and social care need to urgently take a bigger role in working with people with HCV, given the cross-cutting and wide range of issues that arise. This is the first study which uses participant data to argue for the need for social work involvement and in that it highlights a number of points in the experience where social work support is needed including pre and post diagnosis, whilst on treatment and after treatment.
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Affiliation(s)
| | - Ian Paylor
- *Correspondence to Dr Ian Paylor, Department of Sociology, Bowland College North, Lancaster University, Lancaster, LA1 4YD, UK. E-mail:
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13
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Valizadeh L, Zamanzadeh V, Negarandeh R, Zamani F, Hamidia A, Zabihi A. Psychological Reactions among Patients with Chronic Hepatitis B: a Qualitative Study. J Caring Sci 2016; 5:57-66. [PMID: 26989666 PMCID: PMC4794545 DOI: 10.15171/jcs.2016.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/02/2015] [Indexed: 01/05/2023] Open
Abstract
Introduction: Hepatitis B is the most prevalent type of
viral hepatitis. Psychological reactions among patients with hepatitis B infection is
considerably different and affects their decision about treating and following up the
disease. The present study aims at explaining the psychological demonstrations experienced
by these patients. Methods: In this qualitative study, a total of 18 patients
with hepatitis B (8 women and 10 men) were selected by purposive sampling method. Data
were collected by unstructured in-depth interviews during 2014-2015 in the medical centers
of three cities in Iran. All interviews were recorded, typed and analyzed by the
conventional content analysis approach. Results: By analyzing the data, the main theme including
psychological instability, with three sub-themes were emerged: grief reaction (stupor,
denial, anger and aggression), emotional challenges (worry and apprehension, contradiction
with beliefs, fear of deprivation, fear of stigma, waiting for death and prognosis
ambiguity) and inferiority complex (social withdrawal, sense of humiliation and
embarrassment and sense of guilt and blame) were acquired. Conclusion: The findings indicate that patients with
hepatitis B experience various psychological reactions that need to be controlled and
managed by themselves or healthcare providers. Thus, implementation of health
interventions with emphasis on psychological care to prevent problems and execution of
educational and consultation programs about hepatitis especially by medical centers and
mass media is seems necessary.
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Affiliation(s)
- Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Angela Hamidia
- Department of Psychiatry, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Ali Zabihi
- Department of Community Health, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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14
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Hasanpour-Dehkordi A, Mohammadi N, Nikbakht-Nasrabadi A. Re-designing Orem's Self-care Theory for Patients with Chronic Hepatitis. Indian J Palliat Care 2016; 22:395-401. [PMID: 27803560 PMCID: PMC5072230 DOI: 10.4103/0973-1075.191754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis is an inflammatory disease which has many adverse effects on patients' life because of its chronic nature. Since Orem's theory of self-care is a grounded theory, the concepts and applications of this theory in patients with chronic hepatitis who have special needs may lead to some challenges. The purpose of this study was to explore self-care in patients with chronic hepatitis. METHODS/DESIGN A directed content analysis was used in this qualitative study. Participants were recruited from a metropolitan area. Data were collected through semi-structured interviews. The verbatim transcripts of the participants' interviews were analyzed according to directed content analysis. RESULTS In this study, four themes, suggested by Orem, were drawn from the data according to directed content analysis. The codes generated from the data were classified into concepts and then the concepts were assigned into these four themes. These themes were needs in the matrix of time and place, self-care agency, need for change in self-care and consequences of hepatitis. CONCLUSION The use of Orem's self-care theory cannot meet the need for self-care in hepatitis patients because these patients have vital sexual, respect and belonging, physical, economical, and psychological-behavioral needs, and lack adequate knowledge about self-care. Consequently, the specific self-care model developed in this study helps health professionals identify self-care activities in patients with chronic hepatitis.
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Affiliation(s)
- Ali Hasanpour-Dehkordi
- Department of Medical surgical Nursing and Nursing and Midwifery Palliative Care Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Nooredin Mohammadi
- Department of Critical Care Nursing, Center for Nursing Care Research and Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran; Department of Nursing, School of Nursing and Midwifery, Flinders University, Adelaide, Australia
| | - Alireza Nikbakht-Nasrabadi
- Department of Medical surgical Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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15
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Pawlotsky JM, Aghemo A, Back D, Dusheiko G, Forns X, Puoti M, Sarrazin C. Reply to "Debilitating fatigue as a treatment indication in chronic hepatitis C". J Hepatol 2015; 63:1535-6. [PMID: 26375242 DOI: 10.1016/j.jhep.2015.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 01/26/2023]
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Health-Related Quality of Life for individuals with hepatitis C: A narrative review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:936-49. [DOI: 10.1016/j.drugpo.2015.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/10/2015] [Accepted: 04/24/2015] [Indexed: 02/06/2023]
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Ferreira FAP, de Almeida-Neto C, Teixeira MCD, Strauss E. Health-related quality of life among blood donors with hepatitis B and hepatitis C: longitudinal study before and after diagnosis. Rev Bras Hematol Hemoter 2015; 37:381-7. [PMID: 26670400 PMCID: PMC4678909 DOI: 10.1016/j.bjhh.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/15/2015] [Accepted: 08/24/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction There is evidence that patients suffering from chronic hepatic diseases, including chronic hepatitis B and chronic hepatitis C, have a reduced health-related quality of life. The aim of this study was to evaluate the impact of the notification of test results for hepatitis B and hepatitis C on the quality of life of blood donors. Methods Over a 29-month period, this study assessed the quality of life of 105 blood donors with positive serological screening tests for hepatitis B and hepatitis C and donors who presented false-positive test results. The Medical Outcome Study 36-Item Short Form Health Survey Questionnaire was applied at three time points: (1) when an additional blood sample was collected for confirmatory tests; (2) when donors were notified about their serological status; and (3) when donors, positive for hepatitis B and hepatitis C, started clinical follow-up. Quality of life scores for the confirmed hepatitis B and hepatitis C groups were compared to the false-positive control group. Results The domains bodily pain, general health perception, social function, and mental health and the physical component improved significantly in donors with hepatitis C from Time Point 1 to Time Point 3. Health-related quality of life scores of donors diagnosed with hepatitis B and hepatitis C were significantly lower in six and four of the eight domains, respectively, compared to the false-positive control group. Conclusion A decreased quality of life was detected before and after diagnosis in blood donors with hepatitis B and hepatitis C. Contrary to hepatitis B positive donors, the possibility of medical care may have improved the quality of life among hepatitis C positive donors.
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Affiliation(s)
| | | | | | - Edna Strauss
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Development of Self-Management Indicators for Chronic Hepatitis B Patients on Antiviral Therapy: Results of a Chinese Delphi Panel Survey. PLoS One 2015; 10:e0134125. [PMID: 26327606 PMCID: PMC4556706 DOI: 10.1371/journal.pone.0134125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 07/06/2015] [Indexed: 12/27/2022] Open
Abstract
Objective This study aimed to develop a set of indicators that could be used to measure and monitor the self-management performance for chronic hepatitis B (CHB) patients on antiviral therapy in China. Methods A two-round Delphi study via e-mail correspondence was conducted, with a group of 30 Chinese experts. The Delphi questionnaire consisted of 53 indicators identified from a literature review. Experts rated and scored the importance of indicators on a five-point Likert scale. Consensus was considered to be reached if a median score in the top tertile (4-5) and ≥80% of panel ratings in the top tertile (4-5) after Round 2. The included indicators were validated with a group of 106 CHB patients. Results The response rates for the first and second rounds were 90.9% (n=30) and 86.7% (n=26), respectively. Three new indicators were suggested in the first round. 55 indicators were included in the second round after modified. 45 (81.8%) indicators achieved on the level of consensus, all of which had an inter-quartile range of 1 or below. The final set included 4 domains and 45 indicators which were well accepted and understandable by CHB patients. Conclusion This Delphi study produced a set of 45 self-management indicators for CHB patients on antiviral therapy in China. These indicators could be used to measure and monitor the patients’ self-management performance, with the goal of improving the quality of life in this population.
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Winn JL, Francis EM, Shealy SE, Levarge M, Paton S, Planner A, Kelly K, Gonzales-Nolas C. Accelerated Hepatitis A and B Immunization in a Substance Abuse Treatment Program. Fed Pract 2015; 32:38-43. [PMID: 30766082 PMCID: PMC6363320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An accelerated dosing program for hepatitis A and B vaccination among veterans receiving treatment for addictive disorders was successfully implemented, although many veterans with hepatitis C did not complete the immunization series.
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Affiliation(s)
- Jaime L Winn
- is a clinical psychologist, is an attending psychiatrist, is a clinical psychologist, is a retired licensed practical nurse, is a retired registered nurse, is a retired registered nurse, and is an attending psychiatrist, all at the James A. Haley Veterans' Hospital in Tampa, Florida. is an advanced registered nurse practitioner at American Lake Division of the VA Puget Sound Healthcare System in Lakewood, Washington. Dr. Winn is an assistant professor, Dr. Francis is an associate professor, Dr. Shealy is an assistant professor, and Dr. Gonzales-Nolas is an assistant professor, all at the University of South Florida in Tampa
| | - Elie M Francis
- is a clinical psychologist, is an attending psychiatrist, is a clinical psychologist, is a retired licensed practical nurse, is a retired registered nurse, is a retired registered nurse, and is an attending psychiatrist, all at the James A. Haley Veterans' Hospital in Tampa, Florida. is an advanced registered nurse practitioner at American Lake Division of the VA Puget Sound Healthcare System in Lakewood, Washington. Dr. Winn is an assistant professor, Dr. Francis is an associate professor, Dr. Shealy is an assistant professor, and Dr. Gonzales-Nolas is an assistant professor, all at the University of South Florida in Tampa
| | - Suzanne E Shealy
- is a clinical psychologist, is an attending psychiatrist, is a clinical psychologist, is a retired licensed practical nurse, is a retired registered nurse, is a retired registered nurse, and is an attending psychiatrist, all at the James A. Haley Veterans' Hospital in Tampa, Florida. is an advanced registered nurse practitioner at American Lake Division of the VA Puget Sound Healthcare System in Lakewood, Washington. Dr. Winn is an assistant professor, Dr. Francis is an associate professor, Dr. Shealy is an assistant professor, and Dr. Gonzales-Nolas is an assistant professor, all at the University of South Florida in Tampa
| | - Michelle Levarge
- is a clinical psychologist, is an attending psychiatrist, is a clinical psychologist, is a retired licensed practical nurse, is a retired registered nurse, is a retired registered nurse, and is an attending psychiatrist, all at the James A. Haley Veterans' Hospital in Tampa, Florida. is an advanced registered nurse practitioner at American Lake Division of the VA Puget Sound Healthcare System in Lakewood, Washington. Dr. Winn is an assistant professor, Dr. Francis is an associate professor, Dr. Shealy is an assistant professor, and Dr. Gonzales-Nolas is an assistant professor, all at the University of South Florida in Tampa
| | - Stephanie Paton
- is a clinical psychologist, is an attending psychiatrist, is a clinical psychologist, is a retired licensed practical nurse, is a retired registered nurse, is a retired registered nurse, and is an attending psychiatrist, all at the James A. Haley Veterans' Hospital in Tampa, Florida. is an advanced registered nurse practitioner at American Lake Division of the VA Puget Sound Healthcare System in Lakewood, Washington. Dr. Winn is an assistant professor, Dr. Francis is an associate professor, Dr. Shealy is an assistant professor, and Dr. Gonzales-Nolas is an assistant professor, all at the University of South Florida in Tampa
| | - Anne Planner
- is a clinical psychologist, is an attending psychiatrist, is a clinical psychologist, is a retired licensed practical nurse, is a retired registered nurse, is a retired registered nurse, and is an attending psychiatrist, all at the James A. Haley Veterans' Hospital in Tampa, Florida. is an advanced registered nurse practitioner at American Lake Division of the VA Puget Sound Healthcare System in Lakewood, Washington. Dr. Winn is an assistant professor, Dr. Francis is an associate professor, Dr. Shealy is an assistant professor, and Dr. Gonzales-Nolas is an assistant professor, all at the University of South Florida in Tampa
| | - Karen Kelly
- is a clinical psychologist, is an attending psychiatrist, is a clinical psychologist, is a retired licensed practical nurse, is a retired registered nurse, is a retired registered nurse, and is an attending psychiatrist, all at the James A. Haley Veterans' Hospital in Tampa, Florida. is an advanced registered nurse practitioner at American Lake Division of the VA Puget Sound Healthcare System in Lakewood, Washington. Dr. Winn is an assistant professor, Dr. Francis is an associate professor, Dr. Shealy is an assistant professor, and Dr. Gonzales-Nolas is an assistant professor, all at the University of South Florida in Tampa
| | - Cheryl Gonzales-Nolas
- is a clinical psychologist, is an attending psychiatrist, is a clinical psychologist, is a retired licensed practical nurse, is a retired registered nurse, is a retired registered nurse, and is an attending psychiatrist, all at the James A. Haley Veterans' Hospital in Tampa, Florida. is an advanced registered nurse practitioner at American Lake Division of the VA Puget Sound Healthcare System in Lakewood, Washington. Dr. Winn is an assistant professor, Dr. Francis is an associate professor, Dr. Shealy is an assistant professor, and Dr. Gonzales-Nolas is an assistant professor, all at the University of South Florida in Tampa
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Mehta G, Dusheiko G. Hepatitis C treatment and quality of life - You can't always get what you want, but you might get what you need. J Hepatol 2015; 63:300-2. [PMID: 25980761 DOI: 10.1016/j.jhep.2015.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Gautam Mehta
- UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Campus, London NW3 2PF, United Kingdom
| | - Geoffrey Dusheiko
- UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Campus, London NW3 2PF, United Kingdom.
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Valery PC, Powell E, Moses N, Volk ML, McPhail SM, Clark PJ, Martin J. Systematic review: unmet supportive care needs in people diagnosed with chronic liver disease. BMJ Open 2015; 5:e007451. [PMID: 25854973 PMCID: PMC4390721 DOI: 10.1136/bmjopen-2014-007451] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE People with chronic liver disease, particularly those with decompensated cirrhosis, experience several potentially debilitating complications that can have a significant impact on activities of daily living and quality of life. These impairments combined with the associated complex treatment mean that they are faced with specific and high levels of supportive care needs. We aimed to review reported perspectives, experiences and concerns of people with chronic liver disease worldwide. This information is necessary to guide development of policies around supportive needs screening tools and to enable prioritisation of support services for these patients. DESIGN Systematic searches of PubMed, MEDLINE, CINAHL and PsycINFO from the earliest records until 19 September 2014. Data were extracted using standardised forms. A qualitative, descriptive approach was utilised to analyse and synthesise data. RESULTS The initial search yielded 2598 reports: 26 studies reporting supportive care needs among patients with chronic liver disease were included, but few of them were patient-reported needs, none used a validated liver disease-specific supportive care need assessment instrument, and only three included patients with cirrhosis. Five key domains of supportive care needs were identified: informational or educational (eg, educational material, educational sessions), practical (eg, daily living), physical (eg, controlling pruritus and fatigue), patient care and support (eg, support groups), and psychological (eg, anxiety, sadness). CONCLUSIONS While several key domains of supportive care needs were identified, most studies included hepatitis patients. There is a paucity of literature describing the supportive care needs of the chronic liver disease population likely to have the most needs--namely those with cirrhosis. Assessing the supportive care needs of people with chronic liver disease have potential utility in clinical practice for facilitating timely referrals to support services.
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Affiliation(s)
- Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Powell
- Centre for Liver Disease Research, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Neta Moses
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael L Volk
- Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Paul J Clark
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jennifer Martin
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
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Scott J, Rosa K, Fu M, Cerri K, Peeters M, Beumont M, Zeuzem S, Evon DM, Gilles L. Fatigue during treatment for hepatitis C virus: results of self-reported fatigue severity in two Phase IIb studies of simeprevir treatment in patients with hepatitis C virus genotype 1 infection. BMC Infect Dis 2014; 14:465. [PMID: 25164700 PMCID: PMC4162924 DOI: 10.1186/1471-2334-14-465] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 08/15/2014] [Indexed: 01/25/2023] Open
Abstract
Background Fatigue is a common symptom of chronic hepatitis C virus (HCV) infection and a frequent side-effect of peginterferon/ribavirin (PR) therapy for HCV. This study evaluated the impact of adding the oral HCV NS3/4A protease inhibitor simeprevir to PR on patient-reported fatigue and health status among patients with chronic HCV genotype 1 infection enrolled in the Phase IIb PILLAR and ASPIRE trials [NCT00882908; NCT00980330]. Methods Treatment-naïve patients (PILLAR, n = 386) and treatment-experienced patients (ASPIRE, n = 462) were randomized to simeprevir plus PR (simeprevir/PR) or placebo plus PR (placebo/PR). In PILLAR, duration of PR treatment in the simeprevir/PR groups was determined using response-guided therapy (RGT) criteria. PR could be terminated at Week 24, instead of Week 48, if HCV RNA was <25 IU/mL by Week 4 and then undetectable at Weeks 12, 16, and 20. In both studies, patients completed the Fatigue Severity Scale (FSS) and EQ-5D quality-of-life questionnaire in their native language at baseline and throughout the studies up until Week 72. Results During the first 24 weeks of treatment, mean FSS total score was increased to a similar degree compared with baseline among patients receiving simeprevir/PR or placebo/PR in both studies indicating increased fatigue severity. Mean FSS scores returned to values comparable with baseline among patients receiving simeprevir/PR after Week 24 in PILLAR (after treatment completion for the majority of patients) and in ASPIRE (after Week 48), consistent with RGT enabling early termination of all treatment at Week 24 in 82.2% of simeprevir/PR-treated patients in the PILLAR study. Similar results were observed for EQ-5D, with simeprevir/PR-treated patients experiencing less time with worse health problems according to EQ-5D scores compared with placebo/PR groups in both studies, and more rapid improvement in health status associated with shorter treatment duration in the PILLAR study. Conclusions Combination of simeprevir with PR did not increase patient-reported fatigue severity or health status impairments beyond that reported by patients treated with PR alone. Many patients treated with simeprevir/PR returned to pretreatment fatigue and health status levels sooner due to increased treatment efficacy that enabled shorter duration of all therapy, compared with PR alone. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-465) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jane Scott
- Janssen Global Services LLC, 50-100 Holmers Farm Way, Holmers Lane, High Wycombe, Bucks HP12 4DP, UK.
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Hill R, Pfeil M, Moore J, Richardson B. Living with hepatitis C: a phenomenological study. J Clin Nurs 2014; 24:428-38. [PMID: 24811299 DOI: 10.1111/jocn.12620] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 02/06/2023]
Abstract
AIMS AND OBJECTIVES To explore the experience of adults living with hepatitis C over time. BACKGROUND Hepatitis C virus is a growing problem affecting thousands of people worldwide. The majority of individuals infected develop chronic liver disease, but treatment is not always successful, leaving many to live with the virus indefinitely. Experiences of living with hepatitis C are poorly understood yet essential to meet the needs of an increasing number of affected people. DESIGN A qualitative study using a descriptive phenomenological methodology. METHODS Unstructured interviews were conducted with 23 hepatitis C-positive individuals in the East of England; participants were interviewed twice within a year. RESULTS Data analysis revealed six themes of the experience of living with hepatitis C: hepatitis C and self; hepatitis C, self and others; self and handling hepatitis C; self and handling hepatitis C treatment issues; living with the consequences of hepatitis C; self, hepatitis C and thoughts of the future. CONCLUSIONS Diagnosis of hepatitis C can disrupt people's sense of identity and trigger a life transition. A complex range of factors create uncertainty for people living with hepatitis C. Many struggle to make a healthy transition to life with the condition, instead living in a state of sustained uncertainty. RELEVANCE TO CLINICAL PRACTICE Nurses working within a chronic care framework of ongoing advice and support can improve experiences for those living with hepatitis C. Practice aimed at reducing both the disruptive effect of the diagnosis and the uncertainties it creates can help facilitate a transition to life with the disease.
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Measurement properties of the flu-like symptom index from the hepatitis physical symptom severity diary. Qual Life Res 2013; 23:1489-96. [PMID: 24379136 PMCID: PMC4031396 DOI: 10.1007/s11136-013-0609-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE Chronic Hepatitis C (CHC) Virus infection is a serious health issue in the US. Standard treatment involves peginterferon alpha and ribavirin, often associated with adverse side effects including flu-like symptoms. These adverse effects are common reasons for the discontinuation of treatment and therefore represent a major obstacle in the effective treatment of CHC. METHODS The Hepatitis Physical Symptom Severity Diary, a newly developed patient-reported outcome measure for assessing physical symptoms in CHC patients, was recently developed. It contains four questions addressing flu-like symptoms [the Flu-Like Symptom Index (FLSI)]. Measurement properties of the FLSI in CHC patients were assessed using data from two randomized clinical trials. RESULTS Exploratory factor analysis using data from baseline and the last visit while on treatment supported a single-factor solution for the FLSI. Internal reliability and test-retest reliability are acceptable (Cronbach's alpha range 0.73-0.81; intraclass correlation coefficient range 0.85-0.97), and correspondence to several similar constructs was acceptable. The FLSI score was higher among those with investigator-reported flu-like symptoms (mean = 4.1) versus those without (1.4), although not statistically significant (p = 0.12). Responsiveness of the FLSI was moderate, as measured by standardized effect sizes and response means, and the minimum important difference (MID) was estimated at 2.5-3.0 points. CONCLUSIONS While additional research should be conducted to evaluate validity with more closely related constructs and to utilize anchor-based methods for estimating the MID, data suggest that the FLSI has acceptable measurement properties and can be an effective tool in assessing flu-like symptoms in CHC patients.
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Contreras R, Jason LA. Experiences of Oxford House Residents Living with the Hepatitis C Virus. FRONTIERS IN PSYCHOLOGICAL AND BEHAVIORAL SCIENCE 2013; 2:57-63. [PMID: 24340280 PMCID: PMC3856901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hepatitis C virus (HCV) is the most prevalent chronic blood-borne infection in the United States and the leading cause of chronic liver disease. HCV is transmitted through blood-to-blood contact. New infections remain common among IDUs, prisoners, and others likely to be exposed to infected blood. The purpose of this study was to use qualitative methods to gain insight into the experiences of HCV-infected residents, an approach that has proved informative in helping individuals manage similar challenging chronic illnesses. Semi-structured interviews were conducted with four Oxford House female residents living with HCV. The semi-structure qualitative interview consisted of 18 questions which were designed to focus on three broad areas: experiences of contracting and being diagnosed with HCV, ways in which HCV affected their lives, and experiences living in an Oxford House. Overall, participants were not surprised at their diagnosis, but it did impact their mood. Participants had difficulty with social functioning, experienced physical and psychological symptoms, and received a substantial amount of social support from family and Oxford House residents.
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Groessl EJ, Ho SB, Asch SM, Stepnowsky CJ, Laurent D, Gifford AL. The hepatitis C self-management program: sustainability of primary outcomes at 1 year. HEALTH EDUCATION & BEHAVIOR 2013; 40:730-40. [PMID: 23445604 DOI: 10.1177/1090198113477112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Chronic hepatitis C infection afflicts millions of people worldwide. Although antiviral treatments are increasingly effective, many hepatitis C virus (HCV) patients avoid treatment, do not complete or respond to treatment, or have contraindications. Self-management interventions are one option for promoting behavioral changes leading to liver wellness and improved quality of life. Our objective was to evaluate whether the effects of the HCV self-management program were sustained at the 12-month follow-up assessment. METHODS Veteran Affairs patients with hepatitis C (N = 134; mean age = 54.6 years, 95% male, 41% ethnic minority, 48% homeless in last 5 years) were randomized to either a 6-week self-management workshop or an information-only intervention. The weekly 2-hour self-management sessions were based on a cognitive-behavioral program with hepatitis C-specific modules. Outcomes including hepatitis C knowledge, depression, energy, and health-related quality of life were measured at baseline, 6 weeks, 6 months, and 12 months later. Data were analyzed using repeated measures ANOVA. RESULTS Compared with the information-only group, participants attending the self-management workshop improved more on HCV knowledge (p < .005), SF-36 energy/vitality (p = .016), and the Quality of Well-Being Scale (p = .036). Similar trends were found for SF-36 physical functioning and Center for Epidemiologic Studies Short Depression Scale. CONCLUSION Better outcomes were sustained among self-management participants at the 12-month assessment despite the intervention only lasting 6 weeks. HCV health care providers should consider adding self-management interventions for patients with chronic HCV.
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27
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Miller ER, McNally S, Wallace J, Schlichthorst M. The ongoing impacts of hepatitis c--a systematic narrative review of the literature. BMC Public Health 2012; 12:672. [PMID: 22900973 PMCID: PMC3505729 DOI: 10.1186/1471-2458-12-672] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 08/13/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many countries have developed, or are developing, national strategies aimed at reducing the harms associated with hepatitis C infection. Making these strategies relevant to the vast majority of those affected by hepatitis C requires a more complete understanding of the short and longer term impacts of infection. We used a systematic approach to scope the literature to determine what is currently known about the health and psychosocial impacts of hepatitis C along the trajectory from exposure to ongoing chronic infection, and to identify what knowledge gaps remain. METHODS PubMed, Current Contents and PsychINFO databases were searched for primary studies published in the ten years from 2000-2009 inclusive. Two searches were conducted for studies on hepatitis C in adult persons focusing on: outcomes over time (primarily cohort and other prospective designs); and the personal and psychosocial impacts of chronic infection. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness and methodological coherence. Outcomes reported in 264 included studies were summarized, tabulated and synthesized. RESULTS Injecting drug use (IDU) was a major risk for transmission with seroconversion occurring relatively early in injecting careers. Persistent hepatitis C viraemia, increasing age and excessive alcohol consumption independently predicted disease progression. While interferon based therapies reduced quality of life during treatment, improvements on baseline quality of life was achieved post treatment--particularly when sustained viral response was achieved. Much of the negative social impact of chronic infection was due to the association of infection with IDU and inflated assessments of transmission risks. Perceived discrimination was commonly reported in health care settings, potentially impeding health care access. Perceptions of stigma and experiences of discrimination also had direct negative impacts on wellbeing and social functioning. CONCLUSIONS Hepatitis C and its management continue to have profound and ongoing impacts on health and social well being. Biomedical studies provided prospective information on clinical aspects of infection, while the broader social and psychological studies presented comprehensive information on seminal experiences (such as diagnosis and disclosure). Increasing the focus on combined methodological approaches could enhance understanding about the health and social impacts of hepatitis C along the life course.
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Affiliation(s)
- Emma R Miller
- Discipline of General Practice, School of Population Health, University of Adelaide, Adelaide, 5005, South Australia
| | - Stephen McNally
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
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Kleinman L, Mannix S, Yuan Y, Kummer S, L’Italien G, Revicki D. Review of patient-reported outcome measures in chronic hepatitis C. Health Qual Life Outcomes 2012; 10:92. [PMID: 22871087 PMCID: PMC3547737 DOI: 10.1186/1477-7525-10-92] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 07/13/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic hepatitis C (CHC) and its treatment are associated with a variety of patient-reported symptoms and impacts. Some CHC symptoms and impacts may be difficult to evaluate through objective clinical testing, and more easily measured through patient self-report. This literature review identified concepts raised by CHC patients related to symptoms, impacts, and treatment effects, and evaluated integration of these concepts within patient-reported outcome (PRO) measures. The goal of this work was to provide recommendations for incorporation of PRO measurement of concepts that are relevant to the CHC experience into CHC clinical trial design. METHODS A three-tiered literature search was conducted. This included searches on concepts of importance, PRO measures used in clinical trials, and existing PRO measures. The PRO Concept Search focused on reviewing issues raised by CHC patients about CHC symptoms, disease impact, and treatment effects. The CHC Trials with PRO Endpoints Search reviewed clinical trials with PRO endpoints to assess differences between treatments over time. The PRO Measure Search reviewed existing PRO measures associated with the concepts of interest. RESULTS This multi-tiered approach identified five key concepts of interest: depression/anxiety, fatigue, flu-like symptoms, cognitive function, insomnia. Comparing these five concepts of interest to the PRO measures in published CHC clinical trials showed that, while treatment of CHC may decrease health-related quality of life in a number of mental and physical domains, the PRO measures that were utilized in published clinical trials inadequately covered the concepts of interest. Further review of 18 existing PRO measures of the concepts of interest showed only four of the 18 were validated in CHC populations. CONCLUSIONS This review identified several gaps in the literature regarding assessment of symptoms and outcomes reported as important by CHC patients. Further research is needed to ensure that CHC clinical trials evaluate concepts that are important to patients and include measures that have evidence supporting content validity, reliability, construct validity, and responsiveness.
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Affiliation(s)
- Leah Kleinman
- United BioSource Corporation, Bethesda, MD, USA
- Senior Research Scientist, United BioSource Corporation, 1417 4th Avenue, Suite 510, Seattle, WA, 98101, USA
| | | | - Yong Yuan
- Bristol-Myers Squibb Company, Global Health Outcomes, Plainsboro, NJ, USA
| | | | - Gilbert L’Italien
- Bristol-Myers Squibb Company, Global Health Outcomes, Plainsboro, NJ, USA
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Morse DS, Schiff M, Levit S, Cohen-Moreno R, Williams GC, Neumark Y. A pilot training program for a motivational enhancement approach to hepatitis C virus treatment among individuals in Israeli methadone treatment centers. Subst Use Misuse 2012; 47:56-66. [PMID: 22216992 PMCID: PMC3305804 DOI: 10.3109/10826084.2011.628735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Although hepatitis C virus (HCV) can be cleared, very few infected persons complete the treatment, resulting in disease progression and transmission. Motivational interventions effectively address health and substance-use-related conditions in many cultures. The research team piloted an HCV treatment motivational enhancement training and supervision for four counselors treating four patients in one (of 11) large methadone programs in Israel between 2007 and 2008. The counselors received a 3-day training followed by seven supervision sessions. Training included cultural and language adaptation from the original United States version to practice in Israel. Feasibility was assessed and demonstrated through training field notes and questionnaire feedback, review of taped intervention sessions for counselor proficiency and patient engagement, and patient completion of intervention sessions and piloted measures. While positive feasibility outcomes were noted, future studies should employ larger numbers of counselors and patients to assess the effectiveness of motivational enhancement in promoting HCV treatment in methadone patients.
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Affiliation(s)
- Diane S Morse
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York 14642, USA. diane
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Stewart BJ, Mikocka-Walus AA, Harley H, Andrews JM. Help-seeking and coping with the psychosocial burden of chronic hepatitis C: a qualitative study of patient, hepatologist, and counsellor perspectives. Int J Nurs Stud 2011; 49:560-9. [PMID: 22154094 DOI: 10.1016/j.ijnurstu.2011.11.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 11/03/2011] [Accepted: 11/07/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chronic hepatitis C affects millions of people worldwide, may have significant physical consequences, and patients are also at increased risk of psychiatric morbidity. However, it is currently unknown how patients cope with, and seek help for the psychosocial issues which contribute to this psychiatric morbidity. OBJECTIVES This study aimed to qualitatively explore the biopsychosocial burden of chronic hepatitis C, patients' subsequent coping and help-seeking, and the patient-health professional relationship from the different perspectives of patients, hepatologists, and counsellors. METHODS Thirteen patients, five hepatologists, and two hepatitis C specific counsellors from South Australia participated in semi-structured interviews, which were audio-recorded, transcribed verbatim, and analysed thematically. RESULTS All groups perceived chronic hepatitis C as a severe disease involving inextricably intertwined biological, psychological, and social impacts. Negative factors included the impact of diagnosis, stigmatisation, and often unwarranted fears regarding transmission and disease progression. The key positive influences reported across the groups involved information provision and access to informal and formal support. However, a number of barriers were noted to accessing this support, particularly stigmatisation. All respondents highlighted the importance of the patient-health professional relationship. This relationship was perceived to be enhanced by empathetic, compassionate professionals who provided comprehensive information in a sensitive and timely manner. Key negative influences on this relationship included discrimination or inappropriate treatment from mainstream health professionals, time constraints of doctors, patient non-attendance, and discordant views regarding treatment decisions. CONCLUSIONS Reducing the psychosocial impact of chronic hepatitis C requires targeted information provision for patients, the general public, and mainstream health services. This may increase patient education, reduce the extent and impact of stigmatisation, remove barriers to help-seeking, and improve the patient-health professional relationship.
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Social support and clinical outcomes during antiviral therapy for chronic hepatitis C. J Psychosom Res 2011; 71:349-56. [PMID: 21999979 PMCID: PMC3197215 DOI: 10.1016/j.jpsychores.2011.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 05/04/2011] [Accepted: 05/05/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine if social support (SS) is associated with clinical outcomes during antiviral therapy for chronic hepatitis C virus (HCV). METHODS Data from 394 patients who participated in the prospective, longitudinal VIRAHEP-C study were examined. VIRAHEP-C enrolled 401 adults with HCV to evaluate factors associated with antiviral treatment response. Perceived SS was measured using the Medical Outcome Study Social Support Survey (MOS-SSS) at baseline and treatment week 24. Scores were calculated as a continuous variable ranging from 0% to 100% with higher scores indicating greater support. Two SS variables were created: (1) baseline SS (BL-SS) and (2) change in SS from baseline to treatment week 24 (CH-SS). The primary endpoint was sustained virological response (SVR) six months post-treatment. Intermediate outcomes included: symptom-reporting; virological response at treatment week 24; medication adherence; neuropsychiatric adverse events; and dose reductions and premature medication discontinuation. The relative risk of each outcome was estimated using modified Poisson regression models or linear mixed models. RESULTS BL-SS was relatively high (mean=79%). Overall, SS declined from baseline to treatment week 24 (median change: -1.3%; p<.01). Neither BL-SS nor CH-SS was associated with SVR. However, BL-SS was associated with multiple symptoms (fatigue, headache, irritability, aches/pains) during treatment, even after adjusting for baseline depression, which was significantly associated with symptom-reporting. CONCLUSIONS SS was not directly associated with efficacy measures, such as SVR. However, baseline SS predicted an increase in symptomatology over the course of antiviral therapy. Baseline depression was also significantly associated with symptom-reporting.
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Zhu CY, Wang JJ, Fu XH, Zhou ZH, Zhao J, Wang CX. Correlates of quality of life in China rural-urban female migrate workers. Qual Life Res 2011; 21:495-503. [PMID: 21695594 DOI: 10.1007/s11136-011-9950-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rural-urban female migrant workers living in factories are a special majority group in the city of Shenzhen, China. These female workers came from different provinces of mainland China. The health-related issues and quality of life (QOL) of this migrator have become serious public health and social problems, which have not been well characterized. This study aimed to explore the QOL and related factors of rural-urban female migrant workers living in factories in China. METHODS In total, 3,622 rural-urban female migrant workers completed the Health Survey Short Form (SF-36). Sociodemographic characteristics, health status and job satisfaction during the past 6 months were also collected. RESULTS Subjects had an average of 2.53 ± 1.93 (median = 2.00, quartile interval = 3.00) diseases. The two-week Morbidity Rate was 21.9%, and only 14.0% of the subjects were satisfied with their current job. Compared to Chinese female norms, the participants scored lower in seven concepts domains of SF-36 (role physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health). Multiple stepwise linear regression analysis showed that after adjustment for age, education level, work duration and job satisfaction, two-week Morbidity Rate, anemia symptoms and muscular soreness proved to be significant predictors for all the 7 domains (except for physical functioning). Digestive system disease was a significant predictor in 5 out of 7 domains, while urinary system disease and gynecological disease were significant predictors in 4 out of 7 domains. CONCLUSIONS In general, QOL in rural-urban female migrant workers was lower than Chinese female norms. Improving their job satisfaction and controlling job-related disease appears to be critical to improving their QOL.
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Affiliation(s)
- Chun-Yan Zhu
- Department of Prevention Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, People's Republic of China.
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Groessl EJ, Weingart KR, Gifford AL, Asch SM, Ho SB. Development of the hepatitis C self-management program. PATIENT EDUCATION AND COUNSELING 2011; 83:252-255. [PMID: 20638216 DOI: 10.1016/j.pec.2010.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 06/03/2010] [Accepted: 06/05/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Chronic hepatitis C infection (HCV) is a major health problem that disproportionately affects people with limited resources. Many people with HCV are ineligible or refuse antiviral treatment, but less curative treatment options exist. These options include adhering to follow-up health visits, lifestyle changes, and avoiding hepatotoxins like alcohol. Herein, we describe a recently developed self-management program designed to assist HCV-infected patients with adherence and improve their health-related quality of life (HRQOL). METHODS The development of the Hepatitis C Self-Management Program (HCV-SMP) was informed by scientific literature, qualitative interviews with HCV-infected patients, self-management training, and feedback from HCV clinical experts. RESULTS The Hepatitis C Self-Management Program (HCV-SMP) is a multi-faceted program that employs cognitive-behavioral principles and is designed to provide HCV-infected people with knowledge and skills for improving their HRQOL. The program consists of six 2-h workshop sessions which are held weekly. The sessions consist of a variety of group activities, including disease-specific information dissemination, action planning, and problem-solving. CONCLUSION The intervention teaches skills for adhering to challenging treatment recommendations using a validated theoretical model. A randomized trial will test the efficacy of this novel HCV self-management program for improving HRQOL in a difficult to reach population.
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Affiliation(s)
- Erik J Groessl
- Health Services Research and Development, VA San Diego Healthcare System, San Diego, CA 92161, USA.
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Groessl EJ, Weingart KR, Stepnowsky CJ, Gifford AL, Asch SM, Ho SB. The hepatitis C self-management programme: a randomized controlled trial. J Viral Hepat 2011; 18:358-68. [PMID: 20529203 DOI: 10.1111/j.1365-2893.2010.01328.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Chronic hepatitis C (HCV) infection afflicts millions of people worldwide. While antiviral treatments are effective for some patients, many either cannot or choose not to receive antiviral treatment. Education about behavioural changes like alcohol avoidance and symptom management, in contrast, is universally recommended, particularly in HCV-infected persons from disadvantaged groups where liver risk factors are most prevalent. Self-management interventions are one option for fostering improved HCV knowledge and health-related quality of life (HRQOL). One hundred and thirty-two patients with VA with HCV (mean age of 54.6, 95% men, 41% ethnic minority, 83% unmarried, 72% unemployed/disabled, 48% homeless in last 5 years) were randomized to either a 6-week self-management workshop or an information-only intervention. The weekly 2-h self-management sessions were based on cognitive-behavioural principles and were adapted from an existing self-management programme that has been efficacious with other chronic diseases. HCV-specific modules were added. Outcomes including HRQOL, HCV knowledge, self-efficacy, depression, energy and health distress were measured at baseline and 6 weeks later. Data were analysed using ANOVA. When compared to the information-only group, participants attending the self-management workshop improved more on HCV knowledge (P < 0.001), HCV self-efficacy (P = 0.011), and SF-36 energy/vitality (P = 0.040). Similar trends were found for SF-36 physical functioning (P = 0.055) and health distress (P = 0.055). Attending the self-management programme improved disease knowledge and HRQOL 6 weeks later in this disadvantaged population. The intervention can improve the health of people with hepatitis C, independent of antiviral therapy. Future research will study longer-term outcomes, effects on antiviral treatment and costs.
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Surjadi M, Torruellas C, Ayala C, Yee HF, Khalili M. Formal patient education improves patient knowledge of hepatitis C in vulnerable populations. Dig Dis Sci 2011; 56:213-9. [PMID: 20972850 PMCID: PMC3008930 DOI: 10.1007/s10620-010-1455-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 10/05/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis C (HCV) knowledge is limited in injection drug users (IDU). Vulnerable populations including IDUs are disproportionally affected by HCV. Effective HCV education can potentially reduce disparity in HCV prevalence and its outcome in this population. AIM This study aimed to assess the impact of formal HCV education and factors associated with improved HCV knowledge in the vulnerable population. METHODS Over 18 months, 201 HCV-infected patients underwent a 2-h standardized education and completed demographic and pre- and post-education questionnaires. RESULTS Patient characteristics were: 69% male, mean age 49±10, 49% White (26% AA, 10% Latino), 75% unemployed, 83% high school education and above, 64% were IDU, and 7% were HIV co-infected. On multivariate analysis, baseline knowledge scores were higher in patients with at least a high school education (coef 7.1, p=0.045). Baseline knowledge scores were lower in African Americans (coef -12.3, p=0.004) and older patients (coef -0.7, p=0.03). Following HCV education, the overall test scores improved significantly by 14% (p=0.0001) specifically in the areas of HCV transmission (p=0.003), general knowledge (p=0.02), and health care maintenance (p=0.004). There was a high compliance with liver specialty clinic attendance following education. CONCLUSIONS Formal HCV education is effective in improving HCV knowledge. Although White race, younger age, and higher education were predictors of having more HCV knowledge prior to education, all patients independent of racial background had a significant improvement in their knowledge after education. Therefore, promoting effective HCV education among vulnerable populations may be an important factor in reducing the disparities in HCV disease.
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Affiliation(s)
- Miranda Surjadi
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110 USA
| | - Cara Torruellas
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110 USA
| | - Claudia Ayala
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110 USA
| | - Hal F. Yee
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110 USA ,UCSF/SFGH Center for Specialty Access & Quality, San Francisco, CA USA
| | - Mandana Khalili
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave, NH-3D, San Francisco, CA 94110 USA ,UCSF/SFGH Center for Specialty Access & Quality, San Francisco, CA USA
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Bailey DE, Barroso J, Muir AJ, Sloane R, Richmond J, McHutchison J, Patel K, Landerman L, Mishel MH. Patients with chronic hepatitis C undergoing watchful waiting: Exploring trajectories of illness uncertainty and fatigue. Res Nurs Health 2010; 33:465-73. [PMID: 20730869 PMCID: PMC3525323 DOI: 10.1002/nur.20397] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We identified trajectories of illness uncertainty in chronic hepatitis C patients and examined their association with fatigue levels during 12 months of disease monitoring without treatment (watchful waiting). Sixty-two men and 63 women completed uncertainty and fatigue measures. Groups were formed by uncertainty scores (high, medium, and low) at baseline. Baseline fatigue levels were higher in the high uncertainty group than in the medium and low groups. Over time, uncertainty levels did not change. Fatigue levels in the low uncertainty group remained constant, increased in the medium, and decreased in the high groups. Findings suggest that uncertainty and fatigue do not remit spontaneously. Being aware of this may help nurses identify those patients needing support for these two concerns.
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Affiliation(s)
| | - Julie Barroso
- Duke University School of Nursing, Durham, North Carolina
| | - Andrew J. Muir
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University, Durham, North Carolina
| | - Richard Sloane
- Duke University Center for Aging, Duke University, Durham, North Carolina
| | - Jacqui Richmond
- Department of Gastroenterology, St. Vincent’s Hospital, Melbourne PO Box 2900, Fitzroy, Victoria 3065, Australia
| | - John McHutchison
- Duke Clinical Research Institute, and Division of Gastroenterology, Duke University, Durham, North Carolina
| | - Keyur Patel
- Duke Clinical Research Institute and Division of Gastroenterology, Duke University, Durham, North Carolina
| | | | - Merle H. Mishel
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Pichetshote N, Groessl E, Yee H, Ho SB. Optimizing the dose and duration of therapy for chronic hepatitis C. Gut Liver 2009; 3:1-13. [PMID: 20479894 DOI: 10.5009/gnl.2009.3.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 01/31/2009] [Indexed: 12/12/2022] Open
Abstract
Recent studies indicate that antiviral treatment with pegylated interferon alfa and ribavirin for hepatitis C can be individualized based on viral and host characteristics and the pattern of virologic response during the initial months of antiviral treatment. Patients with a low initial viral load who demonstrate a rapid virologic response to antiviral therapy may be treated with a shorter duration of therapy and are less sensitive to reduced dosing of ribavirin. Patients with delayed virologic response will require a longer duration of therapy - up to 72 weeks for patients with genotype 1 - in order to optimize chances of a sustained virologic response. Patients who were nonresponders or relapsed after an acceptable course of antiviral therapy may be retreated using a more intensive regimen and/or a longer duration of therapy. Previous nonresponders to pegylated interferon alfa and ribavirin are less likely to respond to retreatment unless they demonstrate a virologic response within the first three months of retreatment, lack advanced fibrosis, and can tolerate a more intensive and/or lengthier treatment. Individualized treatment based on viral genotype, viral load, the presence of advanced fibrosis, and initial virologic response can improve therapy for some patients and save resources in others.
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Affiliation(s)
- Nipaporn Pichetshote
- Department of Medicine, Health Services Research and Development, VA San Diego Healthcare System, and University of California, San Diego, CA and Hepatitis C Resource Center, VA Medical Center, San Francisco, CA, USA
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