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Sobode OR, Jegan R, Toelen J, Dierickx K. Shared decision-making in adolescent healthcare: a literature review of ethical considerations. Eur J Pediatr 2024; 183:4195-4203. [PMID: 39167164 DOI: 10.1007/s00431-024-05687-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Adolescence is a period of growing independence and maturity, within the period of legal minority. As parents or guardians are socially and legally responsible for adolescents' medical decisions, shared decision-making in adolescent healthcare could be ethically challenging. This review aims to identify and map the ethical tensions in shared decision-making in adolescent healthcare. METHODS We systematically searched the literature following the PRISMA guidelines to identify relevant articles, which were analyzed using the review of reasons methodology Strech and Sofaer (J Med Ethics 38(2):121-6, 2012). RESULTS We included 38 articles which involved adolescents, healthcare professionals and parents as being the main stakeholders. Shared decision-making was influenced not only by individual stakeholders' characteristics, but by tensions between stakeholder dyads. Most studies supported the involvement of the adolescent in decision-making, depending on their life experience, decision-making capacity and clinical condition. CONCLUSIONS Shared decision-making in adolescent health is receiving increasing attention. However, questions remain on what this concept entails, the roles and involvement of stakeholders and its practical implementation. WHAT IS KNOWN • Although adolescents wish to be involved in health decisions, shared decision-making in adolescents is underexplored • Adolescent shared decision-making is different from pediatric and adult shared decision-making, and is ethically complex due to the adolescent's growing autonomy What is new: • Adolescent SDM involves three-way interactions between the adolescent, healthcare professional and parents • In adolescent shared decision-making, involving or excluding a stakeholder and sharing or withholding information are ethically value-laden steps • Research is needed to further understand the roles of adolescents' personal value systems, extended or reconstituted families and decision aids in shared decision-making.
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Affiliation(s)
- Oluwaseun Rebecca Sobode
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Roshni Jegan
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jaan Toelen
- Department of Development and Regeneration, Leuven, Belgium
| | - Kris Dierickx
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
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Wang CH, Bryant BL, Cogen FR, Marks BE, Monaghan M. Preferences for Health Care Professional Interactions Among Adolescents and Young Adults with Type 1 Diabetes. Clin Pediatr (Phila) 2024; 63:620-624. [PMID: 37497925 DOI: 10.1177/00099228231189649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Christine H Wang
- Center for Translational Research, Children's National Hospital, Washington, DC, USA
| | - Breana L Bryant
- Center for Translational Research, Children's National Hospital, Washington, DC, USA
| | - Fran R Cogen
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Brynn E Marks
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Maureen Monaghan
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC, USA
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Currie GR, Kennedy BL, S M B, R S M Y, J F S, S J V, N M W, M M A K, MacKean G, Marshall DA. Managing juvenile idiopathic arthritis within the context of their life: What we learnt from children and youth living with juvenile idiopathic arthritis and their parents. Musculoskeletal Care 2023; 21:1248-1260. [PMID: 37596866 DOI: 10.1002/msc.1805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and causes short- and long-term disability. Optimal management requires pharmacologic and non-pharmacologic interventions. Few studies have explored the youth and family experience of the management of JIA. This study's objective was to explore the management experience of youth with JIA and their parents. METHODS This qualitative study used semi-structured interviews with youth 12-18 years of age with JIA receiving biological medication and parents of children with JIA on biological medication. Participants were recruited in clinics using convenience sampling. A thematic analysis approach was employed for data analysis. RESULTS Nine youth and 14 parents participated. Four themes were identified that encompassed an overarching theme of participants managing JIA within the context of their life: aspects of life affected by JIA and its management, lived experience with JIA management, medication decision-making, and involvement in decision-making. Juvenile idiopathic arthritis management is situated within the context of their life but is normally (outside acute events) not central. CONCLUSION Two dimensions were added to those in the literature: parents' overall approaches to health and the sense of urgency surrounding decision-making. Our findings reinforce the importance of person- and family-centred care in paediatric rheumatology. That is, identifying what matters most to youth and their parents given their current life circumstances to provide a foundation for discussions of how they want to manage their JIA.
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Affiliation(s)
- G R Currie
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - B L Kennedy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benseler S M
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yeung R S M
- Departments of Paediatrics, Immunology and Medical Science, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Swart J F
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Vastert S J
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Wulffraat N M
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Kip M M A
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - D A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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France E, Uny I, Turley R, Thomson K, Noyes J, Jordan A, Forbat L, Caes L, Silveira Bianchim M. A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments. Cochrane Database Syst Rev 2023; 10:CD014873. [PMID: 37795766 PMCID: PMC10552070 DOI: 10.1002/14651858.cd014873.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.
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Affiliation(s)
- Emma France
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Turley
- Development Directorate, Cochrane Central Executive, Cochrane, London, UK
| | - Katie Thomson
- Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Line Caes
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Mayara Silveira Bianchim
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Centre for Population Health and Wellbeing Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Foster A, Chan JM, Wine E, El-Matary W, Carroll MW, Kroeker KI, deBruyn JC, Seow CH, Lawrence S, Evans K, Kluthe C, Sharifi N, Pears C, Nicol S, Olayinka L, Fu N, Huynh HQ, Bressler B, Bernstein CN, Jacobson K. Transition Readiness in Youth with Inflammatory Bowel Disease. J Pediatr 2023; 258:113403. [PMID: 37019332 DOI: 10.1016/j.jpeds.2023.113403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES To examine readiness of adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) to transition to adult care. STUDY DESIGN A cross-sectional multicenter study evaluating transition readiness in individuals with IBD 16-19 years old prospectively recruited from 8 Canadian IBD centers using the validated ON Taking Responsibility for Adolescent to Adult Care (ON TRAC) questionnaire. Secondary aims included (1) screening for depression and anxiety using the 8-item Personal Health Questionnaire Depression Scale and The Screen for Child Anxiety Related Emotional Disorders questionnaires, respectively; (2) evaluating the association between depression and anxiety with readiness and disease activity; and (3) subjectively evaluating AYA readiness based on physician and parent assessments. RESULTS In total, 186 participants (139 adolescent, 47 young adult) were enrolled, mean age 17.4 years (SD, 0.87). ON TRAC scores determined that 26.6% of AYAs at pediatric and 40.4% at adult centers reached the threshold of readiness. On multivariable linear regression analysis age was positively (P = .001) and disease remission negatively (P = .03) associated with ON TRAC scores. No statistically significant differences were determined across centers. A significant percentage of AYAs reported moderate-to-severe depression (21.7%) and generalized anxiety (36%); however, neither were significantly associated with ON TRAC scores. Notably, physician and parental assessment of AYA readiness correlated poorly with ON TRAC scores (⍴ = 0.11, ⍴ = 0.24, respectively). CONCLUSIONS Assessment of transition readiness in AYAs with IBD highlighted that a large proportion do not have adequate knowledge or behavior skills needed for transition to adult care. This study infers that readiness assessment tools are essential during transition to identify deficits in knowledge and behavior skills that could be specifically targeted by the youth, caregivers, and multidisciplinary team.
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Affiliation(s)
- Alice Foster
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Justin M Chan
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Eytan Wine
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Wael El-Matary
- Department of Pediatrics, Division of Gastroenterology, Winnipeg Children's Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew W Carroll
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Karen I Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer C deBruyn
- Departments of Pediatrics and Community Health Sciences, Division of Gastroenterology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H Seow
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sally Lawrence
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kathy Evans
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cheryl Kluthe
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Nastaran Sharifi
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Simone Nicol
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lily Olayinka
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nancy Fu
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Department of Pediatrics, Division of Gastroenterology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Brian Bressler
- IBD Center of BC, Vancouver, British Columbia, Canada; Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles N Bernstein
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Center and Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kevan Jacobson
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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Weidler EM, Gardner M, Suorsa-Johnson KI, Schafer-Kalkhoff T, Rutter MM, Sandberg DE, van Leeuwen K. Surgical Decision-Making for Individuals with Differences of Sex Development: Stakeholders' views. FRONTIERS IN UROLOGY 2023; 3:1092256. [PMID: 37920724 PMCID: PMC10621752 DOI: 10.3389/fruro.2023.1092256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Introduction Advocacy and human rights organizations have called for a moratorium on elective surgical procedures until the patient is able to fully participate in the decision-making process. Due to the controversial nature surrounding surgery in differences of sex development (DSD) care, we aimed to assess the factors that teens and adults with DSD, parents, healthcare providers and other allied professionals consider pertinent to complex surgical decisions in DSD. Methods Stakeholders (n=110) in DSD care participated in semi-structured interviews exploring features and potential determinants of successful healthcare outcomes. Audio-recordings were transcribed, coded, and analyzed using qualitative data software. Codes for "Process of Decision-Making" and "Successful Outcome-Surgery/Appearance/Function" were further searched using keywords "surgery," "procedure," and "timing." Results Several themes were identified: 1) The nature or type of the decision being made; 2) Who should be involved in the decision-making process; 3) Timing of conversations about surgery; 4) Barriers to decision-making surrounding surgery; 5) The elements of surgical decision-making; and 6) The optimal approach to surgical decision-making. Many stakeholders believed children and adolescents with DSD should be involved in the process as developmentally appropriate. Conclusion DSD include a wide range of diagnoses, some of which may require urogenital reconstruction to relieve obstruction, achieve continence, and/or address other anatomical differences whether cosmetic or functional. Adolescents and adults with DSD desired autonomy and to be part of the decision-making process. Parents were divided in their opinion of who should be involved in making elective surgical decisions: the child or parents as proxy medical decision-makers. Providers and other professionals stressed the importance of process and education around surgical decisions. Ongoing research examines how decision-makers evaluate tradeoffs associated with decision options.
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Affiliation(s)
- Erica M. Weidler
- Division of Pediatric Surgery, Phoenix Children’s, Phoenix, Arizona
- Accord Alliance, USA
| | - Melissa Gardner
- Susan B. Meister Child Health Evaluation & Research (CHEAR) Center and Division of Pediatric Psychology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kristina I. Suorsa-Johnson
- Division of Pediatric Psychology and Behavioral Health, Department of Pediatrics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Tara Schafer-Kalkhoff
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meilan M. Rutter
- Accord Alliance, USA
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David E. Sandberg
- Accord Alliance, USA
- Susan B. Meister Child Health Evaluation & Research (CHEAR) Center and Division of Pediatric Psychology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kathleen van Leeuwen
- Division of Pediatric Surgery, Phoenix Children’s, Phoenix, Arizona
- Accord Alliance, USA
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Fremont ER, Friedrich EA, Feudtner C, Grimberg A, Miller VA. Perceptions of Youth and Parent Decision-Making Roles Regarding Recombinant Human Growth Hormone Treatment. ENDOCRINES 2022; 3:590-600. [PMID: 37152718 PMCID: PMC10162591 DOI: 10.3390/endocrines3040050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Recombinant human growth hormone (rhGH) is prescribed to youth with growth hormone deficiency (GHD) to support normal growth and ensure healthy physical development, and to youth without GHD to address height concerns. Perceptions of youth involvement in rhGH treatment decisions have not been explored. This study aimed to examine perceptions of youth and parent roles in decisions around rhGH treatment. Youth (n = 22, 11.5 ± 2.0 years) who had undergone evaluation for short stature and their parents (n = 22) participated in semi-structured interviews after stimulation test results had been received. Interviews revealed the following themes: 1) parent provided youth with support; 2) parent facilitated youth's decision-making involvement; 3) youth had no role or did not remember their role; and 4) youth did not remember conversations with their parents or providers. Parents facilitated their children's involvement by sharing information and seeking their opinions. Whereas some participants described youth as having a substantial decision-making role, not all youth felt they were involved, and some youth could not recall conversations about rhGH. Parents can bolster youth involvement by having conversations using developmentally appropriate language, which is critical to youth feeling empowered and developing efficacy over their own care.
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Affiliation(s)
- Ettya R. Fremont
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia
| | | | - Chris Feudtner
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania
| | - Adda Grimberg
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia
| | - Victoria A. Miller
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia
- Correspondence:
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Matula KA, Minar P, Daraiseh NM, Lin L, Recker M, Lipstein EA. Pilot trial of iBDecide: Evaluating an online tool to facilitate shared decision making for adolescents and young adults with ulcerative colitis. Health Expect 2022; 25:3105-3113. [PMID: 36161973 DOI: 10.1111/hex.13618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION This pilot, randomized controlled trial aimed to evaluate the usability, among adolescents and young adults (AYAs) with ulcerative colitis (UC), of a web-based tool ('iBDecide') designed to facilitate shared decision making (SDM). METHODS AYAs with UC (n = 35) were randomized to intervention (iBDecide, n = 14) and control (n = 12) arms before a scheduled clinic visit. We measured the usability of iBDecide, SDM, preferred decision-making style, decision conflict and intervention use. RESULTS Participants in the intervention group found iBDecide easy to use and agreed that it made them feel ready to participate in decision making and that they would use it to prepare for appointments. There were 130 visits to iBDecide, lasting on average 3 min, 41 s. The medication and nutrition trackers were among the most-viewed pages. Pages specifically designed to facilitate SDM were viewed only four times. Across groups, too few participants reported making decisions during clinic visits for decision-related measures to be reported. CONCLUSIONS This pilot trial provides evidence for the usability of iBDecide and guidance for developing a larger-scale trial of a combined web-based and in-clinic SDM intervention. Overall, iBDecide shows promise in engaging AYAs with UC in SDM and condition management. PATIENT OR PUBLIC CONTRIBUTION Patients, specifically AYAs with UC, and healthcare providers were involved in the design of this study's intervention, iBDecide. Additionally, the research team, from study conception to manuscript writing, included a young adult with inflammatory bowel disease. CLINICAL TRIAL REGISTRATION This study was registered at clinicaltrials.gov (NCT04207008).
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Affiliation(s)
- Kelly A Matula
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Philip Minar
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nancy M Daraiseh
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Li Lin
- Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Marlee Recker
- Division of Social Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Suarez L, Skinner AC, Truong T, McCann JR, Rawls JF, Seed PC, Armstrong SC. Advanced Obesity Treatment Selection among Adolescents in a Pediatric Weight Management Program. Child Obes 2022; 18:237-245. [PMID: 34757829 PMCID: PMC9145572 DOI: 10.1089/chi.2021.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Treatment options for adolescents with obesity are limited. Yet, therapies previously reserved for adults, such as medications and bariatric surgery, are increasingly available to adolescents in tertiary obesity treatment settings. We aimed to identify the factors associated with selecting an advanced obesity treatment (diets, medications, and surgery) beyond lifestyle therapy among adolescents presenting to a tertiary, pediatric weight management program. Methods: We conducted a secondary analysis of adolescents (N = 220) who participated in a longitudinal, observational case-control study within a pediatric weight management program. The exposures were potential individual and clinical factors, including sociodemographic characteristics and comorbidities. The outcome was treatment selection, dichotomized into lifestyle vs. advanced treatment. We modeled associations between these factors and treatment selection using logistic regression, controlling for confounding variables (age, race/ethnicity, sex, and insurance). Results: The study population included a majority of non-Hispanic Black (50.5%) and Hispanic/Latino (19.5%) adolescents, of whom 25.5% selected advanced treatment. Adolescents were more likely to choose an advanced treatment option if they had a greater BMI [odds ratio (OR) 1.09, 95% confidence interval (95% CI) 1.04-1.15], lived further from the clinic (OR 1.03, 95% CI 1.00-1.05), and had an elevated glycohemoglobin level (OR 2.46, 95% CI 1.24-4.92). Conclusions: A significant fraction of adolescents seeking obesity treatment in a specialized care setting chose new and emerging obesity treatments, particularly those at high risk of developing diabetes. These findings can inform patient-clinician obesity treatment discussions in specialty care settings. Clinical Trial Registration number: NCT03139877.
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Affiliation(s)
- Lilianna Suarez
- Duke University School of Medicine, Durham, NC, USA.,Address correspondence to: Lilianna Suarez, MPH, Duke University School of Medicine, 4020 N Roxboro Street, Durham, NC 27704, USA
| | - Asheley C. Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Jessica R. McCann
- Department of Molecular Genetics and Microbiology, Duke Microbiome Center, Duke University School of Medicine, Durham, NC, USA
| | - John F. Rawls
- Department of Molecular Genetics and Microbiology, Duke Microbiome Center, Duke University School of Medicine, Durham, NC, USA
| | - Patrick C. Seed
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah C. Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
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10
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Daraiseh NM, Black A, Minar P, Meisman A, Saxe M, Lipstein EA. iBDecide: A web-based tool to promote engagement in shared decision-making among adolescents with ulcerative colitis. PATIENT EDUCATION AND COUNSELING 2022; 105:1628-1633. [PMID: 34756638 DOI: 10.1016/j.pec.2021.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Adolescents and young adults (AYAs) seek increased autonomy and self-efficacy. AYAs must learn to manage their medical care in preparation for transition to adult healthcare. Our team's research found that AYAs need more information about their disease and treatment OBJECTIVE: To develop and test the usability of a decision tool "iBDecide" to promote shared decision-making among AYAs with ulcerative colitis (UC) who are beginning to manage their treatment and medications METHODS: Using design thinking, 14 AYAs, 6 healthcare providers, 4 designers, a social worker, and a human factors researcher developed a shared decision-making tool. The System Usability Scale (SUS) assessed usability RESULTS: AYAs preferred an application with information on treatment, medication, nutrition, and symptom tracking. A web-based application, 'iBDecide', was developed to include these options. SUS results indicated that participants on average "agree" that: 'they would use iBDecide' and that 'it was easy to use and streamlined'. The mean SUS score was 78.25 (+/-12.91), range 70-90 DISCUSSION: Including AYAs in tool development helps ensure usability and improves engagement in shared decision-making. Co-designed tools may remove barriers for engagement and skill-building needed for the transition to adult care. CONCLUSION iBDecide can stimulate AYA engagement in shared decision-making in treating UC.
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Affiliation(s)
- N M Daraiseh
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A Black
- College of Design, Architecture, Art, and Planning, University of Cincinnati, Cincinnati, OH, USA
| | - P Minar
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A Meisman
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M Saxe
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - E A Lipstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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11
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Lipstein EA, Brinkman WB, Zhang Y, Hommel KA, Ittenbach RF, Liu C, Denson LA. Decision making about anti-TNF therapy: A pilot trial of a shared decision-making intervention. PATIENT EDUCATION AND COUNSELING 2022; 105:1075-1081. [PMID: 34629231 DOI: 10.1016/j.pec.2021.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We conducted a pre-post pilot trial to determine the feasibility and acceptability of a multi-component intervention (pre-clinic letter, shared decision making cards and follow-up phone call) designed to facilitate SDM in pediatric inflammatory bowel disease (IBD). METHODS We recruited physicians (n = 11) caring for IBD patients and families (n = 36) expected to discuss anti-tumor necrosis treatment. We measured feasibility and acceptability of the intervention, observed SDM, perceived SDM, decision conflict, and regret. Medical records were used to assess clinical outcomes, time to decision and adherence. We compared all outcomes between the usual care and intervention study arms. RESULTS Two out of three intervention components were feasible. Visit length increased significantly in the intervention arm. Parents and patients rated the intervention as acceptable, as did most physicians. The intervention was associated with a higher-level of observed SDM. There was no difference perceived SDM, decision conflict, regret or quality of life outcomes between arms. Physician global assessment improved over time in the intervention arm. CONCLUSIONS This pilot trial provides important guidance for developing a larger scale trial of a modified intervention. PRACTICE IMPLICATIONS Overall, our intervention shows promise in supporting SDM and engaging both parents and patients in pediatric IBD decisions.
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Affiliation(s)
- Ellen A Lipstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
| | - William B Brinkman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Yin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Kevin A Hommel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Richard F Ittenbach
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Lee A Denson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
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12
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2022; 74:521-537. [PMID: 35233986 PMCID: PMC10124899 DOI: 10.1002/acr.24853] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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13
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2022; 74:553-569. [PMID: 35233993 PMCID: PMC10161784 DOI: 10.1002/art.42037] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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14
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Gupta A, Cafazzo JA, IJzerman MJ, Swart JF, Vastert S, Wulffraat NM, Benseler S, Marshall D, Yeung R, Twilt M. Genomic Health Literacy Interventions in Pediatrics: Scoping Review. J Med Internet Res 2021; 23:e26684. [PMID: 34951592 PMCID: PMC8742210 DOI: 10.2196/26684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/21/2021] [Accepted: 11/10/2021] [Indexed: 01/16/2023] Open
Abstract
Background The emergence of genetic and genomic sequencing approaches for pediatric patients has raised questions about the genomic health literacy levels, attitudes toward receiving genomic information, and use of this information to inform treatment decisions by pediatric patients and their parents. However, the methods to educate pediatric patients and their parents about genomic concepts through digital health interventions have not been well-established. Objective The primary objective of this scoping review is to investigate the current levels of genomic health literacy and the attitudes toward receiving genomic information among pediatric patients and their parents. The secondary aim is to investigate patient education interventions that aim to measure and increase genomic health literacy among pediatric patients and their parents. The findings from this review will be used to inform future digital health interventions for patient education. Methods A scoping review using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and protocols was completed using the following databases: MEDLINE, Embase, CINAHL, and Scopus. Our search strategy included genomic information inclusive of all genetic and genomic terms, pediatrics, and patient education. Inclusion criteria included the following: the study included genetic, genomic, or a combination of genetic and genomic information; the study population was pediatric (children and adolescents <18 years) and parents of patients with pediatric illnesses or only parents of patients with pediatric illnesses; the study included an assessment of the knowledge, attitudes, and intervention regarding genomic information; the study was conducted in the last 12 years between 2008 and 2020; and the study was in the English language. Descriptive data regarding study design, methodology, disease population, and key findings were extracted. All the findings were collated, categorized, and reported thematically. Results Of the 4618 studies, 14 studies (n=6, 43% qualitative, n=6, 43% mixed methods, and n=2, 14% quantitative) were included. Key findings were based on the following 6 themes: knowledge of genomic concepts, use of the internet and social media for genomic information, use of genomic information for decision-making, hopes and attitudes toward receiving genomic information, experiences with genetic counseling, and interventions to improve genomic knowledge. Conclusions This review identified that older age is related to the capacity of understanding genomic concepts, increased genomic health literacy levels, and the perceived ability to participate in decision-making related to genomic information. In addition, internet-searching plays a major role in obtaining genomic information and filling gaps in communication with health care providers. However, little is known about the capacity of pediatric patients and their parents to understand genomic information and make informed decisions based on the genomic information obtained. More research is required to inform digital health interventions and to leverage the leading best practices to educate these genomic concepts.
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Affiliation(s)
- Aarushi Gupta
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre of Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre of Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Maarten J IJzerman
- Department of Health and Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Twente, Netherlands.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Joost F Swart
- Division of Pediatrics, Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Sebastiaan Vastert
- Division of Pediatrics, Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Nico M Wulffraat
- Division of Pediatrics, Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Susanne Benseler
- Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah Marshall
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department of Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rae Yeung
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, AB, Canada.,Immunology and Institute of Medical Science, University of Toronto, Toronto, AB, Canada
| | - Marinka Twilt
- Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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15
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Lin JL, Lipstein EA, Wittenberg E, Tay D, Lundstrom R, Lundstrom GL, Sediqzadah S, Wright DR. Intergenerational Decision Making: The Role of Family Relationships in Medical Decision Making. MDM Policy Pract 2021; 6:23814683211039468. [PMID: 34734118 PMCID: PMC8559218 DOI: 10.1177/23814683211039468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
A symposium held at the 42nd annual Society for Medical Decision Making conference on October 26, 2020, focused on intergenerational decision making. The symposium covered existing research and clinical experiences using formal presentations and moderated discussion and was attended by 43 people. Presentations focused on the roles of pediatric patients in decision making, caregiver decision making for a child with complex medical needs, caregiver involvement in advanced care planning, and the inclusion of spillover effects in economic evaluations. The moderated discussion, summarized in this article, highlighted existing resources and gaps in intergenerational decision making in four areas: decision aids, economic evaluation, participant perspectives, and measures. Intergenerational decision making is an understudied and poorly understood aspect of medical decision making that requires particular attention as our society ages and technological advances provide new innovations for life-sustaining measures across all stages of the lifespan.
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Affiliation(s)
- Jody L Lin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, Utah
| | | | | | - Saadia Sediqzadah
- Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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16
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Buljac-Samardzic M, Clark MA, van Exel NJA, van Wijngaarden JDH. Patients as team members: Factors affecting involvement in treatment decisions from the perspective of patients with a chronic condition. Health Expect 2021; 25:138-148. [PMID: 34598308 PMCID: PMC8849256 DOI: 10.1111/hex.13358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/17/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Active patient involvement in treatment decisions is seen as a feature of patient-centred care that will ultimately lead to better healthcare services and patient outcomes. Although many factors have been identified that influence patient involvement in treatment decisions, little is known about the different views that patients have on which factors are most important. OBJECTIVE This study explores the views of patients with a chronic condition on factors influencing their involvement in treatment decisions. DESIGN Q-methodology was used to study the views of patients. Respondents were asked to rank a set of 42 statements from the least important to the most important for active patient involvement in treatment decision-making. The set of 42 statements was developed based on a literature search and a pilot in which two external researchers, 15 patients and four healthcare professionals participated. A total of 136 patients with one of three major chronic conditions were included: diabetes types 1 and 2, respiratory disease (i.e., chronic obstructive pulmonary disease and asthma) and cancer (i.e., breast cancer and prostate cancer). Data were collected in a face-to-face interview setting in the Netherlands. RESULTS Four distinct views on the factors influencing active patient involvement were identified among patients with a chronic condition. (1) Enabled involvement: the extent to which patients are facilitated and empowered to participate will lead to patient involvement. (2) Relationship-driven involvement: the relationship between patients and healthcare professionals drives patient involvement. (3) Disease impact-driven involvement: the severity of disease drives patient involvement. (4) Cognition-driven involvement: knowledge and information drive patient involvement. DISCUSSION AND CONCLUSION From the patients' perspective, this study shows that there is no one-size-fits-all approach to involving patients more actively in their healthcare journey. Strategies aiming to enhance active patient involvement among patients with a chronic condition should consider this diversity in perspectives among these patients. PATIENT CONTRIBUTION Patients are the respondents as this study researches their perspective on factors influencing patient involvement. In addition, patients were involved in pilot-testing the statement set.
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Affiliation(s)
- Martina Buljac-Samardzic
- Department Health Services Management and Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mark A Clark
- Kogod School of Business, American University, Washington, DC, USA
| | - N Job A van Exel
- Department Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jeroen D H van Wijngaarden
- Department Health Services Management and Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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17
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Fremont ER, Slick N, Willi SM, Miller VA. "I Think Parents Shouldn't Be Too Pushy": A Qualitative Exploration of Parent and Youth Perspectives of Youth Decision-Making Involvement in Starting Continuous Glucose Monitoring. Sci Diabetes Self Manag Care 2021; 47:355-366. [PMID: 34448420 DOI: 10.1177/26350106211040424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this qualitative study was to explore parent and youth perspectives of the decision-making process to start continuous glucose monitoring (CGM). METHODS Youth with type 1 diabetes and their parents were assessed with semistructured interviews before adding CGM to their regimen and 2 months after device initiation. Interviews focused on parent, youth, and provider decision-making roles and suggestions for enhancing youth decision-making involvement (DMI). Data were coded and analyzed using thematic analysis. RESULTS Youth (N = 41; 13.7 ± 2.9 years) were categorized into decision-making roles: (1) youth primary decision maker (54.8%), (2) youth primary decision maker with parental influence (14.3%), (3) parent primary decision maker with youth agreement (26.2%), and (4) parent primary decision maker without youth agreement (4.8%). Participants described that clinicians provided information, recommended CGM, and gave support. Recommendations to enhance youth DMI included that youth should ask questions, express opinions, and do their own research. Providers should give unbiased information and use visual aids (eg, show the device and videos) to engage youth. CONCLUSIONS Participants agreed that whereas youth should have a primary role in the decision about CGM, parental and provider support is critical. Parents and providers can facilitate dialogue by directly engaging with youth about their thoughts, feelings, and concerns. Provider use of visual aids may enhance youth engagement and expectations.
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Affiliation(s)
- Ettya R Fremont
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nathalie Slick
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven M Willi
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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18
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Wu LM, Huang IC, Su HL, Lee SL. Interventions to Support Adolescents With Cancer in Decision-Making: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs 2021; 18:339-349. [PMID: 34291849 DOI: 10.1111/wvn.12522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adolescents have autonomous views and participatory rights. There is increasing support for involving adolescents with cancer in the healthcare decision-making process. AIMS The purpose of this study was to synthesize current knowledge to identify major components and outcomes of interventions to enhance shared decision-making (SDM) by adolescents with cancer during and after treatment. METHODS Six electronic databases (PubMed, CINHAL, MEDLINE, Cochrane, EBSCO, and Web of Science) were searched from their inceptions to February 2020. Eligibility criteria were intervention studies, studies of interventions to support adolescents with cancer involved in SDM, and studies of patients diagnosed with cancer between 10 and 18 years of age. Data extraction and quality appraisal were conducted by using a standardized data extraction form. Quality appraisal was based on the Cochrane Risk of Bias Tool. RESULTS Of 331 citations, five studies with a total of 648 participants aged between 13 and 21 years met inclusion criteria. Interventions included structured sessions held one to three times per week. SDM engagement strategies incorporated weekly assignments, live action videos, brochures, Five Wishes© advance directives, and follow-up counseling. Treatment preference congruence in adolescent and parent dyads was higher in intervention groups. Meta-analysis was performed on two studies and demonstrated statistically significant improvements in decision quality at 6 months (z = 3.37, p = .001; 95% CI = .174-.657) and 12 months (z = 3.17, p = .002; 95% CI = .150-.633) after SDM interventions in adolescent cancer survivors. No adverse events among patients were found, although anxiety scores increased in families in an intervention group. LINKING EVIDENCE TO ACTION This review identified essential components of SDM interventions. Our findings may guide the future design of interventions to support high-quality decision-making by adolescents with cancer. Coaching can educate adolescent cancer survivors on quality decision-making methods and can improve the quality of consequent decisions. More research is needed to determine outcomes of SDM interventions.
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Affiliation(s)
- Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - I-Chin Huang
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hsiu-Lan Su
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Li Lee
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
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19
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Fisher K, Byham-Gray L, Rothpletz-Puglia P. Characterizing the Parental Perspective of Food-Related Quality of Life in Families After Pediatric Inflammatory Bowel Disease Diagnosis. Gastroenterol Nurs 2021; 44:E69-E77. [PMID: 34149042 DOI: 10.1097/sga.0000000000000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
Food-related quality of life is defined as achieving adequate nutrition, deriving pleasure, and maintaining social activities through eating and drinking. The objective of this qualitative study was to characterize the parental perspective about eating experiences and family functioning after diagnosis of inflammatory bowel disease in their child in order to describe how these experiences may impact food-related quality of life. Semistructured interviews were completed with 10 parents of a child with inflammatory bowel disease. Conventional content analysis was conducted with steps to ensure trustworthiness. Family Systems Theory was the interpretive framework. Ambiguous nutrition information emerged as the main theme. Families experienced various and conflicting viewpoints regarding the role of diet, which presented a challenge after diagnosis. Parents reported frustration regarding the lack of uniform and personalized nutrition guidance. Our results support that families desire shared decision-making in regard to medication and diet, which is an important clinical practice implication for the entire gastroenterology medical team. Understanding the challenges faced by families after a major medical diagnosis in a child provides insight into designing medical interventions that maintain optimal quality of life in families.
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Affiliation(s)
- Kelly Fisher
- Kelly Fisher, DCN, RD, CSP, LD, is Assistant Professor of Professional Practice, Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas
- Laura Byham-Gray, PhD, RD, LD, FNKF, is Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
- Pamela Rothpletz-Puglia, EdD, RD, LD, is Associate Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
| | - Laura Byham-Gray
- Kelly Fisher, DCN, RD, CSP, LD, is Assistant Professor of Professional Practice, Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas
- Laura Byham-Gray, PhD, RD, LD, FNKF, is Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
- Pamela Rothpletz-Puglia, EdD, RD, LD, is Associate Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
| | - Pamela Rothpletz-Puglia
- Kelly Fisher, DCN, RD, CSP, LD, is Assistant Professor of Professional Practice, Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas
- Laura Byham-Gray, PhD, RD, LD, FNKF, is Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
- Pamela Rothpletz-Puglia, EdD, RD, LD, is Associate Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
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20
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Newton L, Delbecque L, Coşkun U, Symonds T, Clegg J, Hunter T. A qualitative study to explore symptoms and impacts of pediatric and adolescent Crohn's disease from patient and caregiver perspective. J Patient Rep Outcomes 2021; 5:49. [PMID: 34170423 PMCID: PMC8233440 DOI: 10.1186/s41687-021-00321-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that affects people across the age spectrum but often starts in childhood or early adulthood. Despite this, almost all published research examining the symptomatic and health-related quality of life (HRQL) experiences of CD has been conducted in an adult population. Studies providing a comprehensive overview of the lived experience of pediatric and adolescent CD are virtually non-existent. The experiences of younger children aged 2-7 years are especially unknown. RESULTS A total of 49 participants (31 children and 18 parents) were interviewed. This included 11 dyads (i.e., parents and children from the same family). Analyses were conducted based on reporter-type (patient self-report vs parent observer-report) and age subgroups (ages 2-4 vs 5-7 vs 8-11 vs 12-17). Key symptoms were identified across the age subgroups and reporter types. Abdominal/stomach pain, passing gas/feeling gassy, diarrhea/liquid stools, fatigue/tiredness, bowel urgency, blood in stools, stomach cramping, constipation, and incomplete evacuation were discussed most frequently. The most common HRQL impacts included impact on physical activity, school, social life, and mood (i.e., feeling sad/low), and were mostly consistent between reporter type and across age spectrum. Concept agreement between parents and children in the dyad analysis was > 60% for most symptoms and impacts. CONCLUSIONS Qualitative interviews revealed the substantial symptom and HRQL burden of pediatric CD from the child and parent perspectives and that disease experiences were largely consistent across the age range and based on both reporter perspectives. This is an important first step towards implementing a robust measurement strategy for the assessment of symptoms and HRQL impacts in pediatric CD.
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Affiliation(s)
| | | | - Ufuk Coşkun
- Clinical Outcomes Solutions, Tucson, AZ, USA
| | | | - Jennifer Clegg
- Clinical Outcomes Solutions, 53 W Jackson Blvd, Ste 1150, Chicago, IL, 60604, USA.
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21
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Horton DB, Salas J, Wec A, Kohlheim M, Kapadia P, Beukelman T, Boneparth A, Haverkamp K, Mannion ML, Moorthy LN, Ringold S, Rosenthal M. Making Decisions About Stopping Medicines for Well-Controlled Juvenile Idiopathic Arthritis: A Mixed-Methods Study of Patients and Caregivers. Arthritis Care Res (Hoboken) 2021; 73:374-385. [PMID: 31880862 PMCID: PMC7319899 DOI: 10.1002/acr.24129] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Improved treatments for juvenile idiopathic arthritis (JIA) have increased remission rates. We conducted this study to investigate how patients and caregivers make decisions about stopping medications when JIA is inactive. METHODS We performed a mixed-methods study of caregivers and patients affected by JIA, recruited through social media and flyers, and selected by purposive sampling. Participants discussed their experiences with JIA, medications, and decision-making through recorded telephone interviews. Of 44 interviewees, 20 were patients (50% ages <18 years), and 24 were caregivers (50% caring for children ages ≤10 years). We evaluated characteristics associated with high levels of reported concerns about JIA or medicines using Fisher's exact testing. RESULTS Decisions about stopping medicines were informed by competing risks between disease activity and treatment. Participants who expressed more concerns about JIA were more likely to report disease-related complications (P = 0.002) and more motivated to continue treatment. However, participants expressing more concern about medicines were more likely to report treatment-related complications (P = 0.04) and felt more compelled to stop treatment. Additionally, participants considered how JIA or treatments facilitated or interfered with their sense of normalcy and safety, expressed feelings of guilt and regret about previous or potential adverse events, and reflected on uncertainty and unpredictability of future harms. Decision-making was also informed by trust in rheumatologists and other information sources (e.g., family and online support groups). CONCLUSION When deciding whether to stop medicines whenever JIA is inactive, patients and caregivers weigh competing risks between disease activity and treatment. Based on our results, we suggest specific approaches for clinicians to perform shared decision-making regarding stopping medicines for JIA.
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Affiliation(s)
- Daniel B. Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Jomaira Salas
- Department of Sociology, Rutgers University, New Brunswick, NJ, USA
| | | | - Melanie Kohlheim
- Pediatric Rheumatology Care and Outcomes Improvement Network, Cincinnati, OH, USA
| | - Pooja Kapadia
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | | | | | - Ky Haverkamp
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - L. Nandini Moorthy
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Marsha Rosenthal
- Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
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22
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David JG, Daly BP, Chute D, Katz-Buonincontro J, Clemente I, Lipstein EA. Use of language in the medical decision-making process for biologic therapy: Youth and parent perspectives. Child Care Health Dev 2021; 47:208-217. [PMID: 33274460 DOI: 10.1111/cch.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/12/2020] [Accepted: 11/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Youth with chronic illnesses and their parents make complex medical decisions and also need to develop medical decision-making skills for transition of care to adult care. The use of inclusive (e.g. 'we decided …') and exclusive (e.g. 'they decided …') language in youth and parents' medical decision-making experiences provides insights into perceptions of engagement. This study assessed youth and parents' perceptions of engagement in medical decision-making about biologic therapy. METHODS This exploratory mixed-methods secondary analysis of semistructured interview data included youth with juvenile idiopathic arthritis (JIA) and Crohn's disease (CD) and parents. Iterative qualitative coding of interviews generated themes. Exploratory analyses of variance (ANOVAs) and analyses of covariance (ANCOVAs) investigated differences in language use between youth and parents. RESULTS Parents used more inclusive language in perceptions of medical decision-making experiences than youth, which exploratory analyses found significant (p < 0.05). Youth used more exclusive language than parents in perceptions of medical decision-making. CONCLUSION This research suggests that youth with chronic illnesses perceived limited engagement in medical decision-making, with parents perceiving higher engagement. This presents challenges for youth as they prepare for the transition to adult care. Future research should assess how inclusive and exclusive language use impacts psychosocial and health outcomes.
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Affiliation(s)
- Jennie G David
- Department of Psychology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brian P Daly
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Douglas Chute
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | | | | | - Ellen A Lipstein
- UC Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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23
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de Oliveira RJ, Kishimoto ST, de Souza DP, Fernandes PT, Marini R, Appenzeller S. The importance of transition from pediatric to adult rheumatology care in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2021; 17:155-161. [PMID: 33393405 DOI: 10.1080/1744666x.2020.1865157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Juvenile idiopathic arthritis (JIA) is the most common rheumatic inflammatory condition in childhood. The long-term morbidity, mortality, and quality of life have improved with the earlier use of disease-modifying drugs (DMARDs) and the availability of biology disease-modifying drugs (bDMARDs). Despite the improvement of treatment, around 50% of the patients reach adulthood with articular and/or extra articular disease activity. A careful planned transition from pediatric to adult care is necessary to reduce the loss of follow-up that is associated with stopping medications, flares, and disability due to untreated arthritis or uveitis.Areas covered: This narrative review provides an overview of the importance of transition in JIA Articles were selected from Pubmed searches.Expert opinion: JIA patients, family, and healthcare workers have to be trained to provide an effective transition plan, based on local and national policies. Important aspects such as expectations, maturation, disease characteristics, disease activity, adherence, disability, and psychological aspects among others have to be considered and addressed during the transition phase to improve self-esteem, self-assurance, and quality of life.
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Affiliation(s)
- Rodrigo Joel de Oliveira
- School of Medical Science, University of Campinas, Campinas, Brazil.,Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Simone Thiemi Kishimoto
- Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil.,Pathophysiology Program, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Débora Pessoa de Souza
- School of Medical Science, University of Campinas, Campinas, Brazil.,Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Paula Teixeira Fernandes
- Department of Sport Sciences, Faculty of Physical Education, University of Campinas, Campinas, Brazil
| | - Roberto Marini
- Department of Orthopedics, School of Medical Sciences and University of Campinas (UNICAMP), Campinas, Brazil
| | - Simone Appenzeller
- Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil.,Rheumatology Unit-Department of Medicine, School of Medical Sciences and University of Campinas (UNICAMP), São Paulo, Brazil
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24
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Ismailov RM, Pouillon L, Selinger CP, Khasanova ZD. Knowledge and awareness of biosimilars and shared decision-making among gastroenterology team members in Colorado, USA. Expert Opin Biol Ther 2020; 21:111-119. [PMID: 33107355 DOI: 10.1080/14712598.2020.1842355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: There are gaps in gastroenterologist team members' understanding of various topics related to biosimilars. We aimed to examine perspectives, views, and attitudes toward biosimilar and shared decision-making (SDM) among gastroenterology team members in Colorado, USA. The ultimate goal was to increase knowledge and awareness of biosimilars and SDM. Research design and methods: We developed educational materials focused on biosimilars and SDM and distributed them to each participating gastroenterology office. Subsequently, we conducted a survey of all team members from participating offices. Results: Responses were obtained from 54 gastroenterology team members. Most respondents identified the correct answer regarding biosimilars, the nocebo effect, and SDM. Almost half (47.2%) of respondents scored their level of awareness regarding biosimilars prior to reading our educational materials as poor, and nearly one quarter (26.4%) indicated so for SDM. Improvement in scores after reading our materials was significant for both biosimilars and SDM (i.e. biosimilar: z = 6.276, p-value <0.001 and SDM z = 6.328, p-value <0.001). Conclusions: Educational efforts effectively increased the low baseline knowledge and awareness of biosimilars and SDM among gastroenterology team members. More educational projects focused on biosimilars and SDM are needed to reduce the nocebo effect and prevent hampering of the cost-savings of biosimilars.
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Affiliation(s)
- Rovshan M Ismailov
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation , Denver, CO, USA
| | - Lieven Pouillon
- Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden , Bonheiden, Belgium
| | - Christian P Selinger
- Gastroenterology, Leeds Teaching Hospitals NHS Trust , Leeds, UK.,University of Leeds , Leeds, UK
| | - Zaytuna D Khasanova
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation , Denver, CO, USA
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25
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Meisman A, Daraiseh NM, Minar P, Saxe M, Lipstein EA. The Gray Zone: Adolescent and Young Adult Decision Support Needs for Ulcerative Colitis. MDM Policy Pract 2020; 5:2381468320940708. [PMID: 32685687 PMCID: PMC7343374 DOI: 10.1177/2381468320940708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/08/2020] [Indexed: 01/22/2023] Open
Abstract
Purpose. To understand the medical decision support needs specific to adolescents and young adults (AYAs) with ulcerative colitis (UC) and inform development of a decision support tool addressing AYAs' preferences. Methods. We conducted focus groups with AYAs with UC and mentors from a pediatric inflammatory bowel disease clinic's peer mentoring program. Focus groups were led by a single trained facilitator using a semistructured guide aimed at eliciting AYAs' roles in medical decision making and perceived decision support needs. All focus groups were audio recorded, transcribed, and coded by the research team. Data were analyzed using content analysis and the immersion crystallization method. Results. The facilitator led six focus groups: one group with peer mentors aged 18 to 24 years, three groups with patients aged 14 to 17 years, and two groups with patients aged 18 to 24 years. Decision timing and those involved in decision making were identified as interacting components of treatment decision making. Treatment decisions by AYAs were further based on timing, location (inpatient v. outpatient), and family preference for making decisions during or outside of clinic. AYAs involved parents and health care providers in medical decisions, with older participants describing themselves as "final decision makers." Knowledge and experience were facilitators identified to participating in medical decision making. Conclusions. AYAs with UC experience changes to their roles in medical decisions over time. The support needs identified will inform the development of strategies, such as decision support tools, to help AYAs with chronic conditions develop and use skills needed for participating in medical decision making.
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Affiliation(s)
- Andrea Meisman
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nancy M Daraiseh
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Phil Minar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Schubert-Martin Inflammatory Bowel Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marlee Saxe
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Schubert-Martin Inflammatory Bowel Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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26
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Michel HK, Siripong N, Noll RB, Kim SC. Caregiver and Adolescent Patient Perspectives on Comprehensive Care for Inflammatory Bowel Diseases: Building a Family-Centered Care Delivery Model. CROHN'S & COLITIS 360 2020; 2:otaa055. [PMID: 32851385 PMCID: PMC7437716 DOI: 10.1093/crocol/otaa055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Children with inflammatory bowel diseases (IBDs) require primary and gastrointestinal (GI) care, but little is known about patient and family preferences for care receipt. We aimed to understand caregiver perceptions of current healthcare quality, describe barriers to receiving healthcare, and elicit caregiver and adolescent preferences for how comprehensive care ideally would be delivered. METHODS This was an anonymous survey of caregivers of 2- to 17-year olds with IBD and adolescents with IBD aged 13-17 years at a large, free-standing children's hospital. Surveys assessed patient medical history, family demographics, perceptions of health care quality and delivery, barriers to primary and GI care, and preferences for optimal care delivery. RESULTS Two hundred and seventeen caregivers and 140 adolescents were recruited, 214 caregivers and 133 adolescents consented/assented, and 160 caregivers and 84 adolescents completed the survey (75% and 60% response rate, respectively). Mean patient age was 14 years (SD = 3); 51% male; 79% Crohn's disease, 16% ulcerative colitis, and 4% indeterminate colitis. Caregivers were primarily female (86%), Caucasian (94%), and living in a 2-caregiver household (79%). Most caregivers reported that their child's primary care physician (PCP) and GI doctor oversaw their primary care (71%) and their IBD care (94%), respectively. Caregivers were satisfied with communication with their PCP and GI providers (>90%) but did not know how well they communicated with one another (54%). Barriers to primary and GI care varied, and few caregivers (6%) reported unmet healthcare needs. Caregivers and adolescents saw PCPs and GI doctors having important roles in comprehensive care, though specific preferences for care delivery differed. CONCLUSION Caregivers and adolescent perspectives are essential to developing family-centered care models for children with IBD.
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Affiliation(s)
- Hilary K Michel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Nalyn Siripong
- Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert B Noll
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sandra C Kim
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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27
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Lee MJ, Marshall JH, Jones GL, Lobo AJ, Brown SR. The informational and decisional preferences of patients undergoing surgery for Crohn's anal fistula: a qualitative study. Colorectal Dis 2020; 22:703-712. [PMID: 31868981 DOI: 10.1111/codi.14936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/08/2019] [Indexed: 12/17/2022]
Abstract
AIM One in three patients with Crohn's disease will develop a perianal fistula, but only a few achieve long-term healing. Treatment is both medical and surgical. Since there is no 'best' surgical procedure, patient preference is important in selecting the appropriate treatment for this condition. The aim of this study was to investigate the informational and decisional preferences of patients when surgical treatment is being considered. METHOD Patients who had undergone surgery for Crohn's anal fistula underwent face-to-face semi-structured interviews. These explored the experience of treatments for fistula, of receiving information and of participation in decision-making. Transcripts were analysed by two investigators through inductive thematic analysis. Saturation was assessed for at 12 interviews and then after each subsequent interview. RESULTS Seventeen patients completed interviews, and saturation was achieved. Five themes were identified, of which two (desired information and decision-making) were relevant to this study. Other themes included experience of Crohn's disease, experience of receiving information and procedure-specific comments. Participants wanted to have information on any risks, high-level outcomes (e.g. success), impact on day-to-day life and aftercare. Participants felt they did not always receive the information they needed to select the best treatment option. Participants felt uninvolved in treatment decisions and would have liked to trade off operations to reach their treatment goal. CONCLUSION Information provided to patients about surgical treatment of Crohn's perianal fistula does not meet their needs. Clinicians should address aftercare, impact on quality of life and the risks and benefits of the any proposed procedure.
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Affiliation(s)
- M J Lee
- Academic Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - J H Marshall
- The Medical School, University of Sheffield, Sheffield, UK
| | - G L Jones
- Department of Psychology, Leeds Beckett University, Leeds, UK
| | - A J Lobo
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S R Brown
- Academic Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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28
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Borlot F, Yau I, Olivieri H, Ibrahim GM, Snead III OC. The Dilemma of Hemispherectomy for Rasmussen's Encephalitis in a Neurologically Intact Child. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1710509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractRasmussen's encephalitis is a rare drug-resistant focal epilepsy characterized by progressive hemiparesis, hemianopia, and cognitive decline. Hemispherectomy is currently the only known treatment that can be curative, though expected to cause postoperative motor and visual deficits in children and adolescents. To date, medical treatment with antiseizure medications and immunosuppressive agents can only offer partial, delayed, or temporary alleviation of symptoms. Hence, patients and families are often faced with the difficult decision to consider the possibility of seizure freedom at the cost of incurring permanent deficits. Here, we discussed the unique ethical issues when faced with a cure that can cause harm, and also discussed a shared decision-making approach guided by informed consent, principles of autonomy, and patient-centered values.
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Affiliation(s)
- Felippe Borlot
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ivanna Yau
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Heather Olivieri
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - George M. Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - O. Carter Snead III
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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29
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Fox JC, Lipstein EA. Shared Decision Making in Gastroenterology: Challenges and Opportunities. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2020; 4:183-189. [PMID: 32280929 PMCID: PMC7139984 DOI: 10.1016/j.mayocpiqo.2019.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022] Open
Abstract
This article reviews the current uses of shared decision making in gastroenterology and discusses additional areas of opportunity for shared decision making, especially in the area of functional gastrointestinal disorders. PubMed, MEDLINE, and Cochrane library databases were searched for articles published during a 10-year period from January 1, 2007, through December 31, 2017. Search terms included shared decision making and gastroenterology, shared decision making in gastrointestinal disease, shared decision making in functional GI disorders, and shared decision making and irritable bowel syndrome. Studies were not included in this review when a health care professional other than a gastroenterologist was involved, eg, an article that reported shared decision making regarding the use of radiation therapy in a patient with advanced rectal cancer in which the health care professional helping to make the decision was an oncologist.
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Affiliation(s)
- Jean C Fox
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Ellen A Lipstein
- Department of Pediatrics, University of Cincinnati College of Medicine, James M. Anderson Center for Health Systems Excellence, and Cincinnati Children's Hospital Medical Center, OH
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Miller VA, Jawad AF. Decision-Making Involvement and Prediction of Adherence in Youth With Type 1 Diabetes: A Cohort Sequential Study. J Pediatr Psychol 2020; 44:61-71. [PMID: 29788441 DOI: 10.1093/jpepsy/jsy032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/26/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To assess developmental trajectories of decision-making involvement (DMI), defined as the ways in which parents and children engage each other in decision-making about illness management, in youth with type 1 diabetes (T1D) and examine the effects of DMI on levels of and changes in adherence with age. Methods Participants included 117 youth with T1D, enrolled at ages 8-16 years and assessed five times over 2 years. The cohort sequential design allowed for the approximation of the longitudinal curve from age 8 to 19 from overlapping cohort segments. Children and parents completed the Decision-Making Involvement Scale, which yields subscales for different aspects of DMI, and a self-report adherence questionnaire. Mixed-effects growth curve modeling was used for analysis, with longitudinal measures nested within participant and participants nested within cohort. Results Most aspects of DMI (Parent Express, Parent Seek, Child Express, and Joint) increased with child age; scores on some child report subscales (Parent Express, Child Seek, and Joint) decreased after age 12-14 years. After accounting for age, Child Seek, Child Express, and Joint were associated with overall higher levels of adherence in both child (estimates = 0.08-0.13, p < .001) and parent (estimates = 0.07- 0.13, p < .01) report models, but they did not predict changes in adherence with age. Conclusion These data suggest that helping children to be more proactive in T1D discussions, by encouraging them to express their opinions, share information, and solicit guidance from parents, is a potential target for interventions to enhance effective self-management.
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Affiliation(s)
- Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania
| | - Abbas F Jawad
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania
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Samuel S, Dimitropoulos G, Schraeder K, Klarenbach S, Nettel-Aguirre A, Guilcher G, Pacaud D, Pinzon J, Lang E, Andrew G, Zwaigenbaum L, Scott S, McBrien K, Hamiwka L, Mackie A. Pragmatic trial evaluating the effectiveness of a patient navigator to decrease emergency room utilisation in transition age youth with chronic conditions: the Transition Navigator Trial protocol. BMJ Open 2019; 9:e034309. [PMID: 31826899 PMCID: PMC6924868 DOI: 10.1136/bmjopen-2019-034309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Transition to adult care is a challenging and complex process for youth with special healthcare needs. We aim to compare effectiveness of a patient navigator service in reducing emergency room (ER) use among adolescents with chronic health conditions transitioning to adult care. METHODS AND ANALYSIS Pragmatic randomised controlled trial parallel group design comparing ER visit rates between patients with access to a personalised navigator intervention compared with usual care. Unit of randomisation is the patient. Treatment assignment will not be blinded. Embedded qualitative study to understand navigator's role and cost analysis attributable to the intervention will be performed. Patients aged 16-21 years, followed within a chronic disease clinic, expected to be transferred to adult care within 12 months and residing in Alberta during study period will be recruited from three tertiary care paediatric hospitals. Sample size will be 300 in each arm. Navigator intervention over 24 months is designed to assist participants in four domains: transition preparation, health system brokering, socioeconomic determinants of health and self-management. Primary outcome is ER visit rate during observation period. Secondary outcomes are ambulatory and inpatient care utilisation measures, as well as Transition Readiness Assessment Questionnaire score, and Short-Form Health Survey 12 (SF-12) score at 6 and 18 months post-randomisation. Poisson regression will compare rates of ER/urgent care visits between navigator and control participants, using intention to treat principle. Cost analysis of the intervention will be conducted. Thematic analysis will be used to identify perceptions of stakeholders regarding the role of navigators. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Calgary Conjoint Health Research Ethics Board (REB #162561) and the University of Alberta Health Research Ethics Board (Pro00077325). Our team is composed of diverse stakeholders who are committed to improving transition of care who will assist with dissemination of results. TRIAL REGISTRATION NUMBER NCT03342495.
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Affiliation(s)
- Susan Samuel
- Section of Nephrology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Kyleigh Schraeder
- Alberta Children's Hospital Research Institute, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Greg Guilcher
- Section of Pediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Daniele Pacaud
- Section of Endocrinology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jorge Pinzon
- Section of Adolescent Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, Autism Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry McBrien
- Department of Family Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Hamiwka
- Section of Nephrology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Mackie
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Jordan A, Joseph-Williams N, Edwards A, Holland-Hart D, Wood F. "I'd Like to Have More of a Say Because It's My Body": Adolescents' Perceptions Around Barriers and Facilitators to Shared Decision-Making. J Adolesc Health 2019; 65:633-642. [PMID: 31395512 DOI: 10.1016/j.jadohealth.2019.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/15/2019] [Accepted: 05/24/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Adolescents living with long-term conditions (LTCs) often feel as though they are left out of discussions and decisions with healthcare professionals, which can give them the impression that their views are not important. Research around decision-making during clinical encounters often fails to represent adolescents' perspectives. This study explores adolescents' perceptions and experiences, focusing on identifying the perceived barriers to, and facilitators for, their involvement in shared decision-making (SDM). METHODS Nineteen adolescents (aged 13-19 years) with LTCs were recruited from endocrinology, rheumatology, neurology, and nephrology clinics. Participatory qualitative interviews were conducted using life grids and pie charts, and transcripts were analyzed thematically. RESULTS Four overarching themes and nine sub-themes were identified which describe barriers and facilitators around SDM. Adolescents need to feel, as though their involvement is supported by parents and healthcare professionals, that their contribution to the decision-making process is important and will yield a positive outcome. Adolescents often feel it is their right to be involved in decisions that affect them but also feel as though the adults' contributions to the decisions are considered more valuable. Adolescents need to feel capable of being involved, in terms of being able to understand and process information about the available options and ask appropriate questions. CONCLUSIONS This work highlights a number of ways SDM can be facilitated between healthcare practitioners and adolescents with LTCs. Identifying the needs of adolescents with LTCs is necessary for optimizing the SDM process and to support them during healthcare consultations.
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Affiliation(s)
- Amber Jordan
- Cardiff University, Heath Park Campus, Heath Park, Cardiff, United Kingdom.
| | | | - Adrian Edwards
- Cardiff University, Heath Park Campus, Heath Park, Cardiff, United Kingdom
| | | | - Fiona Wood
- Cardiff University, Heath Park Campus, Heath Park, Cardiff, United Kingdom
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Schuler CL, Dodds C, Hommel KA, Ittenbach RF, Denson LA, Lipstein EA. Shared decision making in IBD: A novel approach to trial consent and timing. Contemp Clin Trials Commun 2019; 16:100447. [PMID: 31538130 PMCID: PMC6745512 DOI: 10.1016/j.conctc.2019.100447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022] Open
Abstract
Background Shared decision making (SDM) between families and physicians may facilitate informed, timely decisions to proceed with biologic therapy in children with inflammatory bowel disease (IBD). Our team previously developed an SDM tool to aid communication between physicians and families when considering biologic therapy for children with IBD. Objective We are conducting a prospective, pre-post pilot trial of a new SDM tool. The primary aim of the study is to assess feasibility of both the intervention and trial procedures for a future large-scale trial. Methods We are enrolling physicians with experience prescribing biologic therapy in the past year and families of children with IBD. Families in the intervention arm receive a 3-step intervention including a letter sent before trial consent or clinic appointment, an in-clinic decision tool and a follow-up phone call. Our primary trial outcome is a measure of feasibility, with measures of clinical and decision outcomes secondary. We seek to enroll 27 families in each of 2 arms (usual-care and intervention) and plan data collection at the time of the initial visit or hospital stay, and at 1 week, 3 months, and 6 months after the initial visit. Conclusion This study protocol is designed to demonstrate that integrating novel consent procedures, including timing and multiple versions of written consent, may increase trial feasibility while maintaining scientific rigor and full protection of study participants.
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Affiliation(s)
- Christine L Schuler
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cassandra Dodds
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lee A Denson
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Daley T, Grossoehme D, McGuire JK, Corathers S, Conard LA, Lipstein EA. "I Couldn't See a Downside": Decision-Making About Gender-Affirming Hormone Therapy. J Adolesc Health 2019; 65:274-279. [PMID: 31196783 DOI: 10.1016/j.jadohealth.2019.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the article was to understand adolescents' and parents' decision-making process related to gender-affirming hormone therapy (GAHT). METHODS We conducted qualitative semistructured interviews with transgender adolescents who began testosterone for GAHT in the prior year and the parents of such adolescents. Questions focused on decision-making roles, steps in the decision process, and factors considered in the decision. Participants used pie charts to describe the division of responsibility for the decision. All interviews were coded by at least two members of the research team with disagreements resolved through discussion. Thematic analysis was used to analyze the data. RESULTS Seventeen adolescents and 13 parents were interviewed (12 dyads). The process of deciding about GAHT involves a series of small conversations, typically with the adolescent advocating to start treatment and the parent feeling hesitant. In most cases, after seeking information from the Internet, healthcare providers and personal contacts move toward acceptance and agree to start treatment. Although adolescents have some short-term concerns, such as about needles, parents' concerns relate more to long-term risks. Ultimately, for both parents and adolescents, the benefits of treatment outweigh any concerns, and they are in agreement about the goals of personal confidence, comfort in one's body and happiness. CONCLUSIONS To the extent that the decision about GAHT is a medical decision, the decision process is similar to others. However, decisions about GAHT are much more about gender identity than medical risks, suggesting that interventions based in a medical framework may not aid in supporting decision-making.
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Affiliation(s)
- Thomas Daley
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel Grossoehme
- University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jenifer K McGuire
- Department of Family Social Science, University of Minnesota, Minneapolis, Minnesota
| | - Sarah Corathers
- University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lee Ann Conard
- University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ellen A Lipstein
- University of Cincinnati College of Medicine, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Shared decision-making aid for juvenile idiopathic arthritis: moving from informative patient education to interactive critical thinking. Clin Rheumatol 2019; 38:3217-3225. [PMID: 31327085 DOI: 10.1007/s10067-019-04687-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/19/2019] [Accepted: 07/09/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To develop and evaluate an illustrated, stand-alone, interactive evidence-based shared decision making (SDM) aid for JIA children; its ability to produce positive perceived involvement of JIA patients in their own management and its impact on their adherence to therapy, school absenteeism and treatment outcomes. METHODS The SDM aid was developed to offer information about the disease, risks and benefits of treatment. A multidisciplinary team defined SDM criteria based on international standards (IPDAS). Eight categories emerged as highly important for SDM. Each category was supported by simple illustrations in an interactive style. At the end of each category, the child is asked to make a decision in view of the information given. Ninety-four JIA children were provided with the tool, in a randomised controlled study, in comparison to a control group of 95 JIA patients treated according to standard protocols. RESULTS A total of 97.5% of the study children reported comprehensibility of more than 90%. The patients' adherence to therapy was significantly (p < 0.01) higher in the SDM group, whereas stopping DMARDs for intolerability was significantly higher in the control group at 12 months of treatment. There was a significant improvement in the patient-reported outcomes in the SDM group, and absence from school was significantly higher in the control group (p < 0.01). CONCLUSIONS The developed SDM aid offered the children evidence-based information about the pros and cons of treatment options and improved their understanding of the disease and their ability to make an informed decision that is reflected on their adherence to therapy and better treatment outcomes. Key Points • This work represents the second generation of shared decision-making tools. • The developed tool adopts an interactive style and enhances critical thinking, giving the patients the facility of making their own decision regarding their management. • The work gives an example of core domain set of outcomes which can be used for shared decision-making interventions.
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Ronis SD, Kleinman LC, Stange KC. A Learning Loop Model of Collaborative Decision-Making in Chronic Illness. Acad Pediatr 2019; 19:497-503. [PMID: 31009759 PMCID: PMC8127066 DOI: 10.1016/j.acap.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/08/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022]
Abstract
Shared decision-making is a core attribute of quality health care that has proved challenging to implement and assess in pediatric practice. Current models of shared decision-making are limited, including their capacity to incorporate multiple stakeholders; to integrate downstream effects of subacute or minor decisions; and to account for the context(s) in which such decisions are being made and enacted. Based on a review of literature from organizational psychology, cognitive sciences, business, and medicine, we propose an iterative decision-making model of care planning and identify targets at several levels of influence warranting measurement in future studies. Our learning loop model posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that "meta-learning" from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians. We consider the model in light of the needs of children with special health care needs, for whom understanding the ongoing iterative effects of decision making and clinician-parent-child dynamics are likely to be particularly important in influencing outcomes.
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Affiliation(s)
- Sarah D Ronis
- Department of Pediatrics, Case Western Reserve University, and UH Rainbow Center for Child Health and Policy, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio (SD Ronis).
| | - Lawrence C Kleinman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (LC Kleinman)
| | - Kurt C Stange
- Center for Community Health Integration, Department of Family Medicine & Community Health, Department of Population & Quantitative Health Sciences, Department of Sociology, Case Western Reserve University, Cleveland, Ohio (KC Stange)
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Fernandez HGC, Moreira MCN, Gomes R. Making decisions on health care for children / adolescents with complex chronic conditions: a review of the literature. CIENCIA & SAUDE COLETIVA 2019; 24:2279-2292. [PMID: 31269185 DOI: 10.1590/1413-81232018246.19202017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/30/2017] [Indexed: 11/21/2022] Open
Abstract
The profile of pediatric care has gone through changes in Brazil and in the world. This process becomes more visible in surveys that deal with hospital admission or specialized outpatient care data. This fact leads us to the idea that it is in such spaces that these children and subjects who care for them are more visible and negotiate decisions. We aim to perform a state of the art literature review on decision making discussions and definitions, analyzing the current research in light of the theoretical Mol perspectives on the actors' logics of chronic diseases care; And the perspective of care goods exchanges in the dialogue between Martins and Moreira, triggering the Theory of Gift. The synthesis of the literature shows that decision making may be understood as a care planning process in which family, patients and health professionals are involved, and is linked to the family-centered care model. In terms of difficulties, we point out the prevalence of a dynamic that favors a criticizable choice because of the risks of inequality, such as the lack of discussion on the options and the actuation of the family mostly in times of difficult decisions.
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Affiliation(s)
| | | | - Romeu Gomes
- Instituto Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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Lunstead J, Weitzman ER, Harstad E, Dedeoglu F, Gaffin JM, Garvey KC, MacGinnitie A, Rufo PA, Fishman LN, Wisk LE, Levy S. Screening and Counseling for Alcohol Use in Adolescents With Chronic Medical Conditions in the Ambulatory Setting. J Adolesc Health 2019; 64:804-806. [PMID: 31122509 PMCID: PMC6540811 DOI: 10.1016/j.jadohealth.2019.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE We seek to determine how youth with chronic medical conditions experience alcohol screening and counseling. METHODS Adolescents with type I diabetes, juvenile idiopathic arthritis, moderate persistent asthma, cystic fibrosis, attention deficit hyperactivity disorder, or inflammatory bowel disease were surveyed. Descriptive statistics and regression analysis quantified rates of asking and counseling about alcohol. RESULTS Of 390 participants (75.1% white/non-Hispanic, 51.8% female, average age 16.4 years), 70% reported being asked about their alcohol use by a healthcare provider, and 76% reported receiving at least one message regarding alcohol and health. Of past year drinkers, 54% disclosed use to their provider. Only 2.0% of youth reported receiving the message "I should not drink." CONCLUSIONS Most youth with chronic medical conditions were asked and counseled about alcohol use although few heard unambiguous recommendations to avoid alcohol consumption.
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Affiliation(s)
- Julie Lunstead
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Elissa R Weitzman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth Harstad
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Fatma Dedeoglu
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Immunology, Rheumatology Program, Boston Children's Hospital, Boston, Massachusetts
| | - Jonathan M Gaffin
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Katharine C Garvey
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Andrew MacGinnitie
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Paul A Rufo
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts
| | - Laurie Newman Fishman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts; Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Lauren E Wisk
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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Malone H, Biggar S, Javadpour S, Edworthy Z, Sheaf G, Coyne I. Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis. Cochrane Database Syst Rev 2019; 5:CD012578. [PMID: 31119726 PMCID: PMC6531890 DOI: 10.1002/14651858.cd012578.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Shared decision-making is important in child and adolescent healthcare because there is growing international recognition of children and young people's rights to be included in decisions that affect them. In order for young people to participate effectively in shared decision-making they need to develop the skills of engagement with healthcare professionals and confidence in interacting with them. They also need to learn how to manage their condition and treatments on their own when they move into adulthood. Children and young people who participate in shared decision-making in healthcare are likely to be more informed, feel more prepared, and experience less anxiety about the unknown. Significant improvements in cystic fibrosis (CF) survival over recent decades, due to improved therapies and better management of care, means that young people with CF are routinely transitioning to adult healthcare where increasing emphasis on self-management brings greater complexity in decision-making. We need to know what interventions are effective in promoting shared decision-making for young people with CF. OBJECTIVES To assess the effectiveness of interventions that promote participation in shared decision-making for children and adolescents (aged between four and 18 years) with CF. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearches of journals and conference abstract books. We also searched the reference lists of articles and reviews addressing shared decision-making.Date of most recent search: 12 March 2019.We searched PubMed, CINAHL (EBSCO), Embase (Elsevier), PsycINFO (EBSCO), WHO ICTRP, ASSIA (ProQuest), ERIC (ProQuest), ProQuest Dissertations and Theses, and ClinicalTrials.gov. We contacted study authors with published relevant research in shared decision-making for adults to ask if they were aware of any published or ongoing studies on the promotion of the intervention for children or adolescents (or both) with CF.Date of most recent search: 19 March 2019. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) (but not cross-over RCTs) of interventions promoting shared decision-making for children and adolescents with CF aged between four and 18 years, such as information provision, booklets, two-way interaction, checking understanding (by the participant), preparation to participate in a healthcare decision, decision-aids, and training interventions or educational programs. We planned to include interventions aimed at children or adolescents (or both), parents or healthcare professionals or any combination of these groups provided that the focus was aimed at promoting shared decision-making for children and adolescents with CF. DATA COLLECTION AND ANALYSIS Two authors independently reviewed papers identified in the searches. MAIN RESULTS No eligible RCTs were identified for inclusion in this systematic review. AUTHORS' CONCLUSIONS We were unable to identify RCTs with evidence which would support healthcare policy-making and practice related to implementation of shared decision-making for children and adolescents (aged between four and 18 years) with CF). We hope that having identified this gap in research, awareness will increase amongst researchers of the need to design high-quality shared decision-making interventions for young people with CF, perhaps adapted from existing models for adults, and to test these interventions and children's preferences in RCTs. It is also important to target health professionals with evidence-based education programmes on shared decision-making and a need for international consensus on addressing the variability in education programmes.
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Affiliation(s)
- Helen Malone
- Trinity College DublinSchool of Nursing & Midwifery24 D’Olier Street, College GreenDublin 2Ireland
| | - Susan Biggar
- Australian Health Practitioner Regulation Agency (AHPRA)111 Burke Street, Level 7MelbourneAustraliaVIC 3000
| | - Sheila Javadpour
- Our Lady's Children's Hospital, CrumlinDepartment of Respiratory MedicineDublinIreland12
| | - Zai Edworthy
- Temple Street Children's University HospitalDepartment of PsychologyTemple StreetDublinIrelandDO1 YC67
| | - Greg Sheaf
- The Library of Trinity College DublinCollege StreetDublinIreland
| | - Imelda Coyne
- Trinity College DublinSchool of Nursing & Midwifery24 D'Olier StDublinIreland2
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Rasmussen GS, Kragballe K, Maindal HT, Lomborg K. Caring for young people with moderate to severe psoriasis: an interpretive description of parental perspectives. J DERMATOL TREAT 2019; 31:227-234. [PMID: 30835580 DOI: 10.1080/09546634.2019.1590523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Psoriasis often sets on during childhood or adolescence, when parents have great importance for the young people's self-management, well-being, and quality of life. The aim of this study was to understand parents' perspectives on young people's daily life with psoriasis in order to improve adolescents' self-management.Method: Adopting interpretive, description methodology (ID), focus group discussion, and interviews were conducted with eight parents of adolescents with psoriasis. The analysis was inductive with an iterative comparative approach. Main themes conveying participants' perceptions were identified for constructing a coherent narrative of parents' perspectives on their young people's transition with psoriasis through adolescence.Results: Parents initially perceived psoriasis mainly a physical and treatment-related burden and not until late realized its socio-emotional impact. They eventually found themselves balancing between declining treatment due to fear of side effects and acknowledging the impact on their young people's quality of life and their desire for effective treatment.Conclusions: Caring for young people with psoriasis is a stressful process involving experimental learning to understand and manage the complexity of psoriasis and its impact on adolescents' emotional and social life. Future research should consider integration of shared decision-making and self-management support interventions in routine daily care as focus points.
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Affiliation(s)
| | - Knud Kragballe
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Grande SW, Longacre MR, Palmblad K, Montan MV, Berquist RP, Hager A, Kotzbauer G. Empowering Young People Living With Juvenile Idiopathic Arthritis to Better Communicate With Families and Care Teams: Content Analysis of Semistructured Interviews. JMIR Mhealth Uhealth 2019; 7:e10401. [PMID: 30794202 PMCID: PMC6406228 DOI: 10.2196/10401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 01/06/2023] Open
Abstract
Background Young people living with juvenile idiopathic arthritis (JIA) face a number of communication barriers for achieving optimal health as they transition from pediatric care into adult care. Despite growing interest in mobile or wireless technologies to support health (mHealth), it is uncertain how these engagement tools might support young people, their families, and care teams to optimize preference-based treatment strategies. Objective This study aims to examine how an mHealth patient support system (mPSS) might foster partnership between young people living with JIA, their families, and care teams. Methods Semistructured interviews with young people (5-15 years old), their families, and JIA care teams were conducted using researcher-developed interviews guides. Transcribed data were qualitatively analyzed using conventional content analysis. Results We conducted semistructured interviews with 15 young people, their parents, and 4 care team members. Content analysis revealed the potential of an mPSS to support productive dialogue between families and care teams. We identified four main themes: (1) young people with JIA face communication challenges, (2) normalizing illness through shared experience may improve adherence, (3) partnership opens windows into illness experiences, and (4) readiness to engage appears critical for clinic implementation. Conclusions A human-centered mPSS design that offers JIA patients the ability to track personally relevant illness concerns and needs can enhance communication, generate consensus-based treatment decisions, and improve efficiency and personalization of care. Technology that supports continuous learning and promotes better understanding of disease management may reduce practice burden while increasing patient engagement and autonomy in fostering lasting treatment decisions and ultimately supporting personalized care and improving outcomes.
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Affiliation(s)
- Stuart W Grande
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Meghan R Longacre
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Karin Palmblad
- Karolinska Institutet, Department of Women and Child Health, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Greg Kotzbauer
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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Boland L, Graham ID, Légaré F, Lewis K, Jull J, Shephard A, Lawson ML, Davis A, Yameogo A, Stacey D. Barriers and facilitators of pediatric shared decision-making: a systematic review. Implement Sci 2019; 14:7. [PMID: 30658670 PMCID: PMC6339273 DOI: 10.1186/s13012-018-0851-5] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/27/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) is rarely implemented in pediatric practice. Pediatric health decision-making differs from that of adult practice. Yet, little is known about the factors that influence the implementation of pediatric shared decision-making (SDM). We synthesized pediatric SDM barriers and facilitators from the perspectives of healthcare providers (HCP), parents, children, and observers (i.e., persons who evaluated the SDM process, but were not directly involved). METHODS We conducted a systematic review guided by the Ottawa Model of Research Use (OMRU). We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, PubMed, and PsycINFO (inception to March 2017) and included studies that reported clinical pediatric SDM barriers and/or facilitators from the perspective of HCPs, parents, children, and/or observers. We considered all or no comparison groups and included all study designs reporting original data. Content analysis was used to synthesize barriers and facilitators and categorized them according to the OMRU levels (i.e., decision, innovation, adopters, relational, and environment) and participant types (i.e., HCP, parents, children, and observers). We used the Mixed Methods Appraisal Tool to appraise study quality. RESULTS Of 20,008 identified citations, 79 were included. At each OMRU level, the most frequent barriers were features of the options (decision), poor quality information (innovation), parent/child emotional state (adopter), power relations (relational), and insufficient time (environment). The most frequent facilitators were low stake decisions (decision), good quality information (innovation), agreement with SDM (adopter), trust and respect (relational), and SDM tools/resources (environment). Across participant types, the most frequent barriers were insufficient time (HCPs), features of the options (parents), power imbalances (children), and HCP skill for SDM (observers). The most frequent facilitators were good quality information (HCP) and agreement with SDM (parents and children). There was no consistent facilitator category for observers. Overall, study quality was moderate with quantitative studies having the highest ratings and mixed-method studies having the lowest ratings. CONCLUSIONS Numerous diverse and interrelated factors influence SDM use in pediatric clinical practice. Our findings can be used to identify potential pediatric SDM barriers and facilitators, guide context-specific barrier and facilitator assessments, and inform interventions for implementing SDM in pediatric practice. TRIAL REGISTRATION PROSPERO CRD42015020527.
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Affiliation(s)
- Laura Boland
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 307D-600 Peter Morand Cresent, Ottawa, ON, K1G 5Z3, Canada
| | - France Légaré
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec City, Quebec, G1L 3L5, Canada
| | - Krystina Lewis
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada
| | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, 31 George Street Kingston, Ottawa, ON, K7L 3N6, Canada
| | - Allyson Shephard
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Alexandra Davis
- Learning Services, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Audrey Yameogo
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada.
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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Beal SJ, Wingrove T, Nause K, Lipstein E, Mathieu S, Greiner MV. The Role of Shared Decision-Making in Shaping Intent to Access Services for Adolescents in Protective Custody. CHILD CARE IN PRACTICE : NORTHERN IRELAND JOURNAL OF MULTI-DISCIPLINARY CHILD CARE PRACTICE 2019; 25:64-78. [PMID: 31130815 PMCID: PMC6532998 DOI: 10.1080/13575279.2018.1521379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Including children in protective custody (e.g., foster care) in legal decisions positively impacts their perceptions of the legal system, with giving youth a voice being particularly important. Studies have primarily focused on including young people in legal processes; however, for adolescents in protective custody, decisions about living arrangements, education, and long-term planning are made outside the courtroom, with ramifications for young people and their perceptions of both legal and child protection systems. This study looks at such decision making using existing data from 151 adolescents who were ages 16-20 and had been in child welfare protective custody for at least 12 months. During in-person interviews we assessed their desired amount of involvement in a recent decision and their perceptions of their actual involvement. Youth named other individuals involved in decision-making. Data were coded and analysed to identify discrepancies in young people's perceptions of desired and actual levels of involvement. Results indicate that while the majority of adolescents (96%) are participating in decision-making, they generally desire more involvement in decisions made (64%). Only 7% of youth reported that their level of personal involvement and the involvement of others matched what they desired. The most common individuals identified in a decision made were child protection workers, legal professionals, and caregivers or family members. These findings enhance the existing literature by highlighting the unique issues related to giving young people in protective custody a voice, and provide an empirical foundation for guiding policies around who to involve in every-day decisions made for young people preparing for emancipation from protective custody.
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Affiliation(s)
- Sarah J Beal
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229. USA
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267. USA
| | - Twila Wingrove
- Department of Psychology, Appalachian State University, 222 Joyce Lawrence Lane, Boone, NC 28608. USA
| | - Katie Nause
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229. USA
| | - Ellen Lipstein
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229. USA
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267. USA
| | - Stephane Mathieu
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229. USA
| | - Mary V Greiner
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229. USA
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267. USA
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Favier LA, Ting TV, Modi AC. Feasibility of a musculoskeletal ultrasound intervention to improve adherence in juvenile idiopathic arthritis: a proof-of concept trial. Pediatr Rheumatol Online J 2018; 16:75. [PMID: 30466449 PMCID: PMC6251087 DOI: 10.1186/s12969-018-0292-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/12/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Non-adherence is a prevalent and modifiable issue in juvenile idiopathic arthritis (JIA) that currently lacks provider-based intervention. Education surrounding disease status is one way in which families remain engaged in their care. Musculoskeletal ultrasound is one such form of demonstrative, real-time education that may impact the way patients and caregivers self-manage their disease. The aims of this study are to 1) assess the feasibility, acceptability and perceived usefulness of musculoskeletal ultrasound as a non-adherence intervention tool and 2) to examine changes in methotrexate adherence in adolescents with JIA following the ultrasound. METHODS Eight adolescents with polyarticular or extended oligoarticular JIA and their caregivers completed this 12 week study. A within subject design was used to compare baseline and post-intervention adherence, quality of life and disease activity indices. Adherence measures included electronic measurement of methotrexate in addition to self-reported adherence questionnaires. The ultrasound intervention included a one-time, rheumatologist provided, educational examination of three or more currently or historically active joints. RESULTS The ultrasound intervention was found to be both feasible and acceptable. One hundred percent of eligible participants completed the ultrasound intervention. The ultrasound was well received by patients and caregivers, with most believing this to be a helpful tool. Baseline adherence was 75.3% among participants, with half of the participants being classified as non-adherent. Electronically measured and self-reported adherence measures did not show significant changes during the post-intervention period. Two participants improved, four participants maintained, and two participants decreased adherence. On ultrasound, 18/27 (66.7%) of the examined joints displayed abnormalities, with 63% being discrepant and additive to the rheumatologist's physical examination. CONCLUSIONS While our intervention did not show any changes in adherence, quality of life or disease activity indices in this proof-of-concept trial, the intervention does show promise in acceptability measures and merits future study in a more robust trial design. An additional study benefit was that the musculoskeletal ultrasound intervention was able to demonstrate subclinical disease, leading to clinically impactful therapeutic changes in several participants.
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Affiliation(s)
- Leslie A. Favier
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, Department of Pediatric Rheumatology, 3333 Burnet Ave, MLC 4010, Cincinnati, OH 45229 USA ,0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229 USA
| | - Tracy V. Ting
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, Department of Pediatric Rheumatology, 3333 Burnet Ave, MLC 4010, Cincinnati, OH 45229 USA
| | - Avani C. Modi
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, Behavioral Medicine and Clinical Psychology, Center for Adherence and Self-Management, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229 USA
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Miller VA. Involving Youth With a Chronic Illness in Decision-making: Highlighting the Role of Providers. Pediatrics 2018; 142:S142-S148. [PMID: 30385620 PMCID: PMC6220652 DOI: 10.1542/peds.2018-0516d] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
Decision-making is important in the context of pediatric chronic illness because children and families need to make decisions about burdensome and complex treatments on a regular basis, and children must eventually learn how to make such decisions independently. Research related to children's decision-making in medical settings has been focused primarily on cognitive aspects of decision-making, such as understanding and capacity. The concept of decision-making involvement (DMI) recognizes that children can be involved in decision-making in multiple ways, regardless of capacity, and that parents and health care providers play a critical role in supporting children as they learn to make decisions on their own. Providers can facilitate DMI during medical encounters by asking for the children's opinions and concerns, encouraging turn-taking, soliciting questions, asking for information directly from the children, and checking that the children understand what has been said. Efforts to involve children send the message that the youth perspective is important and set the expectation for increased participation over time. Providers can also support parent-child decision-making about illness management at home by guiding parents as to how best to involve children in decisions about illness management, identifying areas in which more or less parental guidance and support are needed, and assisting youth in planning ahead for decision-making about illness management in high-risk situations. Additional research is needed to identify why children's DMI in medical settings remains low, develop and evaluate strategies to enhance DMI, and test the effects of DMI on health-related behaviors and outcomes over time.
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Affiliation(s)
- Victoria A Miller
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Jordan A, Wood F, Edwards A, Shepherd V, Joseph-Williams N. What adolescents living with long-term conditions say about being involved in decision-making about their healthcare: A systematic review and narrative synthesis of preferences and experiences. PATIENT EDUCATION AND COUNSELING 2018; 101:1725-1735. [PMID: 29937112 DOI: 10.1016/j.pec.2018.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To understand the preferences and experiences of adolescents (age 10-19) with long-term conditions (LTCs) towards involvement in discussions and decisions regarding management of their condition. METHODS A systematic review and narrative synthesis of mixed-methods, quantitative and qualitative and research was performed. Six databases were searched from inception to March 2017. The quality of the articles was assessed, and relevant data were extracted and coded thematically. RESULTS The search yielded 27 articles which met the inclusion criteria. Decision-making involvement preferences and experiences were reported from the adolescents' perspectives. Adolescents often report that they do not have any choice of treatment options. Variability in preferences and experiences were found within and between individuals. Mismatches between preferences and experiences are common, and often with negative emotional consequences. DISCUSSION Adolescent preferences for involvement in the decision-making process are situational and individualistic. Healthcare professionals can encourage involvement by ensuring that adolescents are informed of treatment options, and aware of the value of their contribution. Future research should explore adolescent perceived barriers and facilitators to SDM. PRACTICAL IMPLICATIONS Interventions are needed to effectively train HCPs in the delivery of shared decision-making, and to support the participation of adolescents with LTCs in shared decision-making.
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Affiliation(s)
- Amber Jordan
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom.
| | - Fiona Wood
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Adrian Edwards
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Victoria Shepherd
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
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Packham J. Optimizing outcomes for ankylosing spondylitis and axial spondyloarthritis patients: a holistic approach to care. Rheumatology (Oxford) 2018; 57:vi29-vi34. [PMID: 30445484 PMCID: PMC6238224 DOI: 10.1093/rheumatology/key200] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/05/2018] [Indexed: 01/20/2023] Open
Abstract
Axial SpA (axSpA) can affect diverse elements of an individual's life. The areas affected can be much more wide-ranging than the historical medical model of SpA, causing increased disease activity (pain and stiffness) and disability (reduced range of movement and physical function). A more holistic view of the individual results in the realization that many other areas of life can be adversely affected by axSpA, from the ability to work effectively and function socially, to effects on quality of life and the onset of worsening fatigue or mood disturbance. A good understanding of these areas outside the medical model allows for an improved understanding of the overall life impact of axSpA. This highlights the importance of understanding how to measure these elements of life using patient-reported outcome measures that can truly reflect an individual's experience of axSpA. These measures can then provide a better insight into the risks and benefits of interventions and medications used to treat axSpA.
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Affiliation(s)
- Jonathan Packham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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Favier LA, Taylor J, Loiselle Rich K, Jones KB, Vora SS, Harris JG, Gottlieb BS, Robbins L, Lai JT, Lee T, Kohlheim M, Gill J, Bouslaugh L, Young A, Griffin N, Morgan EM, Modi AC. Barriers to Adherence in Juvenile Idiopathic Arthritis: A Multicenter Collaborative Experience and Preliminary Results. J Rheumatol 2018; 45:690-696. [PMID: 29419467 PMCID: PMC5932234 DOI: 10.3899/jrheum.171087] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Nonadherence is currently an underrecognized and potentially modifiable obstacle to care in juvenile idiopathic arthritis (JIA). The purpose of our study was to design and implement a standardized approach to identifying adherence barriers for youth with JIA across 7 pediatric rheumatology clinics through the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) and to assess the frequency of adherence barriers in patients and their caregivers across treatment modalities. METHODS An iterative process using coproduction among parents and providers of patients with JIA was used to design the Barriers Assessment Tool to screen for adherence barriers across 4 treatment modalities (i.e., oral medications, injectable medications, infusions, and physical/occupational therapy). This tool was implemented in 7 rheumatology clinics across the United States and patient responses were collected for analysis. RESULTS Data were collected from 578 parents and 99 patients (n = 44 parent-child dyads). Seventy-seven percent (n = 444) of caregivers and 70% (n = 69) of patients reported at least 1 adherence barrier across all treatment components. The most commonly reported adherence barriers included worry about future consequences of therapy, pain, forgetting, side effects, and embarrassment related to the therapy. There was no significant difference between endorsement of barriers between parents and adolescents. CONCLUSION Implementing a standardized tool assessing adherence barriers in the JIA population across multiple clinical settings is feasible. Systematic screening sheds light on the factors that make adherence difficult in JIA and identifies targets for future adherence interventions in clinical practice.
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Affiliation(s)
- Leslie A Favier
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA.
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati.
| | - Janalee Taylor
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Kristin Loiselle Rich
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Karla B Jones
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Sheetal S Vora
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Julia G Harris
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Beth S Gottlieb
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Lisa Robbins
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Jamie T Lai
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Tzielan Lee
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Melanie Kohlheim
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Jennifer Gill
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Laura Bouslaugh
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Angela Young
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Nancy Griffin
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Esi M Morgan
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Avani C Modi
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
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49
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Davidson LF, Doyle M, Silver EJ. Discussing Future Goals and Legal Aspects of Health Care: Essential Steps in Transitioning Youth to Adult-Oriented Care. Clin Pediatr (Phila) 2017; 56:902-908. [PMID: 28466656 DOI: 10.1177/0009922817706142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Discussing realistic future goals with the adolescent alone and with family, and reviewing legal aspects of health care transition (HCT), are essential steps in the transition from pediatric to adult-oriented care. Secondary analysis of datasets from 2 studies related to HCT assessed differences in provider practice for youth with and without special health care needs (SHCNs). Across both datasets, between 57% and 68.6% of providers reported some discussion of future goals with adolescent or with family. However, only 28.6% to 31% of providers reported discussing future goals with youth with SHCNs alone. It was rare for providers to report discussing legal aspects of HCT with any youth. Findings identify a gap in discussing future goals and legal aspects of HCT, as part of routine care for adolescents. Additional research to understand barriers and improve likelihood of these steps within HCT is needed.
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Affiliation(s)
- Lynn F Davidson
- 1 Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maya Doyle
- 1 Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.,2 Quinnipiac University, Hamden, CT, USA
| | - Ellen J Silver
- 1 Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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50
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Condon C, O’Regan D, MacDermott E, Killeen O. Self-management needs of children with JIA in Ireland: a qualitative survey of families. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1342865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Cillin Condon
- Physiotherapy Discipline, Trinity College Dublin, Dublin, Ireland
| | - David O’Regan
- Physiotherapy Discipline, Trinity College Dublin, Dublin, Ireland
| | - Emma MacDermott
- Pediatric Rheumatology, Our Lady’s Hospital for Children, Dublin, Ireland
| | - Orla Killeen
- Pediatric Rheumatology, Our Lady’s Hospital for Children, Dublin, Ireland
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