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Verma P, Sharma S, Kaur S, Rohilla L, Malhi P, Dayal D. Evaluation of a nurse-led counselling intervention on selected outcome variables for parents of children with congenital adrenal hyperplasia. J Pediatr Endocrinol Metab 2023; 36:248-254. [PMID: 36727475 DOI: 10.1515/jpem-2022-0559] [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: 10/30/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Long-term care of children with congenital adrenal hyperplasia (CAH) has psycho-social implications for parents. Experts recommend a customized educational program for parents to facilitate their psychological adaptation and improve disease management. Such educational programs often provided by nurse counsellors are well evaluated in developed countries. There is a dearth of data on nurse-led counselling in the context of less developed countries. We aimed to evaluate the effect of a nurse-led counselling intervention on various psycho-social outcomes among parents of children with CAH. METHODS Fifty consecutive parents of children with CAH attending an outpatient clinic at a tertiary-care teaching hospital were enrolled. Parents' stress level, stigma, knowledge, practices, and treatment adherence were assessed by using Cohen's Perceived Stress Scale (PSS), DSD Stigma scale, and HILL-Bon Medication Adherence Scale (HB-MAS). Three educational counselling sessions were conducted within a month's gap, using PowerPoint presentations and a booklet. Assessment of outcomes was done at baseline and at the end of the third session. RESULTS At baseline, the majority (90%) of the parents had moderate stress. Half of the parents had mild and the rest had moderate stigma. After the intervention, the majority (94%) of parents had shifted to mild levels of stress and stigma. At baseline, 86% of the parents had poor knowledge about the disease whereas post-intervention, 80% were having good knowledge. Disease management practices and treatment adherence also improved after the intervention. CONCLUSIONS Nurse-led counselling was effective in reducing psycho-social problems, increasing knowledge, as well as improving practices and treatment adherence.
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Affiliation(s)
- Poonam Verma
- National Institute of Nursing Education, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sunita Sharma
- National Institute of Nursing Education, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sukhwinder Kaur
- National Institute of Nursing Education, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Latika Rohilla
- Endocrinology & Diabetes Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Prahbhjot Malhi
- Endocrinology & Diabetes Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Devi Dayal
- Endocrinology & Diabetes Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Fisher RS, Espeleta HC, Baskin LS, Buchanan CL, Chan YM, Cheng EY, Coplen DE, Diamond DA, Nokoff NJ, Palmer BW, Poppas DP, Scott Reyes KJ, Tishelman A, Wolfe-Christensen C, Mullins LL, Wisniewski AB. Decisional regret about surgical and non-surgical issues after genitoplasty among caregivers of female infants with CAH. J Pediatr Urol 2022; 18:27-33. [PMID: 34742644 PMCID: PMC8983419 DOI: 10.1016/j.jpurol.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Caregivers of female infants with congenital adrenal hyperplasia (CAH) often confront complex medical decision-making (e.g., early feminizing genitoplasty). OBJECTIVE This study aimed to evaluate the relevant medical decisions and subsequent decisional regret of caregivers following their child's genitoplasty. STUDY DESIGN Caregivers (N = 55) were recruited from multidisciplinary treatment programs for participation in a longitudinal study. Qualitative data was collected at 6-12 months following feminizing genitoplasty to evaluate caregiver-reported decision points across their child's treatment. Quantitative exploratory analysis evaluated pre-operative predictors of subsequent decisional regret. DISCUSSION When prompted about their decision-making and potential regret, most caregivers (n = 32, 80%) reported that their daughter's genital surgery was their primary medical decision. Specific themes regarding genital surgery included the timing and type of surgery. Most caregivers reported no decisional regret (62%), with 38% reporting some level of regret. Greater pre-operative illness uncertainty predicted heightened decisional regret at follow-up, p = .001. CONCLUSION Two-thirds of caregivers of female infants with CAH reported not regretting their decision-making. Nevertheless, over one-third of caregivers reported some level of regret, suggesting the need for improvements in shared decision-making processes. Many, but not all, families reported that this regret was related to surgical decision-making. Reducing caregiver illness uncertainty (e.g., providing clear information to families) may increase their satisfaction with decision-making. Further research is needed to determine how the evolving care practices surrounding early genitoplasty will impact families.
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Affiliation(s)
- Rachel S Fisher
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Hannah C Espeleta
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Laurence S Baskin
- University of California San Francisco Medical Center, Department of Urology, San Francisco, CA, USA
| | - Cindy L Buchanan
- University of Colorado Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, USA
| | - Yee-Ming Chan
- Boston Children's Hospital, Division of Endocrinology, Department of Pediatrics, Harvard Medical School, Department of Pediatrics, Boston, MA, USA
| | - Earl Y Cheng
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Urology, Chicago, IL, USA
| | - Douglas E Coplen
- St. Louis Children's Hospital, Division of Urologic Surgery, St. Louis, MO, USA
| | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Division of Endocrinology, Aurora, CO, USA
| | - Blake W Palmer
- Cook Children's Medical Center, Department of Pediatric Urology, Fort Worth, TX, USA
| | - Dix P Poppas
- New York Presbyterian Weill Cornell Medicine, Department of Urology, Komansky Children's Hospital, New York, NY, USA
| | - Kristy J Scott Reyes
- Cook Children's Medical Center, Department of Pediatric Urology, Fort Worth, TX, USA
| | | | | | - Larry L Mullins
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA
| | - Amy B Wisniewski
- Oklahoma State University, Department of Psychology, Center for Pediatric Psychology, Stillwater, OK, USA.
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Szymanski KM, Rink RC, Whittam B, Hensel DJ. Majority of females with a life-long experience of CAH and parents do not consider females with CAH to be intersex. J Pediatr Urol 2021; 17:210.e1-210.e9. [PMID: 33041207 DOI: 10.1016/j.jpurol.2020.09.009] [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: 07/09/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To assess opinions of females with CAH, and parents of females with CAH, about designating this population "intersex," particularly in legislation about genital surgery during childhood. METHODS We conducted a mixed-methods (quantitative and qualitative) anonymous cross-sectional online survey of females with CAH (46XX, 16+years old) and independently recruited parents of girls with CAH (2019-2020) diagnosed in first year of life from the United States. A multidisciplinary CAH team drafted the survey in collaboration with women with CAH and parents. Fisher's exact test was used to compare female and parent responses. A qualitative thematic approach was used to analyze open-ended answers for emergent categories of reasons why CAH females should or should not be considered as intersex. RESULTS Of 57 females with CAH participating (median age: 39 years, 75.5% of ≥25year olds had post-secondary degree), all had classical CAH and 93.0% underwent genital surgery at median 1-2 years old. While 89.5% did not endorse the intersex designation for CAH, the remaining 5.3% did (5.3% provided no answer, Summary Figure). Most CAH females (63.2%) believed CAH females should be considered separately in "any laws banning or allowing surgery of children's genitals" (19.3% disagreed, 17.5% neutral, 0.0% no answer). Most common themes identified by females with CAH not endorsing an intersex designation were: normal female internal organs, sex chromosomes, personal identity, genital appearance, issues with language, hormones, and those endorsing it: genital appearance, community/group experiences, topic complexity. Overall, 132 parents of females with CAH participated (parent/child median ages: 40/11 years, 81.7% of ≥25year olds had post-secondary degree). All children had classical CAH and 78.8% underwent surgery at median <1 year old. While 95.5% of parents did not endorse the intersex designation for CAH, 2.3% did (2.3% no answer), similar to females (p = 0.29). Most parents (81.1%) believed CAH females should be considered separately in legislation (9.1% disagreed, 6.1% neutral, 3.8% no answer), a slightly higher percentage than females (p = 0.01). DISCUSSION Echoing previously published disagreement with clinically designating CAH females as intersex, majority of CAH females and parents oppose a legal intersex designation. Differing opinions among females and parents strengthen concern about a one-size-fits-all approach to legislation about childhood genital surgery. Differences in opinions between female and parent responses, while statistically significant, were relatively small. CONCLUSION Majority of females with CAH and parents believe CAH should be excluded from the intersex designation, and should be considered separately in legislation pertaining to childhood genital surgery.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Devon J Hensel
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine and Department of Sociology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
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O'Kelly F, Sparks S, Seideman C, Gargollo P, Granberg C, Ko J, Malhotra N, Hecht S, Swords K, Rowe C, Whittam B, Spinoit AF, Dudley A, Ellison J, Chu D, Routh J, Cannon G, Kokorowski P, Koyle M, Silay MS. A survey and panel discussion of the effects of the COVID-19 pandemic on paediatric urological productivity, guideline adherence and provider stress. J Pediatr Urol 2020; 16:492.e1-492.e9. [PMID: 32680626 PMCID: PMC7334656 DOI: 10.1016/j.jpurol.2020.06.024] [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: 05/10/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has led to an unprecedented need to re-organise and re-align priorities for all surgical specialties. Despite the current declining numbers globally, the direct effects of the pandemic on institutional practices and on personal stress and coping mechanisms remains unknown. The aims of this study were to assess the effect of the pandemic on daily scheduling and work balances, its effects on stress, and to determine compliance with guidelines and to assess whether quarantining has led to other areas of increased productivity. METHODS A trans-Atlantic convenience sample of paediatric urologists was created in which panellists (Zoom) discussed the direct effects of the COVID-19 pandemic on individual units, as well as creating a questionnaire using a mini-Delphi method to provide current semi-quantitative data regarding practice, and adherence levels to recently published risk stratification guidelines. They also filled out a Perceived Stress Scale (PSS) questionnaire to assess contemporary pandemic stress levels. RESULTS There was an 86% response rate from paediatric urologists. The majority of respondents reported near complete disruption to planned operations (70%), and trainee education (70%). They were also worried about the effects of altered home-lives on productivity (≤90%), as well as a lack of personal protective equipment (57%). The baseline stress rate was measured at a very high level (PSS) during the pandemic. Adherence to recent operative guidelines for urgent cases was 100%. CONCLUSION This study represents a panel discussion of a number of practical implications for paediatric urologists, and is one of the few papers to assess more pragmatic effects and combines opinions from both sides of the Atlantic. The impact of the pandemic has been very significant for paediatric urologists and includes a decrease in the number of patients seen and operated on, decreased salary, increased self-reported stress levels, substantially increased telemedicine usage, increased free time for various activities, and good compliance with guidelines and hospital management decisions.
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Affiliation(s)
- Fardod O'Kelly
- Division of Paediatric Urology, The Hospital for Sick Children, Toronto, Canada.
| | - Scott Sparks
- Division of Pediatric Urology, Children's Hospital of Los Angeles, CA, USA
| | - Casey Seideman
- Division of Pediatric Urology, OHSU Doernbecher Children's Hospital, Portland, OR, USA
| | | | | | - Joan Ko
- Division of Pediatric Urology, Children's Hospital of Los Angeles, CA, USA
| | | | - Sarah Hecht
- Division of Pediatric Urology, Children's Hospital Colorado, USA
| | - Kelly Swords
- Division of Pediatric Urology, Rady Children's Hospital, San Diego, CA, USA
| | - Courtney Rowe
- Division of Pediatric Urology, Connecticut Children's Hospital, USA
| | - Ben Whittam
- Division of Pediatric Urology, Riley Children's, Indianapolis, IN, USA
| | | | - Anne Dudley
- Division of Pediatric Urology, Connecticut Children's Hospital, USA
| | | | - David Chu
- Division of Pediatric Urology, Lurie Children's Chicago, IL, USA
| | - Jonathan Routh
- Division of Urologic Surgery, Duke University Medical Centre, NC, USA
| | - Glenn Cannon
- Division of Pediatric Urology, University of Pittsburgh Medical Centre, PA, USA
| | - Paul Kokorowski
- Division of Pediatric Urology, Children's Hospital of Los Angeles, CA, USA
| | - Martin Koyle
- Division of Paediatric Urology, The Hospital for Sick Children, Toronto, Canada
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