Counseling children with chronic physical illness

They know it's safe - they know what to expect from that face: perceptions towards a cognitive-behavioural counselling programme among caregivers of children with cystic fibrosis

AIMS AND OBJECTIVES

To explore the experiences of eight caregivers who provide care to children with cystic fibrosis in an eight-week cognitive-behavioural counselling programme at a children's hospital in Winnipeg, Canada.

BACKGROUND

Youth with cystic fibrosis experience significant behavioural and psychosocial challenges, such as depression, anxiety and poor treatment adherence. Caregivers are critical to the provision of care and treatment to young people living with cystic fibrosis. Caregivers of youth with cystic fibrosis experience psychosocial morbidity. Thus, the development of counselling interventions is required to enhance psychosocial well-being among the caregivers of youth with cystic fibrosis.

DESIGN AND METHODS

This study was informed by the thematic analytic qualitative research tradition. In-depth, semistructured interviews were conducted with eight caregivers who participated in our programme. The audiotaped interviews were then subject to thematic analysis.

RESULTS

The counselling sessions were experienced as 'distinctly different' from routine appointments at the hospital and were characterised by a sense of listening and bidirectional communication. In addition to acquiring a sense of trust and accountability through the programme, counselling appeared to enhance caregivers' perception of their time use, leading to greater temporal agency.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

From this evidence-based cognitive-behavioural counselling programme, insights about the complex psychosocial lives of the cystic fibrosis community are discussed within the context of the literature. Integrating cognitive-behavioural counselling into routine clinical CF care should be considered as a method to enhance caregiving capacity in the CF community and should be championed by nurses.

Doenças crônicas em crianças e adolescentes: uma revisão bibliográfica

O artigo analisa artigos publicados entre 2003 e 2011 enfocando discussões sobre condições crônicas ou doenças crônicas de crianças e adolescentes. Metodologicamente conjuga a revisão de literatura a uma análise de conteúdo temática com vistas a identificar quais os elementos que caracterizam doenças crônicas em crianças e adolescentes e as especificidades geradas por essas condições. A revisão resultou na descrição do conjunto dos artigos, caracterizando-os quanto ano de publicação, país, tipo de estudo, população e condição de cronicidade abordada. A análise de conteúdo temática gerou dois temas: Definição de Doença Crônica e Formas de se lidar com as doenças crônicas em crianças e adolescentes. Destaca-se como conclusão que as transições etárias quando uma doença é diagnosticada e tratada desde a infância, vai passar por transformações que incluem a maneira como se dá o seu fluxo entre os serviços e as mudanças que envolvem processos de alta, de tomada de decisão e de construção de rede que inclua família, hospital, escola e sistema de garantia de direitos.

Health-related quality of life in adolescents with chronic physical illness in northern Russia: a cross-sectional study

Background

Health related quality of life (HRQoL) is an important subjectively evaluated outcome of adolescents physical, mental, and social functioning. It gives us the possibility to assess the disease impact on life of adolescents, and to sort out target groups of adolescents for future psychological interventions. The objective of this cross-sectional survey was to study HRQoL in 173 adolescents with chronic physical illness (CPI - diabetes, asthma, and epilepsy), and to find HRQoL predictors in each disease group.

Methods

Disease-specific questionnaires were completed by each adolescent recruited from the local outpatient clinic; mothers answered the questions on socioeconomic status (SES); and the patients’ clinicians evaluated the severity of the disease.

Results

A high proportion of adolescents in each disease specific sample reported moderate to high levels of HRQoL. Gender was the most prominent predictor of HRQoL in all three studied groups, while disease severity predicted HRQoL in the diabetic group and to some extent in the asthma group.

Conclusions

Our results provide evidence that adolescents with diabetes, asthma, and epilepsy in northern Russia maintain relatively moderate to high levels of HRQoL. The domains affecting HRQoL were related to both disease-specific (severity) and non-disease factors (gender and SES). Our study suggests that future psychosocial interventions should focus on aspects of CPI impacting adolescents in gendered ways, furthermore taking into account disease specific factors.

Family functioning and juvenile chronic physical illness in Northern Russia

AIM

To study family functioning of adolescents with chronic physical illnesses and factors related to it. The following research questions were addressed: (i) if families with adolescents with chronic physical illnesses were at increased risk for problematic functioning compared to the healthy control families; (ii) was disease severity associated with family dysfunction; and (iii) did family functioning level differ in three disease groups (diabetes, asthma and epilepsy).

METHODS

Self-report family inventory and socio-economic status questions were individually completed by 148 adolescents with physical illnesses aged 13-16 years and their mothers; medical data were obtained from the files at the outpatient clinics. Comparative data were collected from a group of 301 schoolchildren.

RESULTS

Overall there were no differences found in functioning of families with physically ill adolescents compared to controls. Family functioning was significantly associated with the number of disease-specific (disease severity and duration) and non-disease (socio-economic status and family type) factors.

CONCLUSION

In our study, families with physically ill adolescents showed considerable resilience and tolerance to the changes in habitual functioning of the family unit. While greater disease severity, longer disease duration, as well as single-parent household were the factors that contributed to the family dysfunction.

Mental health in adolescents with chronic physical illness versus controls in Northern Russia

AIM

To study the behaviour/emotional problems and depression in adolescents with and without physical illnesses; to compare the same psychological parameters in adolescents with different disorders.

METHODS

The sample consisted of 148 adolescents aged 13-16 years with one of the following physical chronic conditions: diabetes (n = 55), asthma (n = 59), or epilepsy (n = 59). Comparative data were obtained from a group of 301 schoolchildren. Test batteries (Child Behaviour Check-List, Youth Self Report, Beck Depression Inventory, socio-economic status questions) were individually completed by adolescents and their mothers.

RESULTS

Overall adolescents with physical illness had more behaviour/emotional problems and were more depressed compared to controls although results varied according to the informants and the disease severity. Two risk groups were revealed: girls with asthma and boys with epilepsy.

CONCLUSION

Our results suggest that mental health in adolescents with chronic physical illnesses is poorer than in controls and their mental health state is very much associated with the disease severity. The findings of the study can help to develop disease targeted and comprehensive interventions in outpatient clinics of Northern Russia in order to reduce behaviour and mood disorders in adolescents with chronic physical illnesses and therefore to smooth the transition through their teenage years.