Compliance of adolescents with chronic disease

Amateur dubbing as a healthcare activity in the pediatric hospital setting: a pilot project

BACKGROUND

Dubbing is a mode of audiovisual translation (AVT) usually performed by experienced dubbing actors for professional purposes. Nowadays, thanks to advances in technology, everybody can create personal dubbed versions of audiovisual content for humorous and parodic as well as therapeutic and pedagogical purposes. The aim of this pilot project was to investigate the potential and applicability of amateur dubbing within the hospital setting, targeting children and adolescents.

METHODS

The project was carried out at Meyer Children's Hospital in Florence (Italy). Like other non-pharmacological activities, amateur dubbing was designed to make hospitalization a less traumatic experience for young patients and promote their general well-being. A research team (including psychologists, dubbing actors and a linguist) developed a theoretically sound and replicable set of procedures that combine new technologies with traditional pain management methods.

RESULTS

The amateur dubbing workshops, carried out from January 2017 until the end of December 2019, involved 297 children and adolescents (male=29.8%; female=70.2%), aged 6-17, from different wards (i.e. Oncology, Neuropsychiatry, Pediatric Unit, Diabetology, Neurology, Surgery, etc.). This pilot project has proven to be a positive experience for all the patients and their families, in terms of the children's well-being, quality of life and socialization (i.e. expression of emotions, distraction and reduction of distress).

CONCLUSIONS

Amateur dubbing as a healthcare activity has resulted in interesting recreational and psychological implications and benefits. Clearly, its implementation as a type of non-pharmacological technique needs to be further refined.

“Negotiating a new normality” - a longitudinal qualitative exploration of the meaning of living with an open surgical wound

Purpose

Little is known about the experiences of people living with open surgical wounds. These wounds are common and predominantly affect young and actively working people. The aim of this qualitative study was to explore the meaning of living with open surgical wounds.

Methods

A qualitative exploratory study was conducted. We collected data using two individual interviews with each of ten participants (aged between 18–73 years) who had open surgical wounds. Our analytical approach was based on qualitative content analysis. Methods are reported using COREQ guidelines.

Results

We found that the meaning of living with open surgical wounds is shaped by five subthemes: “enduring healing”, “life disruption”, “adapting to a new reality”, “striving for healing” and “returning to normal life;” all under an overarching theme of “negotiating a new normality”.

Conclusion

Participants’ well-being and everyday living are greatly impacted by open surgical wounds. Findings from this study emphasize that open surgical wounds are a long-term condition with a typical “chronicity” trajectory; this brings a new perspective to previous findings of studies on living with complex wounds. This study has also highlighted areas for further research, related to improving individuals’ experience of living with open surgical wounds.

Perimenstrual Asthma in Adolescents: A Shared Condition in Pediatric and Gynecological Endocrinology

Asthma is a frequent medical condition in adolescence. The worsening of the most common symptoms perimenstrually is defined as perimenstrual asthma (PMA). The cause of PMA remains unclear, but a role for hormonal milieu is plausible. Data on PMA in adolescents are limited, and its management is not fully established. We aimed to discuss the PMA phenomenon in young females from pathophysiology to preventive strategies, focusing on the relationship with the hormonal pattern. The fluctuation of estrogens at ovulation and before menstruation and the progesterone secretion during the luteal phase and its subsequent withdrawal seem to be the culprits, because the deterioration of asthma is cyclical during the luteal phase and/or during the first days of the menstrual cycle. Conventional asthma therapies are not always effective for PMA. Preventive strategies may include innovative hormonal contraception. Even a possible beneficial effect of other hormonal treatments, including estrogens, progestogens, and androgens, as well as leukotriene receptor antagonists and explorative approach using microbial-directed therapy, is considered. The underlying mechanisms, through which sex-hormone fluctuations influence asthma symptoms, represent a challenge in the clinical management of such a distressing condition. Further studies focused on young females are mandatory to promote adolescent health.

Physicians' perspectives on adverse drug reactions in pediatric routine care: a survey

BACKGROUND

Children and adolescents are at particular risk for adverse drug reactions (ADRs). We investigated physicians' perceptions on ADRs in pediatric routine care.

METHODS

In this exploratory study from April to November 2020, we invited physicians treating pediatric patients across Germany to complete an online questionnaire consisting mainly of closed questions.

RESULTS

Completion rate was 98% (127/129). Of all participants, 23% (29/127) stated they were not able to estimate how many of their pediatric patients experienced ADRs during drug therapy. The remaining physicians estimated that 7.5% (median; Q25/Q75 3%/20%) of their pediatric patients were affected by ADRs. Regarding counseling on ADRs, 61% (77/127) stated they do not ask regularly the extent to which parents want to be informed. In total, 26% (33/127) stated they avoid counseling on ADRs concerning commonly used approved therapies, whereas only 4% (5/127) did so concerning off-label use (P < 0.001). Altogether, 16% (20/127) stated they rather prescribe new medicines as they hope for better effectiveness; 72% (91/127) said they are cautious about doing so owing to yet unknown ADRs. Of all respondents, 46% (58/127) stated they do not report ADRs to the authorities. Concerning the black triangle symbol, a European pharmacovigilance measure, 11% (14/127) stated they knew it and 6% (7/127) stated they reported any suspected ADR for drugs with that symbol.

CONCLUSIONS

Physicians' perspectives on ADRs were ambivalent: ADRs influenced their parent counseling and drug prescribing; yet, they struggled to estimate the impact of ADRs on their patients and were not aware of specific pharmacovigilance measures.

Instruments Measuring Self-Care in Children and Young Adults With Chronic Conditions: A Systematic Review

Children and young adults (CYAs) with chronic conditions need to engage in self-care to improve their quality of life. This study aimed to retrieve the literature on instruments to assess self-care in CYAs living with chronic conditions and evaluate the psychometric proprieties of the instruments retrieved. A systematic literature review was conducted on six databases to identify peer-reviewed papers that described or used an evaluation instrument of self-care in CYAs with chronic conditions. Twenty-three articles describing 11 instruments of self-care were identified. Five instruments (45.45%) were developed for specific diseases, while six (54.54%) for various chronic illnesses. Most of the instruments were focused on treatment adherence within self-care maintenance (i.e., behaviors to maintain illness stability), excluding the monitoring of clinical parameters or the management of exacerbations. This review provides an overview of available instruments that measure self-care in CYAs with chronic conditions, which health professionals could use for patient education.

The Relationship Between Emotional Intelligence and Diabetes Management: A Systematic Review

Diabetes has been associated with affective disorders which complicate the management of the disease. Emotional intelligence (EI), or the ability to perceive, facilitate, understand, and regulate emotions, has shown to be a protective factor of emotional disorders in general population. The main objective of this study was to systematically review the role of the EI construct in Type 1 and Type 2 diabetics and to observe how EI is related to biological and psychological variables. Comprehensive searches were conducted in PubMed, Scopus, PsycInfo, and Cochrane without time limitations, for studies examining the link between diabetes and EI. A total of 12 eligible studies were selected according to the inclusion criteria. We divided the results into four sections: (1) EI and hemoglobin glycosylated (HbA1c), (2) EI training effects, (3) differences in EI between persons with diabetes and without diabetes, and (4) EI and psychological adjustment and well-being. The results showed negative correlations between EI and HbA1c, positive effects of EI training on quality of life, anxiety, and glycemic control, no differences in EI between people with diabetes and healthy individuals, and, finally, negative correlations between EI and different psychological variables such as diabetes-related anxiety and distress, and positive correlations with quality of life, well-being, and marital satisfaction. This systematic review offers a starting point for a theoretical and practical understanding of the role played by EI in the management of diabetes and reveals that EI is a promising protective factor for biological and psychological variables in this population.

The Welsh Eating Disorder Service Review 2018, Scottish Eating Disorder Service Review 2021 and recommendations of best practice in comorbid eating disorders and diabetes

BACKGROUND

Diabetes and eating disorders are frequently comorbid. This particular comorbidity is not only often poorly recognised, but is difficult to treat and has a high mortality.

METHOD

In this article, we will briefly review the relationship between diabetes and eating disorders. We will review the current NICE and other guidance and reports concerning both diabetes and eating disorders in the United Kingdom. We will then describe the recommendations of the 2018 Welsh Government Eating Disorder Service Review and the 2021 the Scottish Government Eating Disorder Service Review regarding diabetes and eating disorders, which will lead to service change.

CONCLUSIONS

We conclude that this is a relatively underdeveloped but important area where there needs to be further service development and more collaboration between diabetes and eating disorder services.

Children's Views and Experiences of Treatment Adherence and Parent/Child Co-Management in Eczema: A Qualitative Study

Eczema affects one in five children and can have a substantial impact on quality of life. This qualitative study aimed to explore children's views and experiences of eczema and what may affect treatment adherence from their perspective. We conducted semi-structured, face-to-face interviews with children with eczema aged 6-12 years from March to July 2018. Interviews were transcribed verbatim and analysed using inductive thematic analysis. We found that children do not typically view eczema as a long-term condition, and topical treatments (predominately emollients) were seen to provide effective symptom relief. Uncertainty around co-managing at home was expressed as children typically felt that parental reminders and assistance with applying different types of topical treatments were still needed. For some children, eczema can be difficult to manage at school due to a lack of convenient access and appropriate spaces to apply creams and psychosocial consequences such as attracting unwanted attention from peers and feeling self-conscious. Treatment adherence could be supported by reinforcing that eczema is a long-term episodic condition, providing clear information about regular emollient use, practical advice such as setting reminders to support co-management at home, and working with schools to facilitate topical treatment use when necessary.

Food allergy in at-risk adolescents with asthma: A key area for focus

BACKGROUND

Asthma affects more than 6.2 million children in the United States and is a major source of chronic disease burden. Concurrent food allergy (FA) may be a risk factor for worse asthma outcomes.

OBJECTIVE

To estimate the prevalence of FA among a cohort of adolescents with persistent asthma and assess whether FA is an independent risk factor for asthma morbidity.

METHODS

We included 342 adolescents aged 12 to 16 years with persistent asthma from the Rochester city school district who participated in the School-Based Asthma Care for Teens trial between 2014 and 2018. Multivariable models were used to estimate the association between FA and asthma morbidity.

RESULTS

Overall, 29% of adolescents with asthma reported having a FA. Although there were no statistically significant differences in daytime asthma symptoms, teens with FA had higher fractional exhaled nitric oxide (47.5 vs 33.9 P = .002) and reported more days with activity limitation owing to asthma (3.1 vs 2.3 days/2 weeks, P = .03) compared with teens without FA. Less than half (42%) of adolescents with FA had an epinephrine autoinjector.

CONCLUSION

This study found FA to be common among this cohort of adolescents with asthma. Although FA was not related to asthma symptom severity, adolescents with FA had higher fractional exhaled nitric oxide and more activity limitation, and most did not have epinephrine autoinjectors. A history of FA and lack of epinephrine autoinjector may increase near-fatal outcomes in adolescents with asthma. Preventive measures in addition to standard asthma treatments are warranted for these teens.

Anticonvulsant long-term and rescue medication: The children's perspective

BACKGROUND

Little is known about children's perspectives and attitudes towards their long-term and rescue anticonvulsant medication.

METHODS

We interviewed paediatric patients aged 6-18 years in two university hospitals concerning their anticonvulsant treatment based on a structured questionnaire. We also asked them to draw a picture titled "Me and my medication".

RESULTS

We interviewed 100 patients with anticonvulsant long-term medication. 87/100 patients considered their medication to be helpful. 66/100 patients gave an explanation on why a regular medication intake is important, e.g. "Reduction/prevention of seizures", "Otherwise I have to go to hospital", "I don't want to die" or "Kill the virus which is causing epilepsy". Of 92 patients with a prescribed rescue medication, 22 (24%) did not know about it. Of the remaining 70, 39 (56%) stated they always carry it with them. When asked to imagine being the physician and to inform about the medication, the children would use illustrative (e.g. brochures) or demonstration material (e.g. "real tablets") to aid their consultation (47/100). 55/100 would stress the necessity of a regular intake. 52 participants drew a picture related to the given topic. Of those, only 1 depicted rescue medication.

CONCLUSION

Paediatric patients mostly have a positive attitude towards their medication. However, misconceptions exist and participants expressed the desire for more interactive support in the medical counselling. Children are not sufficiently aware of their rescue medication in everyday life. Consequently, physicians should consider the children's needs in their consultations and put more focus on potentially life-saving rescue medication.

Social and Economic Challenges to Implementing the Ketogenic Diet: A Case Series

The ketogenic diet (KD) is a powerful therapeutic tool that can reduce seizure activity in patients with refractory epilepsy. However, dietary implementation can be difficult for patients and families due to the time and resource intensive nature of the diet. These challenges are particularly pronounced in economically disadvantaged or socially unstable patient populations. The first case of this series describes the successful implementation of KD in a low-income, homeless patient through the use of innovative KD recipes and access to social programs offered through Boston Medical Center. The second case illustrates the importance of consistent parental support to the success of KD and describes mechanisms used to improve familial support within a nonunified household. Collectively, these cases demonstrate ways by which health care providers can make this powerful dietary treatment accessible to low-resource patients.

Compliance, adherence, concordance, empowerment, and self-management: five words to manifest a relational maladjustment in diabetes

Background: The pathological reality of diabetes and the incidents in following the prescribed therapies have been considered and are still a serious and relevant problem in the health sector. Objective: This review aims at highlighting the importance of clinical psychological phenomena that underlie the notion of therapies. Methods: The review was conducted through search engines such as PubMed, Medline, Web of Science and Google Scholar. The articles related to compliance, adherence, concordance, empowerment and the self-management of diabetes were included, in order to highlight the possible similarities and differences that these terms bring with them in them management of diabetes. Results: Starting from 252 initial publications, 101 articles were selected that highlighted the practical implications that each term has compared to the others. Conclusion: The review can represent a bridge between the medical approach and clinical psychology, in which integration can suggest paths aiming at improving patients' existential conditions and adaptation.

Development of a Smartphone Program to Support Adherence to Oral Chemotherapy in People with Cancer

PURPOSE

To describe the theoretical, evidence-based and consumer-informed development of a smartphone self-management program aiming to support adherence to oral chemotherapy in adolescents and adults diagnosed with cancer.

METHODS

The design of the program followed two frameworks for the development and evaluation of mHealth interventions and was conducted in three steps: 1) conceptualization, which involved an extensive literature review and a scoping review that led to the identification of the behavioral change strategies in the program; 2) definition of features and structure, based on a formative study with end-users to explore their preferences about the structure and elements of the program; and 3) selection of program delivery technology, whereby available technology platforms were examined and the most suitable tool to deliver the program was selected.

RESULTS

Three main reasons for oral chemotherapy non-adherence were identified: forgetfulness, side-effects and poor knowledge about oral chemotherapy. Key behavior change strategies were also identified, namely, medication intake reminders and information about oral chemotherapy and managing side-effects. Based upon end-user feedback the method of delivery of these behavioral strategies that was deemed most appropriate was conventional text messages. The reminders were standard, short, text-only messages sent when each oral chemotherapy dose was due, one way (no need to reply) and addressed the end-users using their first name. Delivery of information about oral chemotherapy and side-effects was tailored to each individual's preferred frequency.

CONCLUSION

The careful design process described in this paper may serve to inform the development of future mobile phone-based medication adherence-enhancing interventions for people with cancer. A trial to explore end-users acceptability of and satisfaction with the intervention is currently underway.Trial Registration: ACTRN12618001987257p.

Emotional abilities and HbA1c levels in patients with type 1 diabetes

In recent years a growing body of research is focused on the relationships between emotions and health. When it comes to diabetes, findings suggest that distress might play a key role in the acquisition and maintenance of health habits associated with diabetic management. This report describes two studies examining the roles of emotional abilities in diabetic management from two different conceptual points of view using two culturally different samples. In study 1, we examined the relationship between emotional intelligence and HbA1c levels in a sample of eighty-five patients with type 1 diabetes mellitus (DM1) in Israel. In study 2, we examined the relationship between specific emotional regulation strategies and HbA1c in sixty-seven adolescents with DM1, while examining the mediating role of distress in this association. The results showed a negative association between emotional intelligence and HbA1c levels, even after controlling for potential intervening factors. We found that the relationship between difficulties in emotion regulation and HbA1c seemed to be mediated by diabetes-related distress. These findings may aid in the design of psychological models for future research as well as interventions aimed at improving emotional abilities in people with DM1.

Adolescents and young adults with cancer: aspects of adherence - a questionnaire study

Purpose

For adolescents and young adults (AYAs), a cancer diagnosis represents an extraordinary strike in a vulnerable phase of life. They have special needs that the medical system has to take into consideration, and they exhibit a lower degree of therapy adherence than both older and younger patients. The purpose of this study was first to analyze the adherence of AYAs with cancer compared to a group of older patients and, second, to determine correlated parameters, with focus on the psychosocial interaction between physicians and patients.

Patients and methods

In 2012, a complete 1 year cohort of patients reported, by use of a questionnaire, to the Rostock clinical cancer registry, and a group of older patients were invited to answer a multi-item set of questionnaires on a volunteer basis, leading to a population-based cross-sectional analysis. This included a bias due to non-answering which is unavoidable in such a setting. The questionnaire consisted of well-established standard questionnaires, a questionnaire on adherence that has just recently been published, and a self-written questionnaire focusing on patient–physician relationship. The responses were analyzed for our current study.

Results

Gender, religion, education, age, anxiety, family atmosphere, or physician–patient relationship were not significantly correlated to adherence in AYAs. However, markedly more AYAs, as compared to the older patients group, considered breaking off therapy and reported suboptimal communication with the physicians. Only the perceived physical illness could be identified as a factor related to adherence among the AYA group.

Conclusion

Our findings confirm the need for more focused approaches to serve the special needs of AYAs, with particular attention on specific items that showed up discriminating AYAs from older patients, that is, Internet use and communication with physicians. Here, further research is needed to examine adherence to specific treatment protocols.

Alcohol and cigarette use among adolescents with type 1 diabetes

In this study, we compare the prevalence of alcohol and cigarette use among Polish adolescents with type 1 diabetes mellitus (T1DM) (n = 209), aged 15-18 years, with that of a large cohort of their healthy peers, using standardized questionnaire used in the European School Survey Project on Alcohol and Drugs (ESPAD). The lifetime, previous year, and past 30-day prevalence of alcohol consumption was high among adolescents with T1DM but lower than in the controls (82.8 vs 92.0%, 71.7 vs 85.6%, and 47.5 vs 69.7%, respectively, p < 10^-5). The lifetime and 30-day prevalence of cigarette use was also lower among patients than the controls (54.6 vs 65.5%, p = 0.001 and 27.3 vs 35.9%, p = 0.012, respectively). Patients who admitted smoking exhibited worse metabolic control than non-smokers (p < 0.0001) and had a higher chance of developing diabetic ketoacidosis. The incidence of severe hypoglycemia was higher among those who reported getting drunk in the previous 30 days (p = 0.04) and lifetime smoking (p = 0.01).

CONCLUSIONS

Although alcohol and cigarette consumption is lower than in controls, it is common among teenagers with type 1 diabetes, effecting metabolic control and causing the risk of acute diabetes complications. Better prevention strategies should be implemented in this group of patients in their early teen years. What is Known: • Substance use remains a significant cause of morbidity and mortality among teenagers with type 1 diabetes. • Current medical literature contains inconsistent data on the prevalence of alcohol and cigarette use among adolescents with type 1 diabetes, mostly due to methodological problems with conducting such surveys. What is New: • Methodological approach: we used a validated questionnaire from the European School Survey Project on Alcohol and Other Drugs (ESPAD) and compared the results to a large national control group of 12,114 healthy students who took part in ESPAD in 2011.

Living a secret: Disclosure among adolescents and young adults with chronic illnesses

Objectives This qualitative study examines how and why adolescents living with visible and invisible chronic illnesses choose to share their condition with individuals within their social environments. Methods A sample of 25 adolescents were recruited from five subspecialty services: Spina bifida, rheumatology, cardiology, cystic fibrosis, and renal transplant/dialysis. Recruits completed a semi-structured interview designed to explore: (1) to whom adolescents disclose their conditions, (2) motivation and conditions under which they disclose, (3) content of disclosure, and (4) barriers to disclosure. Results Family members closely connected to treatment or management are most likely to be primary targets of disclosure. Regardless of social network size, respondents disclosed their illness to few peers. Common reasons for disclosure were perceived trust and shared experience with illness and disability. Reasons for withholding disclosure include perceived fear of rejection, pity, and perceptions of being seen as vulnerable or different. Discussion Disclosure was found to be influenced by (a) the visibility of a condition, (b) the anticipated response from the recipient, (c) practical needs, and (d) a decision that disclosure is justified. These findings inform clinical practice, warrant the need for further study, and insinuate practical solutions to combat the socio-emotional impact of nondisclosure among adolescents.

Looking for trouble: Adherence to late-effects surveillance among childhood cancer survivors

BACKGROUND

Childhood cancer survivors (CCSs) are at high risk of morbidity and mortality from long-term complications of their cancer treatment. The Children's Oncology Group developed screening guidelines to enable the early identification of and intervention for late effects of cancer treatment. There is a paucity of data on the adherence of CCSs to screening recommendations.

PROCEDURE

A retrospective analysis of medical records to evaluate the rate of adherence of CCSs to the personalized, risk-based recommendations provided to them in the context of a structured long-term follow-up program over a 3-year period.

RESULTS

Two hundred eighty-six CCSs visited the survivorship clinic 542 times during the 3-year study period. The overall rate of adherence to recommended screening was 74.2%. Using a univariate model and greater age at diagnosis and at screening recommendation were associated with decreased screening adherence. Gender, cancer diagnosis, radiation therapy, anthracycline exposure, and hematopoietic stem cell transplant were not significantly associated with adherence. In a multivariate model, age over 18 years at the time of the visit was significantly associated with decreased adherence (P < 0.0329) (odds ratio: 1.53, 95% confidence interval: 1.04-2.25).

CONCLUSIONS

Adherence to recommended screening tests is suboptimal among CCSs, with lower rates of adherence in CCSs older than 18 years of age compared with those younger than 18 years of age. Given the morbidity and mortality from the late effects of therapy among young adult CCSs, it is critically important to identify and remove barriers to late-effects screening among CCSs.

Healthcare professionals' views on discussing fertility preservation with young cancer patients: a mixed method systematic review of the literature

OBJECTIVE

In spite of efforts to guarantee patients are adequately informed about their risk of fertility loss and offered treatment for fertility preservation (FP), previous studies have reported that this topic is not routinely discussed with patients, especially with younger patient populations. A mixed method systematic review was undertaken to explore the factors shaping the discussion of FP with children (0-15 years) and adolescents/young adults (16-24 years) with cancer.

METHODS

Six databases were searched independently using a combination of keywords and controlled vocabulary/subject headings relating to cancer and fertility. Inclusion criteria consisted of: (a) being published in a peer-reviewed journal, (b) a focus on healthcare professionals' (HCPs') beliefs, attitudes, or practices regarding fertility issues in cancer patients, (c) primary data collection from HCPs, and (d) a focus on HCPs who provide services to young patients. Of the 6276 articles identified in the search, 16 articles presenting the results of 14 studies were included in the final review.

RESULTS

Common themes reported across studies indicate that five main factors influence HCPs' discussion of FP with young cancer patients: (a) HCPs' knowledge, (b) HCPs' sense of comfort, (c) patient factors (i.e., sexual maturity, prognosis, partnership status, and whether or not they initiate the conversation), (d) parent factors (i.e., HCPs' perception of the extent of their involvement), and (e) availability of educational materials.

CONCLUSIONS

Future work should ensure that HCPs possess knowledge of cancer-related FP and that they receive adequate training on how to consent and discuss information with young patients and their parents.

A systematic review of factors that influence treatment adherence in paediatric oncology patients

WHAT IS KNOWN AND OBJECTIVE

Treatment adherence is an essential component in ensuring best outcomes in the management of paediatric cancers. Compared to the adult population, treatment adherence in the paediatric population is a more complex subject which involves unique dimensions. In this study, we aimed to systematically review the literature to identify factors associated with treatment adherence in the paediatric oncology population.

METHODS

A literature search was carried out using related keywords on electronic databases.

RESULTS AND DISCUSSION

A total of 1036 articles were reviewed, and 39 articles were found to be relevant. A comprehensive review of these articles identified 17 factors that influence adherence. These factors were classified into five major categories: patient-/caregiver-related factors; therapy-related factors; condition-related factors; health system-related factors; and social/economic factors. A baby bear model was proposed to better visualize these five categories that affect treatment adherence, and a framework of questions was designed to help clinicians identify those at risk of non-adherence for early intervention.

WHAT IS NEW AND CONCLUSION

Seventeen factors reviewed were categorized into five main categories, namely patient-/caregiver-related factors, therapy-related factors, condition-related factors, health system factors and social/economic factors, as causes for poor medication adherence in the paediatric oncology population. Clinicians need to be aware that these factors can interact to influence treatment adherence and that some factors may be more relevant in specific contexts (e.g. third world countries, minority groups). The baby bear model is presented to help understand the issues affecting adherence in the paediatric oncology population, and a framework of questions is proposed to help clinicians identify patients at risk of non-adherence.

Achieving self-management of prophylactic treatment in adolescents: The case of haemophilia

OBJECTIVE

Adolescents with a chronic disorder, such as haemophilia, need to attain responsibility for their disease. The aim was to gain insight into how adolescents achieve self-management of prophylactic treatment.

METHODS

In three Dutch Haemophilia Treatment Centres, adolescents (10-25 years) received structured questions on treatment responsibility and self-management (pre-specified definitions) during routine nursing consultation.

RESULTS

In total, 155 interviews were performed in 100 patients (median age 14.4 years). Self-infusion was initiated at a median age of 12.3 years (IQR 11.5-13.0) and self-management was achieved 9.6 years later, at a median age of 22.6 years. This process included three phases coinciding with known stages of adolescence. In early adolescence, patients acquired the technique of self-infusion (12.3 years) leading to independent self-infusion in middle adolescence (17.2 years). In late adolescence, patients demonstrated an increase in more complex skills, such as bleeding management and communication with the haemophilia physician (19.9-22.6 years).

CONCLUSION

Although, the first steps in self-management with regard to self-infusion are taken in early adolescence, complete self-management was achieved in late adolescence after almost 10 years.

PRACTICE IMPLICATIONS

Insight in this transitional process helps to provide individualized support and emphasizes the need for continued education with regard to self-management skills.

Predictors of non-adherence to prescribed prophylactic clotting-factor treatment regimens among adolescent and young adults with a bleeding disorder

INTRODUCTION

Adherence to clotting-factor treatment regimens, especially among adolescents and young adults (AYAs), is under-researched.

AIM

We determined factors associated with better adherence to prophylaxis.

METHODS

From April through December 2012, a convenience sample of AYA (aged 13-25 years) persons with haemophilia or von Willebrand disease (VWD) completed an online survey that assessed adherence to prescribed prophylactic treatment regimens [Validated Haemophilia Regimen Treatment Adherence Scale (VERITAS)-Pro]. Logistic regression analysis assessed demographic and clinical factors related to non-adherence (VERITAS-Pro≥57).

RESULTS

Seventy-three prophylactically treating AYAs participated. Of which, 88%, 8% and 4% had haemophilia A, B and VWD respectively. Almost all (90%) had severe disease and 58% had never developed an inhibitor. Most were aged 13-17 years (56%), white (78%), non-Hispanic (88%), never married (94%) and had some type of health insurance (96%). Median VERITAS-Pro score was 48 (range = 25-78) and 22 (30%) participants were non-adherent to prophylaxis (VERITAS-Pro≥57). Final logistic regression modelling suggested that, compared to those aged 13-17 years, participants aged 18-25 years were 6.2 (95% CI: 1.8-21.0; P < 0.01) times more likely to be non-adherent. Compared to respondents whose mother had at least a Bachelor's degree, respondents whose mother did not were 3.8 (95% CI: 1.0-14.3; P = 0.05) times more likely to be non-adherent.

CONCLUSIONS

Results suggest that adherence efforts should be especially targeted to young adults as they transition from adolescence (i.e. parental supervision) and assume primary responsibility for their bleeding disorder care. Healthcare providers should be mindful of AYAs whose mothers have less formal education and ensure that adequate time and resources are dedicated to family adherence education.

Adherence to antiepileptic drugs in children with epilepsy in a Scottish population cohort

AIM

To measure the adherence to antiepileptic drugs (AED) in a population cohort of children with epilepsy and to study the relationship between adherence and a series of clinical variables.

METHOD

A population-based study of children (<16y) with epilepsy on AED treatment from the Tayside region of Scotland during two epochs of 12 months each. A clinical database was constructed using hospital records and linked to a community dispensing pharmacy database to calculate an Adherence Index. The principal outcome measure was the measurement of population-based adherence to AEDs. Secondary outcome measures were the association of adherence with the clinical characteristics of the population.

RESULTS

The median age of study group was 10 years and the median duration of epilepsy was 4 years. Only 30.9% of the total 320 children adhered to recommended AED treatment (Adherence Index >90%) across a year of treatment. Twenty-five percent of children had an Adherence Index of less than 50%. Adherence declined with increasing age. There was no significant correlation between adherence and other clinical characteristics studied (sex, duration of epilepsy, other comorbid health problems, other regular medications, and seizure frequency).

INTERPRETATION

Our data shows adherence to AED treatment is poor in children with epilepsy.

Determinants of Quality of Care for Adolescents and Young Adults With Chronic Illnesses: A Mixed Methods Study

Measuring the quality of service and user experience is an acknowledged priority for healthcare services; however it seems that healthcare systems have to work very hard to achieve this goal as evidenced by reports of gaps and disparities in the quality of care provided to clients, especially within pediatric and adolescent populations.

OBJECTIVES

To identify quality determinants for healthcare services for adolescents and young adults with chronic conditions based on the perceptions and the experiences of adolescents and young adults themselves.

METHODOLOGY

A sequential exploratory mixed method design guided this study. The initial qualitative phase employed semi-structured in-depth interviews to elicit the elements and determinants of quality of care as identified by adolescents and young adults living with chronic conditions. The second phase employed a questionnaire developed from the data gathered during the qualitative phase to survey the target population. This was distributed to a larger sample of adolescents and young adults with chronic conditions to determine and confirm the relevance of the identified care elements and quality determinants.

RESULTS

The study revealed 4 main determinants: the provision of adolescent friendly information relating to all aspects of living with chronic conditions, services that facilitate and encourage independence, services characterized by structure with the capacity to be both dynamic and responsive, and finally health care professionals knowledgeable and skilled in relation to adolescent specific issues.

Medication management in comprehensive schools in Finland: teachers’ perceptions

Objective

Many children who take medication require it during school time, and their participation in school activities could depend on it. The aim of this study was to identify whether schools have guidelines for medication management and to explore teachers’ perceptions about medication administration practices and the characteristics affecting these practices using Bronfenbrenner’s ecological systems theory as the framework.

Methods

A cross-sectional postal survey was conducted in Finland in 2010 covering a representative sample of comprehensive school teachers (n = 1700). The survey included sections on guidelines and practices for medication administration, beliefs about medicines, and background information on the respondent and the respondent’s school. Quantitative and qualitative methods of analysis were used.

Key findings

The response rate was 56% (928/1664). At the national level (macrosystem), teachers reported uncertainty about existing laws and guidelines, while at the local level (exosystem), most of the teachers reported having medication management guidelines (73% primary; 76% lower secondary school). However, a majority described guidelines instructing them not to administer medicines to pupils. Medication management practices were found to differ depending on the province and size of school. At the personal level (microsystem), practices were also affected by teachers’ experience of, and views about, medicines.

Conclusion

No consistent medication administration guidelines exist in Finnish schools. Challenges were identified at all system levels of ecological theory. To ensure proper medication management, school staff need clear and consistent guidance developed in co-operation between different professions, and exploring ways to involve pharmacists in this task.

A Photo Elicitation Study on Chronically Ill Adolescents' Identity Constructions During Transition

Adolescence is an important phase of life with increasing independence and identity development, and a vulnerable period of life for chronically ill adolescents with a high occurrence of insufficient treatment adherence. We conducted four photo elicitation focus group interviews with 14 adolescents (12-20 years) with juvenile idiopathic arthritis to investigate identity constructions during transition. Using a discourse analysis approach, six identity types were identified distributed on normal and marginal identities, which were lived either at home (home arena) or outside home with peers (out arena). Most participants positioned themselves as normal in the out arena and as ill in the home arena. Few participants positioned themselves as ill in an out arena, and they described how peers perceived this as a marginal and skewed behavior. This study contributes to a better understanding of why it can be extremely difficult to live with a chronic illness during adolescence.

Factors Associated With Orthopedic Aftercare in a Publicly Insured Pediatric Emergency Department Population

OBJECTIVES

Children with public insurance are less likely than children with private insurance to obtain follow-up care after emergency department (ED) care. This study aimed to determine if specific demographic and clinical factors are associated with aftercare compliance in a population of publicly insured pediatric ED patients with orthopedic injuries.

METHODS

This was a retrospective case-control study of Washington, DC, children aged 0 to 17 years with public insurance discharged with isolated forearm fractures from the Children's National Medical Center ED from 2003 to 2006. Bivariable analyses and multivariable logistic regression were performed to measure the association between sociodemographic variables and failure to follow up.

RESULTS

Six hundred children met the inclusion criteria. The overall cohort was 63.7% male and 81.7% African American, with a mean age of 8.8 (SE, 0.2) years. Overall, 85.7% of patients went to a follow-up orthopedic appointment, and 68.2% of patients had timely orthopedic follow-up, defined as 14 days or less after discharge from the ED. Treatment with orthopedic reduction (adjusted odds ratio [OR], 2.0 [1.33-2.93]) was positively associated with timely orthopedic follow-up, whereas older age (adjusted OR, 0.9 [0.88-0.97]) was significantly associated with failure to follow up. In the subset of patients who required orthopedic reduction in the ED, older age was significantly associated with failure to follow up (adjusted OR, 0.80 [0.74-0.94]).

CONCLUSIONS

Mild fracture severity is associated with lack of orthopedic follow-up for patients with public insurance. Older age was associated with lack of follow-up, even in the subgroup with severe fractures. Targeted interventions to improve orthopedic aftercare compliance should focus on older patients with severe forearm fractures.

Understanding the Health Behaviors of Survivors of Childhood and Young-Adult Cancer: Preliminary Analysis and Model Development

The current study presents preliminary correlational data used to develop a model depicting the psychosocial pathways that lead to the health behaviors of survivors of childhood and young-adult cancer. Data collected from a sample of 18- to 30-year-old cancer survivors (n = 125) was used to examine the relations among interpersonal support and nonsupport, personal agency, avoidance, depressive symptoms and self-efficacy as they related to health behaviors. The outcome measures examined included tobacco and alcohol use, diet, exercise, sunscreen use, medication compliance and follow-up/screening practices. Correlational analyses revealed a number of significant associations among variables. Results are used to inform the development of a health behavior model. Implications for health promotion and survivorship programming are discussed, as well as directions for future research.

Unravelling adherence to prophylaxis in haemophilia: a patients' perspective

Given the lifelong therapy in haemophilia patients, insight in non-adherence behaviour from a patient perspective is important to understand patients' difficulties with the following treatment recommendations. The aim of this study was to clarify the process underlying adherence (behaviour) to prophylactic treatment, from a patients' perspective. To develop a grounded theory, a qualitative study using individual in-depth interviews was performed to understand experiences, perceptions and beliefs concerning adherence to prophylaxis. From two Dutch treatment centres, 21 adults with haemophilia using prophylaxis were interviewed. Patients were asked how they experience their task to administer prophylaxis and how they adhere to this. The interviews were transcribed, coded and analysed in an iterative process, leading to the development of the grounded theory. Adherence was determined by the position of prophylaxis in life. The position of prophylaxis was determined by the perception of prophylaxis and the ability to exert prophylaxis. Patients' perception was influenced by two main factors: acceptance of haemophilia and feeling/fearing symptoms. The ability to exert prophylaxis was influenced by understanding haemophilia and prophylaxis and planning/infusion skills. The combination of different perceptions and skills led to four main positions of prophylaxis in life: (i) prophylaxis integrated in life, (ii) prophylaxis according to doctors' advice, struggling with irregular situations, (iii) prophylaxis is too much to handle, (iv) prophylaxis is a confrontation with illness. The adherence level gradually decreased from position 1 to 4. This information can be used to design tailored interventions to promote adherence.

Medication adherence in adolescents in current practice: community pharmacy staff's opinions

OBJECTIVE

To explore pharmacy staff's perspectives regarding medication use behaviour in adolescent patients.

METHODS

Structured face-to-face interviews were conducted with 170 community pharmacy staff members.

KEY FINDINGS

Medication-related problems in adolescents had been experienced by 80 respondents; non-adherence was frequently mentioned (n = 73). An important reason for medication-related problems in adolescents not being recognised was that prescriptions are often collected by the parents (with or without the teenager). Solutions suggested by the interviewees to improve adolescents' medication use behaviour included (improving) counselling with emphasis on necessity/benefits of medication (n = 130) and more direct contact with adolescents instead of parent(s) (n = 77). Use of digital media for educational purposes or reminder services was suggested to support medication use (n = 67).

CONCLUSIONS

Almost half of pharmacy staff experienced problems related to medication use in adolescents. Pharmacy staff see a primary role for counselling on the benefits of therapy but foresee difficulties in obtaining direct contact with adolescents. Use of new media could be useful.

Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol

BACKGROUND

Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families.

METHODS/DESIGN

This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children.

DISCUSSION

The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms.

TRIAL REGISTRATION

ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

Adherence to home physiotherapy treatment in children and young people with joint hypermobility: a qualitative report of family perspectives on acceptability and efficacy

OBJECTIVE

Joint hypermobility can lead to pain and motor developmental problems in children and young people (CYP). Exercise programmes may help CYP with joint hypermobility strengthen core muscle groups. Non- adherence to home physiotherapy is common. The present study aimed to understand how families experienced an intensive multidisciplinary intervention.

METHOD

This was a qualitative study nested within a randomized controlled trial of a multidisciplinary treatment intervention, including physiotherapy, for children aged five to 17 years. Twenty-eight families were recruited following the intervention. Semi-structured interviews were used to examine the views and expectations of parents and CYP, and examine adherence to the exercise programme. Thematic analysis of data was used to develop findings.

RESULTS

Parents and CYP reported that exercise reduced the symptoms of hypermobility. Parental motivation, adapting family routines, making exercise a family activity and seeing benefit increased adherence to exercise. Non-adherence to exercise was linked to lower levels of parental supervision, not understanding the treatment, not seeing benefit and not having specific time to dedicate to doing the exercises.

CONCLUSION

Even when exercise is seen to benefit a child's well-being, families experience challenges in adhering to a physiotherapy programme for hypermobility. Therapists can utilize findings on what enhances adherence to help CYP effectively exercise in the home setting.

Self-reported barriers to medication adherence among chronically ill adolescents: a systematic review

PURPOSE

To investigate self-reported barriers to medication adherence among chronically ill adolescents, and to investigate whether barriers are unique to specific chronic diseases or more generic across conditions.

METHODS

A systematic search of Web of Science, PubMed, Embase, PsycINFO, and CINAHL from January 2000 to May 2012 was conducted. Articles were included if they examined barriers to medication intake among chronically ill adolescents aged 13-19 years. Articles were excluded if adolescent's views on barriers to adherence were not separated from younger children's or caregiver's views. Data was analyzed using a thematic synthesis approach.

RESULTS

Of 3,655 records 28 articles with both quantitative, qualitative, and q-methodology study designs were included in the review. The synthesis led to the following key themes: Relations, adolescent development, health and illness, forgetfulness, organization, medicine complexity, and financial costs. Most reported barriers to adherence were not unique to specific diseases.

CONCLUSION

Some barriers seem to be specific to adolescence; for example, relations to parents and peers and adolescent development. Knowledge and assessment of barriers to medication adherence is important for both policy-makers and clinicians in planning interventions and communicating with adolescents about their treatment.

Reproductive health decision-making in perinatally HIV-infected adolescents and young adults

With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a "think tank" session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed.

Psychosocial outcomes in young adults with cancer: emotional distress, quality of life and personal growth

This study aimed at assessing the psychosocial adjustment, specifically the emotional distress, quality of life (QOL) and personal growth, in a sample of 36 Portuguese young adults with cancer and 435 healthy controls. Cancer patients scored significantly lower than controls in the role, cognitive and social domains of QOL and in personal growth. Cancer patients scored significantly lower than off-treatment survivors in the role domain of QOL and personal growth. Cancer patients revealed QOL and personal growth difficulties. These issues need to be considered in the psychosocial intervention within adolescents and young adults' oncology care.

The effect of design on the usability and real world effectiveness of medical devices: a case study with adolescent users

Adolescents are currently overlooked in many fields of healthcare research and as a result are often required to use medical devices that have been designed for use by either children or adults. This can lead to poor adherence and a reduction in health outcomes. This study examines the role of device design in the real-world effectiveness of a medical device used in the treatment of cystic fibrosis from the perspective of adolescent users. Interactive design interviews were carried out with 20 adolescent users of the acapella(®) physiotherapy device to investigate user requirements and themes about the user-device relationship that are important to this user group. This study found that adolescent users of the acapella(®) device do not use the device as regularly and correctly as is recommended by clinicians. A number of aspects of the current design of the acapella(®) device were identified that affect how and how often it is used. Five factors are identified that may improve the real world effectiveness of the acapella(®) device for adolescents with Cystic Fibrosis: engagement, information, confidence, aesthetics and compatibility with lifestyle.

Alcohol use of diabetes patients: the need for assessment and intervention

It is well known that diabetes self-care behaviors are critical to disease progression. Unfortunately, many patients do not adhere to diabetes self-care recommendations despite their importance. Alcohol use has been identified as a barrier to diabetes self-care adherence. Excessive alcohol consumption not only negatively impacts diabetes self-care adherence but also affects the course of diabetes. Diabetes patients who are at-risk drinkers are likely to have poor diabetes treatment adherence, leading to increased morbidity and mortality. Alcohol consumption by diabetes patients is often inadequately assessed and addressed in their medical care. Brief interventions to reduce at-risk drinking have been well validated in a variety of patient populations and offer the potential to improve diabetes treatment adherence and outcome. Assessment and treatment of at-risk drinking could be readily incorporated into routine diabetes care. Strategies for brief assessment of and intervention for at-risk drinking are offered.

Barriers and motivators of adherence to prophylactic treatment in haemophilia: a systematic review

Long-term adherence to prophylactic therapy is the key to successful prevention of bleeds in severe haemophilia. The present study aims to provide a systematic review of the literature on the determinants of adherence to prophylaxis in haemophilia. A literature search in the largest medical databases in Oct 2011 yielded 880 articles, which were reduced to 72 by further selection on title. Twenty-eight articles were excluded due to inclusion criteria. Full paper evaluation of 44 articles yielded five relevant articles that were critically appraised using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement and items extracted from the critical appraisal criteria for cohort studies (Dutch Cochrane Centre). After critical appraisal, 2/5 studies were considered as the best evidence available. The results of these two studies were further used in the synthesis for description of the determinants of adherence. This concerned a total of 245 subjects in all age groups. Data were collected using questionnaires and interviews. Motivators for a high adherence were as follows: experience of symptoms, a positive belief of necessity of treatment and a good relationship with the health care provider. Important barriers were defined as: infrequent or absence of symptoms and increasing age. Two high-quality studies were identified. Reported determinants of adherence to prophylaxis were age, symptoms, beliefs, and the relation with the health care provider. This information may provide a first step towards a strategy to promote adherence in haemophilia, with an important focus on age-specific interventions and patient education.

Navigating the gluten-free diet in college

Factors that affect adherence to the gluten-free diet (GFD) are reported in children and adults; however, there is little data regarding young adults. The objective of the present study is to explore adherence challenges experienced by young adults in college. Responses from the online survey (N = 50), interview (N = 21), and focus group (N = 7) indicate students were motivated to adhere but experience challenges related to dining services and social situations. Dining services from 6 colleges reported a variety of accommodations for students with celiac disease, but request increased student involvement. Tools and strategies that facilitate communication between students and dining services may improve adherence.

Developmental and disease-related influences on self-management acquisition among pediatric liver transplant recipients

Pediatric LT recipients are vulnerable to disruptions in their healthcare management and transitioning to self-managed care. This study aimed to examine whether age at transplant and indication for transplant (acute vs. chronic liver disease) influence later self-management skills. Sixty-three LT recipients, aged 14 and older (M = 17.68, s.d. = 3.01), were recruited and asked to complete a healthcare management survey, the Developmentally Based Skills Checklist, adapted for transplant patients, listing 22 behaviors that medically ill adolescents should progressively master. While there were no significant differences between those who received an LT owing to an acute disease vs. those who received an LT owing to a chronic disease, the age at which patients received their transplant did yield significant results, although, overall, these findings were attenuated by current age. However, our findings indicated that males transplanted at a younger age struggled with mastery over their healthcare responsibilities relative to males transplanted later and females in both age groups. There are many possible reasons why the experience of transplant at a younger age could negatively affect or derail healthcare transitions. Future research is necessary to further untangle this relationship; yet, it seems as though longer time living with LT may make transition harder for families.

Adherence to oral chemotherapy in childhood acute lymphoblastic leukemia: an evolutionary concept analysis

PURPOSE/OBJECTIVES

To clarify the concept of adherence to daily oral chemotherapy in children with acute lymphoblastic leukemia (ALL), to examine its implications for clinical practice, and to provide a foundation for further research and knowledge development.

DATA SOURCES

Published literature identified through the MEDLINE®, CINAHL®, PsycINFO, and ERIC databases.

DATA SYNTHESIS

Identified attributes of adherence to oral chemotherapy in childhood ALL included motivation, persistence, collaboration, mindfulness, cognitive capacity, flexibility, active participation, and identification of key participants in the process. Identified antecedents included a diagnosis of leukemia, the perceived value of adherence, and patient, family, and healthcare system-related factors. Identified consequences included the potential for maintaining optimal drug levels and improving disease outcome, as well as increased patient and caregiver esteem through active participation in the process. Adherence in the context of childhood ALL is defined as the active self-care behavior of taking (or having the responsibility for administering) daily oral chemotherapy, in collaboration with and according to the instructions of the healthcare provider over a defined, prolonged treatment period.

CONCLUSIONS

Adherence to oral chemotherapy in childhood ALL is a complex, multidimensional behavior that involves not only a willingness to follow the prescribed regimen over a prolonged period, but also the cognitive capacity and psychomotor skills to carry out the process.

IMPLICATIONS FOR NURSING

Nurses should recognize the importance of clear communication of medication instructions, reinforcement of adherence-related behaviors, and assistance with common issues such as pill-swallowing skills and reminder systems in caring for children with ALL.

Living with haemodialysis: the experience of adolescents in Turkey

This study explored how adolescents receiving haemodialysis for end-stage renal disease were affected by their diagnosis and treatment. A qualitative approach was used, with data collected through individual interviews with 18 adolescents aged 12-20. Data were analysed using content analysis method. Adolescents reported physical, psychological and social problems. Compliance related to diet and fluid restrictions were issues for the adolescents interviewed. Body image problems related to physical limitations and the fistula were described. Their regular school attendance was reduced by the illness and therapy, as were socialization and peer interactions. Adolescents felt different from their friends/peers and had negative feelings about their future. Nurses need to assess each adolescent to determine their responses and take action to assist the adolescents with the many issues they are likely to experience. Parents and siblings, who contribute significantly to the care of adolescents on haemodialysis, also require support.

The views of compliant glaucoma patients on counselling and social support

The purpose of this study was to describe the views of compliant glaucoma patients with good compliance on patient education and social support they received during their illness. The aim was to gain knowledge for developing patient compliance by means of promoting education and support methods. Twelve glaucoma patients with good compliance were interviewed, and the transcripts based on those interviews were analysed using content analysis. In the data, the participants described education and social support they had received from healthcare personnel, relatives and partly from their peers. Patient education emerged as the content, timing and methods of education. Social support emerged as emotional, informational and instrumental support, lack of support as well as patients' activity. Consequently, patients need education and support from healthcare personnel as well as from their relatives to cope with glaucoma. The need for education and support is individual but the most important time for education and support is at the initial stages of the illness. The need for education and support is also evident when the patient's treatment is changed or an operative procedure is performed. To conclude, the individual, patient-centred and properly timed education and support is a huge challenge for healthcare personnel because of the decrease in individual time for each patient. Therefore, new and timesaving methods of education and support should be developed.

Development and reliability of a correction factor for parent-reported adherence to pediatric antiepileptic drug therapy

PURPOSE

Study aims were (1) to document and examine associations between parent-report and electronic monitoring (EM) of pediatric antiepileptic drug (AED) adherence, (2) to determine the sensitivity and specificity of parent-reported adherence, and (3) to develop a correction factor for parent-reported adherence.

METHODS

Participants included 111 consecutive children with new-onset epilepsy (M(age) = 7.2 ± 2.0; 61.3% male; 75.8% Caucasian) and their primary caregivers. AED adherence was electronically monitored for 3 months prior to the 4-month clinic follow-up visit. Parent-reported adherence captured adherence 1-week prior to the clinic visit. For specificity/sensitivity analyses of parent-reported adherence, cut points of 50%, 80%, and 90% were used with electronically monitored adherence calculated 1-week prior to the clinic visit as the reference criterion.

KEY FINDINGS

Electronically monitored adherence (80.3%) was significantly lower than parent-reported adherence (96.5%; p < 0.0001) 1-week prior to the clinic visit, but both were significantly correlated (rho = 0.46, p < 0.001). The 90% parent-reported adherence cut point demonstrated the most sensitivity and specificity to electronically monitored adherence; however, specificity was still only 28%. A correction factor of 0.83 was identified as a reliable adjustment for parent-reported adherence when compared to electronically monitored adherence.

SIGNIFICANCE

Although EM is the gold standard of adherence measurement for pediatric epilepsy, it is often not clinically feasible to integrate it into routine clinical care. Therefore, use of a correction factor for interpreting parent-reported adherence holds promise as a reliable clinical tool. With reliable adherence measurement, clinicians can provide adherence interventions with the hope of optimizing health outcomes for children with epilepsy.