"Camping up" self-esteem in children with hemophilia

Social participation and hemophilia: Self-perception, social support, and their influence on boys in Canada

BACKGROUND

Patients with hemophilia may experience joint damage, which can impair participation, yet few studies have examined the impact hemophilia may have on social participation and quality of life.

OBJECTIVES

The aims of this study are to assess the relationship between patient social participation and self-perception, social support, and impact on the family.

PATIENTS/METHODS

A random representative sample of 50 boys with hemophilia from The Hospital for Sick Children, Toronto, Canada, completed measures of social participation (Participation Scale for kids), self-perception (Self-Perception Profile for children and adolescents), and social support (Social Support Scale for children). Participants' parents completed Family Impact Module of the Pediatric Quality of Life Inventory. Data were analyzed using Pearson product-moment correlations.

RESULTS

Social participation was strongly correlated with self-perception subscales Social Acceptance (r = -0.5, p = <0.001) and Global Self-Worth (r = -0.6, p = <0.001) for all participants. The Athletic Competence subscale was strongly correlated for adolescents only (r = -0.6, p = <0.01). There were strong correlations between social participation and social support from parents (r = -0.6, p = <0.001), teachers (r = -0.5, p = <0.001), and classmates (r = -0.6, p = <0.001) and moderate correlations for support from close friends (r = -0.4, p = <0.01). There were no significant correlations with family impact.

CONCLUSION

In the context of a country with unlimited access to safe clotting factor concentrates, boys with hemophilia have few social participation restrictions. Although correlational findings do not represent causality, they suggest that encouragement of social participation may be beneficial in boys with hemophilia to increase self-perception as well as strengthen their social support network.

Improvements in Psychosocial Outcomes Following a Summer Camp for Youth with Bleeding Disorders and Their Siblings

PURPOSE

Complications from bleeding episodes from hemophilia can interfere with children's lives and lead to negative psychosocial outcomes. The purpose of this study is to evaluate whether attitude toward illness, hope, perception of illness benefit and/or burden, and/or illness knowledge change for youth with bleeding disorders and their siblings following a five-day education and activity focused summer camp. We hypothesized that youth with bleeding disorders' attitude toward illness, hope, perception of illness benefit, and illness knowledge would improve after camp attendance, and perception of illness burden would decease after camp attendance. We hypothesized that siblings' hope and illness knowledge would improve after camp attendance.

DESIGN AND METHODS

A total of 98 youth (M = 10.9, SD = 3.33, 61.2% male) who attended a bleeding disorder summer camp participated in this study. Fifty percent of participants were diagnosed with either Hemophilia A, Hemophilia B (5%), Von Willebrand Disease (VWD) (28.3%), or platelet deficiency (1.7%), with 38 campers consisting of healthy siblings. The camp hosted "Learning about Hemophilia" breakout sessions for campers. Participants completed self-report questionnaires on the first day and last day of camp.

RESULTS

Of participants with bleeding disorders, illness knowledge, perception of illness benefit, and attitude toward their illness significantly improved from pre-camp to post-camp. Hope did not significantly improve among youth with bleeding disorders. Healthy siblings' total hope significantly improved while illness knowledge remained constant.

CONCLUSIONS

Summer camps are a promising intervention to improve psychosocial outcomes in youth with hemophilia and WVD.

CONCLUSIONS

Summer camps are a promising intervention to improve psychosocial outcomes in youth with hemophilia and WVD.

Psychological interventions for people with hemophilia

BACKGROUND

Managing hemophilia is challenging both in terms of medical treatment and its broad impact on many aspects of the individual's life, including self-perception. Several psychosocial issues are potentially relevant in the clinical management of hemophilia, including it being a chronic and incurable condition; e.g. people with hemophilia must adapt to optimally interact with peers and to practice sports - even choosing a sport represents an issue for perceived limitations, expectations and cultural influences on the individual and their family. People with hemophilia can react by denying their condition and its manifestations and not adhering to treatment. Due to the complexity of relationships surrounding genetic diseases, parents and relatives may have their own issues that contribute to making life easier or more difficult for the person with hemophilia. Anxiety, sadness and depression resulting in mental health disorders are reported in this population and may influence quality of life (QoL) depending on cultural background, religious beliefs, family support and other variables.

OBJECTIVES

Primarily to assess the effectiveness of psychological therapies for improving the ability of people with hemophilia to cope with their chronic condition.

SEARCH METHODS

We aimed to identify trials from the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, Embase and PsycINFO, CINAHL, MEDLINE and trial registries. We searched reference lists of included publications. Most recent search of the Group's register: 13 June 2019.

SELECTION CRITERIA

Randomized controlled trials (RCTs) and quasi-RCTs in people with hemophilia of any age or gender, type A or B, any severity, with or without inhibitors, with or without HIV or hepatitis C virus. All psychological interventions for promoting emotional, intellectual and spiritual wellness. Individual, group or family group therapy interventions were eligible.

DATA COLLECTION AND ANALYSIS

We independently assessed trials, extracted data and assessed the risk of bias and assessed the quality of the evidence using GRADE.

MAIN RESULTS

Seven trials were included (362 participants randomized, data from 264 participants available for analysis); six of parallel design and one a partial cross-over design. One multicenter trial was conducted in Canada; the remaining six were single centre undertaken in the UK, USA, Iran and in the Netherlands. All trials had a high risk of bias for participant blinding and use of patient-reported outcomes. Evidence was retrieved on four interventions: psycho-education (DVD plus information booklet versus information booklet alone; computerised learning versus no intervention); cognitive therapy (auto-hypnosis (self-hypnosis) versus control); and behavioural therapy (relaxation (progressive or self control) versus no treatment). We also aimed to assess psychodynamic therapy and systemic therapy, but no trials were identified. Heterogeneity of the outcome measures and measurements precluded meta-analyses. No trial reported the cost of the psychological intervention and family adjustment. DVD plus information booklet compared to information booklet alone One trial (108 participants) showed coping strategies may lower pre-contemplation scores and negative thoughts, mean difference (MD) -0.24 (95%CI -0.48 - 0.00, low-certainty evidence), however, other measures of coping strategies in the same trial suggest little or no difference between groups, e.g. contemplation, MD (-0.09, 95%CI -0.32 - 0.14, low-certainty evidence). The same trial measured QoL and showed little or no difference between treatment groups for the physical domain, MD 0.59 (95% CI -3.66 to 4.84, low-certainty evidence), but may improve scores in the mental health domain for those receiving the booklet plus DVD compared to booklet alone, MD (4.70, 95% CI 0.33 to 9.07, low-certainty evidence). Mood or personal well-being were not reported. Computerised learning compared to no intervention Two trials (57 participants) reported on interventions aimed at children and adolescents and their impact on promoting a sense of self-efficacy (primary outcome 'Mood and personal well-being'), but only one showed an increase, MD 7.46 (95%CI 3.21 to 11.71, 17 participants, very low-certainty evidence); the second did not report control group data. One trial (30 participants) showed the intervention did not improve self-efficacy in adults, but appropriate data could not be extracted. Two trials (47 participants) reported coping strategies; one only reported within-group differences from baseline, the second showed an increase from baseline in coping strategies in the Internet program group compared to the no intervention group (disease-specific knowledge, MD 2.45 (95% CI 0.89 to 4.01); self-management ability and transition readiness, MD 19.90 (95% CI 3.61 to 36.19; low-certainty evidence). One trial reported QoL but with insufficient information to calculate changes from baseline; no difference in post-treatment scores was seen between groups, MD -8.65, 95% CI -18.30 to 1.00, very low-certainty evidence). Auto-hypnosis (self-hypnosis) compared to control There were two older trials that reported on this intervention (50 participants) focusing mainly on the secondary outcome 'physical health'; only one trial reported the primary outcome 'mood and personal well-being' (only within-group differences in the treatment group). Coping strategies and QoL were not assessed in the trials. Relaxation (progressive or self control) compared to no treatment Only one trial (seven participants) from 1985, was included which focused on 'physical health' and did not report on any of our primary outcomes.

AUTHORS' CONCLUSIONS

Not all of the seven included trials analysed the effects of the interventions on our primary outcomes (mood and personal well-being, coping strategies and QoL). Three trials were conducted in the 1970s and 1980s using techniques of auto-hypnosis or relaxation and, in accordance with the needs and therapeutic possibilities of the time, they focused on secondary outcomes, e.g. frequency of bleeding (physical health) and adherence to the intervention. The four newer trials assessed psycho-educational interventions all mediated by the use of technologies (DVD or computer) and often created according to age needs of the target group. In these cases, attention was shifted to our pre-defined primary outcomes. This review has identified low- and very low-certainty evidence, prompting caution in its interpretation. The major problem we encountered was the heterogeneity of trial designs, of interventions and of outcome measures used across the trials. We strongly suggest that researchers consider developing a core outcome set to streamline future research; randomization was proven to be safe and acceptable, and blinding should be considered for those assessing patient-reported outcomes.

Online Peer-to-Peer Mentoring Support for Youth with Hemophilia: Qualitative Needs Assessment

BACKGROUND

To support adolescents through transition from pediatrics to adult care, health care providers and families help teens gain knowledge and develop self-management skills. Peer mentoring can provide meaningful support and has been associated with improved health outcomes in patients with other chronic conditions. Peer mentoring is an appealing way to provide support, but it is imperative to consider the unique needs of adolescents to ensure its success.

OBJECTIVE

The objective of our study was to identify the peer mentoring wants and needs of youth with hemophilia in order to guide the development of a new program.

METHODS

In this qualitative study, we interviewed a convenience sample of youth with hemophilia from 2 Canadian hemophilia treatment centers. Two iterative cycles of audiorecorded, semistructured individual interviews were conducted. Descriptive statistics and content analyses were used to organize data into categories that reflected emerging themes.

RESULTS

In total, we recruited 23 participants aged 12-20 years, with a mean age of 14.91 (2.57) years. When asked about program design, participants weighed the importance of flexibility in delivery (eg, Web-based, in person, text messaging [short message service]), content (eg, structured vs unstructured), frequency of sessions, and length of the program. Participants identified some potential challenges such as scheduling issues, comfort level for disease discussion, and discordant mentor-mentee personality types. The program was viewed as a positive medium for connecting peers with hemophilia.

CONCLUSIONS

Adolescents with hemophilia expressed interest in a peer mentoring program and provided valuable insight that will be applied in the development of a peer mentoring program for youth with hemophilia.

Perceptions of Health Care Professionals on the Effects of Residential Summer Camp in their Patients

PURPOSE

A growing body of literature exists regarding medical specialty camps for children. However, very little of the research focuses on the perspectives of healthcare providers. This study explored perceptions of pediatric healthcare providers on a medical specialty camp for children.

DESIGN AND METHODS

Interviews with five volunteer physicians and five nurses were conducted and analyzed using inductive content analysis.

RESULTS

Results showed that healthcare providers perceived camp to be a positive influence on campers' normalization and healthcare ownership, and to strengthen patient-provider relationships. Providers contextualized their assertions by discussing the settings of camp and of patients. However, providers also identified multiple barriers perceived as limiting a camp experience's ability to create lasting changes in patients' attitudes or behaviors.

CONCLUSIONS

While healthcare providers in this study perceived camp as being a positive opportunity for patients, the potential for long-lasting effects was seen to be hindered by factors external to the camp and changes in patients' attitudes or behaviors can be difficult to ascribe to the camp experience.

PRACTICE IMPLICATIONS

Healthcare providers can reinforce and extend positive health behavior messages from camp at follow-up appointments. Adding inquiries about camp attendance and experiences to patients' visits can provide healthcare providers with additional insights about patients. Health outcomes before and after camp could be measured to assess change. Camps can send home patient protocols on successes and challenges.

Younger children's nursing students are uniquely placed to provide emotional care for young people in hospital and promote for them a sense of normalcy

OBJECTIVES

To highlight the emotional impact of being in the hospital for young people and to explore the impact of the care by younger student nurses on promoting a sense of "normalcy" for them.

BACKGROUND

Adolescence is strongly influenced by peer relationships and is a unique period in life that requires the achievement of many developmental tasks. An important task of adolescent is developing relationships with peers and feeling part of a recognised peer group. Young people prefer engaging in conversation with people of their own age because they feel less likely to be judged by their peers.

DESIGN

Heideggerian hermeneutic phenomenological study.

METHOD

A Heideggerian phenomenological study was undertaken. Individual unstructured interviews were conducted with eleven younger student nurses (aged l7 years and 5 months-l8 years and 11 months) and nine young people with a chronic illness (aged 13 years and 7 months-18 years and 1 month). The data was collected in 2009.

RESULTS

Young people in the hospital with a chronic illness experienced moments in time when they had nothing to think about but the business of getting better. During unique caring interactions, younger children's nursing students were able to help them temporarily forget about their illness and promote for them a sense of normalcy.

CONCLUSIONS

Younger children's nursing students are in a unique position to engage in ontological caring interactions with the young people due to their similarity in age and stage of development. They are uniquely placed to help the young people reintegrate back into their known "lifeworlds" and promote for them a sense of "normalcy".

RELEVANCE TO CLINICAL PRACTICE

Clinical staff need to be alerted to the emotional distress caused to young people during long periods of time in the hospital. Practitioners and nurse educators should be facilitating younger student nurses to interact with the young people in a therapeutic way and the care delivered to young people in the hospital should promote a sense of normalcy for them.

Craniofacial summer cAMP: an educational experience for campers, cAMP staff, and the craniofacial team

Children with congenital or acquired craniofacial conditions often have complex medical and surgical healthcare needs. To provide holistic care to this unique pediatric population, we must seek methods to address the psychosocial needs of children living with a craniofacial difference. Our multidisciplinary craniofacial team concluded our second-year participating in overnight summer camps for our patients with cleft-craniofacial conditions. We worked with 2 different organizations to host the camps each year. Over the course of 2 years, we enrolled more than 100 children, 7-15 years of age, in 1-week, overnight camp experiences. Campers participated in activities to promote team building, self-esteem, confidence, and social awareness. We share the perspectives of the campers and their parents, the camp staff, and the craniofacial team members.

The experience of living with a chronic illness during adolescence: a critical review of the literature

AIMS

To identify and critique literature on the adolescent lived experience of chronic illness; describe the lived experience; and to make recommendations for clinical practice.

BACKGROUND

Young people with chronic illness have the same developmental issues as those who are healthy. However, development can be disrupted by treatment and repeated hospitalisation. While the physical consequences of chronic illness on development have been established, the subjective personal experience is less known.

DESIGN

Literature review.

METHODS

Electronic databases and hand searches were made of the literature published between January 1990-September 2007. Literature was eligible for inclusion if it involved adolescents between 10-19 years, and published in English and used qualitative methods of data collection. Methodological quality was assessed using the criteria described by Cesario et al. [Journal of Obstetrics, Gynaecology and Neonatal Nursing 31 (2002) 31].

CONCLUSIONS

Twenty studies were identified involving young people with a wide variety of chronic illnesses. The study quality was variable, however, generally the majority was assessed as being good or fair. Seven common themes were found between the identified studies: developing and maintaining friendships; being normal/getting on with life; the importance of family; attitude to treatment; experiences of school; relationship with the healthcare professionals; and the future.

RELEVANCE TO PRACTICE

As there was commonality in themes between studies strategies to lessen the burden of chronic illness during adolescence do not necessarily need to be disease specific. Nurses need to focus on treating the young person rather than their illness.

The benefits of a camp designed for children with epilepsy: evaluating adaptive behaviors over 3 years

OBJECTIVE

Children with epilepsy attending a condition-specific overnight camp were evaluated for behavioral changes over 3 consecutive years, using a modification of the Vineland Adaptive Behavioral Scale.

METHODS

Trained counselors completed pre- and postcamp assessments for each camper. Repeated-measures MANOVA was used to analyze effects of the camp experience for each year, with respect to gender and age. Repeated-measures ANOVA was conducted to evaluate long-term effects from year-to-year comparisons for return campers, following three successive camp experiences.

RESULTS

A significant change in social interaction was observed over 3 years. Despite some decline at the start of camp in consecutive years, the overall trend for return campers suggests a positive cumulative impact of continued camp participation, with improvements in the domains of social interaction, responsibility, and communication.

CONCLUSION

A condition-specific camp designed for children with epilepsy can improve adaptive behaviors and social interactions. Overall net gains appear to increase over time, suggesting additional benefits for return campers.