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Al-Mfarej D, Vojtech JM, Roy SH, Townsend E, Keysor JJ, Kuntz N, Rao V, Kline JC, Shiwani B. A Virtual Reality Exergame: Clinician-Guided Breathing and Relaxation for Children with Muscular Dystrophy. 2023 IEEE CONFERENCE ON VIRTUAL REALITY AND 3D USER INTERFACES ABSTRACTS AND WORKSHOPS (VRW) 2023; 2023:270-276. [PMID: 38009078 PMCID: PMC10676767 DOI: 10.1109/vrw58643.2023.00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
This study introduces a VR-based breathing and relaxation exergame tailored for individuals with Duchenne muscular dystrophy (DMD). DMD is a rare neuromuscular disease that leads to respiratory muscle dysfunction with anxiety being a common comorbidity. Clinical management requires frequent visits to rare disease specialists to manage symptom progression. Limited availability and/or proximity of rare disease experts present challenges to care and can lead to missed care opportunities and reduced quality of life. We propose a breathing and relaxation exergame with remote telehealth applicability that incorporates shared patient-clinician VR interaction, and physiological sensors that provide both real-time feedback to the patient and health analytics for the clinician. The game focuses on two key aspects of DMD clinical care that can be mediated through control of breathing: relaxation/mindfulness training and respiratory muscle exercise. The system was evaluated among 13 individuals, including 4 participants with DMD. Feedback surveys, interviews, and focus group discussions with participants, accompanying family members, and clinicians demonstrated the feasibility of this VR tool for telehealth or as part of a home exercise program.
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Affiliation(s)
- Dalya Al-Mfarej
- Delsys and Altec, Inc., Natick, Massachusetts, United States
| | | | - Serge H. Roy
- Delsys and Altec, Inc., Natick, Massachusetts, United States
| | - Elise Townsend
- MGH Institute of Health Professions, Boston, Massachusetts, United States
| | - Julie J. Keysor
- MGH Institute of Health Professions, Boston, Massachusetts, United States
| | - Nancy Kuntz
- Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
| | - Vamshi Rao
- Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
| | - Joshua C. Kline
- Delsys and Altec, Inc., Natick, Massachusetts, United States
| | - Bhawna Shiwani
- Delsys and Altec, Inc., Natick, Massachusetts, United States
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Urquhart DS, Cunningham S, Taylor E, Vogiatzis I, Allen L, Lewis S, Neilson AR, Soilemezi D, Akooji N, Saynor ZL. Exercise as an Airway Clearance Technique in people with Cystic Fibrosis (ExACT-CF): rationale and study protocol for a randomised pilot trial. NIHR OPEN RESEARCH 2022; 2:64. [PMID: 37881306 PMCID: PMC10593342 DOI: 10.3310/nihropenres.13347.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 10/27/2023]
Abstract
Background Chest physiotherapy is an established cornerstone of care for people with cystic fibrosis (pwCF), but is often burdensome. Guidelines recommend at least one chest physiotherapy session daily, using various airway clearance techniques (ACTs). Exercise (with huffs and coughs) may offer an alternative ACT, however the willingness of pwCF to be randomised into a trial needs testing. The 'ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis' trial will test the feasibility of recruiting pwCF to be randomised to continue usual care (chest physiotherapy) or replace it with exercise ACT (ExACT) for 28-days. Secondary aims include determining the short-term clinical impact (and safety) of stopping routine chest physiotherapy and replacing it with ExACT, and effects on physical activity, sleep, mood, quality of life and treatment burden, alongside preliminary health economic measures and acceptability. Methods Multi-centre, two-arm, randomised (1:1 allocation using minimisation), pilot trial at two sites. Fifty pwCF (≥10 years, FEV 1 >40% predicted, stable on Elexacaftor/Tezacaftor/Ivacaftor (ETI)) will be randomised to an individually-customised ExACT programme (≥once daily aerobic exercise of ≥20-minutes duration at an intensity that elicits deep breathing, with huffs and coughs), or usual care. After baseline assessments, secondary outcomes will be assessed after 28-days, with additional home lung function and exacerbation questionnaires at 7, 14 and 21-days, physical activity and sleep monitoring throughout, and embedded qualitative and health-economic components. Feasibility measures include recruitment, retention, measurement completion, adverse events, interviews exploring the acceptability of trial procedures, and a trial satisfaction questionnaire. Discussion Co-designed with the UK CF community, the ExACT-CF pilot trial is the first multi-centre RCT to test the feasibility of recruiting pwCF stable on ETI into a trial investigating ExACT. This pilot trial will inform the feasibility, design, management, likely external validity for progression to a main phase randomised controlled trial. Registration Clinicaltrials.gov ( NCT05482048).
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Affiliation(s)
- Don S. Urquhart
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Steve Cunningham
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Emily Taylor
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | | | - Steff Lewis
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aileen R. Neilson
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Dia Soilemezi
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Naseerah Akooji
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Zoe L. Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
- Wessex Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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3
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Fairweather N, Jones FW. Facilitators and barriers to empowerment in children and young people with cystic fibrosis: a meta-synthesis of the qualitative literature. Disabil Rehabil 2022; 44:7767-7780. [PMID: 34802345 DOI: 10.1080/09638288.2021.2003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Patient empowerment may be particularly important in children and young people (CYP) with CF, due to high treatment burden and limited peer support opportunities. This review aimed to meta-synthesize the qualitative literature pertaining to empowerment in CYP with CF. MATERIALS AND METHODS This work was guided by the ENTREQ framework, with a search strategy based on the SPIDER framework. A systematic search of PsycInfo, Medline, CINAHL and ASSIA databases was conducted. Identified studies were quality assessed and data analysed using thematic synthesis. PROSPERO registration: CRD42019154014. RESULTS Seventeen studies met inclusion criteria, though none explicitly explored empowerment. Thematic synthesis identified six analytic themes: relational support, information and understanding and feeling heard and respected appeared to facilitate empowerment, while prejudices and assumptions were identified as potential barriers. Mastery and competence and Navigating being different appeared to be components of empowerment. CONCLUSIONS The findings provide an initial understanding of patient empowerment in CYP with CF. Potential clinical implications include the need for more CYP-friendly information, more shared decision making and more opportunities to experience mastery. The need for further research is highlighted, particularly relating to developmental influences and factors unique to CF, which are not adequately addressed in existing patient empowerment models.Implications for rehabilitationEmpowerment in children and young people with cystic fibrosis can be facilitated by supportive and respectful relationships with family, friends and clinical teams, that enable them to feel heard and understood.It can be further supported by providing developmentally appropriate information and opportunities for children and young people to experience mastery and competency in typical childhood activities.Prejudices and assumptions about the capabilities of children and young people with CF, even when based in good intentions, can act as a barrier to empowerment.Empowerment can shape (and be shaped by) the way the children and young people navigate differences associated with living with CF.
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Affiliation(s)
- Naomi Fairweather
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, Kent, UK
| | - Fergal W Jones
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, Kent, UK
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Andrews K, Smith M, Cox NS. Physiotherapy: At what cost? Parents experience of performing chest physiotherapy for infants with cystic fibrosis. J Child Health Care 2021; 25:616-627. [PMID: 33249885 DOI: 10.1177/1367493520976481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physiotherapy is one of the most burdensome aspects of cystic fibrosis (CF) care. Healthcare requirements for older children with CF are reported to impact parental quality of life and physiotherapy adherence. How parents of infants experience performing chest physiotherapy as a part of CF care is unknown. This study aimed to explore the experience of performing chest physiotherapy for parents of infants with CF. In this study, 13 parents of infants (aged 1-2 years) with CF participated in one in-depth semi-structured interview and completed a daily diary for five days. Principles of hermeneutic phenomenology guided interpretation of interview transcripts, diary entries, and field notes. For these parents, being responsible for performing chest physiotherapy was an ever-present experience of pressure, doubt, and guilt. Managing chest physiotherapy resulted in sacrifices that were perceived by parents as an expected and necessary part of meeting the healthcare needs of their child. Despite perceived sacrifices, performing chest physiotherapy was also experienced by parents as an opportunity to positively impact the health of their child. Awareness of parental perceptions and experiences of chest physiotherapy in CF may enhance the personalization of physiotherapy and minimize burden.
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Affiliation(s)
- Kristen Andrews
- School of Community Health, 1109Charles Sturt University, Albury, NSW, Australia
| | - Megan Smith
- Faculty of Science, 1109Charles Sturt University, Albury, NSW, Australia
| | - Narelle S Cox
- Monash University & Institute for Breathing and Sleep, 2541Monash University, Australia
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5
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Ren T, Shen W, Zhang L, Zhao H. Bayesian phase II clinical trial design with noncompliance. Stat Med 2021; 40:4457-4472. [PMID: 34050539 DOI: 10.1002/sim.9041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/27/2021] [Accepted: 04/15/2021] [Indexed: 11/08/2022]
Abstract
Noncompliance issue is common in early phase clinical trials; and may lead to biased estimation of the intent-to-treat effect and incorrect conclusions for the clinical trial. In this work, we propose a Bayesian approach for sequentially monitoring the phase II randomized clinical trials that takes account for the noncompliance information. We adopt the principal stratification framework and propose to use Bayesian additive regression trees for selecting useful baseline covariates and estimating the complier average causal effect (CACE) for both efficacy and toxicity outcomes. The decision of early termination or not is then made adaptively based on the estimated CACE from the accumulated data. Simulation studies have confirmed the excellent performance of the proposed design in the presence of noncompliance.
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Affiliation(s)
- Tingyang Ren
- School of Statistics and Management, Shanghai University of Finance and Economics, Shanghai, China
| | - Weining Shen
- Department of Statistics, University of California, Irvine, California, USA
| | - Liwen Zhang
- School of Statistics and Management, Shanghai University of Finance and Economics, Shanghai, China
| | - Haibing Zhao
- School of Statistics and Management, Shanghai University of Finance and Economics, Shanghai, China
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Dixon E, Puckey M, Collins N, Marsh G, Pabary R. Striving for perfection, accepting the reality: A reflection on adherence to airway clearance and inhalation therapy for paediatric patients with chronic suppurative lung disease. Paediatr Respir Rev 2020; 34:46-52. [PMID: 31130423 DOI: 10.1016/j.prrv.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022]
Abstract
Non-adherence to prescribed treatment is considered the foremost cause of treatment failure in chronic medical conditions. Airway clearance techniques (ACT) play a key role in the management of chronic suppurative lung disease yet, along with inhaled therapies such as nebulised antibiotics, adherence to these is often lower than to other treatments. In this review we discuss methods of monitoring adherence to these therapies and potential barriers and outline suggestions for improving adherence in the paediatric population.
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Affiliation(s)
- Emma Dixon
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Michele Puckey
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Nicola Collins
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Gemma Marsh
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Rishi Pabary
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, SW7 2AZ, United Kingdom.
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Ferreira DP, Chaves CRMDM, Costa ACCD. [Adherence of adolescents with cystic fibrosis to enzyme replacement therapy: associated factors]. CIENCIA & SAUDE COLETIVA 2018; 24:4717-4726. [PMID: 31778521 DOI: 10.1590/1413-812320182412.31622017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/22/2018] [Indexed: 11/21/2022] Open
Abstract
This article sets out to evaluate the prevalence and factors associated with adherence to enzyme replacement therapy among adolescents with cystic fibrosis. It is a cross-sectional, descriptive and observational study. Sociodemographic and clinical data were collected. The instruments used to assess adherence were: the Morisky-Green questionnaire and medication dispensation at the pharmacy, and interviews with structured questionnaires for the associated factors. Forty-four adolescents were interviewed. According to the method of the pharmacy medication dispensation analysis and the Morisky-Green questionnaire, the adherence of 45.5% and 11.4% was found, respectively. The higher adherence was observed in those with early diagnosis and the lowest in older adolescents and girls. The factors with the highest prevalence of non-adherence were: not taking enzymes when eating out of the home; only taking enzymes with major meals; normal lung function; with severe and very severe obstruction. The prevalence of adhesion to enzymes was low. Information related to the disease and treatment should be improved, especially among older adolescents and with impairment of lung function, with the creation of strategies and longitudinal studies to identify factors that interfere with adherence.
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Affiliation(s)
- Danielle Portella Ferreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Célia Regina Moutinho de Miranda Chaves
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Ana Carolina Carioca da Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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8
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Rodriguez Hortal MC, Hedborg A, Biguet G, Nygren-Bonnier M. Experience of using non-invasive ventilation as an adjunct to airway clearance techniques in adults with cystic fibrosis-A qualitative study. Physiother Theory Pract 2017; 34:264-275. [PMID: 29111843 DOI: 10.1080/09593985.2017.1400137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adults with cystic fibrosis (CF) suffer from abnormally thick mucus that is difficult to clear from the airways. Different airway clearance techniques (ACTs) can be used to clear secretions and non-invasive ventilation (NIV) can be used as an adjunct to these techniques. ACTs are ideally introduced at the time of diagnosis and thereafter modified throughout the patient's lifespan and disease progress. PURPOSE The research aim was to describe adult patients' views and experiences with using NIV as an adjunct to ACT. METHOD Eighteen adults with CF were interviewed about their experiences with using NIV during ACT. Semi-structured interviews were conducted and analyzed in accordance with qualitative content analysis. RESULTS The results gave rise to the overall theme 'Becoming Friends with NIV' and six associated categories: 1) getting a sense of control and feedback; 2) getting support; 3) dealing with doubt; 4) finding the rhythm; 5) feeling the effects; and 6) finding their own motivation. The findings represent a learning process for adults during the implementation stages of NIV; the physiotherapist was found to play a key role in this process. CONCLUSION 'Becoming Friends with NIV' involves a learning process for adults with CF. To facilitate this learning process, different aspects should be taken into account so as to promote independence and self-management, which in turn allows the patient to experience the treatment as meaningful. The findings are relevant to physiotherapists working with adults and NIV, as improved insight into and understanding of the relationship may have a positive influence on the outcome and success of NIV usage.
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Affiliation(s)
- Maria Cecilia Rodriguez Hortal
- a Functional Area Occupational therapy and Physiotherapy , Allied Health Professionals Function, Karolinska University Hospital , Huddinge , Sweden.,b Department of Clinical Science , Intervention and Technology, CLINTEC, Karolinska Institutet , Huddinge , Sweden.,c Stockholm CF Center, Karolinska University Hospital , Huddinge , Sweden
| | - Anna Hedborg
- a Functional Area Occupational therapy and Physiotherapy , Allied Health Professionals Function, Karolinska University Hospital , Huddinge , Sweden.,c Stockholm CF Center, Karolinska University Hospital , Huddinge , Sweden
| | - Gabriele Biguet
- d Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden
| | - Malin Nygren-Bonnier
- a Functional Area Occupational therapy and Physiotherapy , Allied Health Professionals Function, Karolinska University Hospital , Huddinge , Sweden.,d Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden
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9
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Pisaturo M, Deppen A, Rochat I, Robinson WM, Hafen GM. Death after cessation of treatment by cystic fibrosis patients: An international survey of clinicians. Palliat Med 2017; 31:82-88. [PMID: 26979669 DOI: 10.1177/0269216316637773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Little is known about cystic fibrosis patients, who are not considered to be terminally ill, and who die after voluntary cessation of treatment. AIM This study was undertaken to provide an international snapshot of this issue. DESIGN An online survey was distributed across three continents. SETTING Distribution to the medical directors of the cystic fibrosis centres affiliated with the US Cystic Fibrosis Foundation, Cystic Fibrosis Australia (inclusion of New Zealand) and to every clinician member of the European Cystic Fibrosis Society. RESULTS More than 200 cystic fibrosis patients not considered to be terminally ill and, who voluntarily ceased treatment, were reported by the clinicians surveyed. Detailed data were reported in 102 patients (4 children, 25 adolescents and 73 adults). Only one child, six adolescents and one adult were judged by clinicians not to be competent to make the decision to stop treatment. Time-consuming and low immediate-impact therapies, such as respiratory physiotherapy, were most frequently discontinued. Resignation was the main reported reason for discontinuing treatment, followed by reactive depression and lack of familial support. A total of 69% of the patients received palliative care and 72% died in the 6 months following cessation of treatment. CONCLUSION Death of cystic fibrosis patients, not considered to be terminally ill, is reported in Europe, the United States and Australia due to voluntary cessation of treatment.
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Affiliation(s)
- Marisa Pisaturo
- 1 Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Alain Deppen
- 2 Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Rochat
- 1 Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,3 Respiratory Unit, Department of Paediatrics, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | | | - Gaudenz M Hafen
- 1 Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,3 Respiratory Unit, Department of Paediatrics, CHUV Lausanne University Hospital, Lausanne, Switzerland
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Al-Jazaeri A. The response pattern and adherence to oral propranolol among Saudi children treated for infantile hemangioma. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2017. [DOI: 10.1016/j.jdds.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Leeman J, Sandelowski M, Havill NL, Knafl K. Parent-to-Child Transition in Managing Cystic Fibrosis: A Research Synthesis. JOURNAL OF FAMILY THEORY & REVIEW 2015; 7:167-183. [PMID: 26279680 PMCID: PMC4532343 DOI: 10.1111/jftr.12070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Although parents and children must adhere to five primary treatments for cystic fibrosis (CF), and their roles transition over time, the scope of CF studies often has been limited to one treatment regimen or to children within a specified age range. The purpose of this mixed research synthesis study is to integrate findings from qualitative and quantitative studies addressing the transition of CF management from parent to child, as well as factors related to adherence across treatments and over time. An existing grounded theory was used as a framework to synthesize findings in 17 reports from 16 studies. The results confirm the theory and posit three additional factors that may influence parent-to-child transition of care management.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill
| | | | - Nancy L Havill
- School of Nursing, University of North Carolina at Chapel Hill
| | - Kathleen Knafl
- School of Nursing, University of North Carolina at Chapel Hill
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12
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Morris JH, Oliver T, Kroll T, Joice S, Williams B. From physical and functional to continuity with pre-stroke self and participation in valued activities: A qualitative exploration of stroke survivors’, carers’ and physiotherapists’ perceptions of physical activity after stroke. Disabil Rehabil 2014; 37:64-77. [DOI: 10.3109/09638288.2014.907828] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Santer M, Ring N, Yardley L, Geraghty AWA, Wyke S. Treatment non-adherence in pediatric long-term medical conditions: systematic review and synthesis of qualitative studies of caregivers' views. BMC Pediatr 2014; 14:63. [PMID: 24593304 PMCID: PMC3984727 DOI: 10.1186/1471-2431-14-63] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 02/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Non-adherence to prescribed treatments is the primary cause of treatment failure in pediatric long-term conditions. Greater understanding of parents and caregivers’ reasons for non-adherence can help to address this problem and improve outcomes for children with long-term conditions. Methods We carried out a systematic review and thematic synthesis of qualitative studies. Medline, Embase, Cinahl and PsycInfo were searched for relevant studies published in English and German between 1996 and 2011. Papers were included if they contained qualitative data, for example from interviews or focus groups, reporting the views of parents and caregivers of children with a range of long-term conditions on their treatment adherence. Papers were quality assessed and analysed using thematic synthesis. Results Nineteen papers were included reporting 17 studies with caregivers from 423 households in five countries. Long-term conditions included; asthma, cystic fibrosis, HIV, diabetes and juvenile arthritis. Across all conditions caregivers were making on-going attempts to balance competing concerns about the treatment (such as perceived effectiveness or fear of side effects) with the condition itself (for instance perceived long-term threat to child). Although the barriers to implementing treatment regimens varied across the different conditions (including complexity and time-consuming nature of treatments, un-palatability and side-effects of medications), it was clear that caregivers worked hard to overcome these day-to-day challenges and to deal with child resistance to treatments. Yet, carers reported that strict treatment adherence, which is expected by health professionals, could threaten their priorities around preserving family relationships and providing a ‘normal life’ for their child and any siblings. Conclusions Treatment adherence in long-term pediatric conditions is a complex issue which needs to be seen in the context of caregivers balancing the everyday needs of the child within everyday family life. Health professionals may be able to help caregivers respond positively to the challenge of treatment adherence for long-term conditions by simplifying treatment regimens to minimise impact on family life and being aware of difficulties around child resistance and supportive of strategies to attempt to overcome this. Caregivers would also welcome help with communicating with children about treatment goals.
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Affiliation(s)
- Miriam Santer
- Aldermoor Health Centre, The University of Southampton, Aldermoor Close, SO16 5ST, Southampton, UK.
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Santer M, Burgess H, Yardley L, Ersser SJ, Lewis-Jones S, Muller I, Hugh C, Little P. Managing childhood eczema: qualitative study exploring carers' experiences of barriers and facilitators to treatment adherence. J Adv Nurs 2013; 69:2493-501. [DOI: 10.1111/jan.12133] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Miriam Santer
- Primary Care and Population Sciences; University of Southampton; UK
| | - Hana Burgess
- Primary Care and Population Sciences; University of Southampton; UK
| | - Lucy Yardley
- School of Psychology; University of Southampton; UK
| | | | - Sue Lewis-Jones
- Ninewells Hospital and Department of Dermatology, University of Dundee; UK
| | | | | | - Paul Little
- Primary Care and Population Sciences; University of Southampton; UK
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Irons JY, Kuipers K, Petocz P. Exploring the health benefits of singing for young people with cystic fibrosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2013. [DOI: 10.12968/ijtr.2013.20.3.144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- J Yoon Irons
- Singer and music therapist, Sydney Conservatorium of Music, University of Sydney, New South Wales, Australia
| | - Kathy Kuipers
- Senior occupational therapist and researcher, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Peter Petocz
- Associate Professor, Department of Statistics, Macquarie University, Sydney, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW Treatment nonadherence is a common problem, yet adherence to treatments is important for the successful management of cystic fibrosis (CF). Previous work has concentrated on rates of adherence in children and adults using self-report questionnaires. Recent studies have employed new measurement methods and evaluated various treatment components. It is important to understand the factors that impede and facilitate adherence in order that research and clinical practice can improve adherence rates. RECENT FINDINGS There is a high perceived treatment burden in CF. Rates of adherence vary according to the treatment and the measurement method. Reasons for nonadherence are numerous. Even with technology designed to reduce treatment time, adherence to nebulized antibiotics is still poor. Nonadherence is a particular issue in adolescence and there is evidence that girls are less adherent than boys, leading to poorer lung function. Patients who have a cohesive and balanced family life may be better able to incorporate CF treatments. Treatment beliefs and the perception of treatment effectiveness are important determinants of adherence. SUMMARY Research needs to move forward to understand how to help patients to improve their adherence and to assist healthcare professionals in supporting them. There is a consensus that tailored interventions are essential. In addition, it is important to understand adherence behaviours over time in order to recognize specific periods during a person's life when adherence is more difficult to achieve.
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Williams B, Anderson AS, Barton K, McGhee J. Can theory be embedded in visual interventions to promote self-management? A proposed model and worked example. Int J Nurs Stud 2012; 49:1598-609. [PMID: 22874588 DOI: 10.1016/j.ijnurstu.2012.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 06/04/2012] [Accepted: 07/07/2012] [Indexed: 10/28/2022]
Abstract
Nurses are increasingly involved in a range of strategies to encourage patient behaviours that improve self-management. If nurses are to be involved in, or indeed lead, the development of such interventions then processes that enhance the likelihood that they will lead to evidence that is both robust and usable in practice are required. Although behavioural interventions have been predominantly based on written text or the spoken word increasing numbers are now drawing on visual media to communicate their message, despite only a growing evidence base to support it. The use of such media in health interventions is likely to increase due to technological advances enabling easier and cheaper production, and an increasing social preference for visual forms of communication. However, the development of such media is often highly pragmatic and developed intuitively rather than with theory and evidence informing their content and form. Such a process may be at best inefficient and at worst potentially harmful. This paper performs two functions. Firstly, it discusses and argues why visual based interventions may be a powerful media for behaviour change; and secondly, it proposes a model, developed from the MRC Framework for the Development and Evaluation of Complex Interventions, to guide the creation of theory informed visual interventions. It employs a case study of the development of an intervention to motivate involvement in a lifestyle intervention among people with increased cardiovascular risk. In doing this we argue for a step-wise model which includes: (1) the identification of a theoretical basis and associated concepts; (2) the development of visual narrative to establish structure; (3) the visual rendering of narrative and concepts; and (4) the assessment of interpretation and impact among the intended patient group. We go on to discuss the theoretical and methodological limitations of the model.
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Affiliation(s)
- B Williams
- Nursing, Midwifery & Allied Health Professions Research Unit, University of Stirling, United Kingdom.
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Moffett A, Ross LF. A pilot study to determine whether health care professionals perceive stigma in heterozygote carrier identification and disclosure decisions. Am J Med Genet A 2011; 155A:1897-905. [DOI: 10.1002/ajmg.a.34091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/12/2011] [Indexed: 11/07/2022]
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Bregnballe V, Schiøtz PO, Boisen KA, Pressler T, Thastum M. Barriers to adherence in adolescents and young adults with cystic fibrosis: a questionnaire study in young patients and their parents. Patient Prefer Adherence 2011; 5:507-15. [PMID: 22114464 PMCID: PMC3218111 DOI: 10.2147/ppa.s25308] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Treatment adherence is crucial in patients with cystic fibrosis, but poor adherence is a problem, especially during adolescence. Identification of barriers to treatment adherence and a better understanding of how context shapes barriers is of great importance in the disease. Adolescent reports of barriers to adherence have been studied, but studies of their parents' experience of such barriers have not yet been carried out. The aim of the present study was to explore barriers to treatment adherence identified by young patients with cystic fibrosis and by their parents. METHODS A questionnaire survey of a cohort of young Danish patients with cystic fibrosis aged 14-25 years and their parents was undertaken. RESULTS Barriers to treatment adherence were reported by 60% of the patients and by 62% of their parents. Patients and parents agreed that the three most common barriers encountered were lack of time, forgetfulness, and unwillingness to take medication in public. We found a significant positive correlation between reported number of barriers and perceived treatment burden. We also found a statistically significant relationship between the reported number of barriers and treatment adherence. A significant association was found between the number of barriers and the reactions of adolescents/young adults and those of their mothers and fathers, and between the number of barriers and the way the family communicated about cystic fibrosis. CONCLUSION The present study showed that the majority of adolescents with cystic fibrosis and their parents experienced barriers to treatment adherence. Agreement between adolescents and their parents regarding the level and types of barriers indicates an opportunity for close cooperation between adolescents, their parents, and health care professionals in overcoming adolescent adherence problems.
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Affiliation(s)
- Vibeke Bregnballe
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
- Correspondence: Vibeke Bregnballe, Department of Pediatrics, Aarhus University Hospital, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark, Tel +45 6169 9001, Fax +45 8949 6790, Email
| | | | - Kirsten A Boisen
- Centre of Adolescent Medicine, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Tacjana Pressler
- Cystic Fibrosis Centre, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Mikael Thastum
- Department of Psychology, University of Aarhus, Aarhus, Denmark
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George M, Rand-Giovannetti D, Eakin MN, Borrelli B, Zettler M, Riekert KA. Perceptions of barriers and facilitators: self-management decisions by older adolescents and adults with CF. J Cyst Fibros 2010; 9:425-32. [PMID: 20846910 DOI: 10.1016/j.jcf.2010.08.016] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/19/2010] [Accepted: 08/18/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adherence to CF treatments is poor, which can lead to negative health outcomes. The objective of our study was to qualitatively investigate the barriers and facilitators of self-management among older adolescents and adults with CF. METHODS Individual semi-structured interviews were conducted, audio-taped, transcribed verbatim and coded to identify common themes. RESULTS Twenty-five patients were interviewed. Four broad themes were identified: Barriers to Self-Management (e.g., treatment burden (identified by 64% of patients), accidental or purposeful forgetting (60%), no perceived benefit (56%)), Facilitators of Self-Management (e.g., CF clinic visits (76%), social support (68%), perceived benefit (68%)), Substitution of Alternative Approaches to Conventional Management (36%) and Planned Non-adherence (32%). CONCLUSIONS Older adolescents and adults with CF identified many barriers and facilitators of adherence that may be amenable to self-management counseling strategies, particularly the use of health feedback.
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Affiliation(s)
- Maureen George
- Family and Community Health Division, Center for Health Equity Research, University of Pennsylvania School of Nursing, Fagin Hall 418 Curie Blvd., Philadelphia, PA 19104-4217, United States
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Abstract
Although communication issues within health care have received greater research and policy attention in recent years, one growing aspect of such communication has been largely overlooked. In this paper we suggest that visual forms of communication, at both the individual and population level, are increasingly used and relied upon. This seems appropriate given a general shift towards a more visual and visually literate society, and the potential of images to convey complex information and influence both beliefs and emotion. However, we also argue that the widespread use of such a potentially powerful tool necessitates a solid evidence base that is currently lacking. Such a lack leaves image-based interventions at best potentially ineffective and at worst harmful. We examine the reasons for the paucity of research in this area and suggest that in fact a multitude of supportive research and theory exists but that at present it is spread across a range of academic fields with little interdisciplinary dialogue. Given the current desire to see increased inter- and multidisciplinary dialogue and the acceptance of the need for theoretical and empirical underpinnings for complex interventions, it would seem that there may now be both the will and the way forward to forge new collaborations, integrate such theories and develop a more sophisticated evidence base to support the growing use of images in health care settings.
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Affiliation(s)
- Brian Williams
- Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, UK.
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Williams B, Corlett J, Dowell JS, Coyle J, Mukhopadhyay S. I've never not had it so I don't really know what it's like not to: nondifference and biographical disruption among children and young people with cystic fibrosis. QUALITATIVE HEALTH RESEARCH 2009; 19:1443-1455. [PMID: 19805806 DOI: 10.1177/1049732309348363] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The relevance of biographical disruption and loss of self for children and young people is unclear, particularly in cases of congenital illness such as cystic fibrosis, where no prior period of wellness, stability, or perceived normality might exist. We explored the meaning, importance, and forms of maintenance of ideas of normality among 32 children and young people with cystic fibrosis. We examine the ways in which normalcy is produced, maintained, and threatened, and discuss the implications for the applicability and relevance of these traditional sociological concepts. Analysis of children's and young people's accounts resulted in a conceptualization of four forms of normalcy based on personal and social definitions and audiences. Biographical disruption appeared relevant but in a more nuanced form than its usual conceptualization when applied to adult populations. Maintaining normality within the family resulted in continual biographical revision in anticipation of future illness trajectory and life course.
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Affiliation(s)
- Brian Williams
- Social Dimensions of Health Institute, University of Dundee, Dundee, United Kingdom.
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McClellan CB, Cohen LL, Moffett K. Time out based discipline strategy for children's non-compliance with cystic fibrosis treatment. Disabil Rehabil 2009; 31:327-36. [DOI: 10.1080/09638280802051713] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Goss CH, Edwards TC, Ramsey BW, Aitken ML, Patrick DL. Patient-reported respiratory symptoms in cystic fibrosis. J Cyst Fibros 2009; 8:245-52. [PMID: 19481983 DOI: 10.1016/j.jcf.2009.04.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 04/08/2009] [Accepted: 04/12/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) specific patient-derived and reported symptom tools are critical steps toward evaluating the outcomes of new therapies for CF. METHODS We conducted 25 in-depth qualitative interviews using the Day Reconstruction Method and 9 cognitive interviews at two CF programs, the University of Washington and Seattle Children's Hospital and Regional Medical Center. The interviews were audio-recorded and transcribed, and then coded and analyzed for themes relating to pulmonary symptoms and related psychosocial impacts. RESULTS Six pulmonary symptoms were identified as central to CF: cough, sputum production, wheeze, chest tightness, difficulty breathing/shortness of breath, and fever. Emotional impacts included frustration, sadness/depression, irritability, worry, difficulty sleeping; while activity impacts included time spent sitting or lying down, reduction of usual activities, and missing school or work. In all, 8 symptom items, 4 emotional impacts items, and 4 activity impacts were selected for inclusion on a new daily diary. We also assessed triggers for seeking care. CONCLUSIONS Using a qualitative inductive methodology, we have obtained patient centered data regarding pulmonary symptoms and burdens and have created a novel patient reported outcome measure for CF. Future studies will assess the validity of the instruments.
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Affiliation(s)
- C H Goss
- Department of Medicine, University of Washington, Seattle, WA, USA.
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Collins S, Reynolds F. How do adults with cystic fibrosis cope following a diagnosis of diabetes? J Adv Nurs 2009; 64:478-87. [PMID: 19146516 DOI: 10.1111/j.1365-2648.2008.04797.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a study examining the experience of adults with cystic fibrosis in adapting to the diagnosis of diabetes, a second chronic illness. BACKGROUND Diabetes is a common complication of cystic fibrosis; the onset signifies the development of a second chronic illness. Both cystic fibrosis and diabetes are complex conditions, which require daily treatment schedules as part of their management. However, it is unclear how people already living with cystic fibrosis respond to the diagnosis of diabetes. METHOD A qualitative method was chosen to obtain an 'insider' experience of adjusting to a second chronic illness. Semi-structured interviews were conducted in 2004 with 22 adults with cystic fibrosis-related diabetes. The data were analysed using interpretative phenomenological analysis. FINDINGS Four recurring themes were identified: emotional response to diagnosis of diabetes, looking for an understanding, learning to live with diabetes, and limiting the impact of diagnosis. Having cystic fibrosis appeared helpful in limiting the impact of the diagnosis of diabetes. Juggling conflicting dietary demands of cystic fibrosis and diabetes coupled with the lack of practical professional advice available was seen as one of the biggest challenges in adapting to diabetes. CONCLUSION Healthcare professionals need increased awareness of diabetes amongst adults with cystic fibrosis and provide adequate support and structured evidence-based education throughout the course of the illness, particularly in relation to diet. Nevertheless, patients' familiarity with regular daily routines and problem-solving attitudes, already developed in the context of cystic fibrosis, may be drawn on to limit the impact of diabetes.
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Affiliation(s)
- Sarah Collins
- Adult Cystic Fibrosis Dietitian Royal Brompton Hospital, London, UK.
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Affiliation(s)
- Terry Y Segal
- Department of Paediatrics and Adolescence University College London Hospital, 250 Euston Road, London NW1 2PG.
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Williams B, Mukhopadhyay S, Dowell J, Coyle J. From child to adult: An exploration of shifting family roles and responsibilities in managing physiotherapy for cystic fibrosis. Soc Sci Med 2007; 65:2135-46. [PMID: 17719160 DOI: 10.1016/j.socscimed.2007.07.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Indexed: 10/22/2022]
Abstract
Although chest physiotherapy is central to the management of cystic fibrosis many report problems with adherence. Research in other long-term conditions suggests that non-adherence may be exacerbated as the child grows older and self-care responsibilities are transferred to the young person. We explored the nature and variation in roles of family members, how responsibility was transferred from the parent/family to the child, and what factors aided or hindered this process. We conducted in-depth interviews with 32 children with a diagnosis of cystic fibrosis aged 7-17 years, and with 31 parents attending cystic fibrosis clinics in two Scottish regions. Family responsibilities were primarily focused on mothers. The level and nature of involvement varied along a continuum that separated into six parental and five child roles and changed over time. However, this movement was frequently reversed during periods of illness or mistrust. The day to day experience of such a transfer was not straightforward, linear or unproblematic for any of the family members. Three factors were identified as assisting the transfer of responsibility: parents' perceptions of the benefits of transferring responsibility, children's perceptions of the benefits, and the available physical, social and psychological resources to support such a transfer. The principles and lessons from "concordance" (a therapeutic alliance based on a negotiation between equals and which may lead to agreement on management or agreement to differ) may provide a foundation for newly developing relationships between parents and their children emerging into adulthood. Further research is required to develop more specifically the content and structure of required support, its effectiveness in achieving more concordant relationships, and the resulting impact on adherence, perceived health and well-being from the perspective of the young person and parent.
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Affiliation(s)
- Brian Williams
- Division of Community Health Sciences, Ninewells Hospital and Medical School, Mackenzie Building, Scotland, UK.
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