1
|
Gerstle M, Beattie JF, Peugh J, Quinton TL, Bradley A, LeJeune B, Beebe DW. Impact of text difficulty and visual emphasis on pediatric neuropsychological evaluation reports: The parent's perspective. Clin Neuropsychol 2024:1-20. [PMID: 38902221 DOI: 10.1080/13854046.2024.2366018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024]
Abstract
Objective: Despite varying opinions, little research has examined how to best write pediatric neuropsychology reports. Method: This study gathered input from 230 parents on how text difficulty (reading level) and visual emphasis (bullets, underline, italics) affect report readability and utility. We focused on the most-read report section: summary/impressions. Each parent rated the readability and usefulness of a generic summary/impressions section written in four different styles. The four styles crossed text difficulty (high school-vs-collegiate) with use of visual emphasis (absent-vs-present). Results: Parents found versions with easier text to be more clearly written, easier to follow, and easier to find information (p<.001). Parents rated those with harder text to be overly detailed, complex, hard to understand, and hard to read (p<.001). Visual emphasis made it easier to find key information and the text easier to follow and understand - but primarily for versions that were written in difficult text (interaction p≤.026). After rating all four styles, parents picked their preference. They most often picked versions written in easier text with visual emphasis (p<.001). Conclusions: Findings support writing styles that use easier text difficulty and visual emphasis.
Collapse
Affiliation(s)
- Melissa Gerstle
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julia Fleming Beattie
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James Peugh
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thea L Quinton
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anne Bradley
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brenna LeJeune
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dean W Beebe
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
2
|
Oswald-McCloskey KA, Kubinec N, Johnson E, Coffey A, Heinrich KP. Teacher Perspectives of Pediatric Neuropsychology and Supporting Children With Chronic Health Conditions. Arch Clin Neuropsychol 2024:acae039. [PMID: 38783484 DOI: 10.1093/arclin/acae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/01/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE The goal of the present study was to examine teachers' perceptions of neuropsychological reports broadly and their preparedness to support the educational needs of students with chronic health conditions. METHOD Teachers were selected from across the United States using stratified random sampling. 280 teachers (76.2% female; 58.4% public school; 53.9% rural setting) completed an anonymous electronic survey via Qualtrics. RESULTS Half of the teachers were familiar with neuropsychology and previously read a neuropsychological report, which the majority found useful with a preference toward shorter reports. Most found listed recommendations to be appropriate, but half of teachers identified limited resources as a barrier to implementation. Teachers reported limited education, training, and comfort for providing accommodations to children with chronic health conditions, which was significantly lower for cancer, congenital heart disease, and sickle cell disease. Older teachers, more years of experience, and special education teachers demonstrated significantly higher levels of education, training, and comfort. Frequency of implementing accommodations was significantly negatively correlated with perceived burden and positively correlated with perceived benefit across most accommodations. Teachers reported a preference for single-page handouts and speaking directly to neuropsychologists about the specific learning needs of students with chronic health conditions. CONCLUSIONS Results highlight areas for future research and intervention regarding teacher's preparedness for working with children with chronic health groups and opportunities to improve communication between neuropsychologists and teachers to ultimately improve access to educational supports and overall quality of life of students with chronic health conditions.
Collapse
Affiliation(s)
| | - Nicole Kubinec
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA
| | - Elizabeth Johnson
- Department of Behavioral Sciences, College of Arts, Sciences, and Letters, University of Michigan - Dearborn, Dearborn, MI 48128, USA
| | - Alice Coffey
- Department of Behavioral Sciences, College of Arts, Sciences, and Letters, University of Michigan - Dearborn, Dearborn, MI 48128, USA
| | - Kimberley P Heinrich
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA
| |
Collapse
|
3
|
Gornik AE, Northrup RA, Kalb LG, Jacobson LA, Lieb RW, Peterson RK, Wexler D, Ludwig NN, Ng R, Pritchard AE. To confirm your appointment, please press one: Examining demographic and health system interface factors that predict missed appointments in a pediatric outpatient neuropsychology clinic. Clin Neuropsychol 2024; 38:279-301. [PMID: 37291078 DOI: 10.1080/13854046.2023.2219421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
Objective: Missed patient appointments have a substantial negative impact on patient care, child health and well-being, and clinic functioning. This study aims to identify health system interface and child/family demographic characteristics as potential predictors of appointment attendance in a pediatric outpatient neuropsychology clinic. Method: Pediatric patients (N = 6,976 across 13,362 scheduled appointments) who attended versus missed scheduled appointments at a large, urban assessment clinic were compared on a broad array of factors extracted from the medical record, and the cumulative impact of significant risk factors was examined. Results: In the final multivariate logistic regression model, health system interface factors that significantly predicted more missed appointments included a higher percentage of previous missed appointments within the broader medical center, missing pre-visit intake paperwork, assessment/testing appointment type, and visit timing relative to the COVID-19 pandemic (i.e. more missed appointments prior to the pandemic). Demographic characteristics that significantly predicted more missed appointments in the final model included Medicaid (medical assistance) insurance and greater neighborhood disadvantage per the Area Deprivation Index (ADI). Waitlist length, referral source, season, format (telehealth vs. in-person), need for interpreter, language, and age were not predictive of appointment attendance. Taken together, 7.75% of patients with zero risk factors missed their appointment, while 22.30% of patients with five risk factors missed their appointment. Conclusions: Pediatric neuropsychology clinics have a unique array of factors that impact successful attendance, and identification of these factors can help inform policies, clinic procedures, and strategies to decrease barriers, and thus increase appointment attendance, in similar settings.
Collapse
Affiliation(s)
- Allison E Gornik
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rachel A Northrup
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Luther G Kalb
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rebecca W Lieb
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Danielle Wexler
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Natasha N Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Rowena Ng
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| | - Alison E Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine University, Baltimore, MD, USA
| |
Collapse
|
4
|
Robinson M, Lazar MF, Zarabba JM, Gold M. School psychologists' perceptions of the effectiveness of neuropsychological evaluation reports. APPLIED NEUROPSYCHOLOGY. CHILD 2023:1-10. [PMID: 38142047 DOI: 10.1080/21622965.2023.2292785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
Referral sources and parents value the report following a neuropsychological evaluation. Nevertheless, key stakeholders have described pediatric reports as excessive in length and jargon. Recent research indicates that it is possible to modify pediatric neuropsychological reports that result in positive outcomes for key stakeholders and clinicians. Evaluating modified pediatric neuropsychological reports for other providers is necessary. School psychologists are key stakeholders who read and interact with such reports. This study assessed school psychologists' perceptions of a modified pediatric neuropsychological report. Forty-one school psychologists were randomly assigned to read either a traditional or modified version of a pediatric report and provide feedback via survey and qualitative questions. Results revealed that school psychologists' perceptions of a traditional and modified report were not significantly different. Qualitatively, respondents noted a disconnect between recommendations and school systems. These findings suggest that pediatric neuropsychologists can create shorter and more easily understood reports that do not impact the effectiveness for school psychologists. Future research should continue to evaluate perceptions of modified pediatric neuropsychological reports for additional key stakeholders. A better understanding of the disconnect between recommendations and their feasibility in schools, as well as barriers to increased interdisciplinary collaboration, is also essential for client care.
Collapse
Affiliation(s)
- Mary Robinson
- Institute of Graduate Clinical Psychology, Widener University, Chester, Pennsylvania, USA
| | - Mary F Lazar
- Institute of Graduate Clinical Psychology, Widener University, Chester, Pennsylvania, USA
| | - Jacqlyn M Zarabba
- Institute of Graduate Clinical Psychology, Widener University, Chester, Pennsylvania, USA
| | - Meghan Gold
- Institute of Graduate Clinical Psychology, Widener University, Chester, Pennsylvania, USA
| |
Collapse
|
5
|
Hale C, Brown‐Chidsey R. Utility of psychological and psychoeducational evaluation reports: A survey of teachers and school administrators. PSYCHOLOGY IN THE SCHOOLS 2023. [DOI: 10.1002/pits.22892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
| | - Rachel Brown‐Chidsey
- School of Education and Human Development University of Southern Maine Gorham Maine USA
| |
Collapse
|
6
|
Dwyer P, Mineo E, Mifsud K, Lindholm C, Gurba A, Waisman T. Building Neurodiversity-Inclusive Postsecondary Campuses: Recommendations for Leaders in Higher Education. AUTISM IN ADULTHOOD 2023; 5:1-14. [PMID: 36941859 PMCID: PMC10024274 DOI: 10.1089/aut.2021.0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Patrick Dwyer
- Center for Mind and Brain, UC Davis, Davis, California, USA
- Department of Psychology, UC Davis, Davis, California, USA
- Address correspondence to: Patrick Dwyer, MA, PhD Candidate, Center for Mind and Brain, UC Davis, 267 Cousteau Place, Davis, CA 95618, USA
| | - Erica Mineo
- College of Biological Sciences, UC Davis, Davis, California, USA
| | - Kristin Mifsud
- Department of Political Science, UC Davis, Davis, California, USA
| | | | - Ava Gurba
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York, USA
| | - T.C. Waisman
- Adapt Coaching & Training, Vancouver, British Columbia, Canada
| |
Collapse
|
7
|
Ruble K, Paré-Blagoev J, Carey LB, Milla K, Thornton CP, Henegan S, Jacobson LA. Strategies to improve communication about neurocognitive impacts in pediatric oncology: Quality improvement findings. Pediatr Blood Cancer 2023; 70:e30072. [PMID: 36326122 DOI: 10.1002/pbc.30072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/07/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Neurocognitive deficits are common among children who receive central nervous system (CNS)-directed therapy for childhood cancer. Parents report that they lack information from and communication with oncology providers about neurocognitive impacts of therapy. Furthermore, oncology providers report they lack training and institutional support to appropriately address the neurocognitive needs of these patients/families. METHODS A parent/provider stakeholder informed, quality improvement (QI) project was conducted to educate providers about neurocognitive impacts, increase parent/provider communication, and improve adherence to supportive care guidelines for neuropsychological assessment for children receiving CNS-directed therapy. A 1-h Continuing Medical Education (CME) course was developed to educate providers about neurocognitive impacts and their relation to schooling. A provider-focused electronic medical record (EMR) strategy was used to deliver parent stakeholder-informed return-to-school "roadmaps," with prompts to scaffold parent/provider communication and enhance documentation of findings. RESULTS Hospital-based CME sessions were attended by 76% (41 out of 54) of providers from our institution. Among the 34 who completed both pretest and posttest, the mean knowledge score improved from 56% at pretest to 74% at posttest. Compliance with the EMR strategy was 80% and there was a 42% increase in neuropsychological assessment referrals. CONCLUSIONS We conclude that this QI project is an example of a successful parent/provider stakeholder collaboration that achieved demonstrable positive change in the areas of provider knowledge, patient/provider communication, and alignment of neuropsychological assessment referrals with existing guidelines. Our results confirm that improving knowledge, communication, and compliance with neuropsychological standards of care is possible with this evidence-based approach.
Collapse
Affiliation(s)
- Kathy Ruble
- Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Juliana Paré-Blagoev
- Division of Advanced Studies in Education, Johns Hopkins University School of Education, Baltimore, MD, United States
| | - Lisa B Carey
- Division of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Kimberly Milla
- Division of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Clifton P Thornton
- Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Phildelphia, Philadelphia, United States
| | - Sydney Henegan
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, MD, United States
| | - Lisa A Jacobson
- Division of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, United States.,Division of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, United States
| |
Collapse
|
8
|
Williams T, Wiener J, Lennox C, Kokai M. Lessons Learned: Achieving Consensus About Learning Disability Assessment and Diagnosis. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2022. [DOI: 10.1177/08295735221089457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current paper describes the process used for developing the Guidelines for Diagnosis and Assessment of Children, Adolescents, and Adults with Learning Disabilities-Consensus Statement and Supporting Documents, and the rationale for some of the decisions. The guidelines were developed by a cross-sectoral working group of psychologists who achieved a consensus on the criteria for diagnosis and the assessment process. We outline key features of the guidelines, describe topics where the group achieved consensus quickly and topics for which there was considerable debate (e.g., intelligence testing, ability/achievement discrepancy, and processing deficits). The group members shared information with each other about topics such as the advantages of early assessment, the importance of formally assessing effort and motivation, and assessment of culturally and linguistically diverse individuals. We conclude with the lessons learned and professional challenges regarding contextual influences on LD assessment and diagnosis and dissemination of research to practitioners.
Collapse
Affiliation(s)
- Tricia Williams
- Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | | | | |
Collapse
|
9
|
Fogler JM, Ratliff-Schaub K, McGuinn L, Crutchfield P, Schwartz J, Soares N. OpenNotes: Anticipatory Guidance and Ethical Considerations for Pediatric Psychologists in Interprofessional Settings. J Pediatr Psychol 2021; 47:189-194. [PMID: 34383944 DOI: 10.1093/jpepsy/jsab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The 21st Century Cures Act included an "OpenNotes" mandate to foster transparent communication among patients, families, and clinicians by offering rapid electronic access to clinical notes. This article seeks to address concerns about increased documentation burden, vulnerability to patient complaints, and other unforeseen consequences of patients having near-real-time access to their records. METHODS This topical review explores both extant literature, and case examples from the authors' direct experience, about potential responses/reactions to OpenNotes. RESULTS The ethics of disclosing medical information calls for nuanced approaches: Although too little access can undermine a patient's autonomy and the capacity for truly egalitarian shared decision-making, unfettered access to all medical information has significant potential to harm them. Suggested strategies for mitigating risks in premature disclosure include patient and provider education and "modularizing" sensitive information in notes. CONCLUSION The OpenNotes era has ushered in the possibilities of greater patient and family collaboration in shared decision-making and reduced barriers to documentation sharing. However, it has raised new ethical and clinician documentation considerations. In addition to clinician education, patients and families could benefit from education around the purpose of clinical documentation, how to utilize OpenNotes, and the benefits of engaging in dialogue regarding the content and tone of documentation.
Collapse
Affiliation(s)
- Jason M Fogler
- Boston Children's Hospital and Harvard Medical School, USA
| | - Karen Ratliff-Schaub
- Prisma Health and University of South Carolina School of Medicine Greenville, USA
| | | | | | | | - Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of Medicine, USA
| |
Collapse
|
10
|
Ostojic-Aitkens D, Ford MK, Cunningham T, Gold A, Janzen LA, Sinopoli KJ, Westmacott R, Williams TS. Examining parent and clinician views of a hospital-based pediatric neuropsychological service: a Canadian perspective. Child Neuropsychol 2021; 28:61-81. [PMID: 34193006 DOI: 10.1080/09297049.2021.1945567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Understanding how pediatric neuropsychological evaluations support families and the child's medical team is an important component of ensuring evidence-based care. For the first time within a Canadian context, we investigated the impact of neuropsychological assessments on parent knowledge, advocacy, and stress and the role of socioeconomic factors in parents' perceptions of the assessment. Responses from referring clinicians were also examined. As part of a hospital quality improvement project, 91 parents of children between the ages of 3 and 17 years (M = 8y7m; SD = 4y1m) and 45 clinician consumers (clinical staff who use neuropsychological services) completed one of two online questionnaires in English: Parent Overall Assessment of Supports and Testing, or Clinician Overall Assessment of Supports and Testing. Most parents indicated the neuropsychological evaluation promoted understanding of their child's cognitive profile and improved their ability to support their child at home and at school or in the community. Families characterized as being at higher social risk indicated that the evaluation led to more changes in how they approached their child at home than families with lower social risk status. Referring clinicians indicated neuropsychological reports were effective in communicating findings to them and patients/families. The most valuable sections of the report according to referring clinicians included the diagnosis/impression and recommendations sections. Parents and referral providers reported many benefits from the neuropsychological evaluation but also identified areas for service delivery improvement. Parent perceptions varied based on family and socio environmental factors, offering important targets for future research and clinical consideration.
Collapse
Affiliation(s)
| | - Meghan K Ford
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Todd Cunningham
- Department of Applied Psychology and Human Development, The University of Toronto, Toronto, Canada
| | - Anna Gold
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada.,Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada
| | - Laura A Janzen
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Katia J Sinopoli
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada.,Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada.,Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Tricia S Williams
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada.,Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
11
|
Jones EF, Pritchard A, Jacobson LA, Mahone EM, Zabel TA. How much testing can a kid take? Feasibility of collecting pediatric patient experience ratings of neuropsychological and psychological assessment. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:610-617. [PMID: 34100332 DOI: 10.1080/21622965.2021.1917410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Parent-reported satisfaction is an important outcome measure in pediatric neuropsychology; however, self-report of patient experience following lengthy pediatric assessments has been under-investigated. Written at a first grade reading level and utilizing touch screen and read-aloud functionality, a set of 15 operationally-focused items were administered to evaluate pediatric patient experience of neuropsychological and psychological assessment. One-hundred ninety-seven clinically-referred patients (M age = 11.74, SD = 3.17, range = 5.86-19.02 years, 56% male) answered the post-assessment survey. The majority of patients (n = 167; 84.77%) accurately completed the initial two validity items, even though many had parent-reported ratings of reading difficulty. More than a third of patients indicated that the assessment made them tired (39%), but fewer patients reported feeling bored (13%) or worried (7%) during testing. Moreover, most patients reported having fun (66%) and many indicated that testing was preferable to other activities typically performed at that same time (i.e., school, homework). Responses to items assessing the child's interactions with the clinician and the child's effort provided little variation and were answered in a socially desirable manner. Items that focused upon the child's personal response to the assessment appointment (e.g., boredom, worry), however, elicited greater variance in patient responding. In general, patient responses did not suggest that assessment was an aversive experience. Overall, these proof of concept findings suggest that most referred pediatric patients, even those with learning issues, may be capable of independently navigating and completing self-report questionnaires while providing differential responses to items assessing clinical experience. Self-report questionnaires appear to be a feasible method for acquiring pediatric patient-reported experiences of assessment.
Collapse
Affiliation(s)
- Erin F Jones
- Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Alison Pritchard
- Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,School of Medicine, The Johns Hopkins University Baltimore, MD, USA
| | - Lisa A Jacobson
- Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,School of Medicine, The Johns Hopkins University Baltimore, MD, USA
| | - E Mark Mahone
- Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,School of Medicine, The Johns Hopkins University Baltimore, MD, USA
| | - T Andrew Zabel
- Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,School of Medicine, The Johns Hopkins University Baltimore, MD, USA
| |
Collapse
|
12
|
Zabel T, Jacobson L, Pritchard A, Mahone E, Kalb L. Pre-appointment online assessment of patient complexity: Towards a personalized model of neuropsychological assessment. Child Neuropsychol 2021; 27:232-250. [PMID: 32969304 PMCID: PMC8112741 DOI: 10.1080/09297049.2020.1822310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/05/2020] [Indexed: 10/23/2022]
Abstract
Recent events such as the global pandemic of COVID-19 have challenged neuropsychologists to scale up their capacity to conduct portions of their assessment remotely. While more complex patients will likely continue to require on-site, office-based interaction and assessment, the current emergency-based expansion of online and telehealth evaluation practices may ultimately lay the groundwork for more routine, online assessment of patients with less complex presentations in the future. To this end, the current study evaluated a pre-appointment, online methodology for differentiating referred pediatric patients based upon the scope and severity of their caregiver-reported adaptive, academic, attentional, behavioral, and emotional impairment. Prior to on-site assessment, parents/caregivers of 2197 children (Mean age = 10.0y, range = 4-19y, 62% male) completed an online developmental history form screening for symptoms of adaptive, attentional, learning, affective, and behavioral impairment; 71% of those children eventually underwent assessment. Using latent class analysis, the data supported a reproducible 4-class model consisting of groups of children at increased risk for: 1) severe multi-domain dysfunction; the "High Complexity" group, 30%, 2) behavioral-affective (but not academic) dysregulation; the "Behavioral Focus" group, 13%, 3) academic (but not behavioral-affective) problems; the "Academic and Inattention" group, 37%, and 4) patients with minimal clinical complexity; the "Low Complexity" group, 20%. Comparison of pre-visit classification with day-of-assessment standardized test scores supported the validity of patient subtypes. Moving forward, pre-appointment clarification of patient complexity may support efficient patient triage with regard to assessment modality (e.g., on-site or online) and length of appointment (e.g., comprehensive or targeted).
Collapse
Affiliation(s)
- T.A. Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - L.A. Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - A.E. Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - E.M. Mahone
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - L. Kalb
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| |
Collapse
|
13
|
Gruters AAA, Ramakers IHGB, Stiekema APM, Verhey FRJ, Kessels RPC, de Vugt ME. An Exploratory Study of the Development and Pilot Testing of an Interactive Visual Tool of Neuropsychological Test Results in Memory Clinics. J Alzheimers Dis 2021; 79:1157-1170. [PMID: 33386807 PMCID: PMC7990417 DOI: 10.3233/jad-201128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Neuropsychological feedback is an important part of the neuropsychological assessment process. However, patients have difficulties remembering this information. Objective: The aim of this study was to develop a web-based visual tool to improve the understanding of neuropsychological results, information retention, and psychologist-patient communication. Methods: The visual tool was developed and optimized using an iterative three-phase stepwise approach to determine its usability, technology acceptance, and feasibility in a memory clinic population. Feedback from different user perspectives (patients, family members, and psychologists) was obtained in each phase using a multimethod approach (e.g. a multidisciplinary brainstorm session, think-aloud sessions, focus groups). The prototype was subsequently tested in a pilot study. Results: The first phases offered insights that led to optimization of the prototype. On a scale ranging from 0 to 100, psychologists evaluated the usability as high [88.1±7.6,70–87]. During the pilot study, both patients and significant others gave positive feedback, but information retention in patients remained low. All participants thought the benefits of the visual tool included seeing cognitive strengths and weaknesses with a translation to daily life all at one glance and receiving feedback on paper to take home. Important barriers were mentioned by psychologists, such as a limited set of tests included and no integration with hospital systems. Conclusion: Overall, patients, family members, and psychologists reported that a visual display of the cognitive profile with insights into daily life had added value to clinical practice. Feedback from the pilot study was adopted in the tool for future implementation purposes.
Collapse
Affiliation(s)
- Angélique A A Gruters
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Annemarie P M Stiekema
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
14
|
Fisher EL, Zimak E, Sherwood AR, Elias J. Outcomes of pediatric neuropsychological services: A systematic review. Clin Neuropsychol 2020; 36:1265-1289. [PMID: 33307975 DOI: 10.1080/13854046.2020.1853812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The primary aim of this project was to apply systematic review methods to synthesize the literature on outcomes of pediatric neuropsychological services. The secondary aim was to use the results of the systematic review to identify gaps in the extant literature and describe priorities for future research. Method: We identified the relevant studies using a rigorous search strategy, collected data on methodological variables, assessed the risk of bias in the studies, summarized findings by topic and subtopic areas, identified strengths and weaknesses of the literature, and provided recommendations for future research. The outcomes measured were satisfaction, changes in resource or strategy utilization, and changes in symptoms or functioning (i.e. changes in child emotional, behavioral, cognitive, or academic problems, parent stress, or family functioning). Results: The final sources of data were 26 records, pertaining to a total of 974 children who received neuropsychological services. Parents were generally satisfied with services and reported high clinician empathy and increased level of knowledge, based on the evaluation. However, they reported less often that the neuropsychologist provided actual help. Informal home and school-based strategies were implemented more often than other types of recommendations. The research on changes in child symptoms and functioning was limited, but suggests improvements. Conclusions: This is the first systematic review of outcomes of pediatric neuropsychological services. Larger studies involving data collection at multiple time points are needed in order to further clarify mechanisms leading to outcomes and potential targets for improving them.
Collapse
Affiliation(s)
| | - Eric Zimak
- University of New Mexico Hospitals, Albuquerque, NM, USA
| | | | - John Elias
- Baylor Scott & White Health, Austin, TX, USA
| |
Collapse
|
15
|
Jacobson LA, Paré-Blagoev EJ, Ruble K. Barriers to Schooling in Survivorship: The Role of Neuropsychological Assessment. JCO Oncol Pract 2020; 16:e1516-e1523. [PMID: 33006913 DOI: 10.1200/op.20.00549] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Pediatric cancer survivorship rates continue to improve, although disease- and treatment-related neurocognitive impacts substantively affect survivors' educational access and availability for learning. Receiving formal educational supports substantially improves survivors' academic progress and graduation rates; however, parents of survivors report obtaining such support is stressful, in part due to limited knowledge on their part and that of their oncology providers. METHODS Parents (N = 195) of pediatric survivors across the United States were surveyed to explore specific barriers to obtaining appropriate educational supports and the facilitating role of the oncologist. RESULTS Parent-reported barriers included limited access to formal educational supports, under-referral to neuropsychology services, and need for more information about available supports and how best to advocate for these, when needed. Not only were few survivors (35.4%) referred for neuropsychological evaluation, standard of care for many pediatric survivors, but survivors were more than five times more likely to be retained in grade compared with the national retention rate. When obtained, parents reported that the neuropsychological consultation and associated report were helpful in increasing their own understanding and addressing barriers to obtaining adequate supports for their children. CONCLUSION Given the important role of neuropsychological evaluation for survivors and their families, bringing referral rates more in line with national guidelines represents a critical target for oncologists. With adequate training in relevant issues, the oncologist is positioned to be a key support to survivors and their families in ensuring access to neuropsychological services and reducing barriers to an appropriate education.
Collapse
Affiliation(s)
- Lisa A Jacobson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD.,Kennedy Krieger Institute, Department of Neuropsychology, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Kathy Ruble
- Division of Pediatric Oncology, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
16
|
Davis KW, Hamby Erby L, Fiallos K, Martin M, Wassman ER. A comparison of genomic laboratory reports and observations that may enhance their clinical utility for providers and patients. Mol Genet Genomic Med 2019; 7:e00551. [PMID: 31115190 PMCID: PMC6625363 DOI: 10.1002/mgg3.551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 12/28/2022] Open
Abstract
Purpose To assess clinical chromosomal microarray (CMA) genomic testing reports for the following: (a) usage of reporting elements consistent with 2011 ACMG guidelines and other elements identified in the primary literature, (b) information quality, and (c) readability. Methods We retrospectively analyzed genomic testing reports from 2011 to 2016 provided to, or by our laboratory to aid in clinical detection and interpretation of copy number variants. Analysis was restricted to the following sections: interpretation, recommendations, limitations, and citations. Analysis included descriptive characteristics, reporting elements, reading difficulty using the Simple Measure of Gobbledygook (SMOG), and quality ratings using a subset of questions adapted from the DISCERN‐Genetics questionnaire. Results The analysis included 44 unique reports from 26 laboratories comprising four groups: specialty laboratories (SL; N = 9), reference laboratories (RL; N = 12), hospital laboratories (HL; N = 10), and university‐based laboratories (UL; N = 13). There were 23 abnormal/pathogenic reports and 21 of uncertain/unknown significance. Nine laboratories did not include one or more pieces of information based on ACMG guidelines; only one of ten laboratories reported condition‐specific management/treatment information when available and relevant. Average quality ratings and readability scores were not significantly different between laboratory types or result classification. Conclusions Reporting practices for most report elements varied widely; however, readability and quality did not differ significantly between laboratory types. Management and treatment information, even for well‐known conditions, are rarely included. Effectively communicating test results may be improved if certain reporting elements are incorporated. Recommendations to improve laboratory reports are provided.
Collapse
Affiliation(s)
| | - Lori Hamby Erby
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Katie Fiallos
- Sidney Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | |
Collapse
|