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Kimball H, Cobham VE, Sanders M, Douglas T. Procedural anxiety among children and adolescents with cystic fibrosis and their parents. Pediatr Pulmonol 2023. [PMID: 37097054 DOI: 10.1002/ppul.26419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/13/2023] [Accepted: 04/10/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Procedural anxiety involves acute distress around medical procedures and may lead to avoidance or resistance behaviors that interfere with effective cystic fibrosis (CF) care and health outcomes. While individuals with CF commonly endure uncomfortable and/or distressing medical procedures, procedural anxiety among children and adolescents with CF has received little research attention. This study investigated the prevalence and correlates of procedural anxiety among individuals with CF aged 6-18 and their parents. METHOD Eighty-nine parents of children with CF completed surveys examining child procedural anxiety, anxiety, and health behaviors (including treatment adherence); and parent vicarious procedural anxiety. RESULTS Seventy-five percent of participants rated at least one CF-related procedure as "extremely" anxiety-inducing for their child. Parental vicarious procedural anxiety was reported in 80.9% of participants. Procedural anxiety significantly correlated with child anxiety, treatment-resistive behaviors, and parent-vicarious procedural anxiety. Procedural anxiety was associated with younger age and frequency of distressing procedures, but not with forced expiratory volume in 1 s, body mass index, hospitalizations, or exposure to general anesthesia. CONCLUSION Procedural anxiety is common among children, adolescents, and caregivers, and is associated with child anxiety and treatment resistance, emphasizing the importance of screening and interventions for procedural anxiety as part of routine CF care from early childhood. Implications for screening and intervention are discussed.
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Affiliation(s)
- Hayley Kimball
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
- Children's Hospital Foundation, Brisbane, Queensland, Australia
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
- Child and Youth Mental Health Service (CYMHS), Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Matthew Sanders
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Tonia Douglas
- Cystic Fibrosis Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- School of Medicine Clinical Unit, The University of Queensland, Herston, Brisbane, Queensland, Australia
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Dawson S, Girling CJ, Cowap L, Clark-Carter D. Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 3:CD013766. [PMID: 36989170 PMCID: PMC10054300 DOI: 10.1002/14651858.cd013766.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Adherence to treatment, including inhaled therapies, is low in people with cystic fibrosis (CF). Although psychological interventions for improving adherence to inhaled therapies in people with CF have been developed, no previous published systematic review has evaluated the evidence for efficacy of these interventions. OBJECTIVES The primary objective of the review was to assess the efficacy of psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (CF). The secondary objective was to establish the most effective components, or behaviour change techniques (BCTs), used in these interventions. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, which is compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched databases (PubMed; PsycINFO; EBSCO; Scopus; OpenGrey), trials registries (World Health Organization International Clinical Trials Registry Platform; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov), and the reference lists of relevant articles and reviews, with no restrictions on language, year or publication status. Date of search: 7 August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different types of psychological interventions for improving adherence to inhaled therapies in people with CF of any age, or comparing psychological interventions with usual care. We included quasi-RCTs if we could reasonably assume that the baseline characteristics were similar in both groups. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and completed data extraction, risk of bias assessments, and BCT coding (using the BCT Taxonomy v1) for all included trials. We resolved any discrepancies by discussion, or by consultation with a third review author as necessary. We assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 10 trials (1642 participants) in the review (children and adolescents in four trials; adults in five trials; and children and adults in one trial). Nine trials compared a psychological intervention with usual care; we could combine data from some of these in a number of quantitative analyses. One trial compared a psychological intervention with an active comparator (education plus problem-solving (EPS)). We identified five ongoing trials. Psychological interventions were generally multi-component and complex, containing an average of 9.6 BCTs (range 1 to 28). The two most commonly used BCTs included 'problem-solving' and 'instruction on how to perform the behaviour'. Interventions varied in their type, content and mode of delivery. They included a problem-solving intervention; a paper-based self-management workbook; a telehealth intervention; a group training programme; a digital intervention comprising medication reminders and lung function self-monitoring; a life-coaching intervention; a motivational interviewing (MI) intervention; a brief MI intervention (behaviour change counselling); and a digital intervention combined with behaviour change sessions. Intervention duration ranged from 10 weeks to 12 months. Assessment time points ranged from six to eight weeks up to 23 months. Psychological interventions compared with usual care We report data here for the 'over six months and up to 12 months' time point. We found that psychological interventions probably improve adherence to inhaled therapies (primary outcome) in people with CF compared with usual care (mean difference (MD) 9.5, 95% confidence interval (CI) 8.60 to 10.40; 1 study, 588 participants; moderate-certainty evidence). There was no evidence of a difference between groups in our second primary outcome, treatment-related adverse events: anxiety (MD 0.30, 95% CI -0.40 to 1.00; 1 study, 535 participants), or depression (MD -0.10, 95% CI -0.80 to 0.60; 1 study, 534 participants), although this was low-certainty evidence. For our secondary outcomes, there was no evidence of a difference between groups in terms of lung function (forced expiratory volume in one second (FEV1) % predicted MD 1.40, 95% CI -0.20 to 3.00; 1 study, 556 participants; moderate-certainty evidence); number of pulmonary exacerbations (adjusted rate ratio 0.96, 95% CI 0.83 to 1.11; 1 study, 607 participants; moderate-certainty evidence); or respiratory symptoms (MD 0.70, 95% CI -2.40 to 3.80; 1 study, 534 participants; low-certainty evidence). However, psychological interventions may improve treatment burden (MD 3.90, 95% CI 1.20 to 6.60; 1 study, 539 participants; low-certainty evidence). The overall certainty of the evidence ranged from low to moderate across these outcomes. Reasons for downgrading included indirectness (current evidence included adults only whereas our review question was broader and focused on people of any age) and lack of blinding of outcome assessors. Psychological interventions compared with an active comparator For this comparison the overall certainty of evidence was very low, based on one trial (n = 128) comparing an MI intervention to EPS for 12 months. We are uncertain whether an MI intervention, compared with EPS, improves adherence to inhaled therapies, lung function, or quality of life in people with CF, or whether there is an effect on pulmonary exacerbations. The included trial for this comparison did not report on treatment-related adverse events (anxiety and depression). We downgraded all reported outcomes due to small participant numbers, indirectness (trials included only adults), and unclear risk of bias (e.g. selection and attrition bias). AUTHORS' CONCLUSIONS Due to the limited quantity of trials included in this review, as well as the clinical and methodological heterogeneity, it was not possible to identify an overall intervention effect using meta-analysis. Some moderate-certainty evidence suggests that psychological interventions (compared with usual care) probably improve adherence to inhaled therapies in people with CF, without increasing treatment-related adverse events, anxiety and depression (low-certainty evidence). In future review updates (with ongoing trial results included), we hope to be able to establish the most effective BCTs (or 'active ingredients') of interventions for improving adherence to inhaled therapies in people with CF. Wherever possible, investigators should make use of the most objective measures of adherence available (e.g. data-logging nebulisers) to accurately determine intervention effects. Outcome reporting needs to be improved to enable combining or separation of measures as appropriate. Likewise, trial reporting needs to include details of intervention content (e.g. BCTs used); duration; intensity; and fidelity. Large trials with a longer follow-up period (e.g. 12 months) are needed in children with CF. Additionally, more research is needed to determine how to support adherence in 'under-served' CF populations.
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Affiliation(s)
- Sophie Dawson
- Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Carla-Jane Girling
- Sheffield Clinical Trials Research Unit, ScHARR, University of Sheffield, Innovation Centre, Sheffield, UK
| | - Lisa Cowap
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - David Clark-Carter
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
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3
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Singh J, Towns S, Jayasuriya G, Hunt S, Simonds S, Boyton C, Middleton A, Kench A, Pandit C, Keatley LR, Chien J, Bishop J, Song Y, Robinson P, Selvadurai H, Middleton PG, Fitzgerald DA. Transition to adult care in cystic fibrosis: The challenges and the structure. Paediatr Respir Rev 2022; 41:23-29. [PMID: 32917516 DOI: 10.1016/j.prrv.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Abstract
In developed countries, it is projected that there will be a 70% increase in the number of adults living with Cystic Fibrosis (CF) between 2010 and 2025. This shift in demographics highlights the importance of high-quality transition programmes with developmentally appropriate integrated health care services as the individual moves through adolescence to adulthood. Adolescents living with CF face additional and unique challenges that may have long-term impacts on their health, quality of life and life-expectancy. CF specific issues around socially challenging symptoms, body image, reproductive health and treatment burden differentiate people with CF from their peers and require clinicians to identify and address these issues during the transition process. This review provides an overview of the health, developmental and psychosocial challenges faced by individuals with CF, their guardians and health care teams considering the fundamental components and tools that are required to build a transition programme that can be tailored to suit individual CF clinics.
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Affiliation(s)
- Jagdev Singh
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Susan Towns
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Adolescent Medicine, Sydney Children's Hospital Network, Australia
| | - Geshani Jayasuriya
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, Sydney, NSW, Australia; Department of Adolescent Medicine, Sydney Children's Hospital Network, Australia
| | - Sharon Hunt
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sharon Simonds
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Christie Boyton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anna Middleton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Andrea Kench
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Chetan Pandit
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Lucy R Keatley
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Jimmy Chien
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, NSW, Australia
| | - Jennifer Bishop
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Yang Song
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, NSW, Australia
| | - Paul Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Peter G Middleton
- Department of Adolescent Medicine, Sydney Children's Hospital Network, Australia; Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Recipient Age Impacts Long-Term Survival in Adult Subjects with Cystic Fibrosis after Lung Transplantation. Ann Am Thorac Soc 2021; 18:44-50. [PMID: 32795188 DOI: 10.1513/annalsats.201908-637oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Rationale: Lung transplant is an effective treatment option providing survival benefit in patients with cystic fibrosis (CF). Several studies have suggested survival benefit in adults compared with pediatric patients with CF undergoing lung transplant. However, it remains unclear whether this age-related disparity persists in adult subjects with CF.Objectives: We investigated the impact of age at transplant on post-transplant outcomes in adult patients with CF.Methods: The United Network of Organ Sharing Registry was queried for all adult patients with CF who underwent lung transplantation between 1992 and 2016. Pertinent baseline characteristics, demographics, clinical parameters, and outcomes were recorded. The patients were divided into two groups based on age at transplant (18-29 yr old and 30 yr or older). The primary endpoint was survival time. Assessment of post-transplant survival was performed using Kaplan-Meier tests and log-rank tests with multivariable Cox proportional hazards analysis to adjust for confounding variables.Results: A total of 3,881 patients with CF underwent lung transplantation between 1992 and 2016; mean age was 31.0 (± 9.3) years. The 18-29-year-old at transplant cohort consisted of 2,002 subjects and the 30 years or older cohort had 1,879 subjects. Survival analysis demonstrated significantly higher survival in subjects in the 30 years or older cohort (9.47 yr; 95% confidence interval [CI], 8.7-10.2) compared with the 18-29-year-old cohort (5.21 yr; 95% CI, 4.6-5.8). After adjusting for confounders, survival remained higher in recipients aged 30 years or older (hazard ratio, 0.44; 95% CI, 0.2-0.9). Mortality due to allograft failure was significantly lower in patients with CF aged 30 years or older (28% vs. 36.5%; odds ratio [OR], 0.7; 95% CI, 0.6-0.8), whereas the incidence of malignancy was higher in the 30 years or older cohort (8% vs. 2.9%; OR, 3.0; 95% CI, 1.9-4.6).Conclusions: Age at transplant influences lung transplant outcomes in recipients with CF. Subjects with CF aged 30 years or older at transplant have superior survival compared with adult subjects with CF transplanted between the ages 18 and 29 years.
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Trapnell BC, Chen S, Khurmi R, Bodhani A, Kapoor M, Haupt M. Hospitalization rates among patients with cystic fibrosis using pancreatic enzyme replacement therapy. Chron Respir Dis 2021; 17:1479973119900612. [PMID: 31984768 PMCID: PMC6985972 DOI: 10.1177/1479973119900612] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We investigated the relationship between self-reported adherence to pancreatic enzyme replacement therapy (PERT), nutritional status, and all-cause hospitalization in cystic fibrosis (CF) patients with a record of PERT use. Association of self-reported annual PERT use rate (adherence) with annual hospital admission rate (HAR) and annual total hospital nights (THNs) were analyzed for 5301 children (2000–2012) and 13,989 adults (2000–2013) from the CF Foundation Patient Registry. Multivariate linear regression was used to determine the association of HAR and THN with mean annual PERT use rate, cumulative PERT use rate, mean body mass index (BMI) (adult) or BMI percentile (pediatric), age, and sex. The median annual PERT use rate was 87% in children and 80% in adults. Statistically, higher annual PERT use, longer cumulative PERT, and higher BMI percentile (children) or BMI (adults) were significantly (p < 0.0001) associated with lower annual HAR and fewer annual THN in children and adults. Female sex was associated with higher annual HAR and more annual THN in children and adults (p < 0.05). Results indicate self-reported adherence to PERT, increased BMI, and male sex were associated with fewer hospital admissions and annual hospital nights in CF patients.
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Affiliation(s)
- Bruce C Trapnell
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Su Chen
- AbbVie Inc., North Chicago, IL, USA
| | | | | | | | - Mark Haupt
- AbbVie Inc., North Chicago, IL, USA.,ARIEL Precision Medicine, Pittsburgh, PA, USA
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6
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Time Effects of Supportive Interaction and Facilitator Input Variety on Treatment Adherence of Young People with Chronic Health Conditions: A Dynamic Mechanism in Mutual Aid Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063061. [PMID: 33809686 PMCID: PMC8002342 DOI: 10.3390/ijerph18063061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
This study aims to examine the mechanism of how supportive interaction and facilitator input variety in mutual aid groups impact treatment adherence of young people with chronic health conditions, with consideration of time effects, which have been rarely studied in the existing literature. A stratified random sample of 391 individuals aged 12–45 years with chronic health conditions were recruited from mutual aid groups in Hong Kong and completed both the baseline and 12-month follow-up surveys. The results of the structural equation modeling indicated that supportive interaction and facilitator input variety positively predicted treatment adherence in a delayed condition, whereas members’ treatment adherence in the baseline survey had reversed effects on members’ supportive interaction in the follow-up survey. The findings of this study shed light on the dynamic mechanism of the mutual aid groups and provide important implications to promote better rehabilitation outcomes of young people with chronic health conditions.
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Zaidman-Zait A, Shilo I. Parental ADHD Symptoms and Inhibitory Control in Relation to Parenting Among Mothers of Children With and Without ADHD. J Atten Disord 2021; 25:389-402. [PMID: 30442044 DOI: 10.1177/1087054718808063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: The study examined how the interplay between maternal ADHD symptoms and maternal inhibitory control and child ADHD is related to parenting behaviors. Method: The sample included 141 mothers and their 8- to 12-year-old children, 61 children with ADHD and 80 without. Parenting was measured using self-reports (i.e., overreactive and lax parenting) and observation (i.e., negative and supportive parenting). Maternal inhibitory control was measured using a neurocognitive task. Hierarchical multiple regressions were conducted to predict parenting, controlling for child sex, conduct behaviors, and parenting distress. Results: Interactions between maternal ADHD symptoms and maternal inhibitory control suggested that hyperactive-impulsive symptoms were linked to parenting negativity only when inhibitory control was low, and maternal inattention symptoms were related to lax parenting only when maternal inhibitory control was high or when children did not have ADHD. Conclusion: Results indicate the importance of maternal regulation processes in the mechanisms linking maternal ADHD with parenting.
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Affiliation(s)
- Anat Zaidman-Zait
- Tel Aviv University, Israel.,The University of British Columbia, Vancouver, Canada
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8
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Murphy C, Miller VA. Concurrent and Longitudinal Associations among Parenting Style, Responsibility, and Adherence in Youth with Cystic Fibrosis. CHILDRENS HEALTH CARE 2020; 49:153-167. [PMID: 32742054 DOI: 10.1080/02739615.2019.1616295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In an effort to identify pathways for improvements in clinical monitoring and intervention, the current study investigated the role that parenting style plays in treatment adherence and responsibility for youth with CF. Participants (n = 50) completed questionnaires related to treatment adherence, treatment responsibility, and parenting style at baseline and at a two year follow up visit. Aspects of parenting style (e.g., warmth, autonomy support) were related to youth adherence and responsibility in cross-sectional and prospective analyses. These data suggest that aspects of parenting may be important targets of interventions to promote treatment adherence in youth with CF.
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Affiliation(s)
- Christina Murphy
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Victoria A Miller
- Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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9
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Borschuk AP, Molitor S, Everhart RS, Siracusa C, Filigno SS. Executive functioning in pediatric cystic fibrosis: A preliminary study and conceptual model. Pediatr Pulmonol 2020; 55:939-947. [PMID: 31951324 DOI: 10.1002/ppul.24648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Research has shown that broad cognitive functioning in individuals with CF is intact. Specific executive functioning (EF) deficits have been identified, however, and adults with CF report more symptoms of ADHD than the general population. EF skills are critical to the management of a complex disease like CF although studies have not adequately examined EF mechanisms in CF. This manuscript (a) described EF in a small sample of children with CF, (b) summarized relations found between EF and psychosocial variables, and (c) presented a conceptual model by which to understand EF's impact on adherence in CF. METHODS Data for this preliminary study were collected from 19 children with CF and their caregivers (ages, 6-18). Caregivers completed questionnaires assessing their child's physical and mental health, their own functioning, and overall family functioning. EF was measured using a parent-report rating scale. Patient health data were collected from the electronic medical record. RESULTS This sample did not demonstrate elevated levels of EF impairment. Worse EF was related to poor family communication/cohesion, as well as higher treatment burden, worse lung function, poorer adherence, and older age. From these findings, a preliminary model was developed describing EF in the context of CF and adherence. CONCLUSIONS Findings from this preliminary study suggest that the CF regimen and associated symptoms may overload otherwise adequate EF skills. Reducing disease burden and preventing burnout should be a focus of treatment. A better understanding of EF in CF and the impact on adherence would allow for better clinical management and effective design of interventions.
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Affiliation(s)
- Adrienne P Borschuk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephen Molitor
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Christopher Siracusa
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie S Filigno
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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10
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Psihogios AM, Fellmeth H, Schwartz LA, Barakat LP. Family Functioning and Medical Adherence Across Children and Adolescents With Chronic Health Conditions: A Meta-Analysis. J Pediatr Psychol 2020; 44:84-97. [PMID: 29982694 DOI: 10.1093/jpepsy/jsy044] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/03/2018] [Indexed: 12/16/2022] Open
Abstract
Objectives A meta-analysis examined family functioning and medical adherence in children and adolescents with chronic health conditions. Family functioning was evaluated at the level of the family unit, as well as parent-child interactions. Methods We conducted literature searches using PubMed, PsycINFO, SCOPUS, Web of Science, and Cochrane. After reviewing 764 articles, 62 studies met eligibility criteria. Pearson's r correlations were the effect size of interest. We conducted both omnibus and domain-specific (e.g., family conflict, cohesion) meta-analyses. Meta-regressions examined whether relevant covariates related to the magnitude of the effect. Results The omnibus meta-analysis showed that family functioning was significantly related to medical adherence across a variety of pediatric chronic health conditions. Lower family conflict, greater family cohesion, greater family flexibility, more positive communication, and better family problem-solving were each associated with better adherence. There were no significant differences in the magnitude of the omnibus effect based on child age, measurement features (subjective vs. objective or bioassay adherence; family unit vs. parent-child interactions), or study quality. Conclusions Consistent with social-ecological frameworks, findings supported links between family functioning and medical adherence. This study highlights several limitations of the extant research, including absence of a guiding theoretical framework and several methodological weaknesses. We offer clinical and research recommendations for enhancing scientific understanding and promotion of adherence within the family context.
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Affiliation(s)
| | | | - Lisa A Schwartz
- The Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia.,Perelman School of Medicine of the University of Pennsylvania
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11
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Sullivan JA, Wiese AM, Boone KM, Rausch J, Keim SA. To attend, or not to attend: Examining caregiver intentions and study compliance in a pediatric, randomized controlled trial. Clin Trials 2020; 17:223-230. [PMID: 31984781 DOI: 10.1177/1740774519893307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS The Intent to Attend is a brief questionnaire recommended by the National Research Council to address dropout concerns and improve prediction of missing data in clinical trials, although implementation has been very limited. As a formative study in pediatric research, the relationship between caregiver intentions and study compliance was investigated in a 180-day trial of dietary supplementation of preterm toddlers. Treatment effect estimation in the context of missing data was also explored. METHODS Study compliance (i.e. study completion, supplement adherence, and diary completion) was tracked over three study visits. Baseline questionnaires asked caregivers about intentions concerning study completion via the Intent to Attend, screened for mental health symptoms (depression, trait anxiety), and captured family demographics. Simple and multiple logistic regression models were built to examine associations between caregiver intent and compliance outcomes. The Intent to Attend was also employed as an auxiliary variable to account for missing data within mixed models estimating the treatment effect on the primary outcomes. RESULTS Of the 316 caregiver-child dyads included, 95% of caregivers with low intentions had a child complete the study, but only 87% of caregivers with high intentions had a child complete the study. Low intentions to complete the study were associated with a more than 60% lower odds of study non-completion, but the confidence interval included the null (odds ratio: 0.36; 95% confidence interval: 0.11, 1.20). No effect measure modification by caregiver mental health, child sex, or annual income was detected. Income was the only significant predictor of study non-completion; the lowest income group was almost four times more likely to be study non-completers compared with the highest income group, even after adjustment for child sex and caregiver mental health (adjusted odds ratio = 3.59, 95% confidence interval: 1.38, 9.31). When using Intent to Attend as an auxiliary variable, similar results were obtained when compared with the original treatment effect estimates on the primary outcomes. CONCLUSION Contrary to prior adult studies, there is no clear relationship between caregiver intentions and study compliance. Findings elucidate the complexities of caregiver-child interactions during pediatric trial participation.
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Affiliation(s)
- Jacqueline A Sullivan
- The Research Institute, Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anna M Wiese
- The Research Institute, Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kelly M Boone
- The Research Institute, Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph Rausch
- The Research Institute, Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Sarah A Keim
- The Research Institute, Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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12
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Muther EF, Butcher JL, Riekert KA. Understanding Treatment Adherence in Cystic Fibrosis: Challenges and Opportunities. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Cave L, Milnes LJ. The lived experience of adults with cystic fibrosis: what they would tell their younger selves about the gut. J Hum Nutr Diet 2019; 33:151-158. [PMID: 31763740 PMCID: PMC7079059 DOI: 10.1111/jhn.12703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Little is known about adults’ experience of living with cystic fibrosis (CF) specifically in relation to the gut. However, their unique perspectives may be meaningful to children with CF and inform the understanding and practice of dietitians. The present study aimed to explore adults’ lived experience of the CF gut and how they learnt to manage the gut as they were growing up. Methods Semi‐structured interviews were conducted with adult inpatients (n = 10). Interviews were audio‐recorded, transcribed verbatim and accounts analysed using interpretative phenomenological analysis. Results Three super‐ordinate themes were identified: taking Creon, the learning process and this much I (now) know. Participants accounts of how CF affects the gut predominantly focused on taking Creon (pancreatin, Mylan). Various strategies were employed for coping with peer responses to taking Creon at school. Several participants reached adulthood before they understood and/or accepted that taking Creon consistently needed to be normal for them. Knowledge and understanding developed over time, with ‘CF experience’ and was shaped by family, CF care teams and other children with CF. All had unmet information needs when growing up. Having key explanations earlier, to make connections between eating, taking Creon, gaining weight and growth, did or would have helped most participants. Participants urged children to be assertive, ask questions and not only be involved in managing their diet and gut, but also begin to take control of this aspect of their CF. Conclusions Supporting development of knowledge, skills and confidence to manage diet and the gut needs to be integral to care throughout childhood.
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Affiliation(s)
- L Cave
- Children's Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - L J Milnes
- School of Healthcare, University of Leeds, Leeds, UK
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14
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Murphy LK, Preacher KJ, Rights JD, Rodriguez EM, Bemis H, Desjardins L, Prussien K, Winning AM, Gerhardt CA, Vannatta K, Compas BE. Maternal Communication in Childhood Cancer: Factor Analysis and Relation to Maternal Distress. J Pediatr Psychol 2019; 43:1114-1127. [PMID: 30016505 DOI: 10.1093/jpepsy/jsy054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 06/17/2018] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to characterize mothers' communication with their children in a sample of families with a new or newly relapsed pediatric cancer diagnosis, first using factor analysis and second using structural equation modeling to examine relations between self-reported maternal distress (anxiety, depression, and posttraumatic stress) and maternal communication in prospective analyses. A hierarchical model of communication was proposed, based on a theoretical framework of warmth and control. Methods The sample included 115 children (age 5-17 years) with new or newly relapsed cancer (41% leukemia, 18% lymphoma, 6% brain tumor, and 35% other) and their mothers. Mothers reported distress (Beck Anxiety Inventory, Beck Depression Inventory-II, and Impact of Events Scale-Revised) 2 months after diagnosis (Time 1). Three months later (Time 2), mother-child dyads were video-recorded discussing cancer. Maternal communication was coded with the Iowa Family Interaction Ratings Scales. Results Confirmatory factor analysis demonstrated poor fit. Exploratory factor analysis suggested a six-factor model (root mean square error of approximation = .04) with one factor reflecting Positive Communication, four factors reflecting Negative Communication (Hostile/Intrusive, Lecturing, Withdrawn, and Inconsistent), and one factor reflecting Expression of Negative Affect. Maternal distress symptoms at Time 1 were all significantly, negatively related to Positive Communication and differentially related to Negative Communication factors at Time 2. Maternal posttraumatic stress and depressive symptoms each predicted Expression of Negative Affect. Conclusions Findings provide a nuanced understanding of maternal communication in pediatric cancer and identify prospective pathways of risk between maternal distress and communication that can be targeted in intervention.
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Affiliation(s)
- Lexa K Murphy
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Jason D Rights
- Department of Psychology & Human Development, Vanderbilt University
| | - Erin M Rodriguez
- Department of Psychology & Human Development, Vanderbilt University
| | - Heather Bemis
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Kemar Prussien
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Bruce E Compas
- Department of Psychology & Human Development, Vanderbilt University
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15
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Borschuk AP, Filigno SS, Opipari-Arrigan L, Peugh J, Stark LJ. Psychological predictors of nutritional adherence in adolescents with cystic fibrosis. Clin Nutr ESPEN 2019; 33:143-147. [PMID: 31451251 DOI: 10.1016/j.clnesp.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/07/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS The CF medical regimen is notoriously burdensome, comprised of respiratory treatments, oral medications, and nutritional demands. Adequate caloric intake has been identified as a challenge over the lifespan; however, we lack detailed information about nutritional adherence in teens, and the contextual drivers of these behaviors. Adolescence is a time of increased responsibility, reduced parental monitoring, and growing peer connections. There is no literature examining the impact of familial attitudes (e.g., privacy, disease disclosure) and the social milieu (e.g., friendships) on teen nutritional adherence behavior. We hypothesized that better teen nutritional adherence behaviors would be predicted by more favorable familial privacy attitudes, better relationship quality, and greater comfort in disease disclosure. METHODS Assessment included questionnaires of caregiver privacy attitudes, relationship quality, and disease disclosure. Teens tracked PERT adherence for 1 month and logged daily caloric intake for 2 weeks. This produced detailed information on daily enzyme adherence, caloric intake, and eating frequency. RESULTS Average PERT adherence, caloric intake, and eating frequency were suboptimal in this sample. More comfort in disease disclosure and less teen/mother discord predicted better PERT adherence. Higher caregiver privacy and lower teen closeness with friends predicted greater caloric intake and eating frequency. CONCLUSIONS Results suggest that comfort in disease disclosure supports consistent PERT adherence across environments. Adolescents with close friendships may have less time for self-management (e.g., eating). Future research should collect more detailed information about friendships of teens with CF. Results suggest that daily structure and positive, appropriately supportive relationships should be encouraged by care teams.
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Affiliation(s)
| | | | | | - James Peugh
- Cincinnati Children's Hospital Medical Center, USA
| | - Lori J Stark
- Cincinnati Children's Hospital Medical Center, USA
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16
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Malone H, Biggar S, Javadpour S, Edworthy Z, Sheaf G, Coyne I. Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis. Cochrane Database Syst Rev 2019; 5:CD012578. [PMID: 31119726 PMCID: PMC6531890 DOI: 10.1002/14651858.cd012578.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Shared decision-making is important in child and adolescent healthcare because there is growing international recognition of children and young people's rights to be included in decisions that affect them. In order for young people to participate effectively in shared decision-making they need to develop the skills of engagement with healthcare professionals and confidence in interacting with them. They also need to learn how to manage their condition and treatments on their own when they move into adulthood. Children and young people who participate in shared decision-making in healthcare are likely to be more informed, feel more prepared, and experience less anxiety about the unknown. Significant improvements in cystic fibrosis (CF) survival over recent decades, due to improved therapies and better management of care, means that young people with CF are routinely transitioning to adult healthcare where increasing emphasis on self-management brings greater complexity in decision-making. We need to know what interventions are effective in promoting shared decision-making for young people with CF. OBJECTIVES To assess the effectiveness of interventions that promote participation in shared decision-making for children and adolescents (aged between four and 18 years) with CF. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearches of journals and conference abstract books. We also searched the reference lists of articles and reviews addressing shared decision-making.Date of most recent search: 12 March 2019.We searched PubMed, CINAHL (EBSCO), Embase (Elsevier), PsycINFO (EBSCO), WHO ICTRP, ASSIA (ProQuest), ERIC (ProQuest), ProQuest Dissertations and Theses, and ClinicalTrials.gov. We contacted study authors with published relevant research in shared decision-making for adults to ask if they were aware of any published or ongoing studies on the promotion of the intervention for children or adolescents (or both) with CF.Date of most recent search: 19 March 2019. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) (but not cross-over RCTs) of interventions promoting shared decision-making for children and adolescents with CF aged between four and 18 years, such as information provision, booklets, two-way interaction, checking understanding (by the participant), preparation to participate in a healthcare decision, decision-aids, and training interventions or educational programs. We planned to include interventions aimed at children or adolescents (or both), parents or healthcare professionals or any combination of these groups provided that the focus was aimed at promoting shared decision-making for children and adolescents with CF. DATA COLLECTION AND ANALYSIS Two authors independently reviewed papers identified in the searches. MAIN RESULTS No eligible RCTs were identified for inclusion in this systematic review. AUTHORS' CONCLUSIONS We were unable to identify RCTs with evidence which would support healthcare policy-making and practice related to implementation of shared decision-making for children and adolescents (aged between four and 18 years) with CF). We hope that having identified this gap in research, awareness will increase amongst researchers of the need to design high-quality shared decision-making interventions for young people with CF, perhaps adapted from existing models for adults, and to test these interventions and children's preferences in RCTs. It is also important to target health professionals with evidence-based education programmes on shared decision-making and a need for international consensus on addressing the variability in education programmes.
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Affiliation(s)
- Helen Malone
- Trinity College DublinSchool of Nursing & Midwifery24 D’Olier Street, College GreenDublin 2Ireland
| | - Susan Biggar
- Australian Health Practitioner Regulation Agency (AHPRA)111 Burke Street, Level 7MelbourneAustraliaVIC 3000
| | - Sheila Javadpour
- Our Lady's Children's Hospital, CrumlinDepartment of Respiratory MedicineDublinIreland12
| | - Zai Edworthy
- Temple Street Children's University HospitalDepartment of PsychologyTemple StreetDublinIrelandDO1 YC67
| | - Greg Sheaf
- The Library of Trinity College DublinCollege StreetDublinIreland
| | - Imelda Coyne
- Trinity College DublinSchool of Nursing & Midwifery24 D'Olier StDublinIreland2
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17
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Quittner AL, Eakin MN, Alpern AN, Ridge AK, McLean KA, Bilderback A, Criado KK, Chung SE, Riekert KA. Clustered randomized controlled trial of a clinic-based problem-solving intervention to improve adherence in adolescents with cystic fibrosis. J Cyst Fibros 2019; 18:879-885. [PMID: 31103533 DOI: 10.1016/j.jcf.2019.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/12/2019] [Accepted: 05/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND In Cystic Fibrosis (CF), adherence to pulmonary medications is about 50% and decreases during adolescence. Effective interventions have not been integrated into CF care. This effectiveness study tested a brief, clinic-based behavioral intervention to improve adherence. METHODS iCARE (I Change Adherence and Raise Expectations) was a pragmatic, clustered, 2-arm randomized controlled trial at 18 CF Centers. 607 adolescents with CF, ages 11-20 years, participated. Centers were randomized to IMPACT (n = 9; 300 adolescents), a brief problem-solving + education intervention, or standard care (SC; n = 9; 307 adolescents). IMPACT was delivered during a regularly scheduled clinic visit by a member of the clinical care team. The primary outcome was composite pulmonary medication possession ratio (cMPR); secondary endpoints were lung function, Body Mass Index percentile, courses of IV antibiotics, and health-related quality of life at 12 months. RESULTS Effectiveness of the intervention was tested using mixed models, generalized estimating equations comparing IMPACT to SC. Fifty-eight percent of problem-solving sessions targeted barriers to airway clearance, exercise or nutrition, while 18% addressed pulmonary medications. Average intervention fidelity score was 67% (SD = 14%; Range = 25-100%). No significant intervention effects were found for cMPR or any of the secondary outcomes compared to SC. CONCLUSIONS The IMPACT intervention did not improve medication adherence or health outcomes over 12 months. Challenges to implementing the intervention as intended during busy clinic visits were identified. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01232478; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Alexandra L Quittner
- Nicklaus Children's Research Institute, Nicklaus Children's Hospital, Miami, FL, USA.
| | - Michelle N Eakin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Adrianne N Alpern
- Department of Psychology, University of Miami, P.O. Box 248185, Miami, FL, USA
| | - Alana K Ridge
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Katherine A McLean
- Department of Psychology, University of Miami, P.O. Box 248185, Miami, FL, USA
| | - Andrew Bilderback
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Kristen K Criado
- Department of Psychology, University of Miami, P.O. Box 248185, Miami, FL, USA
| | - Shang-En Chung
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Kristin A Riekert
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
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18
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Assessment of children with pectus excavatum without surgical correction. Wien Klin Wochenschr 2018; 131:126-131. [DOI: 10.1007/s00508-018-1406-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/20/2018] [Indexed: 11/26/2022]
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19
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Singh N, McDonald PJ. Transitioning in hydrocephalus: Current practices in Canadian Paediatric Neurosurgery centres. Paediatr Child Health 2018; 23:e150-e155. [PMID: 30374224 DOI: 10.1093/pch/pxy016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Advances in perinatal care in the developed world have resulted in more children living into adulthood with complex chronic health conditions. Transition is a process to improve and maximize the functional status of adolescents via the provision of adequate and appropriate health services in adulthood. This process is frequently disjointed, fragmented and inconsistent and inadequate transition increases morbidity, hospital admissions and urgent interventions. Ten thousand children are diagnosed with hydrocephalus annually in North America. Most survive to adulthood yet there are few transitioning programs and little research data on successful programs for this population. Methods An email survey of paediatric neurosurgical centres in Canada was carried out to establish current transition practices and attitudes for adolescents with hydrocephalus. Data were analyzed descriptively. Results Eleven out of 12 centres responded. The age of transition ranged from 16 to 18 years. Four centres have access to a dedicated Adult Hydrocephalus Clinic. Referral practices vary between centres and we highlight inconsistencies in care to this cohort of patients in Canada. There is little satisfaction among neurosurgeons with current transition arrangements in Canada. Several suggestions were made on how to improve this process. Conclusion We recommend research into the needs of patients with hydrocephalus in order to formalize appropriate standards for transitioning patients with a view to developing national guidelines to standardize the transition process. This will require input from patients, families and the wider medical and allied health professional groups.
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Affiliation(s)
- Navneet Singh
- Division of Neurosurgery, BC Children's Hospital, Vancouver, British Columbia
| | - Patrick J McDonald
- Division of Neurosurgery, BC Children's Hospital, Vancouver, British Columbia.,BC Children's Hospital Research Institute, Vancouver, British Columbia.,Department of Surgery, University of British Columbia, Vancouver, British Columbia.,National Core for Neuroethics, University of British Columbia, Vancouver, British Columbia
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20
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Everhart RS, Molitor SJ, Wentz D, Schmidt HJ, Schechter MS. Identifying and Integrating Parent Priorities for Psychosocial Support Services in a Pediatric Cystic Fibrosis Clinic. J Clin Psychol Med Settings 2018; 26:235-241. [PMID: 30368723 DOI: 10.1007/s10880-018-9588-1] [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: 10/28/2022]
Abstract
Engaging parents early in the development of psychosocial support programs in cystic fibrosis (CF) clinics may enable services and care team recommendations to be tailored appropriately. This pilot study identified psychosocial priorities of parents of children with CF related to treatment adherence, parent/child mental health, and CF-related communication. Forty parents of children with CF (2 months to 17 years) completed an anonymous 17-item survey during routine clinic visits that assessed priorities related to psychosocial services. Elements of a quality improvement framework were used to develop the survey and determine recommendations based on findings. Parents reported the most interest in support related to improving adherence to respiratory therapies and helping children complete treatments independently. Other priority areas included services that helped children cope with feelings of isolation or abnormality due to CF and strategies to improve communication with the care team. Additionally, the majority of families indicated that they preferred receiving psychosocial services during routine clinic visits, followed by periodic parent workshops. Based on survey results, the psychosocial team at our center developed a survey/response model (e.g., roundtables, workshops) that may serve useful for other CF care teams as they identify the priorities of parents and adapt to their needs.
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Affiliation(s)
- Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA.
| | - Stephen J Molitor
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
| | - Dena Wentz
- Division of Pulmonary Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - H Joel Schmidt
- Division of Pulmonary Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Michael S Schechter
- Division of Pulmonary Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
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21
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Jakubowska-Winecka A, Biernacka M. Parental Attitudes and Medication Adherence in Groups of Adolescents After Liver and Kidney Transplantations. Transplant Proc 2018; 50:2145-2149. [PMID: 30177127 DOI: 10.1016/j.transproceed.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/13/2018] [Accepted: 05/07/2018] [Indexed: 11/18/2022]
Abstract
The objective of the study was to determine the connection between parental attitudes and medication adherence and the selected aspects of treatment in groups of adolescents after kidney and liver transplantations, in comparison with adolescents with diabetes and inflammatory bowel disease. Attitudes were assessed using M. Plopa's Parental Attitudes Scale, which distinguishes 5 types of attitudes. Medication adherence was evaluated on the basis of the Morisky Medication Adherence Scale (MMAS-8), used with the author's consent. With the 4-item scale developed by the authors, the following aspects of treatment were assessed: the patient's level of knowledge about the disease, treatment effects, and physician's satisfaction with patient cooperation. In both groups of adolescents after transplantation, 2 types of parental attitudes were found to correlate with medication adherence: the Accepting Attitude and the Overly Protective Attitude. The results of other studied aspects varied in terms of gender, age, and chronic disease type.
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Affiliation(s)
- A Jakubowska-Winecka
- Health Psychology Department, the Children's Memorial Health Institute, Warsaw, Poland.
| | - M Biernacka
- Health Psychology Department, the Children's Memorial Health Institute, Warsaw, Poland.
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22
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McLoughlin A, Matthews C, Hickey TM. "They're kept in a bubble": Healthcare professionals' views on transitioning young adults with congenital heart disease from paediatric to adult care. Child Care Health Dev 2018; 44:736-745. [PMID: 29882316 DOI: 10.1111/cch.12581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Due to medical advances, growing numbers of adolescents with congenital heart disease (CHD) survive into adulthood and transferring from paediatric to adult healthcare. This transfer is significant step in a young person's life, and this study examines the views of Irish healthcare professionals' on how best to manage this transition. METHODS Purposeful sampling was used to invite participation by healthcare professionals (HCPs) from a variety of disciplines whose caseloads include adolescents and young adults with CHD. Fourteen professionals participated in semistructured interviews regarding their experiences of the transition process and their recommendations. Data were collected during Spring 2016 and analysed using thematic analysis. RESULTS Results indicated that the current approach to transition and transfer could be improved. Professionals identified barriers hindering the transition process such as cultural and attitudinal differences between HCPs dealing with child and adult patients, inadequate preparation and education of patients about their condition, parental reluctance to transfer, and concern about parents' role in on-going treatment. Measures such as better support and education for both the patients and their parents were recommended, in order to facilitate a smoother transition process for all parties involved. Additionally, HCPs identified the need for better collaboration and communication, both between paediatric and adult healthcare professionals and between hospitals, to ensure greater continuity of care for patients. CONCLUSIONS Action is required in order to improve the current transition process. Measures need to be taken to address the barriers that currently prevent a smooth transition process for young adult CHD patients. Professionals recommended the implementation of a structured transition clinic to deal with the wide variety of needs of transitioning adolescent patients and their families. Recommendations for future research are also made.
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Affiliation(s)
| | - C Matthews
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - T M Hickey
- University College Dublin, Dublin, Ireland
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23
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Birnie KA, Chambers CT, Chorney J, Fernandez CV, McGrath PJ. A Multi-Informant Multi-Method Investigation of Family Functioning and Parent-Child Coping During Children's Acute Pain. J Pediatr Psychol 2018; 42:28-39. [PMID: 28165527 DOI: 10.1093/jpepsy/jsw045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 03/31/2016] [Accepted: 04/26/2016] [Indexed: 11/12/2022] Open
Abstract
Objective To explore relations between family functioning and child acute pain, including pain ratings, coping, and parent–child behaviors. Methods Community sample of 171 dyads including one child aged 8–12 years (52% girls) and one parent (79% mothers). Family functioning was assessed via child and parent self-report, and observation during a conflict discussion task. Children and parents rated pain catastrophizing at baseline, and child pain and distress following a cold pressor task (CPT). Parent–child interactions during the CPT were coded for observed behaviors during child pain. Results Self-report of poorer family functioning predicted greater child and parent pain catastrophizing, and parent distress. Less observed family negativity/conflict and cohesiveness, and greater family focus of problems and parent emotional support predicted more child symptom complaints. Family functioning was not associated with child pain or distress. Conclusions Family functioning influenced parent and child coping and child behavioral responses, but not the experience, of acute pain.
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Affiliation(s)
- Kathryn A Birnie
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Christine T Chambers
- Department of Pediatrics, Dalhousie University & IWK Health Centre, Halifax, NS, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Jill Chorney
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada.,Department of Anesthesia, Pain, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Conrad V Fernandez
- Department of Pediatrics, Dalhousie University & IWK Health Centre, Halifax, NS, Canada
| | - Patrick J McGrath
- IWK Health Centre and Science, Pediatrics, Psychiatry, and Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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24
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Question 12: What do you consider when discussing treatment adherence in patients with Cystic Fibrosis? Paediatr Respir Rev 2018. [PMID: 28625493 DOI: 10.1016/j.prrv.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Shen C, Wan A, Kwok LT, Pang S, Wang X, Stewart SM, Lam TH, Chan SSC. A Community-Based Intervention Program to Enhance Family Communication and Family Well-being: The Learning Families Project in Hong Kong. Front Public Health 2017; 5:257. [PMID: 29085815 PMCID: PMC5649187 DOI: 10.3389/fpubh.2017.00257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/11/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Family communication is important to maintain family relationships and family well-being. To enhance family communication and family well-being, a community-based "Learning Families Project," based on the social ecological model was developed in Kwun Tong in Hong Kong, a district with high prevalence of family problems. METHODS This quasi-experimental study included two nearby government subsidized low-rent housing estates separated by busy main roads, as the intervention [Tsui Ping (South) Estate] and control (Shun Tin Estate) estate. The main intervention was resident training programs, such as talks, day camps, and thematic activities. No program was implemented in the control estate. Participants in the intervention group received assessments before the intervention (T1), immediately after the intervention (T2), and 6 weeks after the intervention (T3). Control group participants were assessed at baseline (March to April 2011) and follow-up (December 2011 to March 2012). Assessments of family communication (time and perceived adequacy) and family well-being (harmony, happiness, and health) at T1 and T3 were obtained in the intervention group to examine within-group changes. In addition, these differences in outcomes in the intervention group were compared with those in the control group to examine the effectiveness of the intervention. RESULTS Family communication time and perceived communication adequacy increased significantly in the intervention group (n = 515) with a small effect size (Cohen effect d: 0.10 and 0.24, respectively). Compared with the control group (n = 476), the improvements in family communication time and perceived communication adequacy (Cohen effect d: 0.13 and 0.14, respectively), and perceived family harmony and happiness (Cohen effect d: 0.12 and 0.12, respectively) were significantly greater in the intervention group, adjusting for age and education, suggesting the intervention was effective in improving family communication and family well-being. Mediation analysis showed that perceived communication adequacy mediated the effects of the intervention on family harmony [β = 0.10, 95% confidence interval (CI) 0.03, 0.18], happiness (β = 0.12, 95% CI 0.04, 0.20), and health (β = 0.10, 95% CI 0.02, 0.17), adjusting for age and education. CONCLUSION This community intervention based on the social ecological model improved family well-being through improving family communication, which could be an effective target to promote family well-being in other communities. TRIAL REGISTRATION This study was registered under ClinicalTrials.gov, identifier NCT02851667. URL: https://clinicaltrials.gov/ct2/show/NCT02851667?term=02851667&rank=1.
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Affiliation(s)
- Chen Shen
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Alice Wan
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Lit Tung Kwok
- Christian Family Service Center, Kwun Tong, Hong Kong
| | - Sally Pang
- Christian Family Service Center, Kwun Tong, Hong Kong
| | - Xin Wang
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sunita M. Stewart
- Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, United States
| | - Tai Hing Lam
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sophia Siu Chee Chan
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
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Faint NR, Staton JM, Stick SM, Foster JM, Schultz A. Investigating self-efficacy, disease knowledge and adherence to treatment in adolescents with cystic fibrosis. J Paediatr Child Health 2017; 53:488-493. [PMID: 28186386 DOI: 10.1111/jpc.13458] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/05/2016] [Accepted: 10/28/2016] [Indexed: 12/27/2022]
Abstract
AIM Patient adherence is integral to the effectiveness of prescribed treatment, and is associated with beneficial disease outcomes, yet in adolescents with cystic fibrosis, adherence is often sub-optimal. Multiple factors may contribute to treatment adherence, including disease knowledge and self-efficacy. In adolescents with cystic fibrosis: (i) to compare the disease knowledge of adolescents and their parents before transition to adult care; (ii) to determine the relationship between disease knowledge (adolescent, parent) and adherence; and (iii) to evaluate self-efficacy and its association with disease knowledge and adherence. METHODS Adolescents with cystic fibrosis and their parents were recruited from a tertiary children's hospital. Disease knowledge and self-efficacy was assessed using the Knowledge of Disease Management-CF and General Self-Efficacy Scales respectively. Using pharmacy records, medication possession ratio was calculated to measure treatment adherence in the preceding year. RESULTS Thirty-nine adolescent (aged 12-17 (median 14) years) and parent pairs were recruited. Adherence to hypertonic saline, but not other medications, was significantly associated with disease knowledge in adolescents (r 2 = 0.40, P = 0.029). Mean (SD) adolescent self-efficacy was 30.8 (4.0), and not associated with disease knowledge or adherence. Mean (SD) disease knowledge was less in adolescents than parents (55 (16)% and 72 (14)% respectively, P < 0.001). CONCLUSION Disease knowledge is sub-optimal in adolescents with cystic fibrosis, even in the 2 years immediately before transition to adult care. Given that adherence with some treatments has been associated with disease knowledge our results suggest the need for educational interventions in adolescents with cystic fibrosis to optimise self-management and health outcomes.
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Affiliation(s)
- Nicholas R Faint
- The University of Notre Dame, Perth, Western Australia, Australia
| | - Janelle M Staton
- The University of Notre Dame, Perth, Western Australia, Australia
| | - Stephen M Stick
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children and Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Juliet M Foster
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - André Schultz
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children and Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Paediatric and Child Health, University of Western Australia, Perth, Western Australia, Australia
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Bishay LC, Sawicki GS. Strategies to optimize treatment adherence in adolescent patients with cystic fibrosis. Adolesc Health Med Ther 2016; 7:117-124. [PMID: 27799838 PMCID: PMC5085292 DOI: 10.2147/ahmt.s95637] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
While development of new treatments for cystic fibrosis (CF) has led to a significant improvement in survival age, routine daily treatment for CF is complex, burdensome, and time intensive. Adolescence is a period of decline in pulmonary function in CF, and is also a time when adherence to prescribed treatment plans for CF tends to decrease. Challenges to adherence in adolescents with CF include decreased parental involvement, time management and significant treatment burden, and adolescent perceptions of the necessity and value of the treatments prescribed. Studies of interventions to improve adherence are limited and focus on education, without significant evidence of success. Smaller studies on behavioral techniques do not focus on adolescents. Other challenges for improving adherence in adolescents with CF include infection control practices limiting in-person interactions. This review focuses on the existing evidence base on adherence intervention in adolescents with CF. Future directions for efforts to optimize treatment adherence in adolescents with CF include reducing treatment burden, developing patient-driven technology to improve tracking, communication, and online support, and rethinking the CF health services model to include assessment of individualized adherence barriers.
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Affiliation(s)
- Lara C Bishay
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA, USA
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA, USA
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Nock NL, Ievers-Landis CE, Dajani R, Knight D, Rigda A, Narasimhan S, Uli N. Physical Activity Self-Efficacy and Fitness: Family Environment Relationship Correlates and Self-Esteem as a Mediator among Adolescents Who Are Overweight or Obese. Child Obes 2016; 12:360-7. [PMID: 27243476 DOI: 10.1089/chi.2016.0007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little is known regarding how dimensions of the family social environment relate to fitness levels and physical activity self-efficacy (PASE) among adolescents who are overweight or obese and whether these relationships are mediated by self-esteem. METHODS Potential associations were evaluated between relationship subdomains (cohesion, conflict, expressivity) of the Family Environment Scale (FES), self-esteem (Rosenberg Self-Esteem Scale, RSES), and PASE and fitness, using recovery heart rate [RHR, beats per minute (bpm)] from a 3-minute submaximal step test at baseline. Participants were 108 adolescents who were overweight or obese and were seeking weight-loss treatment as part of the Healthy Kids, Healthy Weight 12-week multidisciplinary pediatric weight management program. Structural equation modeling (SEM) was used to simultaneously evaluate paths between these variables and test for mediation. RESULTS In multivariable models, higher FES cohesion (β = -2.18, s.e. = 0.98; p = 0.02), expressivity (β = -1.97, s.e. = 0.99; p < 0.05), and PASE (β = -0.64, s.e. = 0.33; p < 0.05) scores were associated with lower RHR, which represents higher fitness. Furthermore, higher FES conflict scores were associated with lower RSES scores (β = -0.83, s.e. = 0.29; p < 0.01), and FES conflict (β = -0.63, s.e. = 0.22; p < 0.01) and RSES (β = 0.33, s.e. = 0.07; p < 0.01) were associated with PASE scores. In a good-fitting multivariate SEM [Comparative Fit Index (CFI) = 1.00; Standardized Root Mean Square Residual (SRMR) = 0.02; Tucker-Lewis index (TLI) = 1.22; Root Mean Squared Error of Approximation (RMSEA) <0.01], RSES mediated the relationship between FES conflict and PASE (sum of indirect paths: β = -0.30, s.e. = 0.11; p < 0.01) scores. CONCLUSIONS Our results highlight the importance of the relationship domain of the family environment on self-esteem, PASE, and physical fitness in adolescents who are overweight or obese.
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Affiliation(s)
- Nora L Nock
- 1 Department of Epidemiology and Biostatistics, Case Western Reserve University , Cleveland, OH
| | - Carolyn E Ievers-Landis
- 1 Department of Epidemiology and Biostatistics, Case Western Reserve University , Cleveland, OH.,2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Rachel Dajani
- 2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Darryl Knight
- 2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Alexander Rigda
- 2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Sumana Narasimhan
- 2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Naveen Uli
- 2 University Hospitals Case Medical Center , Rainbow Babies and Children's Hospital, Cleveland, OH
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Nguyen T, Henderson D, Stewart D, Hlyva O, Punthakee Z, Gorter JW. You never transition alone! Exploring the experiences of youth with chronic health conditions, parents and healthcare providers on self-management. Child Care Health Dev 2016; 42:464-72. [PMID: 27103590 PMCID: PMC5021141 DOI: 10.1111/cch.12334] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/21/2016] [Accepted: 02/04/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent evidence suggests that fostering strategies to enable youth with chronic health conditions to work towards gradual self-management of their health is key in successful transition to adult healthcare. To date, there is limited research on self-management promotion for youth. The purpose of this study is to explore self-management from the perspectives of youth, parents and healthcare providers in transition to adult healthcare. METHODS Part of a larger longitudinal transition (TRACE-2009-2013) study, interpretive phenomenology was used to explore the meaning of the lived experiences and perceptions of youth, parents, and healthcare providers about transition to adult healthcare. Purposeful sampling was utilized to select youth with a range of chronic health conditions from the TRACE cohort (spanning 20 diagnoses including developmental disabilities and chronic conditions), their parents and healthcare providers. RESULTS The emerging three themes were: increasing independence of youth; parents as safety nets and healthcare providers as enablers and collaborators. The findings indicate that the experiences of transitioning youth, parents and service providers are interconnected and interdependent. CONCLUSIONS Results support a dynamic and developmentally appropriate approach when working with transitioning youth and parents in practice. As youth depend on parents and healthcare providers for support in taking charge of their own health, parents and healthcare providers must work together to enable youth for self-management. At a policy level, adequate funding, institutional support and accreditation incentives are recommended to allow for designated time for healthcare providers to foster self-management skills in transitioning youth and parents.
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Affiliation(s)
- T Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | | | - D Stewart
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - O Hlyva
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Z Punthakee
- Department of Pediatrics, McMaster University, Hamilton, Canada
- School of Medicine, McMaster University, Hamilton, Canada
| | - J W Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
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Christin A, Akre C, Berchtold A, Suris JC. Parent-adolescent relationship in youths with a chronic condition. Child Care Health Dev 2016; 42:36-41. [PMID: 26140665 DOI: 10.1111/cch.12266] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 05/13/2015] [Accepted: 05/27/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Suffering from a chronic disease or disability (CDD) during adolescence can be a burden for both the adolescents and their parents. The aim of the present study is to assess how living with a CDD during adolescence, the quality of parent-adolescent relationship (PAR) and the adolescent's psychosocial development interact with each other. METHODS Using the Swiss Multicenter Adolescent Survey on Health 2002 (SMASH02) database, we compared adolescents aged 16-20 years with a CDD (n = 760) with their healthy peers (n = 6493) on sociodemographics, adolescents' general and psychosocial health, interparental relationship and PAR. RESULTS Bivariate analyses showed that adolescents with a CDD had a poorer psychosocial health and a more difficult relationship with their parents. The log-linear model indirectly linked CDD and poor PAR through four variables: two of the adolescents' psychosocial health variables (suicide attempt and sensation seeking), the need for help regarding difficulties with parents and a highly educated mother that acted as a protective factor, allowing for a better parent-adolescent with a CDD relationship. CONCLUSION It is essential for health professionals taking care of adolescents with a CDD to distinguish between issues in relation with the CDD from other psychosocial difficulties, in order to help these adolescents and their parents deal with them appropriately and thus maintain a healthy PAR.
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Affiliation(s)
- A Christin
- Research Group on Adolescent Health (GRSA/IUMSP), Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - C Akre
- Research Group on Adolescent Health (GRSA/IUMSP), Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Berchtold
- Research Group on Adolescent Health (GRSA/IUMSP), Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - J C Suris
- Research Group on Adolescent Health (GRSA/IUMSP), Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Friedrich E, Jawad AF, Miller VA. Correlates of Problem Resolution during Parent-Child Discussions about Chronic Illness Management. CHILDRENS HEALTH CARE 2015; 45:323-341. [PMID: 28133408 DOI: 10.1080/02739615.2015.1038681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Families impacted by pediatric chronic illness must navigate treatment regimens that can present multiple problems and decisions to be addressed on a daily basis. The extent to which parents and children are able to solve such problems is likely to have implications for health behaviors and outcomes. The aims of this study were to examine correlates of problem resolution in families of children with a chronic illness. Participants were 167 children (ages 8-16) with type 1 diabetes or cystic fibrosis and a parent. Parent-child dyads recounted a recent discussion they had related to illness management and completed questionnaires. The research team coded the discussions for topic and outcome (i.e., did the dyad come up with a plan to address the problem). The results indicated that the majority of dyads in both illness groups came up with a plan during their discussions. Lack of problem resolution during the discussion was associated with higher parent coercion, more child resistance to the regimen, and worse adherence. Parent coercion and child resistance could be the targets of interventions to enhance problem solving and improve adherence.
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Affiliation(s)
- Elizabeth Friedrich
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Abbas F Jawad
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA ; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
| | - Victoria A Miller
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA ; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
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Hobart-Porter L, Wade S, Minich N, Kirkwood M, Stancin T, Taylor HG. Determinants of Effective Caregiver Communication After Adolescent Traumatic Brain Injury. PM R 2015; 7:836-844. [PMID: 25687111 PMCID: PMC5437845 DOI: 10.1016/j.pmrj.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/31/2015] [Accepted: 02/10/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the effects of caregiver mental health and coping strategies on interactions with an injured adolescent acutely after traumatic brain injury (TBI). DESIGN Multi-site, cross-sectional study. SETTING Outpatient setting of 3 tertiary pediatric hospitals and 2 tertiary general medical centers. PARTICIPANTS Adolescents (N = 125) aged 12-17 years, 1-6 months after being hospitalized with complicated mild to severe TBI. METHODS Data were collected as part of a multi-site clinical trial of family problem-solving therapy after TBI. Multiple regression analyses were used to examine the relationship of caregiver and environmental characteristics to the dimensions of effective communication, warmth, and negativity during caregiver-adolescent problem-solving discussions. MAIN OUTCOMES MEASURES Adolescent and caregiver interactions, as measured by the Iowa Family Interaction Rating Scales. RESULTS Caregivers who utilized problem-focused coping strategies were rated as having higher levels of effective communication (P < .01), as were those with higher socioeconomic status (P < .01). Problem-focused coping style and higher socioeconomic status were also associated lower levels of negative interactions (P < .01 and P < .05, respectively). Female gender of the adolescent and fewer children in the home were associated with increased parental warmth during the interaction (P < .01 and P < .05, respectively). Neither adolescent TBI severity nor caregiver depression significantly influenced caregiver-teen interactions. CONCLUSIONS Problem-focused coping strategies are associated with higher levels of effective communication and lower levels of caregiver negativity during the initial months after adolescent TBI, suggesting that effective caregiver coping may facilitate better caregiver-adolescent interactions after TBI.
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Affiliation(s)
| | - Shari Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nori Minich
- Case Western Reserve University, Cleveland, OH
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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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34
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Beinke KL, O’Callaghan FV, Morrissey S. The impact of social constraints and sense of coherence on the psychological adjustment of adolescents and young adults with CF. COGENT PSYCHOLOGY 2015. [DOI: 10.1080/23311908.2015.1019237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Kaya L. Beinke
- School of Applied Psychology and Griffith Health Institute, Griffith University, Gold Coast, Queensland 4222, Australia
| | - Frances V. O’Callaghan
- School of Applied Psychology and Griffith Health Institute, Griffith University, Gold Coast, Queensland 4222, Australia
| | - Shirley Morrissey
- School of Applied Psychology and Griffith Health Institute, Griffith University, Gold Coast, Queensland 4222, Australia
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Hayes D, McCoy KS, Whitson BA, Mansour HM, Tobias JD. High-risk age window for mortality in children with cystic fibrosis after lung transplantation. Pediatr Transplant 2015; 19:206-10. [PMID: 25430504 DOI: 10.1111/petr.12401] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 11/29/2022]
Abstract
LTx in children with CF remains controversial. The UNOS database was queried from 1987 to 2013 for CF patients <18 yr of age at time of transplant. PCHR model was used to quantify hazard of mortality. 489 recipients were included in the survival analysis. The hazard function of post-transplant mortality was plotted over attained age to identify age window of highest risk, which was 16-20 yr. Unadjusted PCHR model revealed ages immediately after the high-risk window were characterized by lower hazard of mortality (HR = 0.472; 95% CI = 0.302, 0.738; p = 0.001). After adjusting for potential confounders, the decline in mortality hazard immediately after the high-risk window remained statistically significant (HR = 0.394; 95% CI: 0.211, 0.737; p = 0.004). Hazard of mortality in children with CF after LTx was highest between 16 and 20 yr of attained age and declined thereafter.
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Affiliation(s)
- Don Hayes
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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Sawicki GS, Heller KS, Demars N, Robinson WM. Motivating adherence among adolescents with cystic fibrosis: youth and parent perspectives. Pediatr Pulmonol 2015; 50:127-36. [PMID: 24616259 PMCID: PMC4160425 DOI: 10.1002/ppul.23017] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/09/2014] [Indexed: 11/06/2022]
Abstract
As advances in the care of individuals with cystic fibrosis (CF) have resulted in improved survival, therapeutic regimens for treatment of CF have become increasingly complex. This high treatment burden poses challenges to chronic disease self-management, particularly amongst adolescents. The aim of this qualitative study was to understand the barriers and facilitators of adherence to chronic CF therapies as perceived by adolescents with CF and their parents. In a series of structured interviews with 18 youth and their parents, we explored issues related to daily routines, youth and parental roles regarding chronic therapy, and motivators for adherence. All interviews were audio-recorded and coded for themes and patterns. Reported barriers to adherence included time pressures, competing priorities, heightened awareness of disease trajectory, privacy concerns, and lack of perceived consequences from non-adherence. Identified facilitators for adherence included recognizing the importance of therapies, developing strong relationships with care teams, establishing structured routines, and focusing on shifting responsibilities from a parent to their adolescent child. The themes uncovered by these interviews identify areas for intervention and support by clinical programs seeking to improve adherence and self-management strategies for adolescents with CF.
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Affiliation(s)
- Gregory S Sawicki
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts
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Grossoehme DH, Filigno SS, Bishop M. Parent routines for managing cystic fibrosis in children. J Clin Psychol Med Settings 2015; 21:125-35. [PMID: 24838648 DOI: 10.1007/s10880-014-9396-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Management of cystic fibrosis (CF) is burdensome and adherence is often suboptimal. Family routines are associated with adherence and health outcomes in other disease populations. Few studies have examined routines in CF. The study's aim was to describe parent experiences developing and utilizing CF care routines. Semi-structured interviews with a convenience sample of 25 parents of children under 13 years of age with CF were analyzed using phenomenological analysis. Three domains emerged: parent experiences developing a routine, support systems facilitating maintenance of routines, and challenges with maintaining care routines. Parents found routines difficult to establish, used trial and error, encountered barriers, and found support helpful to manage care demands. Some parents chose to deviate from their routine. Providing anticipatory guidance to promote the use of care routines and strategies to manage potential challenges may facilitate use of routines and improve CF management.
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Affiliation(s)
- Daniel H Grossoehme
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC2021, Cincinnati, OH, 45229, USA,
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Beacham BL, Deatrick JA. Children with chronic conditions: perspectives on condition management. J Pediatr Nurs 2015; 30:25-35. [PMID: 25458105 PMCID: PMC4291290 DOI: 10.1016/j.pedn.2014.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/07/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
This qualitative study described children's (8-13 years old) perspectives of their chronic health conditions (e.g., asthma, diabetes, cystic fibrosis): how they perceived their condition, its management, and its implications for their future. The study used the family management style framework (FMSF) to examine child perspectives on the joint venture of condition management between the child and family. Children within this age group viewed condition management in ways similar to their parents and have developed their own routines around condition management. Future studies of this phenomenon comparing child and parent perspectives would further our understanding of the influence of family management.
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Affiliation(s)
- Barbara L. Beacham
- University of Pennsylvania School of Nursing 418 Curie Blvd. Philadelphia, PA 19104-4217
- Indiana University School of Nursing 1111 Middle Drive Indianapolis, IN 46202
| | - Janet A. Deatrick
- University of Pennsylvania School of Nursing 418 Curie Blvd. Philadelphia, PA 19104-4217
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Hogan A, Bonney MA, Brien JA, Karamy R, Aslani P. Factors affecting nebulised medicine adherence in adult patients with cystic fibrosis: a qualitative study. Int J Clin Pharm 2014; 37:86-93. [PMID: 25432693 DOI: 10.1007/s11096-014-0043-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/19/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nebulised medicines contribute to the high treatment burden experienced by patients with cystic fibrosis (CF). OBJECTIVES This study explored experiences of adult patients with CF when using nebulised medicines, factors impacting on their adherence to nebulised therapy and strategies they used to facilitate adherence. SETTING Community setting, in Sydney, Australia. METHODS Ten patients with CF were recruited through a CF patient organisation. Semi-structured face-to-face interviews were conducted, addressing the study objectives. Interviews were audio-recorded, transcribed verbatim and content analysed for anticipated and emergent themes. MAIN OUTCOME MEASURE Experiences with using nebulised medicines; and barriers and facilitators of adherence to nebulised medicines. RESULTS Participants' age ranged from 22 to 45 years, with half being male. Four broad themes (with more specific sub-themes) were identified from the interviews: experiences with using nebulised medicines (cleaning nebuliser, time taken to use nebuliser medicine, flexibility in use of nebuliser); feelings about using nebulised medicines (necessary/important, dislike, part of life); factors impacting non-adherence (time consuming therapy, side effects/effects of medicine, work/social demands, lack of perceived importance); factors and strategies facilitating adherence (perceived medicine importance, habit/routine, support, health benefits, technology/medicine dose form, timetabling). CONCLUSIONS Nebulised therapy for cystic fibrosis patients takes a substantial amount of time, with patients trying to alter their routine to incorporate nebulising into their daily lives. However there are still many factors that lead to low adherence, including work/social demands and travelling. Patients balance the necessity for nebulised therapy against the barriers, and engage in intentional non-adherence at times. Future strategies and resources should target and address specific factors identified by patients with CF as being important and impacting their adherence to nebulised medicines.
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Affiliation(s)
- Alice Hogan
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, Broadway, NSW, 2006, Australia
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40
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Butcher JL, Nasr SZ. Direct Observation of Respiratory Treatments in Cystic Fibrosis: Parent–Child Interactions Relate to Medical Regimen Adherence. J Pediatr Psychol 2014; 40:8-17. [DOI: 10.1093/jpepsy/jsu074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hauser SI, Economos CD, Nelson ME, Goldberg JP, Hyatt RR, Naumova EN, Anderson SE, Must A. Household and family factors related to weight status in first through third graders: a cross-sectional study in Eastern Massachusetts. BMC Pediatr 2014; 14:167. [PMID: 24984590 PMCID: PMC4112984 DOI: 10.1186/1471-2431-14-167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 06/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early environmental influences have been linked to child weight status, however further understanding of associations in diverse populations is needed. METHODS A cross-sectional analysis of household and family factors associated with overweight was conducted on a culturally diverse, urban dwelling sample of 820 first through third graders (mean age 7.6 ± 1.0 years) residing in three eastern Massachusetts cities. Overweight was defined as BMI > 85th percentile, based on measured height and weight, and the CDC growth reference. Multivariate logistic regression was used to identify demographic, behavioral, and social environmental variables significantly related to weight status. Independent variables included race-ethnicity, age, sex, servings of sugar-sweetened beverages/week, hours of screen time/week, parent overweight, (calculated from self-reported weight/height), parent education, household food restriction rules regarding snacking and/or kitchen access, frequency of having dinner as a family (reported as "a lot" vs. "sometimes/rarely/never") and child vitamin/mineral supplement use. Selected interactions were explored based on prior studies. RESULTS Prevalence of overweight was 35.5% in girls and 40.8% in boys. In the final, adjusted model, compared to white children, the odds of overweight were higher in children of Hispanic race-ethnicity (odds ratio (OR) = 2.4, 95% CI = 1.4 - 4.1). In the same adjusted model, compared to children with no household food restriction rules, the odds of overweight were 2.6 (95% CI = 1.3-5.1) times higher and 3.5 (95% CI = 1.9-6.4) times higher for children having one rule or two rules, respectively. Parent report of frequent family dinner and child vitamin use were protective, with a halving of risk for overweight for each behavior (OR = 0.47, 95% CI = 0.31-0.71 and OR = 0.54, 95% CI = 0.37-0.78, respectively). CONCLUSIONS In the presence of other factors, frequent family dinner and vitamin use were associated with lower risk of overweight and household food restriction rules with higher risk. Although such relationships have previously been reported, this investigation is among the first to demonstrate these associations in a low-income, racially-diverse early elementary school population, and suggest potential targets of opportunity within the family context that could reduce child overweight risk in a subgroup of children at elevated risk of obesity.
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Affiliation(s)
- Sonya Irish Hauser
- The Sage Colleges, School of Health Sciences, 65 First St, Troy, NY 12180, USA.
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Goldbeck L, Fidika A, Herle M, Quittner AL. Psychological interventions for individuals with cystic fibrosis and their families. Cochrane Database Syst Rev 2014; 2014:CD003148. [PMID: 24941199 PMCID: PMC7388585 DOI: 10.1002/14651858.cd003148.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND With increasing survival estimates for individuals with cystic fibrosis, long-term management has become an important focus. Psychological interventions are largely concerned with adherence to treatment, emotional and social adaptation and health-related quality of life. We are unaware of any relevant systematic reviews. OBJECTIVES To determine whether psychological interventions for people with cystic fibrosis provide significant psychosocial and physical benefits in addition to standard medical care. SEARCH METHODS Studies were identified from two Cochrane trials registers (Cystic Fibrosis and Genetic Disorders Group; Depression, Anxiety and Neurosis Group), Ovid MEDLINE and PsychINFO; unpublished trials were located through professional networks and Listserves. Most recent search of the Cystic Fibrosis and Genetic Disorders Group's register: 19 December 2013.Most recent search of the Depression, Anxiety and Neurosis Group's register: 12 November 2013. SELECTION CRITERIA Randomised controlled studies of a broad range of psychological interventions evaluating subjective and objective health outcomes, such as quality of life or pulmonary function, in individuals of all ages with cystic fibrosis and their immediate family. We were interested in psychological interventions, including psychological methods within the scope of psychotherapeutic or psychosomatic mechanism of action (e.g. cognitive behavioural, cognitive, family systems or systemic, psycho-dynamic, or other, e.g. supportive, relaxation, or biofeedback), which were aimed at improving psychological and psychosocial outcomes (e.g. quality of life, levels of stress or distress, psychopathology, etc.), adaptation to disease management and physiological outcomes. DATA COLLECTION AND ANALYSIS Three authors were involved in selecting the eligible studies and two of these authors assessed their risk of bias. MAIN RESULTS The review includes 16 studies (eight new studies included in this update) representing data from 556 participants. Studies are diverse in their design and their methods. They cover interventions with generic approaches, as well as interventions developed specifically to target disease-specific symptoms and problems in people with cystic fibrosis. These include cognitive behavioural interventions to improve adherence to nutrition or psychosocial adjustment, cognitive interventions to improve adherence or those associated with decision making in lung transplantation, a community-based support intervention and other interventions, such as self-hypnosis, respiratory muscle biofeedback, music therapy, dance and movement therapy, and a tele-medicine intervention to support patients awaiting transplantation.A substantial proportion of outcomes relate to adherence, changes in physical status or other specific treatment concerns during the chronic phase of the disease.There is some evidence that behavioural interventions targeting nutrition and growth in children (4 to 12 years) with cystic fibrosis are effective in the short term. Evidence was found that providing a structured decision-making tool for patients considering lung transplantation improves patients' knowledge of and expectations about the transplant, and reduces decisional conflict in the short term. One study about training in biofeedback-assisted breathing demonstrated some evidence that it improved some lung function measurements. Currently there is insufficient evidence for interventions aimed at other aspects of the disease process. AUTHORS' CONCLUSIONS Currently, insufficient evidence exists on psychological interventions or approaches to support people with cystic fibrosis and their caregivers, although some of the studies were promising. Due to the heterogeneity between studies, more of each type of intervention are needed to support preliminary evidence. Multicentre studies, with consequent funding implications, are needed to increase the sample size of these studies and enhance the statistical power and precision to detect important findings. In addition, multicentre studies could improve the generalisation of results by minimizing centre or therapist effects. Psychological interventions should be targeted to illness-specific symptoms or behaviours to demonstrate efficacy.
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Affiliation(s)
- Lutz Goldbeck
- Dptm. Child and Adolescent Psychiatry/Psychotherapy, University Clinic Ulm, Steinhoevelstr. 5, Ulm, Baden-Württemberg, Germany, D-89075
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Everhart RS, Fiese BH, Smyth JM, Borschuk A, Anbar RD. Family Functioning and Treatment Adherence in Children and Adolescents with Cystic Fibrosis. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2014; 27:82-86. [PMID: 24963456 DOI: 10.1089/ped.2014.0327] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/24/2014] [Indexed: 11/12/2022]
Abstract
Background: Cystic fibrosis (CF) is one of the most challenging pediatric illnesses for families to manage. There is, however, limited research that considers the associations between family functioning and treatment adherence in children and adolescents with CF. Methods: Nineteen children with CF (mean age=12.42 years, mean forced expiratory volume in one second (FEV1)=90.9% predicted) and their families participated in the study. Caregiver and child participants completed interview-based assessments and were then videotaped during a family mealtime. Results: Mean scores on several domains of family functioning fell in the "unhealthy" range. Better family functioning was found among older children. Better family functioning was also associated with better adherence to antibiotic treatment and worse adherence to enzymes. Conclusions: Findings suggest that family functioning may be an important correlate of treatment adherence in children and adolescents with CF. Future research should replicate these findings in larger samples of children and adolescents with CF.
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Affiliation(s)
- Robin S Everhart
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
| | - Barbara H Fiese
- Family Resiliency Center, Department of Human and Community Development, University of Illinois at Urbana-Champaign , Champaign, Illinois
| | - Joshua M Smyth
- Department of Biobehavioral Health, The Pennsylvania State University , State College, Pennsylvania
| | - Adrienne Borschuk
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
| | - Ran D Anbar
- Department of Pediatrics, State University of New York Upstate University Hospital , Syracuse, New York
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Abstract
Nonadherence to inhaled therapies is a major problem in the treatment of cystic fibrosis that can influence lung function and health outcomes. Potential contributors to nonadherence have been identified, including demographic and psychosocial factors, time and convenience of inhaled therapy, and treatment beliefs. Additional research is clearly needed to clarify the contributors and to determine which interventions and technological advances will enhance adherence to inhaled therapies in patients with cystic fibrosis. Nurses and allied health professionals are ideally positioned to assist patients and families with adherence to inhaled therapies through monitoring, communication, and education about the available therapies and their proper use. This review briefly summarizes the available evidence about contributors to nonadherence, potential interventions, novel delivery devices for inhaled therapies, and opportunities for additional research.
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Affiliation(s)
- Paula Lomas
- Nurse Coordinator, Adult Cystic Fibrosis Center, Morristown Medical Center, Morristown, NJ 07962, USA
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Faulkner C, Taper LJ, Scott M. Adherence to pancreatic enzyme supplementation in adolescents with cystic fibrosis. CAN J DIET PRACT RES 2013; 73:196-9. [PMID: 23217448 DOI: 10.3148/73.4.2012.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Levels of adherence to pancreatic enzyme supplementation were investigated in Atlantic Canada adolescents with cystic fibrosis (CF). METHODS Participants were recruited from CF clinics at the Izaak Walton Killam Health Centre in Halifax, Nova Scotia, and the Janeway Children's Health & Rehabilitation Centre in St. John's, Newfoundland and Labrador. Self-report questionnaires were mailed to potential participants (n=51) by clinic staff and completed surveys (n=9) were mailed to the principal investigator. RESULTS Nine adolescents (mean age 15.2 ± 1.9 years) participated in the study. The adherence survey indicated that the majority perceived themselves to be adherent to taking enzymes with meals (67%), but only 44% perceived themselves to be adherent to taking enzymes with snacks. Recorded amounts of enzymes, taken over three days, indicated that 67% of participants were actually adherent to taking enzymes with meals and 56% with snacks. Including those who correctly predicted non-adherence, 56% and 44% of participants accurately predicted their adherence to taking enzymes with meals and snacks, respectively. CONCLUSIONS Adherence rates in the literature vary because of differences in definition and measurement. In the CF population, adherence has been shown to have a positive effect on quality of life. Results for this small group of patients suggest that Atlantic Canada adolescents with CF are able to estimate correctly their adherence to taking pancreatic enzymes, but definite conclusions cannot be made because of the small number of respondents.
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Affiliation(s)
- Colleen Faulkner
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS
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Tluczek A, Laxova A, Grieve A, Heun A, Brown RL, Rock MJ, Gershan WM, Farrell PM. Long-term follow-up of cystic fibrosis newborn screening: psychosocial functioning of adolescents and young adults. J Cyst Fibros 2013; 13:227-34. [PMID: 24157354 DOI: 10.1016/j.jcf.2013.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/30/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term psychosocial outcomes of cystic fibrosis (CF) patients diagnosed through newborn screening remain unknown. METHODS This cross-sectional study compared three groups of youths (16 to 22 years): CF patients diagnosed through NBS (CF-NBS, n = 13), CF patients diagnosed through standard practice (CF-SP, n = 26) and healthy peers (H, n = 42), plus 72 of their parents. We hypothesized that adolescent psychological functioning would be mediated by parent depression and quality of parent-child communication and cohesiveness. RESULTS A path analysis showed significantly more depression among CF-NBS group parents (p = .006-.008). Parent-child cohesiveness was related to communication (p < .001). Cohesiveness and communication were associated with youth Internalizing Problems (p = .037, p = .009), Emotional Symptoms (p = 0.018, p = 0.022), and Personal Adjustment (communication only, p = 0.009). Parent depression was related to youth Personal Adjustment (p = 0.022). CONCLUSIONS CF patients report psychosocial function similar to healthy peers. Parents of children diagnosed with CF through NBS may be at risk for depressive symptoms when their children reach adolescence.
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Affiliation(s)
- Audrey Tluczek
- University of Wisconsin, School of Nursing, Madison, WI, United States; University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States.
| | - Anita Laxova
- University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States
| | - Adam Grieve
- University of Wisconsin, School of Medicine and Public Health, Department of Psychiatry, Madison, WI, United States
| | - Anne Heun
- Iowa Health Des Moines, Blank Children's Hospital and John Stoddard Cancer Center, Des Moines, IA, United States
| | - Roger L Brown
- University of Wisconsin, School of Nursing, Madison, WI, United States
| | - Michael J Rock
- University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States
| | - William M Gershan
- University of Utah, School of Medicine, Department of Pediatrics, Salt Lake City, UT, United States
| | - Philip M Farrell
- University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States
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Raj SP, Wade SL, Cassedy A, Taylor HG, Stancin T, Brown TM, Kirkwood MW. Parent psychological functioning and communication predict externalizing behavior problems after pediatric traumatic brain injury. J Pediatr Psychol 2013; 39:84-95. [PMID: 24065551 DOI: 10.1093/jpepsy/jst075] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Adolescents sustaining traumatic brain injury (TBI) show increased prevalence of behavior problems. This study investigated the associations of parent mental health, family functioning, and parent-adolescent interaction with adolescent externalizing behavior problems in the initial months after TBI, and examined whether injury severity moderated these associations. METHODS 117 parent-adolescent dyads completed measures of family functioning, adolescent behavior, and parent mental health an average of 108 days post-TBI. Dyads also engaged in a 10-min video-recorded problem-solving activity coded for parent behavior and tone of interaction. RESULTS Overall, higher ratings of effective parent communication were associated with fewer externalizing behavior problems, whereas poorer caregiver psychological functioning was associated with greater adolescent externalizing behaviors. Results failed to reveal moderating effects of TBI severity on the relationship between socio-environmental factors and behavior problems. CONCLUSIONS Interventions targeting parent communication and/or improving caregiver psychological health may ameliorate potential externalizing behavior problems after adolescent TBI.
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Affiliation(s)
- Stacey P Raj
- PhD, Division of Pediatric Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 4009, Cincinnati, OH 45229, USA.
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Rodriguez EM, Dunn MJ, Zuckerman T, Hughart L, Vannatta K, Gerhardt CA, Saylor M, Schuele CM, Compas BE. Mother-child communication and maternal depressive symptoms in families of children with cancer: integrating macro and micro levels of analysis. J Pediatr Psychol 2013; 38:732-43. [PMID: 23616622 PMCID: PMC3721187 DOI: 10.1093/jpepsy/jst018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 02/25/2013] [Accepted: 03/04/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study examines associations between maternal depressive symptoms and macro- and micro-level aspects of mothers' communication about their children's cancer. METHODS Mothers reported depressive symptoms after diagnosis or relapse (child mean age = 10.4 years; 53% male). Mother-child dyads (N = 94) were subsequently observed discussing the child's cancer and maternal communication was coded. RESULTS Macro-level indicators (positive and negative communication) were associated with certain micro-level indicators of communication (topic maintenance, reflections, reframes, and imperatives). Higher depressive symptoms predicted lower positive communication and higher negative communication. Maternal reflections and imperatives predicted positive communication, and topic maintenance and reframes predicted negative communication, beyond child age, family income, and depressive symptoms. CONCLUSIONS Findings suggest concrete targets for improving communication in families after diagnosis or relapse.
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Affiliation(s)
- Erin M Rodriguez
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN 37203, USA.
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Findler L, Shalev K, Barak A. Psychosocial Adaptation and Adherence Among Adults With CF. REHABILITATION COUNSELING BULLETIN 2013. [DOI: 10.1177/0034355213495922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Based on Moos and Holahan’s “Coping With Chronic Illness and Disability” model, we examined the contribution of medical impairment, illness perception, sense of coherence (SOC), relationship with the professional team, and adherence to treatment to the psychosocial adaptation (social adjustment and life satisfaction) of young adults with cystic fibrosis (CF). We also examined adherence, an important goal in and of itself for patients with CF. Seventy-one participants completed the following questionnaires: Social Adjustment, Life Satisfaction, Perceived Illness Severity, SOC, Relationship With Team, and Compliance. The legal criteria for medical impairment were also examined. Findings indicate that female patients and patients with high SOC reported better psychosocial adaptation. Participants with more severe medical impairments reported higher levels of adherence, and those who perceived their illness to be less severe reported lower levels of adherence and greater satisfaction in life. Relationship with the team was found to contribute to social adjustment. Psychosocial adaptation is associated with internal and external resources, but not necessarily with adherence to treatment. The rehabilitation counselor’s role is, therefore, to help adults with CF bridge between the contrasting dimensions of their lives, namely adherence to strict treatment protocols and psychosocial adaptation.
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Affiliation(s)
| | | | - Asher Barak
- Sheba Medical Center, The Edmond and Lili Safra Children’s Hospital, The Pediatric Pulmonology Unit, Israel
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Usitalo A, Leister E, Tassiopoulos K, Allison S, Malee K, Paul ME, Smith R, Van Dyke RB, Seage GR, Mellins CA. Relationship between viral load and self-report measures of medication adherence among youth with perinatal HIV infection. AIDS Care 2013; 26:107-15. [PMID: 23800360 DOI: 10.1080/09540121.2013.802280] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Poor adherence to antiretroviral therapy (ART) contributes to disease progression and emergence of drug-resistant HIV in youth with perinatally acquired HIV infection (PHIV +), necessitating reliable measures of adherence. Although electronic monitoring devices have often been considered the gold-standard assessment in HIV research, they are costly, can overestimate nonadherence and are not practical for routine care. Thus, the development of valid, easily administered self-report adherence measures is crucial for adherence monitoring. PHIV+youth aged 7-16 (n = 289) and their caregivers, enrolled in a multisite cohort study, were interviewed to assess several reported indicators of adherence. HIV-1 RNA viral load (VL) was dichotomized into >/≤ 400 copies/mL. Lower adherence was significantly associated with VL >400 copies/mL across most indicators, including ≥ 1 missed dose in past seven days [youth report: OR = 2.78 (95% CI, 1.46-5.27)]. Caregiver and combined youth/caregiver reports yielded similar results. Within-rater agreement between various adherence indicators was high for both youth and caregivers. Inter-rater agreement on adherence was moderate across most indicators. Age ≥ 13 years and living with biological mother or relative were associated with VL >400 copies/mL. Findings support the validity of caregiver and youth adherence reports and identify youth at risk of poor adherence.
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Affiliation(s)
- Ann Usitalo
- a Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology , University of Florida/Jacksonville , Jacksonville , FL , USA
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