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Drabble SJ, O’Cathain A, Arden MA, Hutchings M, Beever D, Wildman M. When Is Forgetting Not Forgetting? A Discursive Analysis of Differences in Forgetting Talk Between Adults With Cystic Fibrosis With Different Levels of Adherence to Nebulizer Treatments. QUALITATIVE HEALTH RESEARCH 2019; 29:2119-2131. [PMID: 31303116 PMCID: PMC7322938 DOI: 10.1177/1049732319856580] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Forgetting is often cited as a reason why people struggle to adhere to treatments for chronic conditions. Interventions have tried to improve forgetting behavior using reminders. We used a discursive psychological approach to explore differences in how high and low adherers constructed forgetting their nebulizer treatments for cystic fibrosis. Interviews were conducted with 18 adults from a cystic fibrosis center in the United Kingdom. High adherers constructed forgetting treatments as occasional lapses in automaticity and temporary lapses in memory that they found easy to repair. Low adherers utilized forgetting to normalize more consistent nonadherence to treatments. However, it is important to contextualize forgetting as a discursive resource that helped these participants to negotiate moral discourses around adherence to treatment that reminder interventions cannot address; we therefore recommend a more behavioral, patient-focused, theory-driven approach to intervention development.
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Affiliation(s)
| | | | | | | | - Daniel Beever
- The University of Sheffield, Sheffield,
United Kingdom
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2
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Davies JC. Trials and tribulations: The highs and lows of running cystic fibrosis drug studies. Paediatr Respir Rev 2019; 31:25-27. [PMID: 31153791 DOI: 10.1016/j.prrv.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
So many new trials of drugs for CF are being conducted each year it can be difficult to keep up. Yet, almost as numerous are the review articles written about them. I have chosen therefore to use this paper to discuss some of the difficult ethical issues arising during trials, in particular how to fairly distribute opportunities to participate. Some of these issues may be specific to countries like my own with very limited access to genotype-specific CFTR modulators, others may apply more generally. We have made enormous progress as a community over the recent past, but there is still much more to do before all our patients are reaping health and quality of life benefits.
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Affiliation(s)
- Jane C Davies
- Imperial College London and Royal Brompton & Harefield NHS Foundation Trust, London, UK.
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Arden MA, Drabble S, O'Cathain A, Hutchings M, Wildman M. Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework. Br J Health Psychol 2019; 24:357-380. [PMID: 30825258 PMCID: PMC6519271 DOI: 10.1111/bjhp.12357] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 02/04/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Adherence to nebulizer treatment in adults with Cystic Fibrosis (CF) is poor, and interventions are needed. This research aimed to identify the factors affecting nebulizer adherence using the Theoretical Domains Framework (TDF) and to compare these for participants with different levels of adherence. DESIGN Data-prompted interviews using the TDF. METHODS Eighteen semi-structured interviews were conducted with adults with CF during which objectively measured adherence data were discussed. Framework analysis was used to code the data into TDF domains, and inductive qualitative content analysis was used to code different beliefs and experiences. Aspects of the TDF that differed between participants with different adherence levels were explored. RESULTS Factors influencing adherence to treatment included all 14 domains of the TDF, 10 of which appeared to vary by adherence level: Skills; Memory and decision-making; and Behavioural regulation; Environmental context and resources; Social influences; Beliefs about consequences; Beliefs about capability; Reinforcement; Social role and identify; Intentions; Optimism; and Emotions. CONCLUSIONS This study is the first to use objectively measured adherence data in a data-prompted interview using the TDF framework to systematically assess the full range of factors potentially influencing adherence. The results highlighted that interventions need to consider issues of capability, opportunity, and motivation. Interventions that challenge dysfunctional beliefs about adherence and which support the development of routines or habits and problem-solving may be particularly useful for adults with CF. Statement of contribution What is already known? Adherence to medication in adults with cystic fibrosis is poor. Previous research has identified a range of contributing factors in relation to subjective reports of adherence. There is a wide discrepancy between self-reported adherence and objectively measured adherence. What this study adds A data-prompted interview using objectively measured adherence data enabled the systematic assessment of potential factors that could be targeted in an intervention to increase adherence. There were some differences in the factors that were identified by high and low adherers. There is not one-size fits all intervention for adherence to medication in cystic fibrosis.
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Affiliation(s)
- Madelynne A. Arden
- Centre for Behavioural Science and Applied Psychology (CeBSAP)Sheffield Hallam UniversityUK
| | - Sarah Drabble
- School of Health and Related Research (ScHARR)University of SheffieldUK
| | - Alicia O'Cathain
- School of Health and Related Research (ScHARR)University of SheffieldUK
| | | | - Martin Wildman
- School of Health and Related Research (ScHARR)University of SheffieldUK
- Sheffield Adult CF CentreNorthern General HospitalSheffieldUK
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4
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A weekend/weekday comparison of adherence to daily treatment regimens in adults with cystic fibrosis. HEALTH PSYCHOLOGY REPORT 2018. [DOI: 10.5114/hpr.2018.72331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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5
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Pisaturo M, Deppen A, Rochat I, Robinson WM, Hafen GM. Death after cessation of treatment by cystic fibrosis patients: An international survey of clinicians. Palliat Med 2017; 31:82-88. [PMID: 26979669 DOI: 10.1177/0269216316637773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Little is known about cystic fibrosis patients, who are not considered to be terminally ill, and who die after voluntary cessation of treatment. AIM This study was undertaken to provide an international snapshot of this issue. DESIGN An online survey was distributed across three continents. SETTING Distribution to the medical directors of the cystic fibrosis centres affiliated with the US Cystic Fibrosis Foundation, Cystic Fibrosis Australia (inclusion of New Zealand) and to every clinician member of the European Cystic Fibrosis Society. RESULTS More than 200 cystic fibrosis patients not considered to be terminally ill and, who voluntarily ceased treatment, were reported by the clinicians surveyed. Detailed data were reported in 102 patients (4 children, 25 adolescents and 73 adults). Only one child, six adolescents and one adult were judged by clinicians not to be competent to make the decision to stop treatment. Time-consuming and low immediate-impact therapies, such as respiratory physiotherapy, were most frequently discontinued. Resignation was the main reported reason for discontinuing treatment, followed by reactive depression and lack of familial support. A total of 69% of the patients received palliative care and 72% died in the 6 months following cessation of treatment. CONCLUSION Death of cystic fibrosis patients, not considered to be terminally ill, is reported in Europe, the United States and Australia due to voluntary cessation of treatment.
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Affiliation(s)
- Marisa Pisaturo
- 1 Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Alain Deppen
- 2 Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Rochat
- 1 Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,3 Respiratory Unit, Department of Paediatrics, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | | | - Gaudenz M Hafen
- 1 Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,3 Respiratory Unit, Department of Paediatrics, CHUV Lausanne University Hospital, Lausanne, Switzerland
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Pakhale S, Baron J, Armstrong M, Tasca G, Gaudet E, Aaron SD, Cameron W, Balfour L. Lost in translation? How adults living with Cystic Fibrosis understand treatment recommendations from their healthcare providers, and the impact on adherence to therapy. PATIENT EDUCATION AND COUNSELING 2016; 99:1319-1324. [PMID: 27036082 DOI: 10.1016/j.pec.2016.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study builds on the limited research documenting Cystic Fibrosis (CF) patients' understanding of treatment recommendations and how this may impact adherence to therapy. METHODS We surveyed adults with CF and their healthcare professional (HCP) to capture treatment recommendations provided by the HCP, and patients' knowledge, and frequency of performance, of these recommendations. We classified CF participants' understanding of treatment recommendations (correct/incorrect) as compared to the actual recommendations made by the HCP. We computed CF participants' adherence in relation to HCP treatment recommendations and to their own understanding of treatment recommendations (adherent/non-adherent). RESULTS Complete HCP and patient data were available for 42 participants. The recommended treatment frequency was correctly understood by 0%-87.8% of CF participants. Adherence to HCP treatment recommendations ranged from 0 to 68.3% (mean 45.4%±21.5), and rates were low (<33%) for acapella, percussion/postural drainage, tobramycin nebulization and insulin. Participants' adherence was greater when calculated in relation to participants' understanding of treatment recommendations (62.4%±25.1) than when calculated in relation to actual HCP treatment recommendations (45.4%±21.5%) (p=0.009). CONCLUSION AND PRACTICE IMPLICATIONS Adults with CF misunderstand treatment recommendations; this likely affects treatment adherence. Interventions to ensure HCPs use effective communication strategies are needed.
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Affiliation(s)
- S Pakhale
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada; Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, Canada.
| | - J Baron
- Ottawa Hospital Research Institute, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
| | - M Armstrong
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - G Tasca
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
| | - E Gaudet
- The Ottawa Hospital, Ottawa, Canada
| | - S D Aaron
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada; Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, Canada
| | - W Cameron
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
| | - L Balfour
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
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Sylvain C, Lamothe L, Berthiaume Y, Rabasa-Lhoret R. How patients' representations of cystic fibrosis-related diabetes inform their health behaviours. Psychol Health 2016; 31:1129-44. [PMID: 27112101 DOI: 10.1080/08870446.2016.1183008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although diabetes is a frequent complication of cystic fibrosis (CF), patients' behaviours tend not to comply with best practice recommendations. Using Leventhal's Common-Sense Model, we address this issue by exploring patients' representations of CF-related diabetes (CFRD) to better understand the discrepancy between patients' expected and observed health behaviours. METHODS Semi-structured individual interviews were conducted with patients (n = 39) in six CF clinics in Quebec, Canada. These interviews were part of a larger research project on screening and management practices for CFRD. RESULTS Illness representations differed between two groups of interviewed patients: (1) one group had either CF without dysglycemia or CF with impaired glucose tolerance; and (2) the other group had CFRD. Both representations were internally consistent and encompassed Leventhal's five dimensions of illness representation: illness identity, cause, timeline, consequences and control. CONCLUSIONS Patients require specific information on CFRD. The screening phase could be a crucial time to help patients adjust their representations to fit the reality of CFRD.
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Affiliation(s)
- Chantal Sylvain
- a School of Rehabilitation , Université de Sherbrooke, Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT) , Longueuil , Canada
| | - Lise Lamothe
- b School of Public Health , Université de Montréal, Université de Montréal Public Health Research Institute (IRSPUM) , Montréal , Canada
| | - Yves Berthiaume
- c Department of medicine , Université de Montréal, Institut de Recherches Cliniques de Montréal (IRCM) , Montréal , Canada
| | - Rémi Rabasa-Lhoret
- d Department of Nutrition , Université de Montréal, Institut de Recherches Cliniques de Montréal (IRCM) , Montréal , Canada
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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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Quittner AL, Zhang J, Marynchenko M, Chopra PA, Signorovitch J, Yushkina Y, Riekert KA. Pulmonary medication adherence and health-care use in cystic fibrosis. Chest 2014; 146:142-151. [PMID: 24480974 DOI: 10.1378/chest.13-1926] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Poor treatment adherence is common in cystic fibrosis (CF) and may lead to worse health outcomes and greater health-care use. This study evaluated associations of adherence to pulmonary medications, age, health-care use, and cost among patients with CF. METHODS Patients with CF aged ≥ 6 years were identified in a national commercial claims database. A 12-month medication possession ratio (MPR) was computed for each pulmonary medication and then averaged for a composite MPR (CMPR) for each patient. The CMPR was categorized as low (< 0.50), moderate (0.50-0.80), or high (≥ 0.80). Annual health-care use and costs were measured during the first and second year and compared across adherence categories by multivariable modeling. RESULTS Mean CMPR for the sample (N = 3,287) was 48% ± 31%. Age was inversely related to CMPR. In the concurrent year, more CF-related hospitalizations were observed among patients with low (event rate ratio [ERR], 1.35; 95% CI, 1.15-1.57) and moderate (ERR, 1.25; 95% CI, 1.05-1.48) vs high adherence; similar associations were observed for all-cause hospitalizations and CF-related and all-cause acute care use (hospitalizations + ED) in the concurrent and subsequent year. Rates of CF-related and all-cause outpatient visits did not differ by adherence. Low and moderate adherence predicted higher concurrent health-care costs by $14,211 ($5,557-$24,371) and $8,493 (-$1,691 to $19,709), respectively, compared with high adherence. CONCLUSIONS Worse adherence to pulmonary medications was associated with higher acute health-care use in a national, privately insured cohort of patients with CF. Addressing adherence may reduce avoidable health-care use.
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Affiliation(s)
| | - Jie Zhang
- Novartis Pharmaceuticals Corp, East Hanover, NJ
| | | | | | | | | | - Kristin A Riekert
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
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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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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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Sawicki GS, Tiddens H. Managing treatment complexity in cystic fibrosis: challenges and opportunities. Pediatr Pulmonol 2012; 47:523-33. [PMID: 22467341 DOI: 10.1002/ppul.22546] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 02/15/2012] [Indexed: 12/30/2022]
Abstract
Cystic fibrosis (CF) is a complex, chronic, multisystem disease for which there is currently no cure. Nonetheless, advances in management have led to dramatic improvements in patient survival. With this development, new issues have arisen for CF patients and their care providers, including an increased symptom burden and increased frequency of co-morbidities as patients reach older ages, leading to the need for a highly complicated and time-consuming regimen of treatments. Such high symptom and treatment burden often leads to non-adherence and low levels of competence with administration of therapy, both of which may have detrimental impacts on CF outcomes. Optimal management is also hindered by other patient-related factors, including inadequacies in disease education which may lead to issues with self-management. This is particularly important during the transition from parent-directed therapy to independent self-management that occurs during adolescence and early adulthood. Clinicians are also faced with a considerable challenge when selecting interventions for individual patients; although the paradigm of aggressive care necessitates a wide range of therapies, there is a limited evidence base with which to compare available therapeutic regimens. Novel pharmacological agents are being developed to target the underlying cause of CF, while non-pharmacological interventions aim to improve competence and maximize adherence and health outcomes. Comparative effectiveness research is needed to simplify management and facilitate the implementation of appropriate treatment strategies.
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Affiliation(s)
- Gregory S Sawicki
- Division of Respiratory Diseases, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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Greally P, Whitaker P, Peckham D. Challenges with current inhaled treatments for chronic Pseudomonas aeruginosa infection in patients with cystic fibrosis. Curr Med Res Opin 2012; 28:1059-67. [PMID: 22401602 DOI: 10.1185/03007995.2012.674500] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa (Pa) is the predominant pathogen infecting the airways of patients with cystic fibrosis (CF). Initial colonization is usually transient and associated with non-mucoid strains, which can be eradicated if identified early. This strategy can prevent, or at least delay, chronic Pa infection, which eventually develops in the majority of patients by their late teens or early adulthood. This article discusses the management and latest treatment developments of Pa lung infection in patients with CF, with a focus on nebulized antibiotic therapy. METHODS PubMed was searched to identify English language articles published up until August 2011 using combinations of the following key words: 'antibiotics', 'chronic', 'cystic fibrosis', 'eradication', 'exacerbations', 'guidelines', 'inhaled', 'intravenous', 'lung infection', 'burden', 'adherence', 'patient segregation', 'pseudomonas aeruginosa' and 'resistance'. FINDINGS Antibiotics form a central part of the treatment regimens for chronic Pa lung infection. Current treatment guidelines recommend that patients with chronic pulmonary infection with Pa should receive long-term inhaled anti-pseudomonal therapy to preserve lung function, and to reduce the frequency of pulmonary exacerbations and hospital admissions. While antibiotic resistance seems to increase with frequent antibiotic use, this does not appear to impact on clinical outcome. Negative aspects of therapy include the time needed for drug administration and subsequent cleaning of the equipment. These factors cause a significant treatment burden and impact on adherence. The availability of more convenient formulations and delivery vehicles for anti-pseudomonal antibiotics may help overcome some of these challenges. CONCLUSIONS Current challenges in the management of CF patients with chronic Pa lung infection are numerous. The availability of novel anti-pseudomonal antibiotic formulations/devices is anticipated to improve treatment adherence in patients with CF, and could improve clinical outcomes. Thus, there is hope for improved survival in individuals with CF suffering from chronic pulmonary infection with Pa.
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Affiliation(s)
- Peter Greally
- National Children's Hospital, Tallaght, Dublin, Ireland.
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Christenson KM, Williams AJ, Williams RH, Hawkins GA, Boothe DBR, Sampson KM. Can a Simulation Game Change Cystic Fibrosis Patients' Attitudes Toward Treatment Adherence? Games Health J 2012; 1:129-33. [PMID: 26193187 DOI: 10.1089/g4h.2011.0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The authors hypothesized that playing a simulation game designed according to Multiple Identification Theory (MIT) would improve attitudes toward treatment adherence among adolescent cystic fibrosis (CF) patients. SUBJECTS AND METHODS Study participants (n=16) were recruited from a large Midwestern children's hospital. As part of a within-group pilot study, they played "My Life with CF," an MIT simulation game. Their attitudes toward treatment adherence and general decision-making were assessed prior to playing the game. They were measured again immediately post-play and 1 month afterward. RESULTS Statistically significant differences (P<0.05) were found immediately post-treatment on questionnaires concerning participants' holding present versus future-centered orientations and their attitudes toward adherence. One month post-treatment, significant differences were found regarding participants' attitudes toward adherence and whether luck or effort determines what happens to them in life. Effect sizes for all these differences ranged from large (r(2)=0.31) to very large (r(2)=0.94). CONCLUSION The MIT-based "My Life with CF" game was effective at changing adolescent CF patients' attitudes toward adherence.
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Affiliation(s)
- Kathy M Christenson
- 1 Department of Gastroenterology, Children's Mercy Hospitals and Clinics , Kansas City, Missouri
| | | | - Robert H Williams
- 3 Department of Psychology, Metropolitan Community College-Maple Woods , Kansas City, Missouri
| | | | | | - Katelyn M Sampson
- 5 Metropolitan Community College-Maple Woods , Kansas City, Missouri
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Reychler G, Coppens T, Leonard A, Palem A, Lebecque P. Mucoviscidose : les techniques instrumentales de désencombrement des voies aériennes. Rev Mal Respir 2012; 29:128-37. [DOI: 10.1016/j.rmr.2011.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 04/19/2011] [Indexed: 10/14/2022]
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Konstan MW, Geller DE, Minić P, Brockhaus F, Zhang J, Angyalosi G. Tobramycin inhalation powder for P. aeruginosa infection in cystic fibrosis: the EVOLVE trial. Pediatr Pulmonol 2011; 46:230-8. [PMID: 20963831 PMCID: PMC4112574 DOI: 10.1002/ppul.21356] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 06/09/2010] [Accepted: 07/06/2010] [Indexed: 11/10/2022]
Abstract
Tobramycin inhalation solution is used to treat chronic Pseudomonas aeruginosa lung infection in cystic fibrosis (CF) patients. We evaluated the efficacy and safety of a novel, light-porous particle, dry-powder formulation of tobramycin, which was developed to improve delivery efficiency to the airways and substantially reduce the delivery time. In this randomized, double-blind study, patients with CF (age 6-21 years) received tobramycin inhalation powder (112 mg tobramycin) twice daily (n = 46) or placebo (n = 49) via the T-326 Inhaler for one cycle, followed by two open-label cycles (all patients). Cycles were 28 days on, 28 days off treatment. The primary endpoint was change in forced expiratory volume in 1 sec (FEV1) % predicted from baseline to Day 28 of Cycle 1. The study was terminated early based on positive results in the interim analysis. Tobramycin inhalation powder significantly improved FEV1 % predicted versus placebo at Day 28 (difference 13.3, 95% CI: 5.31-21.28; P = 0.0016). Similar changes in FEV1 were seen in patients switching from placebo to tobramycin inhalation powder in Cycle 2; improvements were maintained over time. Tobramycin inhalation powder also reduced sputum P. aeruginosa density, respiratory-related hospitalization and antipseudomonal antibiotic use versus placebo. The most common adverse event was cough; the frequency of cough was higher in patients receiving placebo (26.5%) versus tobramycin inhalation powder (13.0%) in Cycle 1. Tobramycin inhalation powder was not associated with ototoxicity or nephrotoxicity. Administration time was between 4 and 6 min. In conclusion, tobramycin inhalation powder was effective and well tolerated in CF patients, and may offer an important treatment option to decrease the treatment burden of CF pseudomonas lung infections.
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Affiliation(s)
- Michael W Konstan
- Rainbow Babies and Children's Hospital, and Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Tierney S, Riley D, Jones AM, Webb AK, Horne M. Differing perspectives of sputum and its expectoration: a qualitative study involving patients with cystic fibrosis and physiotherapists. Physiother Theory Pract 2010; 27:278-86. [PMID: 20946069 DOI: 10.3109/09593985.2010.501849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sputum specimens are frequently requested from individuals with chronic suppurative conditions such as cystic fibrosis (CF). For a proportion of people, expectorating sputum can be difficult. Our goal was to explore the potential barriers and facilitators to expectorating sputum from the perspective of those with CF and physiotherapists involved in their care. Eighteen interviews were conducted with people who have CF and three focus groups with physiotherapists. Data were recorded, transcribed verbatim, and analysed using a framework approach. Variation emerged in perceptions between physiotherapists and people with CF in terms of sputum's impact on everyday life and the importance of its role in managing the condition. These differences were reflected in the following themes: (1) seepage of bodily boundaries, (2) discrediting nature of sputum, (3) embodied representation of chronic illness, and (4) non-production as a decisional balance. Differing views between participants could have arisen from the personal nature of sputum for people with CF, whilst physiotherapists may see sputum specimens as a necessary part of holistic management of this condition. Education could assist individuals in overcoming some of the barriers associated with expectorating, but physiotherapists may have to individualise the collection of sputum, recognising not everyone will be at ease with this procedure.
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Affiliation(s)
- S Tierney
- School of Nursing, Midwifery and Social Work, University Place, University of Manchester, Oxford Road, Manchester, United Kingdom.
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McDonald CM, Christensen NK, Lingard C, Peet KA, Walker S. Nutrition Knowledge and Confidence Levels of Parents of Children With Cystic Fibrosis. ACTA ACUST UNITED AC 2009. [DOI: 10.1177/1941406409355192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Optimal growth and nutrition status predict better lung function and longevity for children with cystic fibrosis (CF). Daily nutrition therapy for children with CF requires adequate food resources, parental knowledge of nutrition and behavior management, and confidence in one’s ability to apply the skills. The Mountain West Cystic Fibrosis Consortium Questionnaire (MWCFC-Q) was designed to identify educational intervention targets to improve the growth and nutrition of children with CF. Parents of children with CF returned 305 anonymous MWCFC-Qs. Data analyzed included household food security, knowledge of nutrition and general CF therapies, and self-confidence in one’s ability to manage components of CF care. Factors associated with food insecurity were reported by 26.3% of respondents. The median accuracy for questions regarding nutrient content of commonly used foods was 71.4% and 57.9% for CF nutrition therapy. Parents’ self-confidence in overall CF management was relatively high at a mean value 8.28 ± 1.22 of 10 possible. However, mean self-confidence in the CF nutrition domain was significantly less than mean self-confidence for the CF-related tasks domain, which included chest physiotherapy and medication administration (7.75 ± 1.56, 8.62 ± 1.24, P < .001, respectively). Parental knowledge of nutrition for CF and confidence in the application of this knowledge can improve the growth and nutrition status of children with CF. Identification of food security issues may enable health care professionals to adjust nutrition interventions and direct families to appropriate food resources. The MWCFC-Q could be useful for designing and testing educational interventions for nutrition management of CF.
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Affiliation(s)
| | | | | | | | - Sarah Walker
- Cystic Fibrosis Center, University of New Mexico, Albuquerque
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