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Martin-Denham S. Riding the rollercoaster of school exclusion coupled with drug misuse: the lived experience of caregivers. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2020. [DOI: 10.1080/13632752.2020.1848985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Craig GM, Hajdukova EB, Harding C, Flood C, McCourt C, Sellers D, Townsend J, Moss D, Tuffrey C, Donaldson B, Cole M, Gill A. Psychosocial support for families of children with neurodisability who have or are considering a gastrostomy: the G-PATH mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background
Evidence reviews recommend consistent and structured support for children with neurodisability and their caregivers in care pathways in which professionals recommend a gastrostomy feeding tube. To date, and to our knowledge, no research has shown how these recommendations have been implemented.
Objectives
The objectives were to describe different exemplar models of psychosocial support and provide an estimate of their resources and costs.
Design
This was a mixed-methods study involving (1) a web-based survey, (2) a qualitative, collective case study of psychosocial support provision in four services and (3) an estimate of costs and preference through a willingness-to-pay study.
Setting
Four service configurations in different locations in England and Scotland.
Participants
Participants were staff who responded to a survey (n = 67) and interviewees (staff, n = 58; parents/children, n = 29).
Findings
Psychosocial support was rarely formalised or documented; it was delivered by different members of the multidisciplinary team, rather than by designated staff, and it was often integrated into appointments dominated by clinical care. Parents expressed different needs for support but reported little opportunity to discuss emotional aspects. Psychologists were not routinely involved and, in general, families were underserved by psychosocial services. Professionals constructed families’ need for psychosocial support in terms of their own roles and the management of risk. Mechanisms for integrating and delivering support were identified, including models of care that linked community and tertiary health services and integrated health and education through pooled budgets. Although generally valued by both staff and parents, peer-to-peer parent support was not consistently offered. Barriers included concerns about confidentiality and appropriately matching parents. Parents participated as members of a feeding committee at one site. Three analytical constructs described the provision of psychosocial support: ‘hidden work’, expressing emotional vulnerability and negotiations around risks and values. The cost-of-support study found that there was a mean of 2.25 appointments (n = 8 parents or carers) over the previous 12 months. The cost of health-care professionals’ time spent on providing psychosocial support ranged from £0.00 to £317.37 per child per year, with an average cost of £76.42, at 2017 prices. In the willingness-to-pay study the median rank of enhanced support, involving the opportunity to see a psychologist and parental peers, was significantly higher than that of usual care (n = 96 respondents, both carers and professionals, who completed rating of the service; p < 0.001).
Limitations
It proved difficult to disseminate a national survey, which resulted in a small number of returns, and to cost the provision of psychosocial support, which we designated as ‘hidden work’, owing to the lack of recording in clinical systems. Moreover, estimates were based on small numbers.
Conclusions
Parent interviews and the willingness-to-pay study demonstrated a preference for enhanced psychosocial support. The study suggests that there is a need for services to formally assess families’ needs for psychosocial support to ensure that provision is planned, costed and made explicit in care pathways. Personalised interventions may assist with the targeting of resources and ensuring that there is an appropriate balance in focus on both clinical care and psychosocial support needs in relation to and following treatment.
Future work
More work is needed to develop tools to assess families’ needs for psychosocial support and the effectiveness of training packages to strengthen team competency in providing support.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 38. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gillian M Craig
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- School of Health Sciences, City, University of London, London, UK
| | - Eva Brown Hajdukova
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Celia Harding
- School of Health Sciences, City, University of London, London, UK
| | - Chris Flood
- School of Health Sciences, City, University of London, London, UK
| | | | - Diane Sellers
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Joy Townsend
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Dawn Moss
- Borders General Hospital, Melrose, UK
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Bull KS, Hornsey S, Kennedy CR, Darlington ASE, Grootenhuis MA, Hargrave D, Liossi C, Shepherd JP, Walker DA, Morris C. Systematic review: measurement properties of patient-reported outcome measures evaluated with childhood brain tumor survivors or other acquired brain injury. Neurooncol Pract 2020; 7:277-287. [PMID: 32537177 DOI: 10.1093/nop/npz064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Survivors of childhood brain tumors or other acquired brain injury (ABI) are at risk of poor health-related quality of life (HRQoL); its valid and reliable assessment is essential to evaluate the effect of their illness on their lives. The aim of this review was to critically appraise psychometric properties of patient-reported outcome measures (PROMs) of HRQoL for these children, to be able to make informed decisions about the most suitable PROM for use in clinical practice. Methods We searched MEDLINE, EMBASE, and PsycINFO for studies evaluating measurement properties of HRQoL PROMs in children treated for brain tumors or other ABI. Methodological quality of relevant studies was evaluated using the consensus-based standards for the selection of health status measurement instruments checklist. Results Eight papers reported measurement properties of 4 questionnaires: Health Utilities Index (HUI), PedsQL Core and Brain Tumor Modules, and Child and Family Follow-up Survey (CFFS). Only the CFFS had evidence of content and structural validity. It also demonstrated good internal consistency, whereas both PedsQL modules had conflicting evidence regarding this. Conflicting evidence regarding test-retest reliability was reported for the HUI and PedsQL Core Module only. Evidence of measurement error/precision was favorable for HUI and CFFS and absent for both PedsQL modules. All 4 PROMs had some evidence of construct validity/hypothesis testing but no evidence of responsiveness to change. Conclusions Valid and reliable assessment is essential to evaluate impact of ABI on young lives. However, measurement properties of PROMs evaluating HRQoL appropriate for this population require further evaluation, specifically construct validity, internal consistency, and responsiveness to change.
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Affiliation(s)
- Kim S Bull
- Clinical and Experimental Sciences, University of Southampton, UK
| | - Samantha Hornsey
- Primary Care, Population Sciences, and Medical Education, University of Southampton, UK
| | - Colin R Kennedy
- Clinical and Experimental Sciences, University of Southampton, UK
| | | | - Martha A Grootenhuis
- Psychosocial Research and Healthcare Innovation, Princess Máxima Centre for Paediatric Oncology, Utrecht, NL
| | - Darren Hargrave
- UCL Great Ormond Street Institute of Child Health, University College London, UK.,Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London,UK
| | - Christina Liossi
- Psychology, University of Southampton, UK.,Pain Control Service, Great Ormond Street Hospital for Children NHS Trust, UK
| | - Jonathan P Shepherd
- Southampton Health Technology Assessments Centre, University of Southampton, UK
| | - David A Walker
- Children's Brain Tumour Research Centre, University of Nottingham, UK
| | - Christopher Morris
- The Peninsula Childhood Disability Research Unit, University of Exeter, UK
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Klingler S, Padden B, Horridge KA, van Hedel HJA, Meyer-Heim A. [Improving Communication Quality Caring for Children with Chronic Conditions: Health, Functioning and Wellbeing Traffic-Light Tool]. PRAXIS 2019; 108:249-255. [PMID: 30890082 DOI: 10.1024/1661-8157/a003167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Improving Communication Quality Caring for Children with Chronic Conditions: Health, Functioning and Wellbeing Traffic-Light Tool Abstract. Effective patient-doctor communication is a crucial aspect while caring for children with chronic conditions or disabilities. The Health, Functioning and Wellbeing Summary Traffic Light has been developed as a communication tool especially for these patients. In a two-month pilot phase the German version was evaluated by parents and physicians in a rehabilitation out-patient clinic setting. 71 % (n = 35/49) returned the evaluation form. The traffic-light tool was rated positive by 80 % of participants and physicians. It can be recommended as a useful tool for improved communication. The simple language version as well as translations into other languages and the use of a mobile App will facilitate its use. Its use is not limited to paediatrics and could be adapted for other disciplines.
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Affiliation(s)
- Selina Klingler
- 1 Rehabilitationszentrum für Kinder und Jugendliche und Rehabilitationspoliklinik Universitäts-Kinderspital Zürich, Affoltern am Albis
| | - Beth Padden
- 1 Rehabilitationszentrum für Kinder und Jugendliche und Rehabilitationspoliklinik Universitäts-Kinderspital Zürich, Affoltern am Albis
| | - Karen A Horridge
- 2 Paediatric Disability Team, NHS Sunderland Royal Hospital, Sunderland, UK
| | - Hubertus J A van Hedel
- 1 Rehabilitationszentrum für Kinder und Jugendliche und Rehabilitationspoliklinik Universitäts-Kinderspital Zürich, Affoltern am Albis
| | - Andreas Meyer-Heim
- 1 Rehabilitationszentrum für Kinder und Jugendliche und Rehabilitationspoliklinik Universitäts-Kinderspital Zürich, Affoltern am Albis
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Can a collaborative healthcare network improve the care of people with epilepsy? Epilepsy Behav 2018; 82:189-193. [PMID: 29573986 DOI: 10.1016/j.yebeh.2018.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/31/2023]
Abstract
New opportunities are now available to improve care in ways not possible previously. Information contained in electronic medical records can now be shared without identifying patients. With network collaboration, large numbers of medical records can be searched to identify patients most like the one whose complex medical situation challenges the physician. The clinical effectiveness of different treatment strategies can be assessed rapidly to help the clinician decide on the best treatment for this patient. Other capabilities from different components of the network can prompt the recognition of what is the best available option and encourage the sharing of information about programs and electronic tools. Difficulties related to privacy, harmonization, integration, and costs are expected, but these are currently being addressed successfully by groups of organizations led by those who recognize the benefits.
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