Quality of life, treatment adherence, and locus of control: multiple family groups for chronic medical illnesses

Impact in the quality of life of parents of children with chronic diseases using psychoeducational interventions - A systematic review with meta-analysis

OBJECTIVE

This study aimed to identify psychoeducational interventions applied to parents of children with chronic diseases and evaluate their impact on their quality of life (QoL).

METHODS

It was conducted in six databases, complemented by references from the included studies and other reviews, manual search, and contact with experts. We included primary studies on parents of children with chronic diseases that studied psychoeducational interventions versus standard care.

RESULTS

We screened 6604 titles and abstracts, reviewed the full text of 60 records, and included 37 primary studies. Half of the studies were on Asthma. We found three intervention formats: one-to-one (43%), groups (49%), and combined approach with individual and group settings (8%). More than 60% of the included studies found statistically significant differences between the intervention and the control group (p < 0.05).

CONCLUSION

Several interventions have shown efficacy in improving parental QoL. Despite that, there is insufficient evidence of interventions' implementation.

PRACTICE IMPLICATIONS

A holistic approach encompassing the patient and the family's biopsychosocial dimensions is fundamental in successfully managing chronic disease in children. It is vital to design and implement interventions accommodating the common issues experienced by children, parents, and families that deal with chronic childhood conditions. Systematic review registration number PROSPERO 2018 CRD42018092135.

Health beliefs, attitudes, and health-related quality of life in persons with fibromyalgia: mediating role of treatment adherence

Fibromyalgia is a chronic illness characterized by pain and fatigue. Persons with fibromyalgia experience increased the risk for poor mental and physical health-related quality of life, which may be dependent on multiple factors, including health beliefs, such as confidence in physicians and the health-care system, and health behaviors, such as treatment adherence. Respondents with fibromyalgia (n = 409) were recruited nationally, via support organizations, and completed self-report measures: Multidimensional Health Profile - Health Functioning Index (MHP-H), Short-Form-36 Health Survey (SF-36v2), and Medical Outcomes Study (MOS) Measure of Patient Adherence - General Adherence Items. In mediation models, belief in the healthcare system and health-care personnel, and health efficacy exerted an indirect effect through treatment adherence on mental and physical quality of life. Adaptive health beliefs and attitudes were related to greater treatment adherence and, in turn, to a better quality of life. Maladaptive health beliefs and mistrusting attitudes about physician-level and systemic-level healthcare provision are negatively related to both treatment adherence and consequent physical and mental health-related quality of life in persons with fibromyalgia. Future randomized controlled trials are needed to determine if therapeutic strategies to alter health values might improve adherence and self-rated health.

Young people's experiences of living with epilepsy: The significance of family resilience

OBJECTIVE

Young people with chronic illnesses, such as epilepsy, tend to have poorer psychosocial outcomes compared to their peers. Nevertheless, not all young people experience difficulties adapting to living with epilepsy. The aim of this study was to examine family processes, as little is known about their impact on young people's adaptation to the condition.

METHOD

Semi-structured interviews were conducted with 15 young people, aged between 13 and 16 years old, to explore their experiences of living with epilepsy from the perspective of family resilience.

RESULTS

Findings from these interviews provided in-depth descriptions of stressful circumstances encountered and family processes. These processes, which in turn promoted positive adaptation, included shared family beliefs, family connectedness, and communication processes that supported collaborative problem-solving.

CONCLUSION

Practitioners who support young people living with chronic conditions, such as epilepsy, should consider interventions that promote family connectedness, as it allows young people to turn to their families for support in times of stress. Additionally, it is important to explore young people's beliefs, helping them and their families construct a new sense of normality if necessary. Supporting open communication between family members, where differing views were acknowledged, is likely to be important in facilitating resilience.

[Family adherence in serious mental disorder]

Objetivo

Identificar las actitudes y comportamientos que evidencian y caracterizan la adherencia familiar al tratamiento en pacientes con trastorno mental grave.

Diseño

Estudio descriptivo cualitativo, desde un enfoque social interpretativo.

Emplazamiento

Chía (Colombia), con profesionales que trabajan en instituciones psiquiátricas y geriátricas.

Participantes

Muestreo intencional. Se escogieron 12 profesionales de Psiquiatría, Enfermería y Psicología, con experiencia en atención a pacientes con trastorno mental grave.

Método

Se realizaron 12 entrevistas semiestructuradas. El análisis se hizo a partir de los procedimientos de comparación constante y codificación abierta de la teoría fundamentada. Como estrategia de validación se hizo la triangulación entre diferentes evaluadores (triangulación de investigadores) y de los métodos (triangulación metodológica: entrevistas y encuesta de resultados).

Resultados

Se definieron 2 categorías de la adherencia familiar: familia y tratamiento (cooperación con el tratamiento, conocimiento de la enfermedad y atención a la evolución de la enfermedad), y actitudes de la familia hacia el paciente (cuidado al paciente, promoción de autonomía del paciente y vinculación afectiva con el paciente). Una tercera categoría mostró los aspectos que disminuyen la adherencia familiar, tales como la falta de información sobre el trastorno mental o su distorsión, o las actitudes de resistencia de la familia y del paciente.

Conclusiones

Los profesionales participantes coinciden en la relevancia del constructo denominado «adherencia familiar». La adherencia familiar puede verse como un comportamiento de participación activa, pero también como un proceso de fortalecimiento de los vínculos, lo que puede disminuir la sobrecarga y el sufrimiento en familiares, cuidadores y pacientes.

The effects of a multiple family therapy on adolescents with eating disorders: an outcome study

Multiple Family Therapy (MFT) has gained increasing popularity in the treatment of eating disorders and many programs have been developed over the past decade. Still, there is little evidence in the literature on the effectiveness on MFT for treating eating disorders. The present study examines the effects of a particular model of Multiple Family Therapy on eating disorder symptoms, quality of life, and percentage of Expected Body Weight (%EBW) in adolescents with eating disorders (ED). Eighty-two adolescents with ED, aged between 11 and 19 years, were assessed before and after treatment using the Eating Disorders Inventory 2 (EDI-2), the Outcome Questionnaire 45 (OQ-45) and %EBW. Results showed a significant increase in %EBW between the beginning and end of treatment, with a large effect size. 52.4% of patients achieved an EBW above 85%. Symptoms relative to all EDI dimensions (except for bulimia) significantly decreased during treatment. The three dimensions related to quality of life assessment also improved over the course of MFT. At the end of treatment, 70.7% of patients had a total OQ-45 score below clinical significance. This study suggests that Multiple Family Therapy may benefit adolescents with eating disorders, with improvement on several outcome measures (%EBW, ED symptoms, and quality of life). However, the lack of a comparison group entails caution when drawing conclusions.

Evaluation of a family systems intervention for managing pediatric chronic illness: Mastering Each New Direction (MEND)

Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness.