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Schulz GL, Painter AC, McQueen A, Shenoy S, DuBois JM. Barriers and Facilitators to Youth Decision-Making Involvement in Families Referred for Stem Cell Transplant. JOURNAL OF FAMILY NURSING 2024; 30:267-277. [PMID: 39066518 DOI: 10.1177/10748407241261123] [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: 07/28/2024]
Abstract
Youth prefer to be involved in treatment decisions, yet youth participation is minimally present in decisions like stem cell transplant (SCT) that require frequent medications and social isolation to be successful in curing cancer and chronic illness. The purpose of our study is to identify the barriers and facilitators to youth decision-making involvement in the youth-parent interaction when referred for treatment with SCT. We report qualitative findings from our theory-driven mixed-methods study. We thematically analyzed our field notes of youth and parent observations and audio-recordings during SCT consultations and semi-structured interviews. Data were collected from 10 youth, 8 to 16 (median 12) years of age, and their parents (n = 20). Three themes emerged: (a) Reluctant unless motivated, (b) Uncertain but capable, and (c) Limited unless supported. Our findings emphasize the critical role parents may take in facilitating youth involvement in decisions.
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Affiliation(s)
| | | | - Amy McQueen
- Washington University School of Medicine in St. Louis, MO, USA
| | - Shalini Shenoy
- Washington University School of Medicine in St. Louis, MO, USA
| | - James M DuBois
- Washington University School of Medicine in St. Louis, MO, USA
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Sutherland-Foggio M, Olsavsky AL, Skeens MA, Nahata L, Hill K, Schaefer M, Himelhoch A, Kenney AE, Humphrey L, Olshefski R, Gerhardt CA. Mixed-method examination of factors associated with adolescent decision-making and involvement in care in the context of advanced cancer. Palliat Support Care 2024:1-8. [PMID: 38353006 PMCID: PMC11360869 DOI: 10.1017/s1478951524000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
OBJECTIVES Adolescents with cancer often experience significant symptom burden and aggressive treatment near end-of-life. Increased adolescent involvement in care and decision-making may benefit health outcomes. Limited research has examined factors associated with adolescents' involvement in care in the context of advanced disease. Thus, we examined the impact of background factors and decision-making perceptions on both adolescents' involvement in care and their desired change in involvement. METHODS Adolescents with advanced cancer (<60% survival or refractory/relapsed disease), ages 10-23 (n = 41; Mage = 15.37), were recruited approximately 1 month after diagnosis to complete measures of decision-making perceptions and their family role. Hierarchical regressions examined the contributions of background factors and decision-making perceptions to adolescents' frequency and desired involvement in their care. Qualitative interviews regarding decision-making were analyzed using deductive analysis. RESULTS The model examining frequency of involvement in care was significant, F(5,34) = 3.12, p = .02, R2= .31. Older age was the only significant predictor (β = .13, p= .003). The model examining desired involvement was non-significant, F(5,34) = 2.22, p = .075. Qualitative analysis indicated that (1) older adolescents have more involvement in decision-making, (2) collaborative decision-making occurred between the adolescent and extended family, and (3) adolescents trusted others to make decisions. Integration of qualitative and quantitative data revealed congruence in findings. SIGNIFICANCE OF RESULTS Adolescents with advanced cancer, who consider how decisions directly impact them and prefer greater autonomy, may be more involved in their medical care. Research is needed to identify other longitudinal predictors of decision-making and involvement in care. Providers should consider encouraging families to communicate their preferences and engage in shared decision-making.
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Affiliation(s)
- Malcolm Sutherland-Foggio
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Anna L. Olsavsky
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Micah A. Skeens
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Leena Nahata
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kylie Hill
- University of Florida Department of Psychology, Gainsville, FL, USA
| | | | | | - Ansley E. Kenney
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | | | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Yamaguchi M, Honda J, Fukui M. Effects of Parental Involvement on Glycemic Control in Adolescents With Type 1 Diabetes Mellitus: A Scoping Review. JOURNAL OF FAMILY NURSING 2023; 29:382-394. [PMID: 37211777 DOI: 10.1177/10748407231171842] [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: 05/23/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is typically diagnosed in pediatric patients. Transitioning from supported management in childhood to self-management in adolescence is an important step. Parental psychosocial influence is a possible factor in adolescents' disease control. This review summarized the effects of parental involvement on glycemic control in adolescents with T1DM by focusing on hemoglobin A1c (HgbAIc). A scoping review per the Guidance for Systematic Scoping Reviews was conducted with the following inclusion criteria: (a) studies in English, (b) focused on adolescents with T1DM, (c) outcomes included HgbAIc, and (d) focused on parental influence of children with T1DM. Of 476 articles, 14 were included. The study outcomes were classified based on direct or indirect influence. "Parental support for adherence" and "parental conflict" significantly affected HgbAIc control. This study provides current evidence on parental influence on glycemic control in adolescents.
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Affiliation(s)
| | | | - Minae Fukui
- Mukogawa Women's University, Nishinomiya, Japan
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Miller VA, Ibarra Toro A, Friedrich EA, Snyder M, Stevens E, Fremont ER. Adolescent, Parent, and Clinician Perspectives on Increasing Adolescent Involvement in Decision-Making During Clinic Visits. J Pediatr Health Care 2023; 37:528-536. [PMID: 37204373 PMCID: PMC10524528 DOI: 10.1016/j.pedhc.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/05/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION This study aimed to describe adolescent, parent, and clinician ideas for enhancing adolescent decision-making involvement (DMI) during clinic visits for chronic illness. METHOD Adolescents who recently attended a follow-up visit for a chronic illness, their parents, and clinicians were interviewed. Participants completed semistructured interviews; transcripts were coded and analyzed in NVivo. Responses to questions about ideas to increase adolescent DMI were reviewed and sorted into categories and themes. RESULTS There were five themes: (1) adolescents need to understand their condition and regimen, (2) adolescents and parents should prepare before the visit, (3) clinicians and adolescents should have one-on-one time, (4) opportunities for condition-specific peer support would be helpful, and (5) clinicians and parents should engage in specific communication behaviors. DISCUSSION Findings from this study highlight potential clinician-, parent-, and adolescent-focused strategies for enhancing adolescent DMI. Clinicians, parents, and adolescents may need specific guidance on how to enact new behaviors.
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Watson D, Mhlaba M, Molelekeng G, Chauke TA, Simao SC, Jenner S, Ware LJ, Barker M. How do we best engage young people in decision-making about their health? A scoping review of deliberative priority setting methods. Int J Equity Health 2023; 22:17. [PMID: 36698119 PMCID: PMC9876416 DOI: 10.1186/s12939-022-01794-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/18/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION International organisations have called to increase young people's involvement in healthcare and health policy development. We currently lack effective methods for facilitating meaningful engagement by young people in health-related decision-making. The purpose of this scoping review is to identify deliberative priority setting methods and explore the effectiveness of these in engaging young people in healthcare and health policy decision-making. METHODS Seven databases were searched systematically, using MeSH and free text terms, for articles published in English before July 2021 that described the use of deliberative priority setting methods for health decision-making with young people. All titles, abstracts and full-text papers were screened by a team of six independent reviewers between them. Data extraction followed the Centre for Reviews and Dissemination guidelines. The results are presented as a narrative synthesis, structured around four components for evaluating deliberative processes: 1) representation and inclusion of diverse participants, 2) the way the process is run including levels and timing of participant engagement, 3) the quality of the information provided to participants and 4) resulting outcomes and decisions. FINDINGS The search yielded 9 reviews and 21 studies. The more engaging deliberative priority setting tools involved young people-led committees, mixed methods for identifying and prioritising issues and digital data collection and communication tools. Long-term and frequent contact with young people to build trust underpinned the success of some of the tools, as did offering incentives for taking part and skills development using creative methods. The review also suggests that successful priority setting processes with young people involve consideration of power dynamics, since young people's decisions are likely to be made together with family members, health professionals and academics. DISCUSSION Young people's engagement in decision-making about their health is best achieved through investing time in building strong relationships and ensuring young people are appropriately rewarded for their time and contribution. If young people are to be instrumental in improving their health and architects of their own futures, decision-making processes need to respect young people's autonomy and agency. Our review suggests that methods of power-sharing with young people do exist but that they have yet to be adopted by organisations and global institutions setting global health policy.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Global Health and Social Medicine, King's College London, London, UK.
| | - Mimi Mhlaba
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Gontse Molelekeng
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Thulani Andrew Chauke
- Department of Adult, College of Education, Community and Continuing Education, University of South Africa, Pretoria, South Africa
| | - Sara Correia Simao
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah Jenner
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Lisa J Ware
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, UK
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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Baker K, Claridge AM. "I have a Ph.D. in my daughter": Mother and Child Experiences of Living with Childhood Chronic Illness. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 32:1-12. [PMID: 36530562 PMCID: PMC9743100 DOI: 10.1007/s10826-022-02506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Children in the United States are increasingly living with chronic illnesses. Existing literature has focused on adolescent children's experiences. The current study involved interviews with 10 families: children (ages 6-11) diagnosed with chronic illnesses and their mothers to better understand the experience of living with chronic illness. Using grounded theory, participants' responses fell into several themes: impact on family dynamics, parental advocacy, initial difficulty followed by resilience, unique stressors, and areas of social support. Overall, both mothers and children reported unique challenges related to living with childhood chronic illness, especially in terms of family dynamics, sibling relationships, and the mother-child relationship. However, almost all families also emphasized their ability to be resilient. The results have implications for medical practitioners and teachers who work with school-age children with chronic illnesses. Mothers need to feel supported and understood by professionals. Families need support to cope with stressors and strengthen couple, sibling, and parent-child relationships.
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Affiliation(s)
- Kendall Baker
- Mary Bridge Children’s Hospital, MultiCare, 317 Martin Luther King Jr Way, Tacoma, WA 98405 USA
| | - Amy M. Claridge
- Child Development and Family Science, Department of Family and Consumer Sciences, College of Education and Professional Studies, Central Washington University, 400 E University Way, MS: 7565, Ellensburg, WA USA
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Suarez L, Skinner AC, Truong T, McCann JR, Rawls JF, Seed PC, Armstrong SC. Advanced Obesity Treatment Selection among Adolescents in a Pediatric Weight Management Program. Child Obes 2022; 18:237-245. [PMID: 34757829 PMCID: PMC9145572 DOI: 10.1089/chi.2021.0190] [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] [Indexed: 11/12/2022]
Abstract
Background: Treatment options for adolescents with obesity are limited. Yet, therapies previously reserved for adults, such as medications and bariatric surgery, are increasingly available to adolescents in tertiary obesity treatment settings. We aimed to identify the factors associated with selecting an advanced obesity treatment (diets, medications, and surgery) beyond lifestyle therapy among adolescents presenting to a tertiary, pediatric weight management program. Methods: We conducted a secondary analysis of adolescents (N = 220) who participated in a longitudinal, observational case-control study within a pediatric weight management program. The exposures were potential individual and clinical factors, including sociodemographic characteristics and comorbidities. The outcome was treatment selection, dichotomized into lifestyle vs. advanced treatment. We modeled associations between these factors and treatment selection using logistic regression, controlling for confounding variables (age, race/ethnicity, sex, and insurance). Results: The study population included a majority of non-Hispanic Black (50.5%) and Hispanic/Latino (19.5%) adolescents, of whom 25.5% selected advanced treatment. Adolescents were more likely to choose an advanced treatment option if they had a greater BMI [odds ratio (OR) 1.09, 95% confidence interval (95% CI) 1.04-1.15], lived further from the clinic (OR 1.03, 95% CI 1.00-1.05), and had an elevated glycohemoglobin level (OR 2.46, 95% CI 1.24-4.92). Conclusions: A significant fraction of adolescents seeking obesity treatment in a specialized care setting chose new and emerging obesity treatments, particularly those at high risk of developing diabetes. These findings can inform patient-clinician obesity treatment discussions in specialty care settings. Clinical Trial Registration number: NCT03139877.
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Affiliation(s)
- Lilianna Suarez
- Duke University School of Medicine, Durham, NC, USA.,Address correspondence to: Lilianna Suarez, MPH, Duke University School of Medicine, 4020 N Roxboro Street, Durham, NC 27704, USA
| | - Asheley C. Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Jessica R. McCann
- Department of Molecular Genetics and Microbiology, Duke Microbiome Center, Duke University School of Medicine, Durham, NC, USA
| | - John F. Rawls
- Department of Molecular Genetics and Microbiology, Duke Microbiome Center, Duke University School of Medicine, Durham, NC, USA
| | - Patrick C. Seed
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah C. Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
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Lin JL, Lipstein EA, Wittenberg E, Tay D, Lundstrom R, Lundstrom GL, Sediqzadah S, Wright DR. Intergenerational Decision Making: The Role of Family Relationships in Medical Decision Making. MDM Policy Pract 2021; 6:23814683211039468. [PMID: 34734118 PMCID: PMC8559218 DOI: 10.1177/23814683211039468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
A symposium held at the 42nd annual Society for Medical Decision Making conference on October 26, 2020, focused on intergenerational decision making. The symposium covered existing research and clinical experiences using formal presentations and moderated discussion and was attended by 43 people. Presentations focused on the roles of pediatric patients in decision making, caregiver decision making for a child with complex medical needs, caregiver involvement in advanced care planning, and the inclusion of spillover effects in economic evaluations. The moderated discussion, summarized in this article, highlighted existing resources and gaps in intergenerational decision making in four areas: decision aids, economic evaluation, participant perspectives, and measures. Intergenerational decision making is an understudied and poorly understood aspect of medical decision making that requires particular attention as our society ages and technological advances provide new innovations for life-sustaining measures across all stages of the lifespan.
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Affiliation(s)
- Jody L Lin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, Utah
| | | | | | - Saadia Sediqzadah
- Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Schulz GL, Kelly KP, Holtmann M, Armer JM. Navigating decisional conflict as a family when facing the decision of stem cell transplant for a child or adolescent with sickle cell disease. PATIENT EDUCATION AND COUNSELING 2021; 104:1086-1093. [PMID: 33234442 DOI: 10.1016/j.pec.2020.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 09/04/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patients with sickle cell disease (SCD) face unpredictable disease, with stem cell transplant being a curative treatment option with risks. The aim of this study was to describe the level and source of decisional conflict in families of children/adolescents with SCD facing a transplant decision. METHODS A multiple-case study approach described decisional conflict in various SCD severity/donor risk decisional contexts. Cases included parents, child/adolescent with SCD, and sibling donor. The level and source of conflict was measured via O'Connor's Decisional Conflict Scale and analyzed using pattern-matching and cross-case synthesis. In-depth descriptions of conflict sources were obtained through thematic analysis of observation and interview data. RESULTS Among 11 participants in four cases (i.e. family units) decisional conflict was not unique not to the decisional context. Conflict levels represented a level that can be linked with feeling unsure and decisional delay. The theme, 'navigating decisional conflict together', described how family units discussed uncertainties. CONCLUSION Varying levels and sources of decisional conflict exist in pediatric patients with SCD and their families considering transplant. PRACTICE IMPLICATIONS In our cases, decisional conflict and the transplant decision occurred at the family-level. Clinicians should encourage all family members to participate in discussions concerning transplant.
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Affiliation(s)
- Ginny Lynn Schulz
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA; Siteman Kids at St. Louis Children's Hospital, St. Louis, MO, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Katherine Patterson Kelly
- Children's National Hospital, Washington, District of Columbia, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Megan Holtmann
- Siteman Kids at St. Louis Children's Hospital, St. Louis, MO, USA; Kaskaskia College, Centralia, IL, USA
| | - Jane Marie Armer
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA; American Lymphedema Framework Project, Columbia, MO, USA
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Pyke-Grimm KA, Franck LS, Halpern-Felsher B, Goldsby RE, Rehm RS. 3 Dimensions of Treatment Decision Making in Adolescents and Young Adults With Cancer. Cancer Nurs 2021; 43:436-445. [PMID: 33084293 PMCID: PMC10657129 DOI: 10.1097/ncc.0000000000000820] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) experience treatment nonadherence rates as high as 60%, which can increase the risk of cancer relapse. Involvement of AYAs in treatment decisions might support adherence to medical treatment. OBJECTIVE The aim of this study was to explore the involvement of AYAs, aged 15 to 20 years, in cancer treatment decision making (TDM). METHODS Using interpretive focused ethnography, we conducted interviews with 16 AYAs (total of 31 interviews) receiving cancer treatment within 1 year of diagnosis. Participants reflected on a major recent TDM experience (eg, clinical trial, surgery) and other treatment decisions. RESULTS Participants distinguished important major cancer treatment decisions from minor supportive care decisions. We identified 3 common dimensions related to AYAs' involvement in cancer TDM: (1) becoming experienced with cancer, (2) import of the decision, and (3) decision-making roles. The preferences of AYAs for participation in TDM varied over time and by type of decision. We have proposed a 3-dimensional model to illustrate how these dimensions might interact to portray TDM during the first year of cancer treatment for AYAs. CONCLUSIONS As AYAs accumulate experience in making decisions, their TDM preferences might evolve at different rates depending on whether the decisions are perceived to be minor or major. Parents played a particularly important supportive role in TDM for AYA participants. IMPLICATIONS FOR PRACTICE Clinicians should consider the AYAs' preferences and the role they want to assume in making different decisions in order to support and encourage involvement in their TDM and care.
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Affiliation(s)
- Kimberly A Pyke-Grimm
- Author Affiliations: Lucile Packard Children's Hospital Stanford, Palo Alto, California (Drs Pyke-Grimm and Halpern-Felsher); School of Nursing, Department of Family Health Care Nursing, University of California, San Francisco (Drs Franck and Rehm); Department of Pediatrics, Division of Adolescent Medicine, Stanford University, California (Dr Halpern-Felsher); and University of California, San Francisco, Benioff Children's Hospital (Dr Goldsby)
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Decision Making in Pediatric Plastic Surgery: Autonomy and Shared Approaches. J Craniofac Surg 2020; 31:2139-2143. [PMID: 33136843 DOI: 10.1097/scs.0000000000006738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although shared decision-making is essential to patient-centered healthcare, its role in pediatric plastic surgery remains unclear. The objective of this study was to define the preferred level of involvement in surgical decision-making among children, caregivers, and surgeons. METHODS The authors surveyed pediatric plastic surgery patients (n = 100) and their caregivers regarding their preferences on child involvement during surgical decision-making. Fleiss' kappa was used to assess agreement between groups. Bivariate Chi-square tests and multinomial logistic regression were used to assess the relationship between decision-making preferences and select demographic factors. RESULTS Only 34% of children and their caregivers agreed upon their decision-making preferences (k = 0.04). The majority of children (40%) and caregivers (67%) favored shared decision-making between the patient, caregiver, and surgeon. Only 16% of children preferred physician-driven decisions, while 20% of children desired complete autonomy. Children's preferences were significantly associated with their age; the relative risk of children deferring to caregivers or surgeons over a shared approach was lower for adolescents and teens compared to children under 10 years old (relative risk = 0.20; 95% confidence interval: 0.054-0.751; P = 0.02). Caregiver's preferences did not change based on the child's age, but rather were related to the child's gender. Caregivers were more likely to choose the option that gave the child more autonomy when the child was male. CONCLUSIONS While most caregivers preferred a shared approach to decision-making, children desired greater autonomy, particularly with increasing age. Since there was limited agreement between caregivers and children, surgeons must be cognizant of differing preferences when discussing treatment plans to optimize both patient and parent satisfaction.
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Lopes WSDL, Gomes R. The participation of cohabitants with sickle cell disease in health care: a bibliographic study. CIENCIA & SAUDE COLETIVA 2020; 25:3239-3250. [PMID: 32785557 DOI: 10.1590/1413-81232020258.30062018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/21/2018] [Indexed: 11/22/2022] Open
Abstract
This paper aims to analyze the published scientific production about the participation of the sickle cell disease (SCD) subjects and their relatives, and the autonomy and social aspects of these individuals. A qualitative bibliographic search with the Portuguese-equivalent keywords "sickle cell disease" and "participation" was used. As a result, the following themes appeared: (1) Experience of illness, highlighting coexistence and ethnic-racial issues; (2) Participation in research and the perspective of health professionals on SCD; and (3) Autonomy of cohabitants and decision-making. We can conclude that the promotion of the participation of these patients in the studies, either instrumentally, or to contextualize the results better, or - still - to enrich the authors' conclusions, can intentionally or unintentionally contribute to the greater visibility of the problem that involves being a SCD cohabitant for the subjects and their relatives. The duty to analyze intersectionally the entire context of the patient and his family context is also highlighted.
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Affiliation(s)
- Winnie Samanú de Lima Lopes
- Departamento de Ensino, Instituto Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 20550-011 Rio de Janeiro RJ Brasil.
| | - Romeu Gomes
- Departamento de Ensino, Instituto Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 20550-011 Rio de Janeiro RJ Brasil.
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Miano SJ, Douglas SL, Hickman RL, DiMarco M, Piccone C, Daly BJ. Exploration of Decisional Control Preferences in Adolescents and Young Adults with Cancer and Other Complex Medical Conditions. J Adolesc Young Adult Oncol 2020; 9:464-471. [PMID: 32091945 PMCID: PMC7640748 DOI: 10.1089/jayao.2019.0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent and young adults (AYA) with cancer encounter many medical treatment decisions but may have variable desires for involvement in decision-making. This study describes the degree of decisional control AYA patients preferred in complex medical decisions. Methods: A cross-sectional descriptive correlational design evaluated experienced AYA patients' decision-making role preferences using the Control Preference Scale and explored relationships in a proposed model of decision control. Results: Overall, most patients preferred an "active collaborative" role (39%), where the patient prefers to make the final decision with input from the provider, or a "shared decision-making" role (34%), wherein the decision is jointly made between patient and provider. Oncology AYA patients tended to prefer a more passive role than nononcology AYA patients. Time since diagnosis also positively correlated with control preference, with patients preferring a more active level of decisional control as the number of days from diagnosis increased. While no other statistically significant relationships were found between factors put forth in the exploratory model and decision control, there were strong associations between the factors themselves that warrant future study. Conclusion: The findings advance the knowledge of AYA preferences for decision-making involvement, enhancing our ability to identify patients at risk for low health care engagement and explore the consequences of limited or impaired decisional capacity. Future research might examine interventions to promote self-management skills and patient decisional role preferences, fulfilling the need to respect both the desire for decision-making involvement of some patients and the preference to defer to the expertise of providers for others.
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Affiliation(s)
- Sarah J. Miano
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
- University Hospitals Cleveland Medical Center, Angie Fowler's Adolescent & Young Adult Cancer Institute, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Sara L. Douglas
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Ronald L. Hickman
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Marguerite DiMarco
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Connie Piccone
- University Hospitals Cleveland Medical Center, Angie Fowler's Adolescent & Young Adult Cancer Institute, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Barbara J. Daly
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
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Daley T, Grossoehme D, McGuire JK, Corathers S, Conard LA, Lipstein EA. "I Couldn't See a Downside": Decision-Making About Gender-Affirming Hormone Therapy. J Adolesc Health 2019; 65:274-279. [PMID: 31196783 DOI: 10.1016/j.jadohealth.2019.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the article was to understand adolescents' and parents' decision-making process related to gender-affirming hormone therapy (GAHT). METHODS We conducted qualitative semistructured interviews with transgender adolescents who began testosterone for GAHT in the prior year and the parents of such adolescents. Questions focused on decision-making roles, steps in the decision process, and factors considered in the decision. Participants used pie charts to describe the division of responsibility for the decision. All interviews were coded by at least two members of the research team with disagreements resolved through discussion. Thematic analysis was used to analyze the data. RESULTS Seventeen adolescents and 13 parents were interviewed (12 dyads). The process of deciding about GAHT involves a series of small conversations, typically with the adolescent advocating to start treatment and the parent feeling hesitant. In most cases, after seeking information from the Internet, healthcare providers and personal contacts move toward acceptance and agree to start treatment. Although adolescents have some short-term concerns, such as about needles, parents' concerns relate more to long-term risks. Ultimately, for both parents and adolescents, the benefits of treatment outweigh any concerns, and they are in agreement about the goals of personal confidence, comfort in one's body and happiness. CONCLUSIONS To the extent that the decision about GAHT is a medical decision, the decision process is similar to others. However, decisions about GAHT are much more about gender identity than medical risks, suggesting that interventions based in a medical framework may not aid in supporting decision-making.
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Affiliation(s)
- Thomas Daley
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel Grossoehme
- University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jenifer K McGuire
- Department of Family Social Science, University of Minnesota, Minneapolis, Minnesota
| | - Sarah Corathers
- University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lee Ann Conard
- University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ellen A Lipstein
- University of Cincinnati College of Medicine, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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15
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Shared decision-making aid for juvenile idiopathic arthritis: moving from informative patient education to interactive critical thinking. Clin Rheumatol 2019; 38:3217-3225. [PMID: 31327085 DOI: 10.1007/s10067-019-04687-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/19/2019] [Accepted: 07/09/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To develop and evaluate an illustrated, stand-alone, interactive evidence-based shared decision making (SDM) aid for JIA children; its ability to produce positive perceived involvement of JIA patients in their own management and its impact on their adherence to therapy, school absenteeism and treatment outcomes. METHODS The SDM aid was developed to offer information about the disease, risks and benefits of treatment. A multidisciplinary team defined SDM criteria based on international standards (IPDAS). Eight categories emerged as highly important for SDM. Each category was supported by simple illustrations in an interactive style. At the end of each category, the child is asked to make a decision in view of the information given. Ninety-four JIA children were provided with the tool, in a randomised controlled study, in comparison to a control group of 95 JIA patients treated according to standard protocols. RESULTS A total of 97.5% of the study children reported comprehensibility of more than 90%. The patients' adherence to therapy was significantly (p < 0.01) higher in the SDM group, whereas stopping DMARDs for intolerability was significantly higher in the control group at 12 months of treatment. There was a significant improvement in the patient-reported outcomes in the SDM group, and absence from school was significantly higher in the control group (p < 0.01). CONCLUSIONS The developed SDM aid offered the children evidence-based information about the pros and cons of treatment options and improved their understanding of the disease and their ability to make an informed decision that is reflected on their adherence to therapy and better treatment outcomes. Key Points • This work represents the second generation of shared decision-making tools. • The developed tool adopts an interactive style and enhances critical thinking, giving the patients the facility of making their own decision regarding their management. • The work gives an example of core domain set of outcomes which can be used for shared decision-making interventions.
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16
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Fernandez HGC, Moreira MCN, Gomes R. Making decisions on health care for children / adolescents with complex chronic conditions: a review of the literature. CIENCIA & SAUDE COLETIVA 2019; 24:2279-2292. [PMID: 31269185 DOI: 10.1590/1413-81232018246.19202017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/30/2017] [Indexed: 11/21/2022] Open
Abstract
The profile of pediatric care has gone through changes in Brazil and in the world. This process becomes more visible in surveys that deal with hospital admission or specialized outpatient care data. This fact leads us to the idea that it is in such spaces that these children and subjects who care for them are more visible and negotiate decisions. We aim to perform a state of the art literature review on decision making discussions and definitions, analyzing the current research in light of the theoretical Mol perspectives on the actors' logics of chronic diseases care; And the perspective of care goods exchanges in the dialogue between Martins and Moreira, triggering the Theory of Gift. The synthesis of the literature shows that decision making may be understood as a care planning process in which family, patients and health professionals are involved, and is linked to the family-centered care model. In terms of difficulties, we point out the prevalence of a dynamic that favors a criticizable choice because of the risks of inequality, such as the lack of discussion on the options and the actuation of the family mostly in times of difficult decisions.
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Affiliation(s)
| | | | - Romeu Gomes
- Instituto Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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17
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Lerch MF, Thrane SE. Adolescents with chronic illness and the transition to self-management: A systematic review. J Adolesc 2019; 72:152-161. [PMID: 30903932 DOI: 10.1016/j.adolescence.2019.02.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 02/11/2019] [Accepted: 02/24/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Chronic illness effects one in ten adolescents worldwide. Adolescence involves a desire for autonomy from parental control and the necessity to transition care from parent to child. This review investigates the transition to adolescent self-management of chronic illness treatment behaviors in the context of parent-adolescent relationships. METHODS A systematic search of PubMed, CINAHL, and Web of Science was conducted from earliest database records to early June 2017. Articles were included if they focused on adolescents, addressed illness self-management, discussed the parent-adolescent relationship, and were published in English. Articles were excluded if the chronic illness was a mental health condition, included children younger than 10 years of age, or lacked peer review. RESULTS Nine studies met inclusion criteria. Outcomes included challenges to adolescent self-management, nature of the parent-adolescent relationship, illness representation, perceptions of adolescent self-efficacy in compliance, medical decision making, laboratory measures, and adolescent self-management competence. Across diagnoses, parents who were available to monitor, be a resource, collaborate with their adolescent, and engage in ongoing dialogue were key in the successful transition to autonomous illness management. CONCLUSIONS There is a paucity of research addressing the experiences of adolescents in becoming experts in their own care.
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Affiliation(s)
- Matthew F Lerch
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Susan E Thrane
- College of Nursing, The Ohio State University, 322 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, United States.
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18
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Pyke-Grimm KA, Franck LS, Patterson Kelly K, Halpern-Felsher B, Goldsby RE, Kleiman A, Rehm RS. Treatment Decision-Making Involvement in Adolescents and Young Adults With Cancer. Oncol Nurs Forum 2019; 46:E22-E37. [PMID: 30547960 DOI: 10.1188/19.onf.e22-e37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Involvement in treatment decision making (TDM) is considered a key element of patient- and family-centered care and positively affects outcomes. However, for adolescents and young adults (AYAs) with cancer, little is known about the current state of knowledge about their perspective on and involvement in TDM or the factors influencing AYAs' TDM involvement. LITERATURE SEARCH Integrative review focused on AYAs aged 15-21 years, their involvement in TDM, and factors influencing their involvement using the MEDLINE®, PsycINFO®, CINAHL®, and Web of Science databases. DATA EVALUATION 4,047 articles were identified; 21 met inclusion criteria. SYNTHESIS Five factors were identified. IMPLICATIONS FOR RESEARCH Research is needed to understand AYAs' preferences for TDM, the type and degree of their involvement, and the interactions between factors that contribute to or impede TDM.
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Affiliation(s)
| | | | | | | | | | - Ari Kleiman
- UCSF Medical Center Institute for Nursing Excellence
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19
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Beal SJ, Wingrove T, Nause K, Lipstein E, Mathieu S, Greiner MV. The Role of Shared Decision-Making in Shaping Intent to Access Services for Adolescents in Protective Custody. CHILD CARE IN PRACTICE : NORTHERN IRELAND JOURNAL OF MULTI-DISCIPLINARY CHILD CARE PRACTICE 2019; 25:64-78. [PMID: 31130815 PMCID: PMC6532998 DOI: 10.1080/13575279.2018.1521379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Including children in protective custody (e.g., foster care) in legal decisions positively impacts their perceptions of the legal system, with giving youth a voice being particularly important. Studies have primarily focused on including young people in legal processes; however, for adolescents in protective custody, decisions about living arrangements, education, and long-term planning are made outside the courtroom, with ramifications for young people and their perceptions of both legal and child protection systems. This study looks at such decision making using existing data from 151 adolescents who were ages 16-20 and had been in child welfare protective custody for at least 12 months. During in-person interviews we assessed their desired amount of involvement in a recent decision and their perceptions of their actual involvement. Youth named other individuals involved in decision-making. Data were coded and analysed to identify discrepancies in young people's perceptions of desired and actual levels of involvement. Results indicate that while the majority of adolescents (96%) are participating in decision-making, they generally desire more involvement in decisions made (64%). Only 7% of youth reported that their level of personal involvement and the involvement of others matched what they desired. The most common individuals identified in a decision made were child protection workers, legal professionals, and caregivers or family members. These findings enhance the existing literature by highlighting the unique issues related to giving young people in protective custody a voice, and provide an empirical foundation for guiding policies around who to involve in every-day decisions made for young people preparing for emancipation from protective custody.
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Affiliation(s)
- Sarah J Beal
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229. USA
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267. USA
| | - Twila Wingrove
- Department of Psychology, Appalachian State University, 222 Joyce Lawrence Lane, Boone, NC 28608. USA
| | - Katie Nause
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229. USA
| | - Ellen Lipstein
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229. USA
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267. USA
| | - Stephane Mathieu
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229. USA
| | - Mary V Greiner
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229. USA
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267. USA
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20
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Miller VA. Involving Youth With a Chronic Illness in Decision-making: Highlighting the Role of Providers. Pediatrics 2018; 142:S142-S148. [PMID: 30385620 PMCID: PMC6220652 DOI: 10.1542/peds.2018-0516d] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
Decision-making is important in the context of pediatric chronic illness because children and families need to make decisions about burdensome and complex treatments on a regular basis, and children must eventually learn how to make such decisions independently. Research related to children's decision-making in medical settings has been focused primarily on cognitive aspects of decision-making, such as understanding and capacity. The concept of decision-making involvement (DMI) recognizes that children can be involved in decision-making in multiple ways, regardless of capacity, and that parents and health care providers play a critical role in supporting children as they learn to make decisions on their own. Providers can facilitate DMI during medical encounters by asking for the children's opinions and concerns, encouraging turn-taking, soliciting questions, asking for information directly from the children, and checking that the children understand what has been said. Efforts to involve children send the message that the youth perspective is important and set the expectation for increased participation over time. Providers can also support parent-child decision-making about illness management at home by guiding parents as to how best to involve children in decisions about illness management, identifying areas in which more or less parental guidance and support are needed, and assisting youth in planning ahead for decision-making about illness management in high-risk situations. Additional research is needed to identify why children's DMI in medical settings remains low, develop and evaluate strategies to enhance DMI, and test the effects of DMI on health-related behaviors and outcomes over time.
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Affiliation(s)
- Victoria A Miller
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Madrigal VN, Kelly KP. Supporting Family Decision-making for a Child Who Is Seriously Ill: Creating Synchrony and Connection. Pediatrics 2018; 142:S170-S177. [PMID: 30385624 PMCID: PMC6220653 DOI: 10.1542/peds.2018-0516h] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
The families of children with chronic or serious illness are sometimes faced with difficult decisions never previously imagined. We offer a stepwise approach in building a human connection with these families to support them through the decision-making process. We encourage the clinician to stop talking and to actively listen and find common ground. We suggest that offering open and honest information begins with an invitation. We encourage clinicians to explore concepts with the family, including their fears and hopes. We discuss nurturing an emotional connection between the child and family and describe ways to discover a family's preference for involvement in the decision-making process. Central to supporting a family is to place infinite value on the life of their child. We argue that attention to these matters will help the clinician remain in sync with the family to ensure meaningful and high-quality decision-making during highly vulnerable times for families.
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Affiliation(s)
- Vanessa N Madrigal
- Division of Critical Care Medicine, Departments of Pediatrics and
- Associate Professor of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Katherine Patterson Kelly
- Nursing Science, Professional Practice, and Quality, Children's National Health System, Washington, District of Columbia; and
- Director of Pediatric Ethics Program, Assistant Professor and
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22
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Jordan A, Wood F, Edwards A, Shepherd V, Joseph-Williams N. What adolescents living with long-term conditions say about being involved in decision-making about their healthcare: A systematic review and narrative synthesis of preferences and experiences. PATIENT EDUCATION AND COUNSELING 2018; 101:1725-1735. [PMID: 29937112 DOI: 10.1016/j.pec.2018.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To understand the preferences and experiences of adolescents (age 10-19) with long-term conditions (LTCs) towards involvement in discussions and decisions regarding management of their condition. METHODS A systematic review and narrative synthesis of mixed-methods, quantitative and qualitative and research was performed. Six databases were searched from inception to March 2017. The quality of the articles was assessed, and relevant data were extracted and coded thematically. RESULTS The search yielded 27 articles which met the inclusion criteria. Decision-making involvement preferences and experiences were reported from the adolescents' perspectives. Adolescents often report that they do not have any choice of treatment options. Variability in preferences and experiences were found within and between individuals. Mismatches between preferences and experiences are common, and often with negative emotional consequences. DISCUSSION Adolescent preferences for involvement in the decision-making process are situational and individualistic. Healthcare professionals can encourage involvement by ensuring that adolescents are informed of treatment options, and aware of the value of their contribution. Future research should explore adolescent perceived barriers and facilitators to SDM. PRACTICAL IMPLICATIONS Interventions are needed to effectively train HCPs in the delivery of shared decision-making, and to support the participation of adolescents with LTCs in shared decision-making.
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Affiliation(s)
- Amber Jordan
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom.
| | - Fiona Wood
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Adrian Edwards
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Victoria Shepherd
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
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23
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Rosati P, Di Salvo V, D'Amico R, Balduzzi S, Giampaolo R, Rita Marina Mazziotta M, Guerra C, Menichella G, Cosentino SP, Carlino C, Di Ciommo V. Outpatient parents' views on shared-decision-making at an Italian children's hospital. Health Promot Int 2018; 33:572-579. [PMID: 28100640 DOI: 10.1093/heapro/daw105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Information is lacking on what parents in southern European countries know and how they view clinical shared-decision-making (SDM) for their children. This survey assesses general parental views on SDM and patient-physician SDM relationships in an Italian paediatric outpatients' clinic. In a 3-month cross-sectional survey, we enrolled 458 consecutive native and foreign Italian-speaking parents bringing their children to our public hospital for various reasons. Parents completed an anonymous questionnaire exploring their general views on SDM, including what doctor-patient relationship predominates today, and what approach reassures them most. Multivariate logistic regression analysed outcome data from parental questionnaire answers. Results are reported as percentages, odds ratios (OR) and 95% confidence intervals (CI). Multivariate logistic regression showed that 440 parents (96.1%) appreciated SDM, 245 (53.5%) preferred SDM for choosing children's treatment, 126 (27.5%) answered that SDM is the predominant relationship today, and most parents 275 (60.0%) felt reassured by SDM. More native than foreign Italian-speaking parents preferred SDM (97.0 vs 89.7%, OR = 3.8; 95% CI = 1.4-10.8). Highly-educated parents preferred SDM for choosing their child's therapy (57.9 vs 34.1%, OR = 2.7; 95% CI = 1.6-4.4) and this approach reassured them (64.3 vs 41.2%, OR = 2.5; 95% CI = 1.6-4.1). In conclusion, parents bringing children to an Italian outpatient clinic, especially highly-educated parents, wish to be offered SDM and find it reassuring. These findings should encourage paediatricians working in a challenging multicultural environment to change their physician-centred approach and engage parents in tailored SDM strategies.
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Affiliation(s)
- Paola Rosati
- Unit of Clinical Epidemiology Bambino Gesù, Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, Rome, Italy
| | - Viviana Di Salvo
- Department of Paediatrics, Outpatients' Unit, Bambino Gesù, Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Roberto D'Amico
- Department of Diagnostic Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy
| | - Sara Balduzzi
- Department of Diagnostic Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy
| | - Rosaria Giampaolo
- Department of Paediatrics, Outpatients' Unit, Bambino Gesù, Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Mercedes Rita Marina Mazziotta
- Department of Paediatrics, Outpatients' Unit, Bambino Gesù, Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Cesare Guerra
- Department of Paediatrics, Outpatients' Unit, Bambino Gesù, Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Giovanna Menichella
- Department of Paediatrics, Outpatients' Unit, Bambino Gesù, Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Stefania P Cosentino
- Department of Paediatrics, Outpatients' Unit, Bambino Gesù, Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Cecilia Carlino
- Faculty of Medicine and Surgery, Sapienza University, Piazzale Aldo Moro 5, Rome, Italy
| | - Vincenzo Di Ciommo
- Unit of Clinical Epidemiology Bambino Gesù, Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, Rome, Italy
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24
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Farber JG, Prieur MG, Roach C, Shay R, Walter M, Borowitz D, Dellon EP. Difficult conversations: Discussing prognosis with children with cystic fibrosis. Pediatr Pulmonol 2018; 53. [PMID: 29528566 PMCID: PMC5904004 DOI: 10.1002/ppul.23975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Background Despite the chronic, progressive, and life-threatening nature of cystic fibrosis (CF), there are no guidelines for when and how to communicate prognosis to children with CF. METHODS Semi-structured interviews with young adults with CF, parents of young adults with CF, and multidisciplinary CF health care providers assessed recall of and practices for communicating about prognosis. Recommendations for improvements were also solicited. RESULTS Young adults with CF recalled learning that life expectancy is limited by CF between the ages of 8 and 16 years, and that CF is a progressive disease between the ages of 7 and 19 years. They reported that the information often came from CF physicians or from online resources. Patients and parents reported earlier knowledge of prognosis than providers assumed. While learning about prognosis caused sadness and stress for some patients and families, others denied negative feelings. Interestingly, most patients reported that disclosure of prognosis had minimal impact on their adherence and treatment goals. Patients and parents reported wanting physicians to be involved in conversations about prognosis. However, providers noted several barriers to discussing prognosis, including their own reluctance, time limitations, and uncertainty about appropriate timing and content of communication. CONCLUSIONS Communication about prognosis is important but also difficult for providers, patients, and families. Appropriately timed conversations, using tools to facilitate communication, could ensure patients receive timely, accurate information.
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Affiliation(s)
- Julia Gray Farber
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mary G Prieur
- Departments of Psychiatry and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Christine Roach
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo of State University of New York, Buffalo, New York
| | - Rosemary Shay
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michelle Walter
- Department of Geriatrics and Palliative Medicine, Jacobs School of Medicine, University at Buffalo of State University of New York, Buffalo, New York
| | - Drucy Borowitz
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo of State University of New York, Buffalo, New York.,Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Elisabeth P Dellon
- Division of Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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25
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Gray NJ, Wood DM. The Role of Medication in Supporting Emotional Wellbeing in Young People with Long-Term Needs. Healthcare (Basel) 2017; 5:E84. [PMID: 29099742 PMCID: PMC5746718 DOI: 10.3390/healthcare5040084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/20/2017] [Accepted: 10/29/2017] [Indexed: 11/20/2022] Open
Abstract
Young people frequently use and access prescribed medications for a range of health problems. Medications aimed at treating both common health problems and long-term physical and mental health needs in adolescence can have a significant effect on a young person's emotional well-being. We use a series of case studies to illustrate the challenges for healthcare professionals supporting young people with medication use. The studies illustrate the efficacy and limitations of medication on improving emotional well-being by alleviating illness and distress, and how this efficacy must be balanced against both the adverse effects and the burden of treatment. There are specific challenges for medication management during adolescence including issues of adherence/concordance, facilitating autonomy and participation in decision making, and promoting independence.
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Affiliation(s)
- Nicola J Gray
- Green Line Consulting Limited, Manchester M28 7FF, UK.
| | - Damian M Wood
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham NG7 2UH, UK.
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26
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Parsons S, Thomson W, Cresswell K, Starling B, McDonagh JE. What do young people with rheumatic disease believe to be important to research about their condition? A UK-wide study. Pediatr Rheumatol Online J 2017; 15:53. [PMID: 28673355 PMCID: PMC5496376 DOI: 10.1186/s12969-017-0181-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/11/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The involvement of people of all ages including young people in research is now widely advocated but prioritisation of research topics is still driven largely by professional agendas. Evidence from adult literature has reported a mismatch between a researcher and patient generated list of research topics. There have been no studies to date exploring the priorities of young people with long term conditions other than in SLE. The study aimed to explore the research priorities of young people across the UK with respect to rheumatic conditions. METHODS Focus groups were undertaken with young people aged 11-24 years with rheumatic conditions recruited across the UK via members of the Barbara Ansell National Network for Adolescent Rheumatology BANNAR and relevant national charities. Data was analysed using a Framework approach. Participants discussed their beliefs about what should be researched in: Basic Science; Clinical Medicine; Health Services, Psychosocial, and Public Health. They were then invited to prioritize these areas in terms of how much funding they should receive. RESULTS Thirteen focus groups were held involving 63 participants (18 males: 45 females, mean age 16 years, range 10 to 24) in all four nations of the UK. Young people's research priorities were influenced by whether they felt research would achieve benefits for all or just some patients and long or short term goals. Another influence was whether participants felt that research areas were already well funded. Across all groups, Basic Science was a key priority and participants felt that psychosocial research should be prioritized more. Health Services Research was a lower priority, as the majority of participants were happy with their care. Clinical medicine was not a high priority as young people were happy with their medication or uncomfortable with trying new ones. Finally, for nearly all groups, Public Health was a low priority. Differences were also observed between the two age groups and across the geographically diverse focus groups. CONCLUSION Understanding young people's research priorities is important to develop research that is in tune with their needs. The results highlight the importance of considering the whole age range of adolescence and young adulthood as well as geographical diversity. The findings from this work will inform the future research of the Barbara Ansell National Network for Adolescent Rheumatology BANNAR in the UK.
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Affiliation(s)
- Suzanne Parsons
- 0000 0004 0417 0074grid.462482.ePublic Programmes Team, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Wendy Thomson
- 0000000121662407grid.5379.8Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK ,0000000121662407grid.5379.8NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Katharine Cresswell
- 0000 0004 0417 0074grid.462482.ePublic Programmes Team, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Bella Starling
- 0000 0004 0417 0074grid.462482.ePublic Programmes Team, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Janet E McDonagh
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. .,Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
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27
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Kelly KP, Mowbray C, Pyke-Grimm K, Hinds PS. Identifying a conceptual shift in child and adolescent-reported treatment decision making: "Having a say, as I need at this time". Pediatr Blood Cancer 2017; 64. [PMID: 28221731 DOI: 10.1002/pbc.26262] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/03/2016] [Accepted: 08/22/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Professional organizations and governments recommend child and adolescent involvement in cancer treatment decision making (TDM) despite minimal evidence that children prefer involvement, how best to include them, and the result of doing so. PROCEDURE Using descriptive qualitative research methods, we interviewed 20 children ages 9-17 years about their TDM preferences and experiences. We shifted our conceptualizations as findings emerged about how children with cancer viewed their decisional experiences. Results from constant comparative analysis of participant interviews yielded a new construct, "Having a say, as I need at this time" ('Having a Say'), which focuses more broadly on child communication preferences and the dynamism of those preferences. Ten additional interviews confirmed 'Having a Say' results. RESULTS Children's contextually related 'Having a Say' preferences ranged from not wanting to hear information at this time, to being included in treatment discussions, to choosing a treatment option. Children reported both positive and negative effects of being involved (or not) in treatment discussions as they preferred. Children's preferences assumed the presence and involvement of their parents and doctors. Illness conditions (e.g., stage of treatment; symptom distress) informed child communication preferences more so than the child's age. CONCLUSIONS The 'Having a Say' construct challenges the dominant shared TDM paradigm, which presumes it is best to involve children in their treatment decisions. 'Having a Say' is both a developmental and conceptual fit for children that can inform future research to develop and test clinical care approaches to meet child and adolescent communication needs.
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Affiliation(s)
- Katherine Patterson Kelly
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Washington, District of Columbia
| | - Catriona Mowbray
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia
| | - Kimberly Pyke-Grimm
- Center for Nursing Excellence, Bass Center for Childhood Cancer and Blood Diseases, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Washington, District of Columbia.,Department of Nursing Research and Quality Outcomes, Center for Translational Science, Children's National Health System, Department of Pediatrics, George Washington University, Washington, District of Columbia
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28
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Cox ED, Swedlund MP, Young HN, Moreno MA, Schopp JM, Rajamanickam V, Panepinto JA. Family Engagement in Pediatric Sickle Cell Disease Visits. HEALTH COMMUNICATION 2017; 32:51-59. [PMID: 27159356 PMCID: PMC5551046 DOI: 10.1080/10410236.2015.1099503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Adults with sickle cell disease (SCD) report problems in relationship building and information exchange during clinic visits. To explore the origin of these communication challenges, we compare communication in pediatric SCD, diabetes, and asthma visits. We collected visit videos and parent surveys from 78 children ages 9-16 years with SCD, asthma, or diabetes. Coders assessed child, parent, and physician utterances reflecting relationship building, information giving, and information gathering. Associations of engagement with type of chronic disease visit were performed with negative binomial regression. Compared to SCD visits, children in diabetes visits spoke 53% more relationship-building utterances (p < .05) and physicians in asthma visits spoke 48% fewer relationship building utterances to the child (p < .01). In diabetes visits, physicians gave almost twice as much information to children and gave 48% less information to parents (both p < .01) compared to SCD visits. Compared to SCD visits, physicians spoke fewer information-gathering utterances to parents in diabetes and asthma visits (85% and 72% respectively, both p < .001). SCD visits reflect less engagement of the children and greater physician effort to gather information from parents. These differences highlight opportunities to enhance engagement as a mechanism for ultimately improving SCD care.
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Affiliation(s)
- Elizabeth D. Cox
- Department of Pediatrics, University of Wisconsin School of Medicine
and Public Health
| | - Matthew P. Swedlund
- Department of Family Medicine, University of Wisconsin School of
Medicine and Public Health
| | - Henry N. Young
- Department of Clinical and Administrative Pharmacy, University of
Georgia
| | - Megan A. Moreno
- Department of Pediatrics, University of Wisconsin School of Medicine
and Public Health
| | - Jennifer M. Schopp
- Department of Pediatrics, University of Wisconsin School of Medicine
and Public Health
| | - Victoria Rajamanickam
- Department of Biostatistics and Medical Informatics, University of
Wisconsin School of Medicine and Public Health
| | - Julie A. Panepinto
- Department of Pediatrics, Hematology/Oncology/Bone Marrow
Transplant, Medical College of Wisconsin, Children's Hospital of
Wisconsin
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29
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Dodds CM, Britto MT, Denson LA, Lovell DJ, Saeed S, Lipstein EA. Physicians' Perceptions of Shared Decision Making in Chronic Disease and Its Barriers and Facilitators. J Pediatr 2016; 171:307-9.e1-2. [PMID: 26817588 PMCID: PMC4808590 DOI: 10.1016/j.jpeds.2015.12.071] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/01/2015] [Accepted: 12/28/2015] [Indexed: 01/27/2023]
Abstract
This study assessed pediatric physicians' use of shared decision making (SDM) in 2 chronic conditions. Most physicians indicated that parent and adolescent trust and emotional readiness facilitated SDM, physicians' preferred approach to decision making. At the same time, they perceived few barriers, other than insurance limitations, to using SDM.
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30
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Schalkers I, Dedding CWM, Bunders JFG. '[I would like] a place to be alone, other than the toilet'--Children's perspectives on paediatric hospital care in the Netherlands. Health Expect 2015; 18:2066-78. [PMID: 24460634 PMCID: PMC5810735 DOI: 10.1111/hex.12174] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although it is widely recognized that children are willing, capable and legally entitled to be active participants in their health care, parents are generally invited to evaluate paediatric hospital care and services rather than children themselves. This is problematic because parents cannot serve as the only spokespersons for the perspectives and experiences of children. OBJECTIVE To investigate children's experiences with and perspectives on the quality of hospital care and services in the Netherlands, and how they think care and services could be improved. DESIGN A qualitative study incorporating different participatory data collection methods, including photovoice and children writing a letter to the chief executive of the hospital. SETTING Paediatric departments of eight hospitals in the Netherlands (two teaching and six regional). PARTICIPANTS Children and adolescents (n = 63) with either acute or chronic disorders, aged between 6 and 18 years. RESULTS The research results provide insights into children's health and social well-being in hospitals. Important aspects of health, like being able to sleep well and nutrition that fits children's preferences, are structurally being neglected. CONCLUSION The participatory approach brought children's ideas 'alive' and generated concrete areas for improvement that stimulated hospitals to take action. This demonstrates that participatory methods are not merely tools to gather children's views but can serve as vehicles for creating health-care services that more closely meet children's own needs and wishes.
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Affiliation(s)
- Inge Schalkers
- Athena Institute for Research on Innovation and Communication in Health and Life SciencesFree University of AmsterdamAmsterdamThe Netherlands
| | - Christine W. M. Dedding
- Athena Institute for Research on Innovation and Communication in Health and Life SciencesFree University of AmsterdamAmsterdamThe Netherlands
| | - Joske F. G. Bunders
- Athena Institute for Research on Innovation and Communication in Health and Life SciencesFree University of AmsterdamAmsterdamThe Netherlands
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Abstract
Attention deficit/hyperactivity disorder (ADHD) often persists into adolescence and has the same functional impairments as were present during childhood. Medications lessen ADHD symptoms yet do not reliably affect functioning. Thus, there exists a great need for psychosocial treatments in adolescents with ADHD. Nonetheless, relative to the vast literature that has been reported on children with ADHD, much less data have been reported about psychosocial interventions for adolescents with ADHD. Cognitive behavioral therapy interventions that are being used with adolescents rely more on traditional behavioral principles than cognitive therapy tenets.
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32
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Carpenter DM, Stover A, Slota C, Ayala GX, Yeatts K, Tudor G, Davis S, Williams D, Sleath B. An evaluation of physicians' engagement of children with asthma in treatment-related discussions. J Child Health Care 2014; 18:261-74. [PMID: 23818146 PMCID: PMC5379471 DOI: 10.1177/1367493513489780] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8-16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider-child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.
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Affiliation(s)
- Delesha M Carpenter
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Angela Stover
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine Slota
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Guadalupe X Ayala
- Graduate School of Public Health, San Diego State University, California, USA
| | - Karen Yeatts
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Maine, USA
| | | | - Dennis Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Betsy Sleath
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA Cecil G Sheps Center for Health Services Research, North Carolina, USA
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Krol M, Sixma H, Meerdink J, Wiersma H, Rademakers J. Exploring young patients’ perspectives on rehabilitation care: methods and challenges of organizing focus groups for children and adolescents. Child Care Health Dev 2014; 40:507-14. [PMID: 25028746 DOI: 10.1111/cch.12095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In research on quality of care, the experiences of children and (pre)adolescents are usually assessed by asking their parents. However, these young patients may have preferences of their own, and their experiences do not necessarily concur with those of their parents. Therefore, our research aimed to give young patients an opportunity to speak up for themselves. METHODS Focus group meetings and online focus groups were organized for two age groups (8–11 and 12–15 years) of young patients from two Dutch rehabilitation centres, with the use of a tailored interview technique. The feasibility and applicability of both types of focus groups were assessed. RESULTS For both types of focus groups, recruitment proved a major problem. The focus group meetings with (pre)adolescents proved both feasible and applicable in obtaining information regarding the preferences and experiences towards rehabilitation care. Regarding children's meetings, there were mixed results. The setting suited most of them, but some were more anxious. In general, online focus groups were less successful than expected for both age groups. CONCLUSIONS Possibilities for enhancing the recruitment rate should be considered, as the low participation rates limited generalizability of focus group results. The tailored design proved useful for obtaining relevant input from (pre)adolescents through meetings, but, especially for children, repeated meetings or other locations (e.g. at home) could be considered. This may make participants more at ease. For both age groups, the online focus groups proved far less useful, in terms of participation.
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Affiliation(s)
- M. Krol
- Patient Experiences and Evaluations; NIVEL; Utrecht The Netherlands
| | - H. Sixma
- Patient Experiences and Evaluations; NIVEL; Utrecht The Netherlands
| | | | - H. Wiersma
- LSR (National Organisation of Client Councils); Utrecht The Netherlands
| | - J. Rademakers
- Patient Experiences and Evaluations; NIVEL; Utrecht The Netherlands
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34
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Lipstein EA, Dodds CM, Lovell DJ, Denson LA, Britto MT. Making decisions about chronic disease treatment: a comparison of parents and their adolescent children. Health Expect 2014; 19:716-26. [PMID: 24889468 DOI: 10.1111/hex.12210] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare factors considered by parents to those considered by adolescents making decisions about chronic disease treatments. METHODS We conducted individual interviews with 15 parent-adolescent dyads in which the adolescent had either juvenile idiopathic arthritis or Crohn's disease. Questions focused on treatment decisions, with an emphasis on the factors that influenced each individual's preferences related to biologic therapies. A multidisciplinary team developed a coding structure. All interviews were coded by two people with disagreements resolved through discussion. We used content analysis and coding matrices to examine decision factors within and between parent-adolescent dyads. RESULTS Parents and adolescents both participated in decisions about treatment with biologic therapies but considered decision factors differently. In only half of cases did parents and adolescents agree on the factor that most influenced their decision. Although their decision factors often fell into similar categories (e.g. treatment risks, quality of life), in many cases the specifics varied between adolescents and their parents. Adolescents were more likely to focus on immediate treatment effects and quality of life while parents took a longer term view of the decision. Agreement within dyads was most consistent when a special circumstance influenced the treatment decision. CONCLUSIONS Differences regarding influential decision factors exist within parent-adolescent dyads. Continued research is needed to determine the extent to which such differences are due to individual preferences or to variations in the information available to each person. Future decision support interventions will need to address parents' and adolescents' potentially disparate views and information needs.
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Affiliation(s)
- Ellen A Lipstein
- Center for Innovation in Chronic Disease Care, Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cassandra M Dodds
- Center for Innovation in Chronic Disease Care, Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel J Lovell
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lee A Denson
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maria T Britto
- Center for Innovation in Chronic Disease Care, Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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35
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Bewtra M, Johnson FR. Assessing patient preferences for treatment options and process of care in inflammatory bowel disease: a critical review of quantitative data. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 6:241-55. [PMID: 24127239 DOI: 10.1007/s40271-013-0031-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Inflammatory bowel disease (IBD), consisting of both Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions of the intestinal tract. As there is no cure for either CD or UC, patients with these conditions face numerous treatment decisions regarding their disease. The aim of this review is to evaluate literature regarding quantitative studies of patient preferences in therapy for IBD with a focus on the emerging technique of stated preference and its application in IBD. Numerous simple survey-based studies have been performed evaluating IBD patients' preferences for medication frequency, mode of delivery, potential adverse events, etc., as well as variations in these preferences. These studies are limited, however, as they are purely descriptive in nature with limited quantitative information on the relative value of treatment alternatives. Time trade-off and standard-gamble studies have also been utilized to quantify patient utility for various treatment options or outcomes. However, these types of studies suffer from inaccurate assumptions regarding patient choice behavior. Stated preference is an emerging robust methodology increasingly utilized in health care that can determine the relative utility for a therapy option as well as its specific attributes (such as efficacy or adverse side effects). Stated preference techniques have begun to be applied in IBD and offer an innovative way of examining the numerous therapy options these patients and their providers face.
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Affiliation(s)
- Meenakshi Bewtra
- Department of Gastroenterology, University of Pennsylvania, 423 Guardian Drive, 724 Blockley Hall, Philadelphia, PA, 19104-6021, USA,
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36
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Abstract
: Anti-tumor necrosis factor agents are now considered to be a vital component of the treatment algorithm for pediatric inflammatory bowel disease. Despite the clear benefit of these agents and the realignment of treatment goals to achieve early mucosal healing, the decision to initiate therapy is often delayed due to uncertainties regarding risks and benefits. The purpose of this review was to summarize the currently available data regarding anti-tumor necrosis factor agents in pediatric inflammatory bowel disease. Specifically, we review their expected efficacy in both Crohn's disease and ulcerative colitis and the likelihood of side effects associated with these agents. In addition, we address the barriers physicians face when communicating these data and help to identify how pediatric patients and their parents can be more involved in a shared decision-making process. Through the creation of a new decision aid (Option Grid), we hope to allow for a more clear line of communication at the bedside when helping patients and parents make these difficult treatment decisions.
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37
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Kelly KP, Pyke-Grimm K, Stewart JL, Hinds PS. Hypothesis generation for childhood cancer communication research: results of a secondary analysis. West J Nurs Res 2013; 36:512-33. [PMID: 24159058 DOI: 10.1177/0193945913507487] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Secondary analysis of existing qualitative datasets offers an opportunity to efficiently use these difficult-to-collect data to generate hypotheses for future research and expand understanding of the phenomena under study. We conducted a retrospective interpretation of two qualitative datasets regarding childhood cancer treatment decision making to elaborate themes regarding parents' cancer communication (information sharing and involvement of their children in treatment decision making) that were not fully developed in the original analyses. We identified broad variability in parents' cancer communication that was not entirely dependent upon the age of their ill child. We were able to generate multiple hypotheses to help guide our future research.
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38
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Lipstein EA, Brinkman WB, Sage J, Lannon CM, Morgan DeWitt E. Understanding treatment decision making in juvenile idiopathic arthritis: a qualitative assessment. Pediatr Rheumatol Online J 2013; 11:34. [PMID: 24079577 PMCID: PMC3849714 DOI: 10.1186/1546-0096-11-34] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increase in therapeutic options for juvenile idiopathic arthritis (JIA) has added complexity to treatment decisions. Shared decision making has the potential to help providers and families work together to choose the best possible option for each patient from the array of choices. As part of a needs assessment, prior to design and implementation of shared decision making interventions, we conducted a qualitative assessment of clinicians' current approaches to treatment decision making in JIA. METHODS Pediatric rheumatology clinicians were recruited from 2 academic children's hospitals affiliated with a quality improvement learning network, using purposive and snowball sampling. Semi-structured interviews elicited how clinicians with prescribing authority (n = 10) interact with families to make treatment decisions. Interviews were audio-recorded and transcribed verbatim. A multi-disciplinary research team used content analysis to analyze the interview data.To validate data from individual interviews and enrich our understanding, we presented the interview results to pediatric rheumatology clinicians attending a learning network meeting (n = 24 from 12 children's hospitals). We then asked the clinicians questions to further identify and discuss areas of variation in the decision-making processes. RESULTS Clinicians described a decision-making process in which they, rather than the family or other care team members, consistently initiated treatment decisions. Initial treatment options presented to families generally reflected the clinician's preferred treatment approaches, which differed across clinicians. Clinicians used various methods to inform families about treatment options and tailor information according to perceptions of a family's information needs, level of comprehension or mood (e.g. anxiety). The attributes of medication presented to families fell into 4 categories: benefits, risks, logistics and family preferences. Clinicians typically included family members in the decision to initiate JIA treatment after limiting the options to fit the clinical situation and the clinician's own preferences. Family members' preferences were seen as more integral in the decision to stop treatment after symptom remission. CONCLUSIONS Decision making about initial JIA treatment appears to be largely driven by clinician preferences. Family preferences are more likely to be considered for treatment discontinuation. Opportunities exist to develop, test, and implement tools to facilitate shared decision making in pediatric rheumatology.
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Affiliation(s)
- Ellen A Lipstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - William B Brinkman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA,James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica Sage
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Carole M Lannon
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA,James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Esi Morgan DeWitt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA,James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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39
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Lipstein EA, Muething KA, Dodds CM, Britto MT. "I'm the one taking it": adolescent participation in chronic disease treatment decisions. J Adolesc Health 2013; 53:253-9. [PMID: 23561895 DOI: 10.1016/j.jadohealth.2013.02.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE To understand adolescents' roles and preferences in chronic disease treatment decisions, using biologic therapy decisions as an example. METHODS We conducted semistructured interviews with adolescents who have Crohn's disease (n = 7) or juvenile idiopathic arthritis (n = 8). Questions focused on biologic therapy decisions, including who participated, preferred roles, and factors considered in the decision. We used pie charts to help teens describe the division of decisional responsibility. We open-coded the initial interviews to develop a coding structure. Interviews then were coded by two people, with disagreements resolved through discussion. Interviews were analyzed using content analysis. RESULTS Nearly all adolescents participated in the decision about biologic therapy. Roles varied from telling parents about specific symptoms to having the final say in the decision. In addition to discussing their own roles, adolescents identified specific decision-making roles for both parents and physicians. Most factors that influenced adolescents' decision-making related to their quality of life, such as the desire to feel better, concerns about painful injections, and the time needed for treatment. Some adolescents did consider potential side effects and the expected treatment efficacy. Most adolescents were satisfied with how the decision was made, but given a choice would have preferred a different role in the decision. CONCLUSION Adolescents with chronic disease wish to be involved in treatment decision making, but also seek the involvement of parents and physicians. Parents and providers can assist by providing adolescents with relevant information and by helping teens develop the skills necessary for future medical decision-making.
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Affiliation(s)
- Ellen A Lipstein
- Center for Innovation in Chronic Disease Care, Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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40
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Scherer DG, Brody JL, Annett RD, Turner C, Dalen J, Yoon Y. Empirically-derived Knowledge on Adolescent Assent to Pediatric Biomedical Research. AJOB PRIMARY RESEARCH 2013; 4:15-26. [PMID: 23914304 PMCID: PMC3728675 DOI: 10.1080/21507716.2013.806967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND There has been a recent growth in empirical research on assent with pediatric populations, due in part, to the demand for increased participation of this population in biomedical research. Despite methodological limitations, studies of adolescent capacities to assent have advanced and identified a number of salient psychological and social variables that are key to understanding assent. METHODS The authors review a subsection of the empirical literature on adolescent assent focusing primarily on asthma and cancer therapeutic research; adolescent competencies to assent to these studies; perceptions of protocol risk and benefit; the affects of various social context variables on adolescent research participation decision making; and the inter-relatedness of these psychological and social factors. RESULTS Contemporary studies of assent, using multivariate methods and updated approaches to statistical modeling, have revealed the importance of studying the intercorrelation between adolescents' psychological capacities and their ability to employ these capacities in family and medical decision-making contexts. Understanding these dynamic relationships will enable researchers and ethicists to develop assent procedures that respect the authority of parents, while at the same time accord adolescents appropriate decision-making autonomy. CONCLUSIONS Reviews of empirical literature on the assent process reveal that adolescents possess varying capacities for biomedical research participation decision making depending on their maturity and the social context in which the decision is made. The relationship between adolescents and physician-investigators can be used to attenuate concerns about research protocols and clarify risk and benefit information so adolescents, in concert with their families, can make the most informed and ethical decisions. Future assent researchers will be better able to navigate the complicated interplay of contextual and developmental factors and develop the empirical bases for research enrollment protocols that will support increased involvement of adolescents in biomedical research.
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Affiliation(s)
- David G. Scherer
- Department of Psychology, University of Massachusetts Amherst, 610 Tobin Hall, 135 Hicks Way, Amherst, MA 01003
| | - Janet L. Brody
- Center for Family and Adolescent Research, Oregon Research Institute
| | - Robert D. Annett
- Department of Pediatrics, University of New Mexico Health Sciences Center
| | - Charles Turner
- Center for Family and Adolescent Research, Oregon Research Institute
| | - Jeanne Dalen
- Center for Family and Adolescent Research, Oregon Research Institute
| | - Yesel Yoon
- Department of Psychology, University of Massachusetts Amherst
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41
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Nelson PA, Caress AL, Glenny AM, Kirk SA. 'Doing the "right" thing': how parents experience and manage decision-making for children's 'normalising' surgeries. Soc Sci Med 2012; 74:796-804. [PMID: 22305806 DOI: 10.1016/j.socscimed.2011.11.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/09/2011] [Accepted: 11/14/2011] [Indexed: 11/30/2022]
Abstract
Using cleft lip and palate as an exemplar, this article examines parents' decision-making for children in the context of elective treatments which aim to 'normalise' a child's function, appearance, communication or identity. Using purposive and theoretical sampling, 35 parents with children from infancy to young adulthood were recruited through a specialist cleft centre in England. Parents were interviewed in-depth between 2006 and 2008 about their beliefs and motivations in relation to treatment decision-making in this context. A grounded theory approach was used to analyse the data. Findings revealed a core category, 'doing the "right" thing', that encapsulated parents' main concern in relation to their children's treatment and highlighted several emotional, social and cultural considerations underpinning their decision-making stance. Parents fulfilled a perceived 'moral' obligation to be 'good' parents by pursuing the 'normalising' treatments, particularly surgeries, made available to their children. Such treatments were viewed as a way of facilitating their child's social inclusion and helping them reach their full potential. In order to enable their continued pursuit of treatments over the long-term, parents also constructed specialist practitioners as highly competent and particularly trustworthy. This article captures the complexities involved in parents' decision-making for children's elective 'normalising' treatments, where both functional and appearance-related concerns are involved. It suggests that social norms about parenting, physical appearance and healthcare practitioner power may significantly shape decision-making in this context, so that such choices may be viewed primarily as 'moral' rather than social. Services could support parents with such challenges, by gauging their needs for information about surgery and its likely outcomes and providing emotional/decisional support to consider all available options.
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Affiliation(s)
- Pauline Anne Nelson
- University of Manchester, Health Sciences, School of Community Based Medicine, 5th Floor, Williamson Building, Oxford Road, Manchester M13 9PL, United Kingdom.
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Nelson P, Glenny AM, Kirk S, Caress AL. Parents' experiences of caring for a child with a cleft lip and/or palate: a review of the literature. Child Care Health Dev 2012; 38:6-20. [PMID: 21623872 DOI: 10.1111/j.1365-2214.2011.01244.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review brings together for the first time the existing quantitative and qualitative research evidence about the experiences of parents caring for a child with a cleft. It summarizes salient themes on the emotional, social and service-related experiences of parents and critiques the literature to date, comparing it with wider, selected literature from the field of children's long-term conditions, including disability. The review suggests that there are similarities and differences between the literatures, in terms of research focus and approach. Similarities are found across children's conditions in the perspectives of parents on emotional, social and service-related aspects, although much of the cleft literature is focused on the early stages of children's lives. However, the quality of cleft research to date about parents' experiences has also been variable, with a narrow emphasis on cross-sectional, deficit-orientated psychological approaches focused mainly on mothers. Despite a substantial literature, little qualitative research has examined parents' perspectives in-depth, particularly about their child's treatment journey. This contrasts with the wider children's literature, which has traditionally drawn not only on psychological approaches but also on the broader perspectives of sociology, social policy, nursing and health services research, using both qualitative and quantitative methods, often in integrated ways. Such approaches have been able to highlight a greater range of experiences from both mothers and fathers, about caring for a child with a long-term condition and views about treatment. The review identifies a lack of comparable research in the cleft field to examine parents' experiences and needs at different stages of their children's lives. Above all, research is needed to investigate how both mothers and fathers might experience the long-term and complex treatment journey as children become older and to elicit their views about decision making for cleft treatments, particularly elective surgeries.
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Affiliation(s)
- P Nelson
- School of Community Based Medicine, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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Lipstein EA, Brinkman WB, Britto MT. What is known about parents' treatment decisions? A narrative review of pediatric decision making. Med Decis Making 2011; 32:246-58. [PMID: 21969136 DOI: 10.1177/0272989x11421528] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. OBJECTIVE To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. METHODS Articles presenting original research on parent decision making were identified from MEDLINE (1966-6/2011), using the terms "decision making," "parent," and "child." We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. RESULTS We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents' preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child's health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. CONCLUSIONS Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.
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Affiliation(s)
- Ellen A Lipstein
- Division of Adolescent Medicine (EAL, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Center for Innovation in Chronic Disease Care (EAL, WBB, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,University of Cincinnati College of Medicine, Cincinnati, OH (EAL, WBB, MTB)
| | - William B Brinkman
- Center for Innovation in Chronic Disease Care (EAL, WBB, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Division of General and Community Pediatrics (WBB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,University of Cincinnati College of Medicine, Cincinnati, OH (EAL, WBB, MTB)
| | - Maria T Britto
- Division of Adolescent Medicine (EAL, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Center for Innovation in Chronic Disease Care (EAL, WBB, MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Anderson Center for Health Systems Excellence (MTB) Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,University of Cincinnati College of Medicine, Cincinnati, OH (EAL, WBB, MTB)
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Quinn GP, Murphy D, Knapp C, Stearsman DK, Bradley-Klug KL, Sawczyn K, Clayman ML. Who decides? Decision making and fertility preservation in teens with cancer: a review of the literature. J Adolesc Health 2011; 49:337-46. [PMID: 21939862 PMCID: PMC3179606 DOI: 10.1016/j.jadohealth.2011.01.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 12/03/2010] [Accepted: 01/09/2011] [Indexed: 01/15/2023]
Abstract
PURPOSE The knowledge that cancer treatment may impair fertility in pediatric populations is an emerging aspect of quality of life in this population. However, decision making and use of fertility preservation (FP) among adolescent cancer patients and their families has not been well studied. This review summarizes the available published data on aspects of decision making and FP in adolescent cancer patients. METHODS An electronic search was performed to identify peer-reviewed studies published between 1999 and 2009 using key Medical Subject Heading terms and inclusion criteria. Inclusion criteria limited eligible studies to those that focused on adolescent decision making in cancer treatment or FP, fertility concerns in pediatric oncology, capacity for decision making, and health decision making in pediatrics. Studies that did not meet at least one of these criteria were excluded. RESULTS A total of 29 articles were reviewed and summarized. Three categories of results were seen: a focus on adolescent decision making in oncology, decision making in chronic illness, and decision making in cancer-related infertility and preservation. CONCLUSION Most of the studies showed that adolescents have a strong desire to participate in decisions related to their cancer treatment and many have concerns regarding their future fertility, although barriers often prevented these discussions. More research is needed to explore the role of teenagers and parents in decisions about fertility in relation to cancer treatment.
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Affiliation(s)
- Gwendolyn P Quinn
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida 33612, USA.
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van Staa A, Jedeloo S, van der Stege H. "What we want": chronically ill adolescents' preferences and priorities for improving health care. Patient Prefer Adherence 2011; 5:291-305. [PMID: 21792301 PMCID: PMC3140311 DOI: 10.2147/ppa.s17184] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As important users of health care, adolescents with chronic conditions deserve to be consulted about their experiences and expectations. This study aimed to explore chronically ill adolescents' preferences regarding providers' qualities, and outpatient and inpatient care. Furthermore, suggestions for improvement of service delivery were collected. METHODS This research was a sequential mixed methods study in adolescents aged 12-19 years with various chronic conditions treated in a university children's hospital. Methods comprised 31 face-to-face interviews at home, a hospital-based peer research project in which nine adolescents interviewed 34 fellow patients, and a web-based questionnaire (n = 990). Emerging qualitative themes were transformed into questionnaire items. RESULTS Having "a feeling of trust" and "voice and choice" in the hospital were central to these adolescents. Regarding providers' qualities, "being an expert" and "being trustworthy and honest" were ranked highest, followed by "being caring and understanding", "listening and showing respect", and "being focused on me". Regarding outpatient consultations, preferences were ranked as follows: "answering all questions"; "attending to my and my parents' needs"; and "clear communication", while "limited waiting times" and "attractive outpatient surroundings" scored lowest. Regarding hospitalization, adolescents most preferred to "avoid pain and discomfort", "keep in touch with home", and "be entertained", while "being hospitalized with peers" and "being heard" were least important. Regarding priorities for improvement, 52% of the respondents felt that more attention should be paid to older children, followed by enabling more contact with family and friends (45%), shorter waiting times (43%), and more activities to meet fellow patients (35%). CONCLUSION Adolescents prefer technically competent providers, who are honest and trustworthy, and attend to their needs. As they gradually grow out of the pediatric environment, they desire staff attitudes to become less childish and more age-appropriate, and welcome being treated as an equal partner in care. Health care professionals should inquire into preferences and adjust their communication style accordingly.
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Affiliation(s)
- AnneLoes van Staa
- Expertise Center Transitions of Care, Rotterdam University
- Institute of Health Policy and Management, Erasmus University Rotterdam
- Correspondence: AnneLoes van Staa, Erasmus University Rotterdam, Institute of Health Policy and Management, Office W J8-31, PO Box 1738, 3000 DR, Rotterdam, The Netherlands, Tel +31 10 408 8697, Fax +31 10 408 9094, Email
| | - Susan Jedeloo
- Expertise Center Transitions of Care, Rotterdam University
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“I Want to Live, Until I don't Want to Live Anymore”: Involving Children With Life-Threatening and Life-Shortening Illnesses in Decision Making About Care and Treatment. Nurs Clin North Am 2010; 45:329-43. [DOI: 10.1016/j.cnur.2010.03.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Croom A, Wiebe DJ, Berg CA, Lindsay R, Donaldson D, Foster C, Murray M, Swinyard MT. Adolescent and parent perceptions of patient-centered communication while managing type 1 diabetes. J Pediatr Psychol 2010; 36:206-15. [PMID: 20719752 DOI: 10.1093/jpepsy/jsq072] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To examine whether adolescents' and parents' perceptions of patient-centered communication (PCC) with the physician may be associated with aspects of patient empowerment (e.g., perceptions of competence) and diabetes management (i.e., adherence and HbA1c). METHODS One hundred and ninety adolescents with type 1 diabetes and their parents rated perceptions of PCC following a clinic visit and completed measures of competence, illness perceptions, self-efficacy, and adherence in the weeks following their clinic visit, and again 6 months later. Metabolic control was indexed from medical records. RESULTS Higher levels of PCC with physicians were associated cross-sectionally and longitudinally with greater perceptions of control and competence for both adolescents and parents. Mediation analyses indicated that PCC was indirectly related to subsequent adherence and metabolic control through perceptions of the adolescent's competence in diabetes management. CONCLUSIONS Perceptions of PCC with healthcare providers may empower adolescents and parents in their diabetes management.
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Affiliation(s)
- Andrea Croom
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA
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Preferences for health care and self-management among Dutch adolescents with chronic conditions: A Q-methodological investigation. Int J Nurs Stud 2010; 47:593-603. [DOI: 10.1016/j.ijnurstu.2009.10.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 10/06/2009] [Accepted: 10/10/2009] [Indexed: 11/18/2022]
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van Staa A, Jedeloo S, Latour JM, Trappenburg MJ. Exciting but exhausting: experiences with participatory research with chronically ill adolescents. Health Expect 2010; 13:95-107. [PMID: 19682098 PMCID: PMC5060512 DOI: 10.1111/j.1369-7625.2009.00574.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Adolescents with chronic conditions are major users of paediatric hospitals, but seldom participate in the evaluation of services or in research. Little is known about the usefulness of the participatory approach in adolescent health research. OBJECTIVE To evaluate the feasibility, benefits and limitations of a participatory research (PR) project involving chronically ill adolescents as co-researchers. DESIGN SETTING AND PARTICIPANTS Nine adolescents, aged 15-17 years, acted as co-researchers in a hospital-based PR project. They co-developed an interview protocol and during a disco party held for this purpose interviewed each other and 25 fellow patients (12-19 years). They provided advice on the draft report and participated in the dissemination of the results, but were not involved in the design of the project or analysis of results. RESULTS Involving adolescents in participatory health research was feasible and appreciated by researchers and youth alike, but had its drawbacks too. The peer-research attracted few participants, the interviews lacked depth and did not yield substantial new insights. Maintaining a high level of participation of the chronically ill co-researchers also proved difficult. CONCLUSIONS Adolescents with chronic conditions like to have a say in the design and evaluation of hospital services. But their participation as co-researchers demands ample resources from all parties involved without automatically improving research quality. PR does not seem the most effective and efficient way to make services more responsive. We therefore recommend further exploration of other creative and sustainable ways for involving youth in health-care service development and innovation.
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Affiliation(s)
- Anneloes van Staa
- Expertise Centre Transitions of Care, Rotterdam University, Rotterdam, The Netherlands.
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