1
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West KB, Plevinsky JM, Amaral S, Laskin B, Lefkowitz DS. Predicting psychosocial risk in pediatric kidney transplantation: An exploratory cluster analysis of a revised Pediatric Transplant Rating Instrument. Pediatr Transplant 2023; 27:e14454. [PMID: 36518059 DOI: 10.1111/petr.14454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Pediatric Transplant Rating Instrument (P-TRI) is a 17-item scale developed to assess psychosocial risk factors for poor outcomes after solid organ transplantation. Research has identified the limitations of the original instrument and proposed revisions to improve clinical utility. This project examined patterns of risk in children being evaluated for kidney transplant using a revised P-TRI. METHODS A multidisciplinary kidney transplant team revised the P-TRI. A social worker and a psychologist collaboratively completed the modified instrument for 37 children after the psychosocial pretransplant evaluation. Electronic medical records were reviewed for transplant status (transplanted, active waitlist, inactive) 1 year later. Exploratory cluster analyses and chi-square tests examined patterns of risk and correlates with cluster membership. RESULTS Three clusters were identified. The high-risk group (29.7%) had difficulties with medication and appointment adherence, strained relationships with the medical team, and the presence of parent psychiatric history. The medium-risk group (35.1%) had difficulties with parent knowledge, financial strain, and risk factors for medication nonadherence. The low-risk group (35.1%) demonstrated no difficulties with adherence or financial strain. Clusters were prospectively associated with transplant status, such that those in the high-risk group were less likely to be transplanted within 1 year post-evaluation. CONCLUSIONS The revised P-TRI demonstrated good construct validity as risk level appeared to be associated with transplant listing status 1 year post-evaluation. These results suggest that standardized pretransplant psychosocial risk assessment tools may have value in optimizing transplant access if they can be paired with targeted, multidisciplinary interventions to address concerns early in the transplant process.
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Affiliation(s)
- Kara B West
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jill M Plevinsky
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sandra Amaral
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin Laskin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Debra S Lefkowitz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Sakhuja S, Himes R, Carreker C, Guffey D, Beer S, Amin M, Hiremath G, Mysore K. Impact of psychosocial factors on medication level variability index and outcomes in pediatric liver transplant recipients. Pediatr Transplant 2023; 27:e14425. [PMID: 36325588 DOI: 10.1111/petr.14425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/20/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Caregivers play an important role in maintaining a functioning graft after pediatric liver transplantation. Therefore, the psychosocial factors of both patients and caregivers can have a critical impact on transplant outcomes. Appropriate assessment and recognition of these factors pre-transplantation may allow transplant teams to better define the needs of pediatric organ recipients and develop specific countermeasures, which may then contribute toward improving transplant outcomes. METHODS We studied 136 pediatric LT recipients followed at Texas Children's Hospital. Licensed social workers conducted comprehensive pre-transplant assessments on each patient, consisting of 22 psychosocial variables that were thought to impact adherence, which were reviewed during our study period. Non-adherence was determined using the MLVI for up to 4 years after transplantation. Biopsy-confirmed rejection episodes were assessed in the first 3 years after liver transplantation. RESULTS Factors significantly associated with non-adherence (defined as MLVI >2) included parental age and parental education level at assessment, type of insurance, and household income. The number of ACR episodes trended higher in patients with non-adherence, and these patients had a higher number of moderate to severe rejection episodes but this trend was not statistically significant. CONCLUSIONS Psychosocial characteristics such as parental age, education level, insurance, and household income may contribute significantly to suboptimal adherence to medications after transplantation. Identification of these psychosocial factors and early intervention is essential to the success and equitable care of our pediatric LT recipients.
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Affiliation(s)
- Shruti Sakhuja
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Ryan Himes
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.,Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Ochsner Health, New Orleans, Louisiana, USA
| | - Colleen Carreker
- Department of Patient and Family Services, Texas Children's Hospital, Houston, Texas, USA
| | - Danielle Guffey
- Institution for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Stacey Beer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Mansi Amin
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.,Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Girish Hiremath
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.,Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Vanderbilt Children's, Nashville, Tennessee, USA
| | - Krupa Mysore
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Robertson T, Ahola Kohut S, Telfer H, Seifert-Hansen M, Mitchell J, Anthony SJ. Mindfulness-based retreat for mothers of paediatric heart transplant recipients: protocol for a pilot intervention study. BMJ Open 2022; 12:e060461. [PMID: 35803637 PMCID: PMC9272107 DOI: 10.1136/bmjopen-2021-060461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mothers are often the primary caregivers for children requiring heart transplantation. Given that a mother's ability to successfully cope with the demands of her caregiving role may be predictive of positive familial psychosocial outcomes, it is critical that maternal coping is assessed and supported in paediatric healthcare. Mindfulness-based programmes are proposed as one intervention that may enhance quality of life, improve distress tolerance and coping and reduce social isolation in caregiving populations. This pilot study aims to investigate: (1) the implementation success of a mindfulness-based retreat (MBR), and (2) the effectiveness of a MBR at improving quality of life, distress tolerance, coping and perceived social support for mothers of paediatric heart transplant recipients. METHODS AND ANALYSIS A convergent parallel, mixed-method design is proposed for this pilot, exploratory study. Twenty mothers will participate in this pilot MBR held at a resort in Ontario, Canada. Quantitative data will be obtained using five standardised instruments completed at three time points: (T1) 24-hours prior to the intervention, (T2) immediately on completion of the intervention, and (T3) three months post-intervention. Qualitative data will be collected from all participants both through semi-structured focus groups at T2 and individual telephone interviews at T3. Focus groups and individual interviews will be transcribed verbatim for thematic analysis. Quantitative and qualitative data will be merged and compared during interpretation to ensure that the intervention implementation and effectiveness of the MBR retreat are described with comprehensive accuracy. The primary outcomes will be feasibility in relation to implementation effectiveness and participants' perception of social support for efficacy of the MBR intervention. ETHICS AND DISSEMINATION This study received Institutional Research Ethics Board approval from The Hospital for Sick Children (Number: 1000064719). Informed consent will be obtained prior to participant enrolment. Findings will be disseminated via conference presentations and submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Taylor Robertson
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sara Ahola Kohut
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Heather Telfer
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mirna Seifert-Hansen
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joanna Mitchell
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Samantha J Anthony
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Abstract
OBJECTIVES The aim of the study was to determine quality of life (QoL), stress, and anxiety levels in parents of children with biliary atresia (BA), and to assess factors associated with parental QoL. METHODS Parents of children (6-16 years) with BA were included in this cross-sectional study. We used validated questionnaires to assess parental QoL, stress, and anxiety levels. We compared the results with reference data from the general population and determined associated factors using generalized linear mixed model analysis. Results are given as mean ± SD or median [min-max]. RESULTS We included 61 parents of 39 children (aged 11 ± 3 years). Thirty-one children (79%) had undergone a liver transplantation (LTx). Parents reported reduced family activities (88 [8-100] vs 95 [30-100], P = 0.002) and more emotional worry (83 [17-100] vs 92 [95-100], P < 0.001) compared with reference data, but a stronger family cohesion (85 [30-100] vs 60 [30-100], P = 0.05). Scores on parental QoL, anxiety and stress were similar to reference data. Fathers (16.0 [11-19]) and mothers (15.4 ± 1.4) scored higher on the psychological domain compared with reference data (vs 14.7 ± 2.2, P < 0.01). There was no significant difference in QoL of parents with children with native liver or those who had undergone LTx. Older age and high anxiety trait in parents were adversely associated with physical QoL. Household income below &OV0556;35 000/year and high anxiety trait were adversely associated with environmental QoL. CONCLUSIONS QoL in parents of school-aged children with BA appears to be unaffected. Parents with high-anxiety personality trait, older age, and low household income are at increased risk of impaired QoL.
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Kobylianskii A, Jegathesan T, Young E, Fung K, Huber J, Minhas RS. Experiences of Inner-City Fathers of Children With Chronic Illness. Clin Pediatr (Phila) 2018; 57:792-801. [PMID: 28969464 DOI: 10.1177/0009922817734361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aim to explore the experiences of fathers from inner-city families caring for children affected by chronic health conditions or disabilities. A systematic scoping review was conducted using the Arskey and O'Malley framework. Fourteen of the 5114 articles were included in the full review and were qualitatively evaluated in terms of stressors, resources, perception, coping, and adaptation according to the Double ABCX model. Stressors included financial strain and health care access barriers. Resources ranging from immediate to extended family members depended on ethnicity. Fathers' perceptions of their primary caregiver roles depended on ethnicity in the context of cultural gender norms. While inner-city fathers desired information about their children's health, some were uncomfortable asking physicians. They had a higher risk for coping difficulties and maladaptation, including depression. We highlight a need for pediatricians to advocate for additional resources to provide comprehensive care for inner-city fathers caring for their children with chronic health conditions or disabilities.
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Affiliation(s)
- Anna Kobylianskii
- 1 University of Toronto, Toronto, Ontario, Canada.,2 St Michael's Hospital, Toronto, Ontario, Canada
| | - Thivia Jegathesan
- 1 University of Toronto, Toronto, Ontario, Canada.,2 St Michael's Hospital, Toronto, Ontario, Canada
| | - Elizabeth Young
- 1 University of Toronto, Toronto, Ontario, Canada.,2 St Michael's Hospital, Toronto, Ontario, Canada
| | - Kimmy Fung
- 2 St Michael's Hospital, Toronto, Ontario, Canada
| | - Joelene Huber
- 1 University of Toronto, Toronto, Ontario, Canada.,2 St Michael's Hospital, Toronto, Ontario, Canada.,3 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ripudaman S Minhas
- 1 University of Toronto, Toronto, Ontario, Canada.,2 St Michael's Hospital, Toronto, Ontario, Canada
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6
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Tillery R, Joffe NE, Mara CA, Davies SM, Pai ALH. Longitudinal examination of family efficacy following pediatric stem cell transplant. Psychooncology 2018; 27:1915-1921. [PMID: 29682835 DOI: 10.1002/pon.4741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Pediatric stem cell transplant (pSCT) is emotionally demanding for families. Yet, we know little of how the family unit responds to the adversity of pSCT within the first year after transplant. Family efficacy, an indicator of family resilience, is linked to positive parent, child, and family adjustment. Better understanding the factors that promote family efficacy during this difficult time could inform modifiable intervention targets and improve child and parent adjustment. The primary objectives were to examine patterns of family efficacy beliefs and identify factors that promote or hinder family efficacy. METHODS Ninety caregivers (71% white, 7% black, 3% Hispanic, 4% Asian, 14% multiple ethnicities) of children receiving pSCT completed demographic forms, the Psychosocial Assessment Tool, and the Filial Parental and Collective Family Efficacy Beliefs scale prior to the family's discharge, and 1, 3, 6, and 9 months post-discharge. Latent growth curve modeling was used to examine family efficacy across time. Parent, child, and sibling distress, social support, and demographic factors served as predictors. RESULTS Latent growth curve modeling demonstrated that family efficacy was stable for 9 months post pSCT discharge. Social support was positively related to family efficacy beliefs. No other variables predicted family efficacy. CONCLUSION Most families perceive themselves as resilient following pSCT. Social relationships and support are critical in maintaining a family's sense of efficacy during the arduous pSCT course.
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Affiliation(s)
- Rachel Tillery
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Naomi E Joffe
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Constance A Mara
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stella M Davies
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Bone Marrow Transplant and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ahna L H Pai
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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7
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Wang Y, Wan Q, Huang Z, Huang L, Kong F. Psychometric Properties of Multi-Dimensional Scale of Perceived Social Support in Chinese Parents of Children with Cerebral Palsy. Front Psychol 2017; 8:2020. [PMID: 29209254 PMCID: PMC5702313 DOI: 10.3389/fpsyg.2017.02020] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/06/2017] [Indexed: 12/01/2022] Open
Abstract
The Multi-dimensional Scale of Perceived Social Support (MSPSS) is one of the most extensively used instruments to assess social support. The purpose of this research was to test the reliability, factorial validity, concurrent validity and measurement invariance across gender groups of the MSPSS in Chinese parents of children with cerebral palsy. A total of 487 participants aged 21-55 years were recruited to complete the Chinese MSPSS and Parenting Stress Index-Short Form (PSI-SF). Composite reliability was calculated as the internal consistency of the Chinese MSPSS and a (multi-group) confirmatory factor analysis (CFA) was conducted to test the factorial validity and measurement invariance across gender. And Pearson correlations were calculated to test the relationships between MSPSS and PSI-SF. The Chinese MSPSS had satisfactory internal reliability with composite reliability values of more than 0.7. The CFA indicated that the original three-factor model was replicated in this specific population. Importantly, the results of the multi-group CFA demonstrated that configural, metric, and scalar invariance across gender groups was supported. In addition, all the three subscales of MSPSS were significant related with PSI-SF. These findings suggest that the Chinese MSPSS is a reliable and valid tool for assessing social support and can generally be utilized across sex in the parents of children with cerebral palsy.
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Affiliation(s)
- Yongli Wang
- Education and Rehabilitation Department, Faculty of Education, East China Normal University, Shanghai, China
| | - Qin Wan
- Education and Rehabilitation Department, Faculty of Education, East China Normal University, Shanghai, China
| | - Zhaoming Huang
- Education and Rehabilitation Department, Faculty of Education, East China Normal University, Shanghai, China
| | - Li Huang
- Rehabilitation Department, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Feng Kong
- School of Psychology, Shanxi Normal University, Xi’an, China
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Cousino MK, Rea KE, Schumacher KR, Magee JC, Fredericks EM. A systematic review of parent and family functioning in pediatric solid organ transplant populations. Pediatr Transplant 2017; 21. [PMID: 28181361 DOI: 10.1111/petr.12900] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 12/23/2022]
Abstract
The process of pediatric solid organ transplantation (SOT) places new and increased stressors on patients and family members. Measures of family functioning may predict psychological and health outcomes for pediatric patients and their families, and provide opportunity for targeted intervention. This systematic review investigated parent and family functioning and factors associated with poorer functioning in the pediatric SOT population. Thirty-seven studies were identified and reviewed. Studies featured a range of organ populations (eg, heart, liver, kidney, lung, intestine) at various stages in the transplant process. Findings highlighted that parents of pediatric SOT populations commonly report increased stress and mental health symptoms, including posttraumatic stress disorder. Pediatric SOT is also associated with increased family stress and burden throughout the transplant process. Measures of parent and family functioning were associated with several important health-related factors, such as medication adherence, readiness for discharge, and number of hospitalizations. Overall, findings suggest that family stress and burden persists post-transplant, and parent and family functioning is associated with health-related factors in SOT, highlighting family-level functioning as an important target for future intervention.
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Affiliation(s)
- Melissa K Cousino
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - Kelly E Rea
- University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - Kurt R Schumacher
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - John C Magee
- University of Michigan Transplant Center, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
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9
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Sahin Y, Virit O, Demir B. DEPRESSION AND ANXIETY IN PARENTS OF CHILDREN WHO ARE CANDIDATES FOR LIVER TRANSPLANTATION. ARQUIVOS DE GASTROENTEROLOGIA 2017; 53:25-30. [PMID: 27281501 DOI: 10.1590/s0004-28032016000100006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 12/02/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The primary stress factor for families in the pre-transplant period is reported as the waiting time for suitable organs, leading to anxiety, despair, and distress. OBJECTIVE We investigated the psychosocial factors, anxiety and depression, in the parents of children who are candidates for liver transplantation. METHODS Thirty-five pediatric liver transplantation candidates and their 38 parents, from February to August 2014, were included. Participants were evaluated using the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression Scale (CGI). RESULTS We found that a significant number of parents (n=25, 65.7%) were diagnosed with clinical psychiatric disease: 18.4% (n=7) with depression and 47.3% (n=18) with anxiety disorders. There was a significant difference in the examination scores of parents between genders (P <0.05). There was also a significant difference in CGI and HAM-D scores of parents relative to the history and presence of liver disease (P <0.05). CONCLUSION The rate of these disorders was high in relation to the prevalence of depression and anxiety disorders in the community reported in the literature. Therefore, it is necessary to evaluate psychosocial factors of parents of all transplant candidate children as a part of routine care so that the high-risk to family members and to enable early intervention.
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Affiliation(s)
- Yasin Sahin
- Department of Pediatric Gastroenterology-Hepatology and Nutrition, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey;, Istanbul University, Department of Pediatric Gastroenterology-Hepatology and Nutrition, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul , Turkey
| | - Osman Virit
- Department of Psychiatry, Faculty of Medicine, Gaziantep University, Istanbul, Turkey., Gaziantep University, Department of Psychiatry, Faculty of Medicine, Gaziantep University, Istanbul , Turkey
| | - Bahadir Demir
- Department of Psychiatry, Faculty of Medicine, Gaziantep University, Istanbul, Turkey., Gaziantep University, Department of Psychiatry, Faculty of Medicine, Gaziantep University, Istanbul , Turkey
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10
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Eaton CK, Lee JL, Loiselle KA, Reed-Knight B, Mee LL, Gutierrez-Colina AM, Blount RL. Pretransplant patient, parent, and family psychosocial functioning varies by organ type and patient age. Pediatr Transplant 2016; 20:1137-1147. [PMID: 27670949 DOI: 10.1111/petr.12826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
Abstract
The goal of this study was to compare pretransplant patient HRQOL, parent psychological functioning, and the impact of the patient's ongoing illness on the family between organ types (ie, kidney, liver, heart) and age-groups (ie, children, AYAs). The sample included 80 pediatric patients with end-stage organ disease who were evaluated for transplantation and their parents. Parents completed self- and proxy reports at patients' pretransplant evaluations. Results indicated that patients evaluated for heart transplants consistently had lower HRQOL and their parents had greater psychological distress compared to the kidney and liver groups. Within the heart group, parents and families of children (<12 years old) experienced significantly more distress and impact of the patient's illness on the family compared to those of AYAs (≥12 years old). Pediatric patients awaiting heart transplants, particularly younger children, and their parents and families may have greater psychosocial needs compared to patients awaiting kidney or liver transplants.
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Affiliation(s)
- Cyd K Eaton
- Psychology Department, University of Georgia, Athens, GA, USA
| | - Jennifer L Lee
- Children's Healthcare of Atlanta/Emory University School of Medicine, Athens, GA, USA
| | - Kristin A Loiselle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Athens, GA, USA
| | - Bonney Reed-Knight
- Children's Healthcare of Atlanta/Emory University School of Medicine, Athens, GA, USA
| | - Laura L Mee
- Children's Healthcare of Atlanta/Emory University School of Medicine, Athens, GA, USA
| | | | - Ronald L Blount
- Psychology Department, University of Georgia, Athens, GA, USA
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11
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Lim CS, Gowey MA, Silverstein J, Dumont-Driscoll M, Janicke DM. Depressive Symptoms, Ethnic Identity, and Health-Related Quality of Life in Obese Youth. J Pediatr Psychol 2015; 41:441-52. [DOI: 10.1093/jpepsy/jsv014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 02/04/2015] [Indexed: 11/12/2022] Open
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12
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Kaller T, Petersen I, Petermann F, Fischer L, Grabhorn E, Schulz KH. Family strain and its relation to psychosocial dysfunction in children and adolescents after liver transplantation. Pediatr Transplant 2014; 18:851-9. [PMID: 25307019 DOI: 10.1111/petr.12367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 12/01/2022]
Abstract
Parental functioning is essential to children's development. Therefore, this cross-sectional single-center study examined the prevalence of family strain in 181 parents and its associations to psychosocial functioning in their children after LT. Median age at LT was one yr. Mean time elapsed since LT was 5.8 yr. The IFS, and the SDQ were applied to parents. Family strain in the present sample was comparable to that in the German normative group of families with a chronically ill or disabled child, but families of LT recipients showed a significantly higher financial impact, impact on coping, and impact on siblings (p < 0.001). Younger age of patients at survey, a more severe clinical course, child's restrictions, and financial losses following LT were determined as significant predictors of family strain (R(2) = 0.42). Parents reported less family strain after living-related compared with deceased donation. Family strain was significantly correlated to psychosocial dysfunction in children post-LT. Present findings demonstrate a risk of maladjustment to the post-LT condition in families. They emphasize the importance of psychological assessment of parents and patients during transplant and follow-up to ensure the best achievable long-term outcome of patients.
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Affiliation(s)
- T Kaller
- Center of Clinical Psychology and Rehabilitation, University Bremen, Bremen, Germany
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13
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Adams J, Evangeli M, Lunnon-Wood T, Burch M. Restriction and dependence to autonomy and freedom: transformation in adolescent heart transplant recipients. Pediatr Transplant 2014; 18:637-50. [PMID: 24923539 DOI: 10.1111/petr.12287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 11/30/2022]
Abstract
The process of heart transplantation poses numerous challenges and adaptive tasks for paediatric patients and their families. Few studies have examined how the experience of transplant interacts with developmental transitions such as adolescence, a period of significant change, and adjustment in itself. We explored adolescent heart transplant recipients' and their parents' experience of transplant from the point at which their heart condition was diagnosed to several months after transplantation. We adopted a developmental focus, to consider how participants negotiated the tasks of adolescence in the context of their transplant experiences. A qualitative approach was used to interview five adolescent-parent dyads, who reported few post-transplant complications, and the data were analysed according to the principles of IPA. Our findings revealed transplant to be a transformative experience, with two themes marking a contrast between pre- and post-transplant states: "Restriction and Dependence" and "Autonomy and Freedom." The themes are considered in relation to adolescent development. We propose that clinicians working with paediatric heart transplant recipients and their families need to consider the particular developmental challenges faced by adolescent patients and view the attainment of developmental milestones alongside physical and psychological markers of successful adjustment.
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Affiliation(s)
- Joanna Adams
- Department of Psychology, University of Bath, Bath, UK
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14
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Anthony SJ, Annunziato RA, Fairey E, Kelly VL, So S, Wray J. Waiting for transplant: physical, psychosocial, and nutritional status considerations for pediatric candidates and implications for care. Pediatr Transplant 2014; 18:423-34. [PMID: 25041330 DOI: 10.1111/petr.12305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2014] [Indexed: 11/28/2022]
Abstract
The waiting period for an organ transplant has been described as a time of tremendous uncertainty and vulnerability, posing unique challenges and stressors for pediatric transplant candidates and their families. It has been identified as the most stressful stage of the transplant journey, yet little attention has been given to the physical, psychological, or social impact of the waiting period in the literature. In this review, we discuss the physical, nutritional, and psychosocial implications of the waiting period for child and adolescent transplant candidates and the impact on their parents and siblings. We identify areas for future research and provide recommendations for clinical practice to support children, adolescents, and families during the waiting period.
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Affiliation(s)
- Samantha J Anthony
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
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15
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Lewis H, Arber S. Impact of age at onset for children with renal failure on education and employment transitions. Health (London) 2014; 19:67-85. [PMID: 24986907 DOI: 10.1177/1363459314539773] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous medical research has shown that children with end-stage renal failure experience delay or underachievement of key markers of transition to adulthood. This article analyses 35 qualitative interviews with end-stage renal failure patients, aged 20-30 years, first diagnosed at 0-19 years of age, to explore how far delayed or underachievement in education and employment is related to their age at onset of end-stage renal failure. This study shows how unpredictable failures of renal replacement therapies, comorbidities and/or side effects of treatment in the early life course often coincided with critical moments for education and employment. Entering school, college, work-related training or employment, and disclosing health status or educational underachievement to an employer, were particularly critical, and those who were ill before puberty became progressively more disadvantaged in terms of successful transition into full-time employment, compared with those first diagnosed after puberty.
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Waiting for the next shoe to drop: the experience of parents of children with fanconi anemia. J Genet Couns 2011; 21:45-58. [PMID: 21805222 DOI: 10.1007/s10897-011-9394-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
Fanconi Anemia (FA) is a rare genetic disease that generally affects children and results in bone marrow failure requiring blood or marrow transplantation for survival. A unique feature of the condition is the long, often many years, waiting period between genetic diagnosis and treatment. This qualitative study looked at the lived experience of parents confronting their child's diagnosis of FA. We aimed to describe factors which parents found helpful or detrimental during the waiting time period and to recommend strategies to support families who will have these experiences in the future. Categories that emerged were: parents' emotional responses, thoughts about FA (which occurred daily for most parents), sources of stress, mechanisms of coping, family dynamics and responses that were supportive and non-supportive. We found that most parents experience stress, uncertainty, and active surveillance throughout the course of the illness. Healthcare professionals, and especially physicians, were agents of both the most and least supportive experiences of parents. Parents described family centered team care as helpful throughout the illness and health professional education as a priority need.
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Hoekstra-Weebers JEHM, Wijnberg-Williams BJ, Jaspers JPC, Kamps WA, van de Wiel HBM. Coping and its effect on psychological distress of parents of pediatric cancer patients: a longitudinal prospective study. Psychooncology 2011; 21:903-11. [PMID: 21608072 DOI: 10.1002/pon.1987] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This prospective 5-year longitudinal study examined the use of coping styles of fathers and mothers of pediatric cancer patients over time and the prospective effects of coping on distress. METHODS Psychological distress (General Health Questionnaire) and the use of seven coping styles (Utrecht Coping List: active problem focussing, palliative and passive reaction patterns, avoidance, social support seeking, expression of emotions, and comforting cognition) were assessed in 115 parents shortly after diagnosis, 6 and 12 months, and 5 years later. RESULTS At diagnosis, parents' use of coping styles did not differ from the norm population except more frequent use of support seeking. No significant change over time was found in a palliative reaction pattern. Support seeking declined and emotional expression increased linearly, whereas use of the remaining coping styles decreased, followed by an increase. At 5 years, parents' use differed from the norm population only in less use of expression of emotions and comforting cognitions. Initial coping use significantly predicted fathers' future distress at 6 and 12 months but not at 5 years. This was not found for mothers. Changes in coping were significantly associated with both parents' changes in distress only during the first year. Increased passive reaction pattern and social support seeking were the risk factors for mothers. Increased avoidance, a passive reaction pattern, expression of emotions, and decreased active problem focussing formed the risk factors for fathers. CONCLUSION Findings illustrate that coping seems to be a situation-specific process and that coping predictors vary as a function of parents' gender.
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Affiliation(s)
- Josette E H M Hoekstra-Weebers
- Wenckebach Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Comprehensive Cancer Center North East Netherlands, Groningen, The Netherlands
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Wade SL, Walz NC, Cassedy A, Taylor HG, Stancin T, Yeates KO. Caregiver functioning following early childhood TBI: do moms and dads respond differently? NeuroRehabilitation 2010; 27:63-72. [PMID: 20634601 DOI: 10.3233/nre-2010-0581] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Research suggests that pediatric TBI results in injury-related stress and burden and psychological distress for parents. However, existing studies have focused almost exclusively on mothers, so that we know relatively little about the impact of childhood TBI on fathers. SPECIFIC AIMS The aims were to prospectively examine differences in maternal and paternal response to early childhood TBI over time relative to a comparison cohort of mothers and fathers of children with orthopedic injuries (OI). METHODS The concurrent cohort/prospective research design involved repeated assessments of children aged 3-6 years with TBI or OI requiring hospitalization and their families. Shortly after injury and at 6, 12, and 18 months post injury, parents of 48 children with TBI (11 severe and 37 moderate) and 89 with OI completed standardized assessments of injury-related stress and burden, parental distress, and coping strategies. Mixed models analyses and Generalized Estimating Equations examined differences in maternal versus paternal burden, distress, and coping over time. The analyses included interactions of parent sex with group (severe TBI, moderate TBI, OI) and time since injury, to examine the moderating effects of injury severity on parental response to injury over time. RESULTS Fathers were more likely than mothers to use denial to cope following moderate and severe TBI, but not OI. Conversely, mothers were more likely to prefer acceptance and emotion-focused strategies than fathers regardless of the type of injury. The use of active coping strategies varied as a function of injury type, parent sex, and time since injury. Fathers reported greater injury-related stress and distress than mothers over time, with pronounced differences in the severe TBI and OI groups. CONCLUSIONS Mothers and fathers appear to respond differently following TBI. The different types of responses may serve to exacerbate emerging family dysfunction.
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Affiliation(s)
- Shari L Wade
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039, USA.
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Anton MC, Piccinini CA. Aspectos psicossociais associados a diferentes fases do transplante hepático pediátrico. PSICOLOGIA: TEORIA E PESQUISA 2010. [DOI: 10.1590/s0102-37722010000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo buscou investigar os aspectos psicossociais associados a diferentes fases do processo de transplante hepático pediátrico. Participaram do estudo seis mães de crianças com idades entre 4 e 8 anos e que haviam realizado transplante hepático há menos de seis anos. As mães responderam a uma entrevista que investigava sentimentos e vivências da família, nas diferentes fases da doença. Análise de conteúdo qualitativa mostrou intenso sofrimento emocional da criança e da família durante todo o processo. O período de espera e a cirurgia foram vivenciados como os mais estressantes, em virtude do medo intenso da morte. Os resultados apontam para importância do acompanhamento psicológico precoce e sistemático às crianças e às famílias, em todas as fases do processo.
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Wiedebusch S, Konrad M, Foppe H, Reichwald-Klugger E, Schaefer F, Schreiber V, Muthny FA. Health-related quality of life, psychosocial strains, and coping in parents of children with chronic renal failure. Pediatr Nephrol 2010; 25:1477-85. [PMID: 20461533 DOI: 10.1007/s00467-010-1540-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/08/2010] [Accepted: 03/22/2010] [Indexed: 11/26/2022]
Abstract
Health-related quality of life (HRQOL) in parents of children suffering from renal disease is often diminished by the illness burden experienced in daily life and by unfavorable ways of coping. Our aim was to examine the relationship between psychosocial strains perceived by parents, their ways of coping, and HRQOL. In an anonymous cross-sectional study, parents completed a questionnaire concerning psychosocial strains, coping strategies, and HRQOL, as well as sociodemographic and illness parameters. Study participants were recruited in two outpatient dialysis centers. Participating in the study were 195 parents (105 mothers, 90 fathers; age 43 +/- 8 years; representing 108 families) of children suffering from renal disease (age 12 +/- 5 years). Parents of children with chronic renal failure reported moderate HRQOL with parents of children undergoing dialysis experiencing more limitations in quality of life than parents of children living with a kidney graft and parents of children undergoing conservative treatment. Mothers experienced lower HRQOL and higher psychosocial strains than fathers. HRQOL was predicted by the coping strategies "focusing on child" (beta = -0.25), "improving marital relationship" (beta = 0.24), "seeking social support" (beta = -0.22) and "self-acceptation and growth" (beta =0 .19) as well as parents' perceived limitation by illness in daily life (beta = -0.15; explained variance 57%). In the comprehensive care for families with a child suffering from a renal disease, screening for psychosocial strains and ways of coping, along with applying interventions to strengthen adaptive coping strategies, may be a preventative means of improving parents' quality of life.
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Affiliation(s)
- Silvia Wiedebusch
- Department of Medical Psychology, University Hospital of Muenster, Germany.
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Chou CY, Chen YC, Chen CL, Chen JL, Mu PF. Family experience of waiting for living donor liver transplantation: from parental donor perspective. J Clin Nurs 2009; 18:1684-92. [DOI: 10.1111/j.1365-2702.2008.02750.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Simons LE, Anglin G, Warshaw BL, Mahle WT, Vincent RN, Blount RL. Understanding the pathway between the transplant experience and health-related quality of life outcomes in adolescents. Pediatr Transplant 2008; 12:187-93. [PMID: 18307667 DOI: 10.1111/j.1399-3046.2007.00805.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Developments in solid organ transplantation have resulted in improved survival for children with advanced kidney, liver, and heart disease; however, concerns have been raised regarding the quality of life of survivors. This study examined HRQOL in adolescent transplant recipients. We examined the influence of demographic, treatment regimen, and family factors on physical and mental health domains of HRQOL. The current single-center investigation involved 68 solid organ transplant recipients and their parents. All families participated in a structured interview to collect information on demographics, characteristics of the adolescents' disease and treatment regimen, family functioning, and HRQOL for parents and adolescents. Using hierarchical regression analyses, predictive models of physical functioning and mental health outcomes for adolescent transplant recipients were developed for parent-proxy and adolescent self-report. Perceived frequency of medication side-effects and family conflict significantly contributed to adolescent physical functioning and mental health outcomes. Taken together, transplant consequences and family environment significantly impact physical and mental health outcomes in adolescent transplant recipients. Our findings demonstrate the need for pharmacological considerations and psychological interventions to address these areas.
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Affiliation(s)
- Laura E Simons
- Pain Treatment Service, Children's Hospital Boston, Boston, MA 02115, USA.
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Parent Stress and Coping: Waiting for a Child to Receive a Kidney Transplant. J Clin Psychol Med Settings 2007. [DOI: 10.1007/s10880-007-9084-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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