1
|
Sangster SL, Lawson KL. "We're Going to Book This for You": Threats to Informed Decision-Making in the Down Syndrome Determination Experience. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102237. [PMID: 37827331 DOI: 10.1016/j.jogc.2023.102237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES To identify and describe threats to informed decision-making at key junctures of the Down syndrome (DS) determination experience. METHODS We conducted 32 narrative interviews with 42 participants (10 couples and 22 individuals). Participants relayed their stories of receiving their child's or a prospective child's DS determination. Interviews were recorded, transcribed verbatim, and analyzed thematically. RESULTS We identified the following 5 threats to informed decision-making: routinization of screening, screening for reassurance's sake, equating an openness to screening with an openness to testing and termination, misunderstanding and miscommunicating about probability, and a lack of up-to-date, accurate, neutral information. CONCLUSIONS The results contribute to an existing body of literature on the DS determination experience with a uniquely Canadian lens. The threats outline how well-intended counselling can ultimately undermine reproductive autonomy and informed decision-making. With knowledge of how these seemingly harmless behaviours threaten informed decision-making and reproductive autonomy, care providers can modify their counselling to lessen their impact.
Collapse
Affiliation(s)
| | - Karen L Lawson
- Department of Psychology, University of Saskatchewan, Saskatoon, SK
| |
Collapse
|
2
|
Santos AJ, Braz P, Folha T, Machado A, Matias-Dias C. Parents of Children Diagnosed with Congenital Anomalies or Cerebral Palsy: Identifying Needs in Interaction with Healthcare Services. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1051. [PMID: 37371282 DOI: 10.3390/children10061051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
The changes deriving from the birth of a child with a congenital anomaly (CA) or cerebral palsy (CP) imply, in many cases, an increased interaction with health services. A cross-sectional descriptive study was conducted with a convenience sample of parents of children diagnosed with four groups of CA (severe heart anomalies, spina bifida, orofacial clefts, and Down syndrome) and/or CP. A semistructured online questionnaire to be answered by parents was sent by web link to focal points of five parent associations and professional institutions. Data were analyzed through thematic content analysis (open-ended questions) and descriptive analysis (closed-ended questions). The results indicate consistency of responses of parents of children diagnosed with different conditions, namely with respect to the perception of health services and professionals. Closed and open-ended responses indicated three main topics in the interaction between health services and parenthood: information, coordinated and integrated responses, and support. The less positive outcomes suggest unmet information needs, while positive aspects include confidence in the care provided and the "training" received from health professionals.
Collapse
Affiliation(s)
- Ana João Santos
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, 1649-016 Lisboa, Portugal
- Comprehensive Health Research Center, National School of Public Health (ENSP), University of Lisbon, 1600-560 Lisboa, Portugal
| | - Paula Braz
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, 1649-016 Lisboa, Portugal
| | - Teresa Folha
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, 1649-016 Lisboa, Portugal
| | - Ausenda Machado
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, 1649-016 Lisboa, Portugal
- Comprehensive Health Research Center, National School of Public Health (ENSP), University of Lisbon, 1600-560 Lisboa, Portugal
| | - Carlos Matias-Dias
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, 1649-016 Lisboa, Portugal
- Comprehensive Health Research Center, National School of Public Health (ENSP), University of Lisbon, 1600-560 Lisboa, Portugal
| |
Collapse
|
3
|
Sangster SL. "We're in the same book, but we're in different parts of the book": Dominant and sub-group narratives of life following a Down syndrome determination. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:68-86. [PMID: 35341389 PMCID: PMC9940127 DOI: 10.1177/17446295221079584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Parents of children with Down syndrome (DS) were interviewed about if their experiences raising their children matched their initial assumptions about parenting a child with DS. A dominant narrative was identified, wherein most parents described initially having negative assumptions, which did not come to fruition; parenting their child was not very different from parenting a typical child. There was also a sub-group of participants who disputed the dominant narrative; parenting their child was challenging and the dominant narrative marginalizes that experience. The findings indicate that although for many parents, having a child with DS is like "taking the scenic route" (i.e., it involves a few more hurdles, but often more rewards), this framing is not always applicable. Therefore, health care providers and support organizations should promote a narrative that encompasses the diversity of parenting a child with DS.
Collapse
Affiliation(s)
- Sarah L. Sangster
- Sarah L. Sangster, Department of
Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2,
Canada.
| |
Collapse
|
4
|
Robinette B, Palokas M, Christian R, Hinton E. Experiences of parents and prospective parents when receiving a diagnosis of Down syndrome for their child in the perinatal period: a qualitative systematic review protocol. JBI Evid Synth 2022; 20:2995-3000. [PMID: 36065936 DOI: 10.11124/jbies-21-00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to synthesize qualitative evidence regarding the experiences of parents and prospective parents when receiving a diagnosis of Down syndrome for their child in the perinatal period. INTRODUCTION Increased awareness of parental experiences when receiving a Down syndrome diagnosis for their child may help health care professionals provide the parental support needed to promote the best possible outcomes for these children. INCLUSION CRITERIA The participants for this review are the parents and prospective parents of a child with Down syndrome. The phenomenon of interest is parents' and prospective parents' experiences when receiving the diagnosis of Down syndrome for their child in the perinatal period. Experiences of prospective parents, parents whose children are living or deceased, and those who terminated a pregnancy because of the diagnosis will be included. METHODS This review will follow JBI methodology for qualitative reviews. The databases to be searched include Academic Search Premier, AccessPediatrics, Health Source: Nursing/Academic Edition, MEDLINE, CINAHL, Scopus, PsycINFO, and Web of Science. Sources of unpublished studies and gray literature will include ProQuest Dissertations and Theses Sciences and Engineering Collection, MedNar, National Association for Down Syndrome, Down Syndrome International, and WorldWideScience. Studies will be critically appraised by 2 independent reviewers. All studies, regardless of methodological quality, will be included. Data will be extracted by 2 independent reviewers. Findings will be pooled using the meta-aggregation approach. Where textual pooling is not possible, the findings will be presented narratively. The final synthesized findings will be graded according to the ConQual approach. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021250813.
Collapse
Affiliation(s)
- Bethany Robinette
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.,Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, University of Mississippi School of Nursing, Jackson, MS, USA
| | - Michelle Palokas
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.,Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, University of Mississippi School of Nursing, Jackson, MS, USA
| | - Robin Christian
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.,Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, University of Mississippi School of Nursing, Jackson, MS, USA
| | - Elizabeth Hinton
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.,Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, University of Mississippi School of Nursing, Jackson, MS, USA
| |
Collapse
|
5
|
Marcus E, Latos-Bielenska A, Jamry-Dziurla A, Barišić I, Cavero-Carbonell C, Den Hond E, Garne E, Genard L, Santos AJ, Lutke LR, Matias Dias C, Neergaard Pedersen C, Neville AJ, Niemann A, Odak L, Pierini A, Rico J, Rissmann A, Rankin J, Morris JK. Information needs of parents of children with congenital anomalies across Europe: a EUROlinkCAT survey. BMC Pediatr 2022; 22:657. [PMID: 36368959 PMCID: PMC9652126 DOI: 10.1186/s12887-022-03734-z] [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: 05/19/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Parents of children who have a congenital anomaly can experience significant worry about their child's health. Access to clear, helpful, and trustworthy information can provide a valuable source of support. In this study the aim was to explore the information needs of parents/carers of children with congenital anomalies across Europe. METHOD A cross-sectional online survey was developed in nine languages to measure parents' information needs, including: (1) the 'helpfulness'/'trustworthiness' of information received from eight relevant sources, and (2) overall satisfaction with information received. Parents/carers of children (0-10 years) with cleft lip, spina bifida, congenital heart defect [CHD] requiring surgery, and/or Down syndrome were recruited online via relevant organisations in 10 European countries from March-July 2021. Quantitative analyses using multivariable logistic regressions were performed. RESULTS One thousand seventy parents/carers of children with a cleft lip (n = 247), spina bifida (n = 118), CHD (n = 366), Down syndrome (n = 281), and Down syndrome with CHD (n = 58) were recruited in Poland (n = 476), the UK (n = 120), Germany (n = 97), the Netherlands/Belgium (n = 74), Croatia (n = 68), Italy (n = 59), other European countries (n = 92), and not specified/non-European countries (n = 84). Most participants were mothers (92%) and aged 31-40 years (71%). Participants were most likely to rate support groups (63%), patient organisations (60%), specialist doctors/nurses (58%), and social media (57%) as 'very helpful' information sources. 'Very trustworthy' ratings remained high for specialist doctors/nurses (61%), however, they declined for support groups (47%), patient organisations (48%), and social media (35%). Germany had the highest proportion of participants who were 'very satisfied' (44%, 95% CI = 34%-54%) with information, whereas this percentage was lowest in Croatia (11%, 95% CI = 3%-19%) and Poland (15%, 95% CI = 11%-18%). Parents of children with Down syndrome had significantly lower satisfaction ratings than parents of children with CHD; 13% (95% CI = 8%-18%) reported being 'very satisfied' compared to 28% (95% CI = 23%-33%) in the CHD group. CONCLUSIONS Findings suggest that informal sources of information (e.g. support groups) are of value to parents, however, they are not deemed as trustworthy as specialist medical sources. Satisfaction ratings differed across countries and by anomaly, and were particularly low in Croatia and Poland, as well as for parents of children with Down syndrome, which warrants further investigation.
Collapse
Affiliation(s)
- Elena Marcus
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Anna Latos-Bielenska
- Chair and Department of Medical Genetics, Poznan University of Medical Sciences, Collegium Maius, Fredry 10, 61-701, Poznań, Poland
| | - Anna Jamry-Dziurla
- Chair and Department of Medical Genetics, Poznan University of Medical Sciences, Collegium Maius, Fredry 10, 61-701, Poznań, Poland
| | - Ingeborg Barišić
- Centre of Excellence for Reproductive and Regenerative Medicine, Children's Hospital Zagreb, Medical School University of Zagreb, Ul. Vjekoslava Klaića 16, 10000, Zagreb, Croatia
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Fundacio per al Foment de la Investigacio Sanitaria i Biomedica, Av. de Catalunya, 21, 46020, València, Spain
| | - Elly Den Hond
- Provincial Institute for Hygiene (PIH), Kronenburgstraat 45, 2000, Antwerp, Belgium
| | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Lucas Genard
- Provincial Institute for Hygiene (PIH), Kronenburgstraat 45, 2000, Antwerp, Belgium
| | - Ana João Santos
- Department of Epidemiology, National Institute of Health Doctor Ricardo Jorge, Av. Padre Cruz, 1600-609, Lisbon, Portugal
| | - LRenée Lutke
- Department of Genetics, University Medical Center, University of Groningen, 9712 CP, Groningen, Netherlands
| | - Carlos Matias Dias
- Department of Epidemiology, National Institute of Health Doctor Ricardo Jorge, Av. Padre Cruz, 1600-609, Lisbon, Portugal
| | - Christina Neergaard Pedersen
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Amanda J Neville
- IMER Registry (Emilia Romagna Registry of Birth Defects), University of Ferrara and Azienda Ospedaliero Universitaria Di Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Italy
| | - Annika Niemann
- Medical Faculty, Malformation Monitoring Centre Saxony-Anhalt, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Ljubica Odak
- Centre of Excellence for Reproductive and Regenerative Medicine, Children's Hospital Zagreb, Medical School University of Zagreb, Ul. Vjekoslava Klaića 16, 10000, Zagreb, Croatia
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Juan Rico
- Rare Diseases Research Unit, Fundacio per al Foment de la Investigacio Sanitaria i Biomedica, Av. de Catalunya, 21, 46020, València, Spain
| | - Anke Rissmann
- Medical Faculty, Malformation Monitoring Centre Saxony-Anhalt, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
| | - Joan K Morris
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| |
Collapse
|
6
|
Chérif L, Yaich K, Sahnoun C, Khemekhem K, Boudabbous J, HadjKacem I, Ayadi H, Moalla Y. Autisme : annonce du diagnostic et vécu des parents. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Jackson L, Cichon M, Kleinert H, Trepanier A. Teaching medical students how to deliver diagnoses of Down syndrome: Utility of an educational tool. PATIENT EDUCATION AND COUNSELING 2020; 103:617-625. [PMID: 31669046 DOI: 10.1016/j.pec.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study assessed whether using an educational tool increased the knowledge and perceived comfort level of first-year medical students in giving a diagnosis of Down syndrome. METHOD A total of 295 students taking a genetics course completed a knowledge questionnaire and Situations Inventory (aimed at assessing comfort with sharing certain information), prior to and following use of Brighter Tomorrows, a web-based educational module on giving parents a diagnosis of Down syndrome. RESULTS The pre-intervention mean on the knowledge survey was 3.67, which significantly increased to 5.47 following the intervention. Mean Situational Inventory scores were significantly higher pre-intervention (M = 45.5), which indicates greater discomfort, compared to post-intervention (M = 36.7). Qualitative analysis of responses regarding lessons learned fell into 5 major themes. The most common theme (48% of responses) was related to communication skills. The most frequently cited lesson learned was the importance of demonstrating empathy. CONCLUSIONS This study found that knowledge and perceived comfort levels of first-year medical students in giving a postnatal diagnosis of Down syndrome were significantly increased following use of an educational tool. PRACTICE IMPLICATIONS Educational modules can provide medical students with foundational knowledge on providing distressing information to help prepare for future clinical encounters.
Collapse
Affiliation(s)
- Lauren Jackson
- Cytogenetics, Beaumont Hospital, Dearborn, Dearborn, MI, United States.
| | - Michelle Cichon
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States
| | - Harold Kleinert
- The Human Development Institute, University of Kentucky, Lexington, KY, United States
| | - Angela Trepanier
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States
| |
Collapse
|
8
|
Williams GM, Neville P, Gillespie KM, Leary SD, Hamilton-Shield JP, Searle AJ. What factors influence recruitment to a birth cohort of infants with Down's syndrome? Arch Dis Child 2018. [PMID: 29519943 PMCID: PMC6059035 DOI: 10.1136/archdischild-2017-314312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To understand how to maximise recruitment of young infants with Down's syndrome (DS) into research through qualitative interviews with parents and care providers. In complex neonatal and genetic conditions such as DS, frequently diagnosed after birth, parents may go through a period of adaptation. These factors need consideration when overcoming barriers to recruitment. PARTICIPANTS AND DESIGN Participants, who were drawn from health professionals and volunteers working with families experiencing DS, were recruited using a purposive sampling strategy. Semistructured telephone interviews were completed with nine paediatricians, three research nurses and six family support workers. Five of those interviewed had a child with DS. The interviews were transcribed and analysed thematically. RESULTS A positive decision to take part in a 'from-birth' cohort study depends on factors such as the child's overall health, parent demographics (educational background and ethnicity), medical interactions that take place with the families (communication) and study logistics. The data suggest that recruitment methods need to take all these factors into consideration. Multiple recruitment methods should be considered including face to face, through parent and support groups, websites and social media. There also needs to be flexibility in the research timings to fit around the needs of the child and parents. CONCLUSION Researchers need to be aware of the variable responses elicited by families to a diagnosis of DS for their baby and be sensitive to the child's current medical status. This does not preclude recruitment into studies, but to maximise uptake good communication and flexibility is essential.
Collapse
Affiliation(s)
- Georgina M Williams
- The NIHR Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK,Diabetes and Metabolism, Translational Sciences, University of Bristol, Bristol, UK
| | - Patricia Neville
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Kathleen M Gillespie
- Diabetes and Metabolism, Translational Sciences, University of Bristol, Bristol, UK
| | - Sam D Leary
- The NIHR Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK
| | - Julian P Hamilton-Shield
- The NIHR Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK
| | - Aidan J Searle
- The NIHR Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK
| |
Collapse
|
9
|
Boggs S, Daboval T, Ben Fadel N, Moore G, Ferretti E. Neonatal Ethics Teaching Program - Scenario-Oriented Learning in Ethics: Announcing the Diagnosis of Trisomy 21. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10575. [PMID: 30800777 PMCID: PMC6338174 DOI: 10.15766/mep_2374-8265.10575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 04/17/2017] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Delivering unexpected news to families can lead to emotionally charged conversations that cause discomfort and feelings of ineffectiveness in pediatric postgraduate trainees. Although prenatal screening exists, over 80% of trisomy 21 diagnoses continue to be made postnatally to unsuspecting parents who report a desire for better communication from health care professionals when they first receive the news of their child's diagnosis. Recognizing this area for improvement as reported in the literature, as well as the expressed desire from fellows in the University of Ottawa neonatal-perinatal medicine program for additional protected time to preemptively practice such disclosures, this trisomy 21 Scenario-Oriented Learning in Ethics workshop was developed. METHODS During the workshop, trainees are introduced to an evidence-based communication framework that provides them with strategies to facilitate clear knowledge translation and promote rapport with families for this specific clinical scenario. Participants are divided into small groups and practice disclosing a trisomy 21 diagnosis to a standardized patient in the role of a new mother. Each small group is supported by two trained facilitators who are experts in delivering life-altering news. RESULTS The pilot workshop was completed by 21 postgraduate trainees from the University of Ottawa. Qualitative evaluations were overwhelmingly positive, with feedback indicating high levels of perceived usefulness for the workshop. DISCUSSION By preemptively practicing evidence-based communication, we hope to increase trainee confidence and preparation for trisomy 21 disclosures and improve parents' feelings regarding the quality of communication and support provided while receiving real-life trisomy 21 diagnoses.
Collapse
Affiliation(s)
- Samantha Boggs
- Postgraduate Trainee in Pediatrics, University of Ottawa Faculty of Medicine
| | - Thierry Daboval
- Neonatologist, Department of Neonatology, University of Ottawa Faculty of Medicine
| | - Nadya Ben Fadel
- Neonatologist, Department of Neonatology, University of Ottawa Faculty of Medicine
| | - Gregory Moore
- Neonatologist, Department of Neonatology, University of Ottawa Faculty of Medicine
| | - Emanuela Ferretti
- Neonatologist, Department of Neonatology, University of Ottawa Faculty of Medicine
| |
Collapse
|
10
|
Takataya K, Yamazaki Y, Mizuno E. Perceptions and Feelings of Fathers of Children With Down Syndrome. Arch Psychiatr Nurs 2016; 30:544-51. [PMID: 27654235 DOI: 10.1016/j.apnu.2016.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to obtain information about the lives of families with children with Down syndrome through interviews with the fathers. METHODS The participants were 9 fathers who were recruited from the local Association of Parents of Down syndrome. Their children were born between 1996 and 2009. The study used a descriptive exploratory design utilizing a focus group. RESULTS Through analysis of the fathers' transcripts, 7 major themes emerged: 1) crisis of life, 2) emotional turmoil, 3) attitudes toward the disability, 4) parental responsibility, 5) realization of fatherhood, 6) difference of feelings between mother and father, and 7) contact with people. CONCLUSIONS Fathers were upset with the fact that their children were born with Down syndrome. However, they accepted fatherhood through child-rearing in cooperation with others. The experience of fathers in this study provides practical points for caring for families with children with Down syndrome.
Collapse
|
11
|
Gyllén J, Rosenberg A, Nyström A, Forsberg A, Magnusson G. Important sources of information on self-management for families of children with paediatric cataracts. ACTA ACUST UNITED AC 2015. [DOI: 10.12968/ijop.2015.6.1.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jenny Gyllén
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation/Ophthalmology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anna Rosenberg
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation/Ophthalmology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Alf Nyström
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation/Ophthalmology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anna Forsberg
- Health Science Centre, Research Group on Nursing Care in High-Tech Environments, Lund University, Sweden, and Department of thoracic transplantation, Skåne University Hospital, Sweden
| | - Gunilla Magnusson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation/Ophthalmology, Sahlgrenska Academy, University of Gothenburg, Sweden
| |
Collapse
|
12
|
de Groot-van der Mooren MD, Gemke RJBJ, Cornel MC, Weijerman ME. Neonatal diagnosis of Down syndrome in The Netherlands: suspicion and communication with parents. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:953-961. [PMID: 24628769 DOI: 10.1111/jir.12125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To analyse which dysmorphic features are most recognised in newborns with Down syndrome (DS). Furthermore to evaluate the communication techniques used by clinicians to inform parents about the postnatal diagnosis and compare these to current best practice guidelines. STUDY DESIGN Prospective study of a birth cohort of newborns with DS born between 1 January 2003 and 31 December 2006 registered by the Dutch Paediatric Surveillance Unit (DPSU). RESULTS A total of 586 children with trisomy 21 were analysed. Most recognised dysmorphic features in DS newborns were 'upslanted palpebral fissures' (74.1%; n = 426), 'hypotonia' (73.7%; n = 424) and 'epicanthic folds' (68.5%; n = 394). The majority of parents were informed about the suspected diagnosis on the day of birth (76.5%; n = 390). Hospital deliveries had a significantly earlier suspected diagnosis (mean age 3-4 days) compared with home deliveries (mean age 7 days) (P < 0.05). In 10% (n = 44), paediatricians described dissatisfaction with the first conversation with parents. In 88.9% (n = 499) parents were both present when the diagnosis was told, however the child was not present during the conversation in 51.3% (n = 288). In 10.8% (n = 61) parents were not informed about local parent support groups or community resources. CONCLUSION DS is still often diagnosed after birth, usually on the first day of postnatal life. Most identified clinical features were upslanted palpebral fissures, epicanthic folds and hypotonia. Special attention for recognition of all present clinical features is needed for early diagnosis. Appropriate communication with the parents of the message that their child has DS can be difficult. Guidelines can help to make counselling easier and more effective, which in turn may increase parental satisfaction. Not all recommendations for the first conversation with parents were fully implemented in Dutch clinical practice.
Collapse
|
13
|
Boyse KL, Gardner M, Marvicsin DJ, Sandberg DE. "It was an overwhelming thing": parents' needs after infant diagnosis with congenital adrenal hyperplasia. J Pediatr Nurs 2014; 29:436-41. [PMID: 24491814 PMCID: PMC4099414 DOI: 10.1016/j.pedn.2014.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
Abstract
This study characterizes the experiences and expressed needs of parents following diagnosis of their newborn with congenital adrenal hyperplasia (CAH). Six parents (four mothers and two fathers) were interviewed about how they learned about CAH and its management, followed by qualitative data analysis. Coding of transcripts revealed several themes, including health communication problems, a lack of medical home and decision support, and a desire for parent-to-parent social support. Findings have implications for how family-centered health care is delivered following an unexpected newborn diagnosis.
Collapse
Affiliation(s)
- Kyla L Boyse
- School of Nursing, University of Michigan, Ann Arbor, MI.
| | - Melissa Gardner
- Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI
| | | | - David E Sandberg
- Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI; Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| |
Collapse
|
14
|
Marchal JP, Maurice-Stam H, Hatzmann J, van Trotsenburg ASP, Grootenhuis MA. Health related quality of life in parents of six to eight year old children with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4239-4247. [PMID: 24083990 DOI: 10.1016/j.ridd.2013.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 06/02/2023]
Abstract
Raising a child with Down syndrome (DS) has been found to be associated with lowered health related quality of life (HRQoL) in the domains cognitive functioning, social functioning, daily activities and vitality. We aimed to explore which socio-demographics, child functioning and psychosocial variables were related to these HRQoL domains in parents of children with DS. Parents of 98 children with DS completed the TNO-AZL adult quality of life questionnaire (TAAQOL) and a questionnaire assessing socio-demographic, child functioning and psychosocial predictors. Using multiple linear regression analyses for each category of predictors, we selected relevant predictors for the final models. The final multiple linear regression models revealed that cognitive functioning was best predicted by the sleep of the child (β=.29, p<.01) and by the parent having given up a hobby (β=-.29, p<.01), social functioning by the quality of the partner relation (β=.34, p<.001), daily activities by the parent having to care for an ill friend or family member (β=-.31, p<.01), and vitality by the parent having enough personal time (β=.32, p<.01). Overall, psychosocial variables rather than socio-demographics or child functioning showed most consistent and powerful relations to the HRQoL domains of cognitive functioning, social functioning, daily activities and vitality. These psychosocial variables mainly related to social support and time pressure. Systematic screening of parents to detect problems timely, and interventions targeting the supportive network and the demands in time are recommended.
Collapse
Affiliation(s)
- Jan Pieter Marchal
- Academic Medical Center/Emma Children's Hospital, Psychosocial Department, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
15
|
Chiu YN, Chou MC, Lee JC, Wong CC, Chou WJ, Wu YY, Chien YL, Gau SSF. Determinants of maternal satisfaction with diagnosis disclosure of autism. J Formos Med Assoc 2012; 113:540-8. [PMID: 25037759 DOI: 10.1016/j.jfma.2012.07.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 07/30/2012] [Accepted: 07/30/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE Diagnosis disclosure is an important clinical issue in developmental disabilities, which may influence parents' ability to cope with their child's conditions. This paper presents the content and patterns of diagnosis-informed counseling for mothers of children with autism and investigates the determinants for maternal satisfaction with this counseling, in order to improve clinical practice. METHODS Mothers of 151 children, aged 3-12 years, with DSM-IV autistic disorder, confirmed by the Chinese version of the Autism Diagnostic Interview-Revised, were assessed. We collected information about the mothers' experience with diagnosis-informed counseling, their personality characteristics, and the extent to which they were satisfied with the counseling. RESULTS Satisfaction with diagnosis-informed counseling was related more to the context of the counseling, including the attitude of the counselors and the timing and duration of counseling, than to its content. Parents' social desirability, educational level, and employment status were negatively associated with their satisfaction with counseling. However, immediate emotion, neuroticism, and extroversion did not have a significant effect on the satisfaction with counseling. Approximately 60% of the mothers preferred to be informed of having an autistic child after the diagnosis had been confirmed. CONCLUSION Our findings suggest that more efforts are needed to improve the quality of diagnosis-informed counseling in autism, particularly in the context of breaking the news to mothers of children with autism. Future study could further examine the moderating effect of diagnostic subtype of autism spectrum disorders, treatment response, or social support on maternal satisfaction with diagnosis-informed counseling (ClinicalTrials.gov number, NCT00494754).
Collapse
Affiliation(s)
- Yen-Nan Chiu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Miao-Chun Chou
- Department of Child & Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ju-Chin Lee
- Department of Psychiatry, Wan Fang Hospital, Taipei, Taiwan
| | - Ching-Ching Wong
- Taipei Child Assessment and Early Intervention Center, Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan
| | - Wen-Jiun Chou
- Department of Child & Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Yu Wu
- Department of Child Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| |
Collapse
|
16
|
Lunney CA, Kleinert HL, Ferguson JE, Campbell L. Effectively training pediatric residents to deliver diagnoses of Down syndrome. Am J Med Genet A 2012; 158A:384-90. [PMID: 22246816 DOI: 10.1002/ajmg.a.34422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 11/15/2011] [Indexed: 11/10/2022]
Abstract
Physicians and parents report a need for pediatricians to have additional training in delivering a diagnosis of Down syndrome (DS). This study tested a web-based tutorial to assess its effectiveness in improving physicians' perceived comfort with both ambiguous and more medically factual situations as they deliver diagnoses of DS. Based on this web tutorial that integrated prenatal and postnatal information into virtual patient scenarios, the study assessed pediatrics residents' knowledge and comfort in delivering a diagnosis of DS pre and postnatally. A separate survey, given at the same time, asked for residents' perception of their need for this training. Ninety-one volunteer residents from 10 pediatric training programs across the country participated. The tutorial yielded significant improvement in knowledge and a significant decrease in perceived level of discomfort in both ambiguous situations and more medically certain contexts related to a DS diagnosis. In addition, across all pediatric resident groups (by year, gender, and performance on the knowledge test and the comfort scale), residents strongly agreed that this type of training was beneficial for themselves, other residents, practicing physicians, and other medical professionals. This study suggests that web-based, interactive, multi-media training may be an effective tool for improving resident physician comfort with both ambiguous and more medically certain situations in delivering a diagnosis of DS to families.
Collapse
Affiliation(s)
- Carol A Lunney
- The Human Development Institute, University of Kentucky, Lexington, Kentucky, USA.
| | | | | | | |
Collapse
|
17
|
|
18
|
Ribeiro MFM, Barbosa MA, Porto CC. Paralisia cerebral e síndrome de Down: nível de conhecimento e informação dos pais. CIENCIA & SAUDE COLETIVA 2011; 16:2099-106. [DOI: 10.1590/s1413-81232011000400009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Accepted: 09/05/2008] [Indexed: 11/22/2022] Open
Abstract
O estudo objetivou identificar e analisar pesquisas relacionadas ao conhecimento e às informações recebidas pelos pais de crianças com paralisia cerebral ou síndrome de Down. Tratase de revisão bibliográfica com limitação temporal de 1993 a 2008. Utilizaram-se as bases de dados informatizadas para a coleta das informações, tendo como palavras-chave os termos paralisia cerebral, síndrome de Down, conhecimento e família. Foram encontrados 57 estudos e selecionados 16; dentre estes, sete relacionados à paralisia cerebral, quatro referentes à síndrome de Down e cinco sobre deficiências diversas. Os pais recebem poucas informações dos profissionais e apresentam muitas dúvidas em relação à paralisia cerebral e à síndrome de Down, o que dificulta a adesão deles ao tratamento dos filhos, interfere nas práticas educacionais e nas tomadas de decisão. Existe carência de ações educacionais no sentido de mudar essa realidade. Somente uma pesquisa teve como proposta implementar estratégias de educação que buscassem ampliar o conhecimento da família a respeito de aspectos relacionados à síndrome de Down. Concluiu-se que há urgência em pesquisar e elaborar ações que contribuam para que os pais sejam mais bem informados e se tornem seguros no cuidado dos filhos.
Collapse
|
19
|
Gundersen T. 'One wants to know what a chromosome is': the internet as a coping resource when adjusting to life parenting a child with a rare genetic disorder. SOCIOLOGY OF HEALTH & ILLNESS 2011; 33:81-95. [PMID: 20937053 DOI: 10.1111/j.1467-9566.2010.01277.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The internet has democratised access to health and diagnostic information, enabling patients to mobilise social support from peers and advocate their interests in encounters with medical personnel. Research has shown that these possibilities are particularly important for patients and caregivers confronting a rare medical condition. However, little research has focused on how the act of searching for and accumulating information via the internet can be important for coping emotionally with a situation characterised by uncertain prospects and inadequate information from health personnel. This paper explores the experiences of 10 Norwegian parents whose children have different rare genetic disorders and who used the internet as a resource. The analysis draws on the theoretical framework of the medical sociologist Aaron Antonovsky, who emphasises people's inherent ability to manage extremely stressful life experiences. Analysing the process of adjusting to and coping with life parenting a child suffering from a rare genetic disorder, this study shows that becoming knowledgeable about a child's condition is essential for gradually comprehending and managing a situation that initially seems unmanageable and distressful. It also suggests that as parents adjust, so do the frequency and purpose of their internet searches.
Collapse
|
20
|
Reilly D, Huws J, Hastings R, Vaughan F. Life and death of a child with down syndrome and a congenital heart condition: experiences of six couples. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2010; 48:403-416. [PMID: 21166547 DOI: 10.1352/1934-9556-48.6.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Individuals with Down syndrome are at increased risk of congenital heart conditions (CHCs), and mortality is higher in people with Down syndrome and a CHC than those without (J. C. Vis et al., 2009). As a consequence, parents of children with Down syndrome and a CHC are more likely to outlive their child. In this research, semistructured interviews were used to explore the experiences of 6 couples whose child with Down syndrome and a CHC had died. The interviews were analyzed qualitatively using interpretative phenomenological analysis (IPA), and 4 themes emerged: dilemmas associated with the dual diagnosis; treatment decisions during the life and the death of their child ("We had to make a decision"); ways couples coped when bereaved ("We weren't really going through it together"); and ripples from the child's life. There was a high degree of similarity of experience within couples. Differences between couples existed in their experiences of coping and supporting each other. Practical implications include the importance of considering the specific needs of couples, individuals, and fathers within partnerships.
Collapse
Affiliation(s)
- Deirdre Reilly
- School of Psychology, University of East London, London, UK.
| | | | | | | |
Collapse
|
21
|
Skotko BG, Capone GT, Kishnani PS. Postnatal diagnosis of Down syndrome: synthesis of the evidence on how best to deliver the news. Pediatrics 2009; 124:e751-8. [PMID: 19786436 DOI: 10.1542/peds.2009-0480] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Many parents of children with Down syndrome (DS) have expressed dissatisfaction with how they learned about their child's diagnosis. DS remains the most common chromosomal condition, occurring in 1 of every 733 births, with the majority of children still diagnosed postnatally. OBJECTIVE Our goal was to review systematically all available evidence regarding how physicians should approach the conversation in which they explain DS for the first time to new parents. METHODS We searched online databases from 1960 to 2008, including Medline and PsychInfo, as well as Web sites maintained by academic organizations (eg, American Academy of Pediatrics) and other nonprofit or private organizations (eg, the National Down Syndrome Society), by using the terms "Down syndrome," "trisomy 21," "mongolism," "prenatal diagnosis," "postnatal care," and "delivery of health care." Articles were selected that answered > or =1 research question, established a priori: (1) Who is the best person to communicate the news? (2) When is the best time to share the news? (3) Where is the best place or setting to deliver the news? (4) What information should be delivered? and (5) How should the news be communicated? All studies were evaluated for quality according to the method outlined by the US Preventative Services Task Force. Final recommendations were based on the strength of evidence. RESULTS Parents prefer to receive the diagnosis together in a joint meeting with their obstetrician and pediatrician. The conversation should take place in a private setting as soon as a physician suspects a diagnosis of DS. Accurate and up-to-date information should be conveyed, including information about local support groups and resources. CONCLUSION By implementing a few cost-neutral measures, physicians can deliver a postnatal diagnosis of DS in a manner that will be deemed by new parents as sensitive and appropriate.
Collapse
Affiliation(s)
- Brian G Skotko
- Division of Genetics, Department of Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
22
|
Muggli EE, Collins VR, Marraffa C. Going down a different road: first support and information needs of families with a baby with Down syndrome. Med J Aust 2009; 190:58-61. [PMID: 19236288 DOI: 10.5694/j.1326-5377.2009.tb02275.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 08/24/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the experiences of families with a baby with Down syndrome at the time of diagnosis, and their preferences for information and support in the early period after diagnosis. DESIGN, SETTING AND PARTICIPANTS A qualitative, interview-based study of 18 families living in Victoria with a child with Down syndrome born between 2002 and 2004 who had not been diagnosed with the syndrome before birth. Interviews were transcribed verbatim and interpretive content analysis was undertaken. RESULTS Parental coping with the unexpected diagnosis of Down syndrome in their infant was influenced by the time interval between birth and disclosure of clinical suspicion of Down syndrome, the level of certainty of the attending physician at the time of disclosure, and the time interval between disclosure of clinical suspicion and confirmation of karyotype. Initial uncertainty and a delay in the diagnosis were detrimental to parental coping, as was premature communication of the news. Perinatal complications increased parental anxiety regarding their child's condition and future. Individual communication style of midwives and physicians was a powerful predictor of parental adaptation. Parental needs for support and information were facilitated through normalising postnatal care, ensuring privacy, and providing early access to peer support and up-to-date written information. Many parents would have appreciated access to a liaison worker. CONCLUSION The experiences of parents in this study provide practice points for improving postnatal care with minimal changes to formal service systems.
Collapse
Affiliation(s)
- Evelyne E Muggli
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.
| | | | | |
Collapse
|
23
|
Rasmussen SA, Whitehead N, Collier SA, Frías JL. Setting a public health research agenda for Down syndrome: summary of a meeting sponsored by the Centers for Disease Control and Prevention and the National Down Syndrome Society. Am J Med Genet A 2008; 146A:2998-3010. [PMID: 19006076 DOI: 10.1002/ajmg.a.32581] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
On November 8-9, 2007, a meeting entitled "Setting a Public Health Research Agenda for Down Syndrome" was held to review current knowledge, identify gaps, and develop priorities for future public health research related to Down syndrome. Participants included experts in clinical and molecular genetics, pediatrics, cardiology, psychiatry, psychology, neuroscience, epidemiology, and public health. Participants were asked to identify key public health research questions and discuss potential strategies that could be used to address those questions. The following were identified as priority areas for future public health research: identification of risk and preventive factors for physical health and cognitive outcomes, focusing on understanding the reasons for previously recognized disparities; improved understanding of comorbid conditions, including their prevalence, clinical variability, natural history, and optimal methods for their evaluation and treatment; better characterization of the natural history of cognition, language, and behavior; identification of mental health comorbidities and of risk and protective factors for their development; identification of strategies to improve enrollment in research studies; development of strategies for conveying up-to-date information to parents and health professionals; identification of interventions to improve cognition, language, mental health, and behavior; understanding the impact of educational and social services and supports; identification of improved methods for diagnosis of and interventions for Alzheimer disease; and understanding the effects of different types of health care on outcomes. Participants strongly supported the development of population-based resources for research studies and resources useful for longitudinal studies. This agenda will be used to guide future public health research on Down syndrome.
Collapse
Affiliation(s)
- Sonja A Rasmussen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
| | | | | | | |
Collapse
|
24
|
Graungaard AH, Skov L. Why do we need a diagnosis? A qualitative study of parents' experiences, coping and needs, when the newborn child is severely disabled. Child Care Health Dev 2007; 33:296-307. [PMID: 17439444 DOI: 10.1111/j.1365-2214.2006.00666.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Communication with parents who are realizing their child is severely disabled is a difficult task for professionals. Parents are experiencing great emotional stress during the diagnostic process and dissatisfaction with disclosure is widespread. The aim of this study was to investigate parents' reactions when realizing their child's disability, the impact of the diagnosis and parents' ways of coping. METHODS This was a qualitative, longitudinal study, using in-depth interviews with 16 parents of a physically and mentally disabled child who had recently been diagnosed as such. Children's age at inclusion ranged from 1 to 27 months. Half of the children had an unknown diagnosis. Data were analysed using the Grounded Theory method. RESULTS were validated and approved by the interviewed parents. RESULTS The certainty of the diagnosis was central for parents' experiences. First, the emotional reaction of the parents is highly influenced by the diagnostic process. Second, parents needed possibilities for taking action, and third they found difficulty in coping with an uncertain future. These three themes all related to the meaning that parents ascribed to the stating of a diagnosis. Parents' needs in relation to communication were identified as equality in co-operation with doctors, an empathic professional approach, and the child being seen with possibilities despite his or her disabilities. CONCLUSIONS Parents' process of realization was related to the diagnostic process, and information and communication should be individualized accordingly. Parents wanted to co-operate and they needed possibilities for active coping with their situation.
Collapse
Affiliation(s)
- A H Graungaard
- Department of General Practice, Centre of Health and Society, 5 Øster Farimagsgade, 1014 Copenhagen K, Denmark.
| | | |
Collapse
|
25
|
Ferguson JE, Kleinert HL, Lunney CA, Campbell LR. Resident Physiciansʼ Competencies and Attitudes in Delivering a Postnatal Diagnosis of Down Syndrome. Obstet Gynecol 2006; 108:898-905. [PMID: 17012452 DOI: 10.1097/01.aog.0000235709.55395.6a] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study responded to the need expressed by physicians and parents alike for improved medical information and support to families upon the initial diagnosis of Down syndrome at birth. The purpose was to assess obstetrics and gynecology and pediatrics residents' cognitive knowledge about Down syndrome and comfort in counseling parents with a newborn child with Down syndrome before and after intervention (resident viewing and interaction with the educational material). METHODS A team of physicians, parents, and educational specialists developed an interactive CD-ROM that asked resident physicians to read and view virtual patient-doctor sessions, and provide their own responses to critical situations related to Down syndrome diagnoses. The research tested both knowledge and attitude change, as well as the effectiveness of an interactive CD-ROM as a pedagogical tool. RESULTS Our effectiveness study yielded positive and significant improvement in knowledge and level of comfort changes with both obstetrics and gynecology and pediatric physicians in residence at the University of Kentucky. Residents also found the technologically based interactive type of instruction to be usable and valuable. CONCLUSION Teaching physicians to impart accurate and balanced information about Down syndrome at the initial point of diagnosis can be achieved, in part, through training with the CD-ROM. From a broader perspective, this effectiveness study suggests the potential applications of these communication strategies not only to families who have a child with Down syndrome, but also to those with other life-altering disabilities. LEVEL OF EVIDENCE II-3.
Collapse
Affiliation(s)
- James E Ferguson
- Department of Obstetrics and Gynecology, Interdisciplinary Human Development Institute, University of Kentucky and Chandler Medical Center, Lexington, Kentucky 40536-0293, USA.
| | | | | | | |
Collapse
|
26
|
Abstract
Delivering and receiving a postnatal diagnosis of Down syndrome is not an easy experience for most physicians or parents. In this study, 467 mothers of children with Down syndrome in Spain completed a survey about the postnatal support services they received immediately following the diagnosis of their child. Mothers reported feeling anxious, frightened, guilty, angry, and, in rare cases, suicidal. According to most mothers, physicians did not give adequate amounts of information about Down syndrome and rarely did they give enough printed materials or make referrals to parent support groups. Little seems to have changed since 1972. Mothers provided recommendations on how the Spanish medical system could be improved, with implications for other countries including the United States.
Collapse
Affiliation(s)
- Brian Skotko
- Harvard Medical School, 12 Greenway Ct., Suite 5, Brookline, MA 02446, USA.
| | | |
Collapse
|
27
|
Kaye PL, Fiske J, Bower EJ, Newton JT, Fenlon M. Views and experiences of parents and siblings of adults with Down Syndrome regarding oral healthcare: a qualitative and quantitative study. Br Dent J 2005; 198:571-8, discussion 559. [PMID: 15895058 DOI: 10.1038/sj.bdj.4812305] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Accepted: 03/25/2004] [Indexed: 01/13/2023]
Abstract
AIMS To investigate experiences and expectations of parents/siblings of adults with Down Syndrome (DS) regarding oral healthcare, and explore factors impacting on access and experience of dental care for this group. DESIGN A two phase qualitative and quantitative study using in-depth interviews with a convenience sample of six parents/siblings, and a postal questionnaire of 200 parents/siblings of adults with DS who are members of the Down Syndrome Association. RESULTS The main themes elicited from the qualitative interviews related to concern, experiences, parents'/siblings' attitudes, preferences and information. The response rate from the postal questionnaire was 63.5%. Adults with DS attended the dentist regularly but received little restorative treatment. Experience of oral healthcare was influenced by the attitudes and skills of dental health professionals; stigma; and relatives' expectations of dentists, their oral health beliefs, information and support received, knowledge and priorities. Parents/siblings wanted dentists to be proactive in providing more information on oral health issues in collaboration with other health and social care professionals. CONCLUSIONS Whilst most adults with DS visited the dentist regularly, relatively little treatment had been provided. Parents highlighted a need for appropriate and timely oral health information early in their child's life, and access to dentists who were sympathetic, good communicators and well-informed about DS.
Collapse
Affiliation(s)
- P L Kaye
- East Sussex Health Care NHS Trust, Arthur Blackman Clinic, Battle Rd, St. Leonards-on-Sea, UK
| | | | | | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE Since 1964, researchers have been examining the ways in which physicians deliver a postnatal diagnosis of Down syndrome (DS). Almost all of the studies, however, have been limited to reflections or very small sample sizes. The objective of this study was to document, in the most robust comprehensive way, the reflections of mothers in the United States who received diagnoses of DS for their children. METHODS An 11-page survey was mailed to 2945 persons on the membership lists of 5 DS parent organizations. The survey gathered both quantitative and qualitative data with yes/no questions, open-ended questions, and a series of statements asking the mothers to rate their level of agreement on a Likert scale of 1 to 7. RESULTS Of the 1250 responses (42.4%), 985 were from mothers who received postnatal diagnoses of DS for their children. The majority of these mothers reported being frightened or anxious after learning the diagnosis, and very few rated the overall experience as a positive one. Mothers reported that their physicians talked little about the positive aspects of DS and rarely provided enough up-to-date printed materials or telephone numbers of other parents with children with DS. Improvement has been made with time, albeit slowly. CONCLUSION Mothers have called on physicians to improve the way in which postnatal diagnoses are delivered. Specific recommendations are offered.
Collapse
|
29
|
|
30
|
Affiliation(s)
- G Latini
- Perrino Hospital Division of Pediatrics, Clinical Physiology Institute, Lecce Section, National Research Council of Italy, Brindisi, Italy.
| |
Collapse
|
31
|
Taanila A. Well-presented first information supports parents' ability to cope with a chronically ill or disabled child. Acta Paediatr 2003; 91:1289-91. [PMID: 12578281 DOI: 10.1111/j.1651-2227.2002.tb02820.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Taanila
- Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland.
| |
Collapse
|