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Fernandes IAM, Menezes ROA, Rego G. Communicating the diagnosis of spinal muscular atrophy in endogamous vs. non-endogamous regions. BMC Neurol 2024; 24:261. [PMID: 39060954 PMCID: PMC11282695 DOI: 10.1186/s12883-024-03718-9] [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: 07/19/2023] [Accepted: 06/07/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION The high prevalence of endogamy, or inbreeding, in northeastern Brazil, is due to historical and cultural factors, with large families living in cities far from the coast and subject to low socioeconomic and infrastructure levels. This breeding practice results in low genetic variability with an increased prevalence of rare autosomal recessive and neurodegenerative diseases, such as spinal muscular atrophy (SMA). OBJECTIVE Understanding the impact of communicating the diagnosis of SMA on the mental health of patients and their families and the differences between the Northeast (endogamous region) and the other regions of Brazil (non-endogamous ones). METHODS Cross-sectional study obtained through a structured questionnaire about the moment of receiving the SMA diagnosis, containing the Impact of Event Scale-Revised. RESULTS AND DISCUSSION The sample consisted of 100 volunteers from all regions of Brazil, 47 patients diagnosed with SMA and 53 family members present at the time of the diagnosis. There was a predominance of females (83%) and homogeneity between the groups for the variables gender, age, color, education, religion, and SMA subtype (1, 2, 3, and 4). The Northeast region, representing 43% of the sample, despite being less economically favored, showed greater satisfaction with medical care and inclusion in health services, with less self-reported psychological trauma and fewer signs of post-traumatic stress disorder (PTSD) related to the moment of receiving the diagnosis. The non-endogamous regions, in turn, reported the presence of strong waves of emotion, sleep problems, feelings of irritability, anger, and the presence of bad thoughts related to this situation. CONCLUSION The feeling of inclusion in health services and satisfaction with medical care in the endogamous region had a positive impact on the mental health of those involved, reducing psychological trauma and signs of PTSD arising from the communication of the SMA diagnosis.
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Affiliation(s)
- Isabella Araujo Mota Fernandes
- Faculty of Medicine, Lauro Wanderley University Hospital, University of Porto, Federal University of Paraíba, João Pessoa, Paraíba- Brazil, BR 230, Km 10 S /N Condomínio Villas do Atlântico casa 3 B. Intermares, Cabedelo, João Pessoa, CEP: 58102-202, Paraíba, Brazil.
| | - Renata Oliveira Almeida Menezes
- Federal University of Pernambuco and PhD in Legal and Social Sciences from the Federal University of Campina Grande, University of Rio Grande do Norte, Caicó, Brazil
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Nakajima N, Tanaka M, Kanehara A, Morishima R, Kumakura Y, Ohkouchi N, Hamada J, Ogawa T, Tamune H, Nakahara M, Mori S, Ichihashi K, Jinde S, Kano Y, Sakamoto I, Tanaka K, Hirata Y, Ohashi H, Shinohara T, Kasai K. Relationship between high trait anxiety in 22q11.2 deletion syndrome and the difficulties in medical, welfare, and educational services. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e80. [PMID: 38868412 PMCID: PMC11114383 DOI: 10.1002/pcn5.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/08/2023] [Accepted: 01/23/2023] [Indexed: 06/14/2024]
Abstract
Aim The 22q11.2 deletion syndrome (22q11DS) is associated with a high prevalence of mental health comorbidities. However, not enough attention has been paid to the elevated prevalence of high trait anxiety that begins early in life and may be enduring. We sought to identify specific medical, welfare, or educational difficulties associated with high trait anxiety in 22q11DS. Methods A questionnaire-based survey was conducted for the parents of 22q11DS individuals (N = 125). First, a multiple regression analysis was conducted to confirm the hypothesis that high trait anxiety in individuals with 22q11DS would be associated with parents' psychological distress. This was based on 19 questionnaire options regarding what difficulties the parents currently face about their child's disease, characteristics, and traits. Next, we explored what challenges faced in medical, welfare, and educational services would be associated with the trait anxiety in their child. Results The multiple regression analysis confirmed that the high trait anxiety was significantly associated with parental psychological distress (β = 0.265, p = 0.018) among the 19 clinical/personal characteristics of 22q11DS. Furthermore, this characteristic was associated with various difficulties faced in the medical care, welfare, and education services, and the parent-child relationship. Conclusion To our knowledge, this is the first study to clarify quantitatively how the characteristic of high anxiety level in 22q11DS individuals is related to the caregivers' perceived difficulties in medical, welfare, and educational services. These results suggest the necessity of designing service structures informed of the fact that high trait anxiety is an important clinical feature of the syndrome.
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Affiliation(s)
- Naomi Nakajima
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Miho Tanaka
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Akiko Kanehara
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Ryo Morishima
- The Health Care Science InstituteTokyoJapan
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yousuke Kumakura
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
- Department of Mental Health, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Noriko Ohkouchi
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Junko Hamada
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Tomoko Ogawa
- Department of Child PsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Hidetaka Tamune
- Department of Cellular Neurobiology, Graduate School of MedicineThe University of TokyoTokyoJapan
- World‐Leading Innovative Graduate Study Program for Life Science and Technology (WINGS‐LST)The University of TokyoTokyoJapan
| | - Mutsumi Nakahara
- Graduate School of Clinical PsychologyKagoshima UniversityKagoshimaJapan
| | - Shunsuke Mori
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kayo Ichihashi
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Seiichiro Jinde
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yukiko Kano
- Department of Child PsychiatryThe University of Tokyo HospitalTokyoJapan
- Department of Child Neuropsychiatry, Graduate, School of MedicineThe University of TokyoTokyoJapan
| | - Ichiro Sakamoto
- Department of Cardiovascular MedicineKyushu University Graduate School of Medical SciencesFukuokaJapan
| | - Kyoko Tanaka
- Department of Psychosocial MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Yoichiro Hirata
- Department of PediatricsKitasato University School of MedicineKanagawaJapan
| | - Hirofumi Ohashi
- Division of Medical GeneticsSaitama Children's Medical CenterSaitamaJapan
| | - Tokuko Shinohara
- Department of Pediatric Cardiology and Adult Congenital CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Kiyoto Kasai
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
- The International Research Center for Neurointelligence (IRCN), The University of Tokyo Institutes for Advanced Study (UTIAS)The University of TokyoTokyoJapan
- UTokyo Institute for Diversity and Adaptation of Human Mind (UTIDAHM)The University of TokyoTokyoJapan
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Fernandes IAM, Menezes ROA, Rego G. Communication of the Diagnosis of Spinal Muscular Atrophy in the Views of Patients and Family Members, a Qualitative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16935. [PMID: 36554814 PMCID: PMC9779701 DOI: 10.3390/ijerph192416935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/02/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Communicating the diagnosis of a genetic and neurodegenerative disease, such as spinal muscular atrophy (SMA), requires a transmission centered on the patient and/or the family caregiver, ensuring autonomy to those involved and strengthening the doctor-patient relationship. OBJECTIVE Analyzing the communication of the SMA diagnosis from the perspective of patients and family members. METHODS This qualitative study was developed through semi-structured interviews, via teleconsultation. The analysis was developed by systematically condensing the answers and synthesizing them into four thematic axes (clarification of the diagnosis, communication of the prognosis, affective memory related to the event, and advice to physicians). RESULTS AND DISCUSSION Twenty-nine patients with SMA and 28 family caregivers of people with this condition, from all regions of Brazil, reported that individualized, clear, honest, and welcoming communication, emphasizing positive aspects, in the presence of family members and with the possibility of continuous monitoring, was important to meeting their communication needs. A lack of empathy, monitoring and guidance, and estimating life expectancy resulted in negative experiences. CONCLUSIONS The communication needs of patients and family members described during the clarification of the diagnosis and prognosis of SMA predominantly involve empathic factors related to the attitude of the attending physician throughout the evolution of the disease. Future research evaluating other neurodegenerative diseases and the development of research protocols are important to improving communication between physicians, patients, and family members.
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Affiliation(s)
| | | | - Guilhermina Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Fernandes IAM, Menezes ROA, Rego G. Communicating the Spinal Muscular Atrophy diagnosis to children and the principle of autonomy. BMC Pediatr 2022; 22:489. [PMID: 35978280 PMCID: PMC9386960 DOI: 10.1186/s12887-022-03552-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The trinomial relationship between physicians/children/guardians is essential in the process of communicating a disease and its prognosis. OBJECTIVE Analyzing the exercise of autonomy by this trinomial relationship in communicating the diagnosis of spinal muscular atrophy (SMA). METHODOLOGY: Caregivers of SMA patients answered a questionnaire containing a structured interview and the Event Impact Scale - Revised. RESULTS The sample comprised 50 volunteers, 94% of whom were female caregivers. Psychological trauma was predominantly reported when caregivers communicated the diagnosis to children. 22% have a high risk of post-traumatic stress, relating the feeling of unpreparedness in communicating this to the child. CONCLUSIONS It was identified that the failure in communication is the main factor for negative repercussions on the autonomy of children and their guardians, with self-reported psychological trauma, besides the high risk for post-traumatic stress syndrome.
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Affiliation(s)
- Isabella Araujo Mota Fernandes
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Lauro Wanderley University Hospital, Federal University of Paraíba, Cidade Universitária Campus I, 58051-900, João Pessoa, Paraíba, Brasil.
| | | | - Guilhermina Rego
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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Chase CL, Yashar BM, Swope C, Albin RL, Uhlmann WR. Searching for Answers: Information-Seeking by Young People At-Risk for Huntington's Disease. J Huntingtons Dis 2022; 11:337-346. [PMID: 35570496 PMCID: PMC9484118 DOI: 10.3233/jhd-210523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Health information-seeking is a coping strategy used globally by individuals with a personal or family history of a medical condition, including Huntington’s disease (HD). Objective: We sought to ascertain information-seeking practices of young people who grew up at-risk for HD. Methods: Participants ages 18–25 were recruited from HD support organizations. An online 96-item survey assessed information-seeking motivations and timing as well as information topics accessed, sources, and needs. Results: Fifty young adults (mean age 22.2 years) who grew up at-risk for HD responded. HD had been generally kept a secret (35.4%) or talked about but difficult to bring up (43.8%) in many families. Most (78.0%) became aware of HD in their family before age 15. Few (7.1%) received information resources at the time of disclosure. Most (68.1%) first sought information independently online, half within a week of disclosure. Respondents were motivated to understand the potential impact of HD on their personal lives and family members, obtain general information about the condition, and learn about treatments and research. Most sought information on clinical features and inheritance with > 80% interested in information on symptoms and personal risk and > 70% about having children. Conclusion: Limited information is provided to young people when first informed about HD in their families leading to independent, mostly online information-seeking. Information is used to build knowledge about HD to facilitate coping and life planning. Healthcare providers can direct young people to reliable resources and guide parents in talking with children to ensure that information needs are met.
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Affiliation(s)
- Colby L Chase
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Chandler Swope
- Huntington's Disease Youth Organization.,Cystic Fibrosis Foundation
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Wendy R Uhlmann
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Lust JM, Adams ILJ, Reinders‐Messelink HA, Luijckx J, Schoemaker MM, Steenbergen B. The diagnostic trajectory of developmental coordination disorder in the Netherlands: Experiences of mothers. Child Care Health Dev 2022; 48:139-149. [PMID: 34528720 PMCID: PMC9292148 DOI: 10.1111/cch.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/30/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Receiving a diagnosis can have a major impact on the child and its family. Parental satisfaction concerning the diagnostic trajectory is important with regard to acceptance and coping with their child's problems. Our aim was to describe the diagnostic trajectory of developmental coordination disorder (DCD) in the Netherlands and identify factors that are related to parents' satisfaction. METHOD Mothers of 60 children with a DCD diagnosis completed an online survey concerning their experiences during and after the diagnostic trajectory of obtaining this diagnosis. RESULTS Forty percent of the mothers rated the diagnostic trajectory towards a DCD diagnosis as stressful and 47% rated the knowledgeability of the first professional they consulted (mostly a general practitioner, paediatric physical therapist, or youth health care physician) as having no or just superficial knowledge about DCD. Around 60% of the mothers described a lack of knowledge and support at their child's school after receiving the diagnosis. Notwithstanding this, the majority of the participating mothers was (very) satisfied with the diagnostic trajectory. Higher appreciation of both the manner of the diagnosing professional and the post-diagnostic support provided were predictive of higher satisfaction. CONCLUSIONS Our results underline the importance of improving the knowledgeability in primary schools and primary health care professionals with regard to DCD.
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Affiliation(s)
- Jessica M. Lust
- Behavioural Science Institute (BSI)Radboud UniversityNijmegenThe Netherlands
| | - Imke L. J. Adams
- Behavioural Science Institute (BSI)Radboud UniversityNijmegenThe Netherlands
| | - Heleen A. Reinders‐Messelink
- Rehabilitation Center ‘Revalidatie Friesland’BeetsterzwaagThe Netherlands,University of Groningen, University Medical Center Groningen, Center for Human Movement SciencesGroningenThe Netherlands
| | - Joli Luijckx
- Balans, Parents Association for Children With Developmental DisordersDe BiltThe Netherlands
| | - Marina M. Schoemaker
- University Medical Center Groningen, Centre for Human Movement SciencesUniversity of GroningenGroningenThe Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute (BSI)Radboud UniversityNijmegenThe Netherlands,Centre for Disability and Development Research (CeDDR), School of Behavioural and Health SciencesAustralian Catholic UniversityMelbourneVICAustralia
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Kelm K, Bolduc FV. How Knowledge Mapping Can Bridge the Communication Gap Between Caregivers and Health Professionals Supporting Individuals With Complex Medical Needs: A Study in Fragile X Syndrome. Front Psychiatry 2021; 12:731011. [PMID: 34899415 PMCID: PMC8651701 DOI: 10.3389/fpsyt.2021.731011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
The challenges of caring for children with complex health needs, such as intellectual disability (ID) and autism spectrum disorder (ASD), are multiple and experienced by both caregivers and health professionals. Fragile X syndrome (FXS) is the most common single gene cause of ID and ASD, and provides a pertinent model to understand these complexities of care, as well as the communication challenges experienced between caregivers and healthcare professionals. In recent years both caregivers and healthcare professionals have recognized the need for enhancing communication both in clinical and research settings. Knowledge mapping has emerged as a tool to support quality communication between team participants. Here we review how differences in mental models, as well as challenges related to health literacy and knowledge transfer can have an impact on communication. Next, we present different knowledge mapping approaches used in complex situations, with a focus on concept maps and care maps. Finally, we highlight the potential benefits and limitations of mapping to improve communication issues related to caring for individuals with FXS and potentially other neurodevelopmental disorders (NDDs).
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Affiliation(s)
- Karen Kelm
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Francois V. Bolduc
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Women and Children Health Research Institute, University of Alberta, Edmonton, AB, Canada
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Jeschke S, Woltermann S, Neininger MP, Pauschek J, Kiess W, Bertsche T, Bertsche A. Interviews with patients aged 6-17 years provide valuable insights for physicians who need to deliver an epilepsy diagnosis. Acta Paediatr 2021; 110:1556-1561. [PMID: 33207002 DOI: 10.1111/apa.15672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022]
Abstract
AIM Meeting children's needs when communicating an epilepsy diagnosis can have a large impact on their treatment. We investigated children's experiences and wishes concerning their first conversation about epilepsy. METHODS This prospective study was performed in the neuropaediatric departments of two German university hospitals from 2 October 2018 to 12 April 2019. The semi-structured interview contained open questions, and multiple answers were allowed. RESULTS We interviewed 101 patients (57 male) aged 6-17 (median 11) years and asked them to put themselves in the place of a physician delivering an epilepsy diagnosis. They said they would be careful and friendly and consider the children's feelings (29%), give them detailed information about their condition (29%) and reduce their fears and offer hope (26%). They would tell them the importance of always taking their medication and explain why (25%), make sure that the conversation took place in a comfortable setting (21%), explain any safety precautions (19%), keep the conversation straightforward and provide examples (16%). CONCLUSION Children with epilepsy provided concrete recommendations for physicians delivering an epilepsy diagnosis, with regard to the ideal setting, important topics and optimal communication. The recommendations could help physicians meet children's needs.
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Affiliation(s)
- Sarah Jeschke
- Neuropaediatrics University Hospital for Children and Adolescents Rostock Germany
| | - Sarah Woltermann
- Center for Pediatric Research University Hospital for Children and Adolescents Leipzig Germany
- Drug Safety Center and Clinical Pharmacy Institute of Pharmacy Medical Faculty Leipzig University Leipzig Germany
| | - Martina Patrizia Neininger
- Drug Safety Center and Clinical Pharmacy Institute of Pharmacy Medical Faculty Leipzig University Leipzig Germany
| | - Josefine Pauschek
- Neuropaediatrics University Hospital for Children and Adolescents Rostock Germany
| | - Wieland Kiess
- Center for Pediatric Research University Hospital for Children and Adolescents Leipzig Germany
| | - Thilo Bertsche
- Drug Safety Center and Clinical Pharmacy Institute of Pharmacy Medical Faculty Leipzig University Leipzig Germany
| | - Astrid Bertsche
- Neuropaediatrics University Hospital for Children and Adolescents Rostock Germany
- Center for Pediatric Research University Hospital for Children and Adolescents Leipzig Germany
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Zanon BP, Cremonese L, Ribeiro AC, Padoin SMDM, Paula CCD. Communication of bad news in pediatrics: integrative review. Rev Bras Enferm 2020; 73 Suppl 4:e20190059. [PMID: 32785469 DOI: 10.1590/0034-7167-2019-0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/30/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify the scientific evidence of the elements of communication in the process of communicating bad news in pediatrics. METHODS integrative review searched in the LILACS, PubMed and WoS databases. Primary studies in Portuguese, Spanish or English were included. RESULTS the evidence from the 40 studies were organized according to the elements of communication: sender (family and/or professional), receiver (family and/or child), message (bad or difficult news about diagnosis/prognosis; empathetically, honestly, objective, hopeful and available), channel (materials, quality, quantity and pace), context and effects (social and emotional changes), noise (feelings and language) and failures (silencing and misleading information). CONCLUSIONS there is a need to prepare the institution and team, as well as the family and the child, in order to promote co-responsibility in this process, to minimize suffering and communication noise and to avoid failures, recognizing the child's right to know their condition.
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Affiliation(s)
- Bruna Pase Zanon
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Luiza Cremonese
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
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Brief Report: Assessment Experiences of Children with Neurogenetic Syndromes: Caregivers' Perceptions and Suggestions for Improvement. J Autism Dev Disord 2020; 50:1443-1450. [PMID: 31955311 DOI: 10.1007/s10803-020-04363-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
It is well-recognized that measurement options for diagnosing and monitoring children with neurogenetic syndromes (NGS) associated with moderate to severe intellectual impairment are limited (Berry-Kravis, Dev Med Child Neurol https://doi.org/10.1111/dmcn.13018, 2016), and caregivers experience significant concerns regarding the assessment process. However to date, these concerns have not been summarized into actionable steps for clinicians and test-makers. As such, we used a mixed methods approach to assess caregiver-derived perceptions and suggestions for improving assessments in NGS. Results indicated many shared challenges and suggestions for improvement, particularly in the domains of testing procedures and examiner communication. Integrating these suggestions into future protocols is an important next step toward improving the quality of assessment procedures for children with NGS and their families across both clinical and research contexts.
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Sulmonte LAG, Bisordi K, Ulm E, Nusbaum R. Open communication of Duchenne muscular dystrophy facilitates disclosure process by parents to unaffected siblings. J Genet Couns 2020; 30:246-256. [PMID: 32683768 DOI: 10.1002/jgc4.1315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/12/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a progressive childhood onset neuromuscular disease with no known cure. There is extensive literature about the impact of a diagnosis on the psychosocial well-being of unaffected siblings, with a need for additional research to provide information about optimal ways to disclose this information to unaffected children. We sought to explore the parental experiences of disclosing a sibling's diagnosis of DMD to unaffected children who were age 8-17 years old either at the time of their sibling's diagnosis or presently. Parents were recruited through Maryland Muscular Dystrophy Association, Parent Project Muscular Dystrophy, and Cincinnati Children's Hospital Medical Center Neuromuscular Center. An interview guide, rooted in family communication, was created to incorporate themes and topics found in literature specific to DMD and disclosure to unaffected siblings. We qualitatively explored these experiences through semi-structured interviews and performed thematic analysis using a coding system to identify overarching themes and subthemes. Several main themes regarding challenges to the disclosure process emerged. We identified the following themes in procedural aspects of disclosure: lack of provider support, importance of the DMD community, and open and gradual timeline of disclosure. Under emotional experiences, we identified these themes: overwhelming nature, elements of surprise disclosure, and balancing parental and sibling needs. Most questions from unaffected siblings related to procedural elements of care such as treatments and equipment. Additional unanticipated themes emerged that may contribute to the knowledge of family culture surrounding DMD: the complex role of Facebook as a family resource, deferring carrier testing for siblings, and inclusion of DMD in school projects. While the process of disclosure is complicated by a variety of factors such as lack of provider support and overwhelming emotional burden, families highlight the importance of open communication in discussion with unaffected children.
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Affiliation(s)
| | | | - Elizabeth Ulm
- Neuromuscular Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rachel Nusbaum
- University of Maryland School of Medicine, Baltimore, MD, USA
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Adams D, Roche L, Heussler H. Parent perceptions, beliefs, and fears around genetic treatments and cures for children with Angelman syndrome. Am J Med Genet A 2020; 182:1716-1724. [PMID: 32449301 DOI: 10.1002/ajmg.a.61631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/27/2020] [Accepted: 04/28/2020] [Indexed: 01/21/2023]
Abstract
Genetic therapies have shown recent promise in alleviating some of the cognitive issues associated with some genetic disorders; however, these therapies may come with significant health and socio-ethical concerns, particularly when they involve child participants. Little is known about what parents of children with genetic disorders think about genetic therapies, or about their knowledge of how genetic-based therapy might treat their child's symptoms. Forty-two parents of children with Angelman syndrome (AS) and 27 parents of a mixed etiology comparison group completed an online survey reporting on their perceptions of, and priorities for, genetic therapy. Almost all parents of children with AS (95%) and the comparison group (89%) agreed that treatments aiming to reduce symptoms associated with their child's syndrome were positive. However, significantly more parents of children with AS (95%) than the comparison group (56%) felt that genetic treatment trials aiming to "cure" their child should be a research priority. AS parent priorities for the focus of clinical trials were neurology/seizures, communication skills, and motor skills/mobility. For the comparison group, the priorities were IQ, immune response, and expressive speech. Parents of both groups did not want treatments to change their child's personality or their happiness. Global assumptions cannot be made about targets for therapy between syndromes, about parental understanding of genetics, or about research evidence across syndromes. This study highlights the need for true family and patient engagement in all stages of the research design and treatment evaluation.
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Affiliation(s)
- Dawn Adams
- Autism Centre of Excellence, Griffith University, Brisbane, Queensland, Australia
| | - Laura Roche
- Autism Centre of Excellence, Griffith University, Brisbane, Queensland, Australia
| | - Helen Heussler
- Centre for Clinical Trials in Rare Neurodevelopmental Disorders, Children's Health Queensland, Brisbane, Queensland, Australia.,Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia
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Byrd CT, Werle D, St Louis KO. Speech-Language Pathologists' Comfort Level With Use of Term "Stuttering" During Evaluations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:841-850. [PMID: 32233922 DOI: 10.1044/2020_ajslp-19-00081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Speech-language pathologists (SLPs) anecdotally report concern that their interactions with a child who stutters, including even the use of the term "stuttering," might contribute to negative affective, behavioral, and cognitive consequences. This study investigated SLPs' comfort in providing a diagnosis of "stuttering" to children's parents/caregivers, as compared to other commonly diagnosed developmental communication disorders. Method One hundred forty-one school-based SLPs participated in this study. Participants were randomly assigned to one of two vignettes detailing an evaluation feedback session. Then, participants rated their level of comfort disclosing diagnostic terms to parents/caregivers. Participants provided rationale for their ratings and answered various questions regarding academic and clinical experiences to identify factors that may have influenced ratings. Results SLPs were significantly less likely to feel comfortable using the term "stuttering" compared to other communication disorders. Thematic responses revealed increased experience with a specific speech-language population was related to higher comfort levels with using its diagnostic term. Additionally, knowing a person who stutters predicted greater comfort levels as compared to other clinical and academic experiences. Conclusions SLPs were significantly less comfortable relaying the diagnosis "stuttering" to families compared to other speech-language diagnoses. Given the potential deleterious effects of avoidance of this term for both parents and children who stutter, future research should explore whether increased exposure to persons who stutter of all ages systematically improves comfort level with the use of this term.
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Affiliation(s)
- Courtney T Byrd
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Danielle Werle
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Kenneth O St Louis
- Department of Communication Sciences and Disorders, West Virginia University, Morgantown
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Sandini C, Schneider M, Eliez S, Armando M. Association Between Parental Anxiety and Depression Level and Psychopathological Symptoms in Offspring With 22q11.2 Deletion Syndrome. Front Psychiatry 2020; 11:646. [PMID: 32792992 PMCID: PMC7390875 DOI: 10.3389/fpsyt.2020.00646] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022] Open
Abstract
22q11.2 deletion syndrome (22q11DS) is recognized as one of the strongest genetic risk factors for the development of psychopathology, including dramatically increased prevalence of schizophrenia anxiety disorders, mood disorders, and Attention Deficit Hyperactivity Disorder (ADHD). Despite sharing a homogenous genetic deletion, the psychiatric phenotype in 22q11DS still present significant variability across subjects. The origins of such variability remain largely unclear. Levels of parental psychopathology could significantly contribute to phenotypic variability of offspring psychopathology, through mechanisms of gene x gene (GxG) and gene x environment (GxE) interactions. However, this hypothesis has not been explicitly tested to date in 22q11DS. In the present manuscript, we employed a longitudinal design to investigate bi-directional interactions of parental anxiety and depressive symptoms, estimated with Beck Depression Inventory and Beck Anxiety Inventory, and offspring level of psychopathology assessed with a combination of parentally reported Child Behavioral Checklist, Youth Self Report Questionnaire, and Structured Clinical Interviews for Prodromal Syndromes (SIPS). We tested associations in both typically developing healthy controls (HCs) (N = 88 participants; N = 131 time points) and in individuals with 22q11DS (N = 103 participants; N = 198 time points). We observed that 22q11DS individuals with higher levels of parental anxiety and depression presented significant increases in multiple forms of psychopathology, including higher internalizing and externalizing symptoms, as estimated both by parental and self-report questionnaires, along with higher negative and generalized symptoms as measured with the SIPS. Associations for positive and disorganized dimensions of the SIPS were not statistically significant. Purely longitudinal analysis pointed to bi-directional interactions of parental and child psychopathology, with marginally stronger longitudinal associations between early parental anxiety-depression and subsequent child psychopathology. Interestingly, associations between psychopathology across generations were significantly stronger in 22q11DS individuals compared to HCs. Our results show that parental levels of anxiety and depression are associated with levels of offspring psychopathology, particularly in individuals with 22q11DS. These findings point to the existence of GxG or GxE mechanisms, that should be investigated in future work. From a clinical perspective, they highlight a strong rational for the management of parental psychological well-being in 22q11DS.
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Affiliation(s)
- Corrado Sandini
- Developmental Imaging and Psychopathology lab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Maude Schneider
- Developmental Imaging and Psychopathology lab, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Stephan Eliez
- Developmental Imaging and Psychopathology lab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marco Armando
- Developmental Imaging and Psychopathology lab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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15
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Affiliation(s)
- Linda Gilmore
- Queensland University of Technology, Brisbane, Australia
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16
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Douglas T, Redley B, Ottmann G. The need to know: The information needs of parents of infants with an intellectual disability-a qualitative study. J Adv Nurs 2017; 73:2600-2608. [DOI: 10.1111/jan.13321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Tracy Douglas
- School of Nursing and Midwifery; Deakin University; Burwood Vic. Australia
| | - Bernice Redley
- School of Nursing and Midwifery; Deakin University; Burwood Vic. Australia
- Centre for Nursing Research-Deakin University and Monash Health Partnership; Burwood Vic. Australia
| | - Goetz Ottmann
- School of Health and Social Development; Deakin University; Burwood Vic. Australia
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17
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Douglas T, Redley B, Ottmann G. The first year: the support needs of parents caring for a child with an intellectual disability. J Adv Nurs 2016; 72:2738-2749. [DOI: 10.1111/jan.13056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Tracy Douglas
- Deakin University; School of Nursing and Midwifery; Burwood Victoria Australia
| | - Bernice Redley
- Deakin University; School of Nursing and Midwifery; Burwood Victoria Australia
- Centre for Nursing Research - Deakin University and Monash Health Partnership; Burwood Victoria Australia
| | - Goetz Ottmann
- Dr Goetz Ottmann and Associates; Mount Waverley Victoria Australia
- Deakin University; School of Health and Social Development; Burwood Victoria Australia
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