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Wanberg LJ, Pearson DR. Evaluating the Disease-Related Experiences of TikTok Users With Lupus Erythematosus: Qualitative and Content Analysis. JMIR INFODEMIOLOGY 2024; 4:e51211. [PMID: 38631030 PMCID: PMC11063877 DOI: 10.2196/51211] [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: 07/24/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Lupus erythematosus (LE) is an autoimmune condition that is associated with significant detriments to quality of life and daily functioning. TikTok, a popular social networking platform for sharing short videos, provides a unique opportunity to understand experiences with LE within a nonclinical sample, a population that is understudied in LE research. This is the first qualitative study that explores LE experiences using the TikTok platform. OBJECTIVE This study aims to evaluate the disease-related experiences of TikTok users with LE using qualitative and content analysis. METHODS TikTok videos were included if the hashtags included #lupus, were downloadable, were in English, and involved the personal experience of an individual with LE. A codebook was developed using a standardized inductive approach of iterative coding until saturation was reached. NVivo (Lumivero), a qualitative analysis software platform, was used to code videos and perform content analysis. Inductive thematic analysis was used to derive themes from the data. RESULTS A total of 153 TikTok videos met the inclusion criteria. The most common codes were experiences with symptoms (106/153, 69.3%), mucocutaneous symptoms (61/153, 39.9%), and experiences with treatment (59/153, 38.6%). Experiences with symptoms and mucocutaneous symptoms had the greatest cumulative views (25,381,074 and 14,879,109 views, respectively). Five thematic conclusions were derived from the data: (1) mucocutaneous symptoms had profound effects on the mental health and body image of TikTok users with LE; (2) TikTok users' negative experiences with health care workers were often derived from diagnostic delays and perceptions of "medical gaslighting"; (3) TikTok users tended to portray pharmacologic and nonpharmacologic interventions, such as diet and naturopathic remedies, positively, whereas pharmacologic treatments were portrayed negatively or referred to as "chemotherapy"; (4) LE symptoms, particularly musculoskeletal symptoms and fatigue, interfered with users' daily functioning; and (5) although TikTok users frequently had strong support systems, feelings of isolation were often attributed to battling an "invisible illness." CONCLUSIONS This study demonstrates that social media can provide important, clinically relevant information for health practitioners caring for patients with chronic conditions such as LE. As mucocutaneous symptoms were the predominant drivers of distress in our sample, the treatment of hair loss and rash is vital in this population. However, pharmacologic therapies were often depicted negatively, reinforcing the significance of discussions on the safety and effectiveness of these treatments. In addition, while TikTok users demonstrated robust support systems, feelings of having an "invisible illness" and "medical gaslighting" dominated negative interactions with others. This underscores the importance of providing validation in clinical interactions.
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Affiliation(s)
- Lindsey J Wanberg
- University of Minnesota Medical School, Minneapolis, MN, United States
| | - David R Pearson
- University of Minnesota Medical School, Minneapolis, MN, United States
- Department of Dermatology, University of Minnesota, Minneapolis, MN, United States
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Eudy AM, Clowse MEB, Corneli A, McKenna K, Pisetsky DS, Maheswaranathan M, Burshell D, Doss J, Sun K, Sadun RE, Criscione-Schreiber LG, Rogers JL. The Type 1 & 2 systemic lupus erythematosus model: Perspectives of people living with systemic lupus erythematosus. Lupus 2024; 33:266-272. [PMID: 38238905 PMCID: PMC11034781 DOI: 10.1177/09612033241228343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
OBJECTIVE In the new Type 1 & 2 model for systemic lupus erythematosus (SLE), Type 1 SLE represents classic inflammatory manifestations, such as arthritis, while Type 2 SLE encompasses symptoms such as pain and fatigue where the relationship to inflammation is less clear. The objective of this study was to interview individuals living with SLE to determine the content and face validity of the Type 1 & 2 SLE model. METHODS We conducted a qualitative study using semi-structured interviews with a purposeful sample of participants who met classification criteria for SLE. Participants were asked to describe their experiences with Type 1 & 2 SLE symptoms and treatments, and they indicated if and how their personal experiences aligned with the Type 1 & 2 SLE model. All interviews were audio-recorded and transcribed; applied thematic analysis identified the most frequent and salient themes. RESULTS We interviewed 42 participants with SLE. Type 2 SLE symptoms, such as pain and fatigue, were very common, with almost all participants experiencing some Type 2 symptoms at some point during their disease course. Participants described Type 1 SLE symptoms as being acute flares and life-threatening and Type 2 SLE symptoms as "everyday lupus" that affected their daily lives and were a dominant part of their SLE disease experience. Most participants stated they want their rheumatologists to discuss Type 2 symptoms during clinical appointments in order to address their full symptom experience. CONCLUSION We demonstrated content and face validity of the Type 1 & 2 SLE model with people living with SLE. Participants in our study largely understood the model and felt it accurately reflected their experience living with SLE. Type 2 SLE symptoms are very common in individuals with SLE and impact patients' quality of life. Using the model to address Type 2 SLE symptoms allows the rheumatologist to incorporate the patient's perspective and provide patient-centered care.
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Affiliation(s)
- Amanda M. Eudy
- Department of Medicine, Duke University School of Medicine
| | | | - Amy Corneli
- Department of Medicine, Duke University School of Medicine
- Department of Population Health Sciences, Duke University School of Medicine
| | - Kevin McKenna
- Department of Population Health Sciences, Duke University School of Medicine
| | - David S. Pisetsky
- Department of Medicine, Duke University School of Medicine
- Durham VA Medical Center
| | | | - Dana Burshell
- Department of Medicine, Duke University School of Medicine
| | - Jayanth Doss
- Department of Medicine, Duke University School of Medicine
| | - Kai Sun
- Department of Medicine, Duke University School of Medicine
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Leung J, Som A, McMorrow L, Zickuhr L, Wolbers J, Bain K, Flood J, Baker EA. Rethinking the Difficult Patient: Formative Qualitative Study Using Participatory Theater to Improve Physician-Patient Communication in Rheumatology. JMIR Form Res 2023; 7:e40573. [PMID: 36877547 PMCID: PMC10028511 DOI: 10.2196/40573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Effective physician-patient communication is crucial for positive health outcomes for patients with chronic diseases. However, current methods of physician education in communication are often insufficient to help physicians understand how patients' actions are influenced by the contexts within which they live. An arts-based participatory theater approach can provide the necessary health equity framing to address this deficiency. OBJECTIVE The aim of this study was to develop, pilot, and conduct a formative evaluation of an interactive arts-based communication skills intervention for graduate-level medical trainees grounded in a narrative representative of the experience of patients with systemic lupus erythematosus. METHODS We hypothesized that the delivery of interactive communication modules through a participatory theater approach would lead to changes in both attitudes and the capacity to act on those attitudes among participants in 4 conceptual categories related to patient communication (understanding social determinants of health, expressing empathy, shared decision-making, and concordance). We developed a participatory, arts-based intervention to pilot this conceptual framework with the intended audience (rheumatology trainees). The intervention was delivered through routine educational conferences at a single institution. We conducted a formative evaluation by collecting qualitative focus group feedback to evaluate the implementation of the modules. RESULTS Our formative data suggest that the participatory theater approach and the design of the modules added value to the participants' learning experience by facilitating interconnection of the 4 communication concepts (eg, participants were able to gain insight into both what physicians and patients were thinking about on the same topic). Participants also provided several suggestions for improving the intervention such as ensuring that the didactic material had more active engagement and considering additional ways to acknowledge real-world constraints (eg, limited time with patients) in implementing communication strategies. CONCLUSIONS Our findings from this formative evaluation of communication modules suggest that participatory theater is an effective method for framing physician education with a health equity lens, although considerations in the realms of functional demands of health care providers and use of structural competency as a framing concept are needed. The integration of social and structural contexts into the delivery of this communication skills intervention may be important for the uptake of these skills by intervention participants. Participatory theater provided an opportunity for dynamic interactivity among participants and facilitated greater engagement with the communication module content.
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Affiliation(s)
- Jerik Leung
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Avira Som
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Lily McMorrow
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Lisa Zickuhr
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - John Wolbers
- Metro Theater Company, St. Louis, MO, United States
| | - Karen Bain
- Metro Theater Company, St. Louis, MO, United States
| | - Julia Flood
- Metro Theater Company, St. Louis, MO, United States
| | - Elizabeth A Baker
- Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States
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Kasturi S, Price LL, LeClair A, Patel N, Shetty S, Sheira D, Weber S, Curtis D, Nowell WB, Salmon J, Terrin N, McAlindon TE, Mandl LA. Clinical integration of patient-reported outcome measures to enhance the care of patients with SLE: a multi-centre prospective cohort study. Rheumatology (Oxford) 2022; 61:4763-4774. [PMID: 35357445 PMCID: PMC9707322 DOI: 10.1093/rheumatology/keac200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/17/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess the feasibility and impact of integrating electronic patient-reported outcome measures (PROMs) into the routine outpatient care of patients with SLE. METHODS We conducted a prospective cohort study, utilizing a mixed-methods sequential explanatory design, of SLE outpatients receiving rheumatology care at two academic medical centres. Participants completed electronic PROMs at enrolment and then prior to their next two routine rheumatology visits. PROM score reports were shared with patients and rheumatologists before visits. Patients and rheumatologists completed post-visit surveys evaluating the utility of PROMs in the clinical encounters. Focus groups of patients and interviews with treating rheumatologists were conducted to further explore their experience utilizing PROMs. RESULTS A total of 105 SLE patients and 17 rheumatologists participated in the study. Patients completed PROMs in 159 of 184 encounters (86%), with 93% of surveys completed remotely. Patients reported that PROMs were 'quite a bit' or 'very' useful (55% of encounters) and beneficial to communication (55% of encounters). In contrast, physicians found PROMs useful (20%) and beneficial to communication (17%) less frequently. There was no significant change in visit length, health-related quality of life or disease activity after implementation of PROMs; however, patient satisfaction improved slightly. Qualitative analyses revealed that patients felt PROMs provided utility primarily by facilitating communication, particularly when physicians discussed the surveys. CONCLUSION The remote capture and integration of electronic PROMs into clinical care was feasible in a diverse cohort of SLE outpatients. PROMs were useful to patients and enhanced their clinical experience primarily by facilitating communication.
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Affiliation(s)
- Shanthini Kasturi
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University
- Institute for Clinical Research and Health Policy Studies
| | - Amy LeClair
- Department of Medicine, Tufts Medical Center, Boston, MA
| | - Neena Patel
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Shreya Shetty
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Dina Sheira
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
| | - Serena Weber
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | | | | | - Jane Salmon
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
- Division of Rheumatology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Norma Terrin
- Tufts Clinical and Translational Science Institute, Tufts University
| | | | - Lisa A Mandl
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
- Division of Rheumatology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Petrocchi V, Visintini E, De Marchi G, Quartuccio L, Palese A. Patient Experiences of Systemic Lupus Erythematosus: Findings From a Systematic Review, Meta-Summary, and Meta-Synthesis. Arthritis Care Res (Hoboken) 2022; 74:1813-1821. [PMID: 34133081 PMCID: PMC9796081 DOI: 10.1002/acr.24639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore the experience of patients with systemic lupus erythematosus (SLE). METHODS A systematic review of qualitative studies published in English in the past 10 years and identified through the PubMed, CINAHL, Scopus, and Web of Science databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methodologic quality of each included study was assessed using the Critical Appraisal Screening Programme tool. Study findings were then subjected to a meta-summary and meta-synthesis. RESULTS Twenty-six studies with a good overall methodologic quality were included, documenting the experience of 565 adult patients (95% women). A total of 17 codes emerged, summarizing the life experience of SLE patients; the most and least frequent codes in the meta-summary were "feeling not as I usually do" (69.2%) and "having wishes" (7.7%). The codes were then categorized into 5 main themes, summarizing the experience of living with SLE: 1) "experiencing waves of emotions due to the unpredictable nature of the disease," 2) "trying to live an ordinary life," 3) "listening to and obeying the body's limitations," 4) "reviewing my life projects," and 5) "dealing with future uncertainties." CONCLUSION Several qualitative studies have been published to date using good methodologic approaches. According to the findings, SLE negatively impacts patient experiences by affecting multiple dimensions of their daily lives, with fatigue and pain as the most frequent symptoms.
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Alrashdi MN, Alrasheedi SM, Alkhdairi A, Alburaq FN, Muteb AE, Alshamikh AS, Almutairi K, Ammar AN, Saleh AL, Nawaf AW. Primary Healthcare Practitioners' Knowledge, Attitude, and Practice Toward Systemic Lupus Erythematosus in the Qassim Region, Saudi Arabia. Cureus 2022; 14:e30297. [PMID: 36407197 PMCID: PMC9658483 DOI: 10.7759/cureus.30297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 06/16/2023] Open
Abstract
Objective The study aims to evaluate the primary healthcare practitioner's (PHCP) knowledge, attitude, and practice toward systemic lupus erythematosus (SLE) and to explore the difficulties of early referral to specialized clinics. Method This is a cross-sectional study conducted between February and March 2022 targeting the PHCP among the primary healthcare centers in Qassim, Saudi Arabia. The study was conducted among 203 participants who enrolled via a cluster random sampling technique depending on the survey. Qualitative categorical variables are expressed as frequencies and percentages, while continuous variables are reported as means and standard deviations (SD). The one-way analysis of variance (ANOVA) test and the independent T-test have been used to explore the relationship between participants' knowledge scores and their socio-demographic characteristics. A P-value ≤0.05 was considered statistically significant. Result The study found that only 4.4% of participating PHCPs had good knowledge related to SLE, while 45.8% of them had fair knowledge, and nearly half of them (49.8%) had poor knowledge. It was noted that GPs who specialized in family medicine or saw more than 40 patients each week had comparably better knowledge than others, which was statistically significant (p<0.05). The difficulty in diagnosing SLE patients was mentioned by 48.3% of the PHCPs. Family medicine consultants (p<0.001), those who worked in a tertiary care facility for more than six months (p<0.001) and those who worked in a rheumatology department (p<0.05), reported considerably better levels of comfort when treating SLE patients. Conclusion This study found that included participants' understanding of SLE, its diagnosis, and management was inadequate. Coordination between rheumatologists and experts from many disciplines at the primary, secondary, and tertiary levels of care is critical for overcoming ambiguities and obstacles in the diagnosis and therapy of SLE patients.
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Affiliation(s)
- Mousa N Alrashdi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Sami M Alrasheedi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Ahmad Alkhdairi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | | | | | | | - Khalid Almutairi
- Department of Medicine, Unaizah Collage of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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Sims R, Michaleff ZA, Glasziou P, Thomas R. Consequences of a Diagnostic Label: A Systematic Scoping Review and Thematic Framework. Front Public Health 2022; 9:725877. [PMID: 35004561 PMCID: PMC8727520 DOI: 10.3389/fpubh.2021.725877] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: To develop a thematic framework for the range of consequences arising from a diagnostic label from an individual, family/caregiver, healthcare professional, and community perspective. Design: Systematic scoping review of qualitative studies. Search Strategy: We searched PubMed, Embase, PsycINFO, Cochrane, and CINAHL for primary studies and syntheses of primary studies that explore the consequences of labelling non-cancer diagnoses. Reference lists of included studies were screened, and forward citation searches undertaken. Study Selection: We included peer reviewed publications describing the perceived consequences for individuals labelled with a non-cancer diagnostic label from four perspectives: that of the individual, their family/caregiver, healthcare professional and/or community members. We excluded studies using hypothetical scenarios. Data Extraction and Synthesis: Data extraction used a three-staged process: one third was used to develop a preliminary framework, the next third for framework validation, and the final third coded if thematic saturation was not achieved. Author themes and supporting quotes were extracted, and analysed from the perspective of individual, family/caregiver, healthcare professional, or community member. Results: After deduplication, searches identified 7,379 unique articles. Following screening, 146 articles, consisting of 128 primary studies and 18 reviews, were included. The developed framework consisted of five overarching themes relevant to the four perspectives: psychosocial impact (e.g., positive/negative psychological impact, social- and self-identity, stigma), support (e.g., increased, decreased, relationship changes, professional interactions), future planning (e.g., action and uncertainty), behaviour (e.g., beneficial or detrimental modifications), and treatment expectations (e.g., positive/negative experiences). Perspectives of individuals were most frequently reported. Conclusions: This review developed and validated a framework of five domains of consequences following diagnostic labelling. Further research is required to test the external validity and acceptability of the framework for individuals and their family/caregiver, healthcare professionals, and community.
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Affiliation(s)
- Rebecca Sims
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Zoe A Michaleff
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
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Uhrenholt L, Høstgaard S, Pedersen JF, Christensen R, Dreyer L, Leffers HCB, Taylor PC, Strand V, Jacobsen S, Voss A, Gregersen JW, Kristensen S. Patient-reported outcome measures in systemic lupus erythematosus by a web-based application: A randomized, crossover, agreement study. Lupus 2021; 30:2124-2134. [PMID: 34719299 DOI: 10.1177/09612033211051641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are evaluated in randomized controlled trials (RCTs) in patients with systemic lupus erythematosus (SLE), but not widely used in clinical practice. However, interest in incorporating PROMs into the management of SLE is increasing as PROMs provide a unique insight into the patient's perception of lupus disease activity. The objective was to assess agreement in PROMs answered using a web app versus an outpatient touchscreen among patients with SLE. METHODS In a crossover RCT, SLE patients answered the following PROMs in a random order using the web app and the outpatient touchscreen: Systemic Lupus Erythematosus Activity Questionnaire (SLAQ) Global Health, SLAQ Symptom, SLAQ Total, SLAQ Worsening, Pain Visual Analog Scale (VAS), Fatigue VAS, Patient Global Health VAS, Health Assessment Questionnaire Disability Index (HAQ-DI), Patient Acceptable Symptom State (PASS), and an Anchoring Question. Equivalence between the two device types was demonstrated if the 95% confidence interval (95% CI) of the difference in PROM scores was within the prespecified equivalence margin. Agreement between the two device types was assessed using mixed linear models. RESULTS Thirty-four patients with SLE were included. Equivalence was demonstrated between the two device types for SLAQ Global Health with a difference of -0.21 (95% CI: -0.65 to 0.23). Moreover, equivalence was also found for HAQ-DI, Pain VAS, and Fatigue VAS whereas only comparability within the limits of the Minimal Clinically Important Difference (MCID) was demonstrated for VAS Patient Global Health. Statistical comparability was demonstrated for SLAQ Total, SLAQ Worsening, PASS, and Anchoring Question (no predefined MCID/equivalence margins available). However, a statistically significant difference between device types was observed for the SLAQ Symptom of -0.56 (95% CI: -1.10 to -0.01). The difference was, however, very small when considering the scale range of 0-24; thus, it was not judged to be of clinical relevance. Preference for the web app was very high (91.2%). CONCLUSION For the first time ever, equivalence and comparability between two electronic device types for various PROMs were demonstrated among patients with SLE. Implementation of the device is expected to improve the management of SLE.
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Affiliation(s)
- Line Uhrenholt
- Department of Rheumatology, 53141Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark.,Section for Biostatistics and Evidence-Based Research, 542252the Parker Institute, Copenhagen, Denmark.,DANBIO, 70590Rigshospitalet Glostrup, Glostrup, Denmark
| | - Simone Høstgaard
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Julie F Pedersen
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, 542252the Parker Institute, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, 11286Odense University Hospital, Odense, Denmark
| | - Lene Dreyer
- Department of Rheumatology, 53141Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Henrik C B Leffers
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, 6396University of Oxford, Oxford, UK
| | - Vibeke Strand
- Division of Immunology/Rheumatology, 6429Stanford University School of Medicine, Palo Alto, California, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Science, 4321University of Copenhagen, Copenhagen, Denmark
| | - Anne Voss
- Department of Rheumatology, 11286Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jon W Gregersen
- Department of Nephrology, 53141Aalborg University Hospital, Aalborg, Denmark
| | - Salome Kristensen
- Department of Rheumatology, 53141Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
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Yan D, Zamalin D, Chakka S, Krain R, Concha J, Feng R, Ahmed S, Okawa J, Werth VP. Cutaneous lupus concerns from the patient perspective: a qualitative study. Lupus Sci Med 2021; 8:8/1/e000444. [PMID: 34452954 PMCID: PMC8404455 DOI: 10.1136/lupus-2020-000444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/04/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There is a need to identify concerns unique to patients with cutaneous lupus erythematosus (CLE), which may not be captured by current common-practice dermatological quality-of-life tools. This study formally characterises what bothers patients with CLE about their disease by conducting semistructured, qualitative interviews. METHODS Sixteen patients with CLE were interviewed about how their cutaneous findings impact their daily life. Each interview was transcribed, coded and categorised for recurrent themes. Current CLE activity and damage were also assessed by the Cutaneous Lupus Activity and Severity Index tool. RESULTS Responses were categorised into six themes, including Fear of Disease Progression, Unwanted Attention, Self-Consciousness, Physical Signs/Symptoms, Emotional Symptoms and Functional Decline. The most commonly reported themes were Self-Consciousness, mentioned by 13 of 16 (81.3%) patients, Physical Symptoms, mentioned by 12 of 16 (75%), and then Fear of Disease Progression, by 11 of 16 (68.8%). Frequently mentioned physical signs/symptoms included erythema, itch, dyspigmentation, scar and alopecia. The physical signs/symptoms were categorised as activity signs/symptoms, damage signs and other. For activity signs, erythema was mentioned most frequently (5 of 16), then scale (2 of 16). For activity symptoms, itch was mentioned most frequently (6 of 16), then pain (5 of 16). For damage signs, dyspigmentation was mentioned most frequently (4 of 16), followed by scarring (3 of 16). Patients less than 60 years old were more likely to report emotional symptoms than older patients (p<0.05), but there was no significant variation in frequency of reported themes between race, sex or subtype of CLE. CONCLUSIONS These patient experiences and resultant themes elucidated by this study are worth noting in future standardised estimations of the quality of life of patients with CLE. Additionally, the concerns shown by these interviews are important topics for providers to discuss when evaluating patient disease progression.
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Affiliation(s)
- Daisy Yan
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Danielle Zamalin
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Srita Chakka
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Rebecca Krain
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Josef Concha
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Rui Feng
- Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah Ahmed
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Joyce Okawa
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Victoria P Werth
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
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10
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Leung J, Kloos L, Kim AH, Baker EA. Development of a digital toolkit to improve quality of life of patients with systemic lupus erythematosus. Digit Health 2021; 7:20552076211033423. [PMID: 34408903 PMCID: PMC8365175 DOI: 10.1177/20552076211033423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Objective The purpose of this manuscript is to detail development and initial usability
testing of an e-toolkit designed to provide skills and knowledge around
self-management behaviors for individuals living with systemic lupus
erythematosus. Methods Researchers worked with a steering committee of patients and providers to (1)
develop a clickable prototype of an e-toolkit and (2) conduct alpha
(individuals not affiliated with an academic clinic as patient or provider)
and beta (individual patients with systemic lupus erythematosus as well as
members of the clinic healthcare team and individuals who work in patient
advocacy organizations) usability testing through semistructured
interviews. Results During the review of the e-toolkit, the feedback provided by participants in
both alpha and beta groups centered on two overarching themes: (1) improving
user interface and materials and (2) integration of information and supports
between toolkit and clinical personnel. Conclusion Digital approaches that are tailored to individual symptom variation and
integrated with a clinical system have the opportunity to enhance ongoing
clinical care. These findings support movement toward integrated, team-based
care models, tailored digital resources, and use of expanded virtual
interaction options to ensure on-going engagement between healthcare
providers and systemic lupus erythematosus patients.
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Affiliation(s)
- Jerik Leung
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, USA
| | | | - Alfred Hj Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, USA
| | - Elizabeth A Baker
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, USA
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11
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Ubhi M, Dubey S, Gordon C, Adizie T, Sheeran T, Allen K, Jordan R, Sadhra S, Adams J, Daji R, Reynolds JA, Kumar K. Understanding the impact of systemic lupus erythematosus on work amongst South Asian people in the UK: An explorative qualitative study. Lupus 2021; 30:1492-1501. [PMID: 34092136 PMCID: PMC8283190 DOI: 10.1177/09612033211022816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SLE has a range of fluctuating symptoms affecting individuals and their ability to work. Although South Asian (SA) patients are at increased risk of developing SLE there is limited knowledge of the impact on employment for these patients in the UK. Understanding ethnicity and disease-specific issues are important to ensure patients are adequately supported at work. Semi-structured interviews were conducted with patients of SA origin to explore how SLE impacted on their employment. Thematic analysis was used to analyse the data which are reported following COREQ guidelines. Ten patients (8 female; 2 male) were recruited from three rheumatology centres in the UK and interviewed between November 2019 and March 2020. Patients were from Indian (n = 8) or Pakistani (n = 2) origin and worked in a range of employment sectors. Four themes emerged from the data: (1) Disease related factors; (2) Employment related factors; (3) Cultural and interpersonal factors impacting on work ability; (4) Recommendations for improvement. Patients’ ability to work was affected by variable work-related support from their hospital clinicians, low awareness of SLE and variable support from their employers, and cultural barriers in their communities that could affect levels of family support received. These findings highlight the need for additional support for SA patients with SLE in the workplace.
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Affiliation(s)
- Mandeep Ubhi
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Shirish Dubey
- University Hospitals Coventry, Coventry, UK.,Warwickshire NHS Trust, Warwick, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | | | - Tom Sheeran
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Kerry Allen
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Rachel Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
| | - Jo Adams
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | | | - John A Reynolds
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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12
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Tan QEC, Gao X, Ang WHD, Lau Y. Medication adherence: a qualitative exploration of the experiences of adolescents with systemic lupus erythematosus. Clin Rheumatol 2021; 40:2717-2725. [PMID: 33566194 DOI: 10.1007/s10067-021-05583-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/13/2020] [Accepted: 01/10/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/OBJECTIVE There are increasing numbers of children diagnosed with systemic lupus erythematosus (SLE). Given the chronicity of the disease, individuals are confronted with cocktails of medications for an extended period. The present study explores experiences in medication adherence among adolescents with SLE in an acute care hospital. METHOD A descriptive qualitative design was employed. Fourteen adolescents with SLE were purposively selected. Face-to-face audio-recorded semi-structured interviews were conducted. Field notes and reflexive journals were maintained, and frequent debriefing sessions were performed to ensure the study's methodological rigour. Interviews were transcribed verbatim and thematic analyses were used. Constant comparative analysis was used to identify similarities and differences among the participants. RESULTS Four themes emerged from interviews: (1) making sense of the treatment; (2) contending with side effects of medications; (3) maintaining networks of support; and (4) creating a new normal. The participants were motivated to adhere to medications when they developed awareness, received social support from family and friends and created routines for new normal when confronted with their diseases. However, some attributed a lack of parental support, poor doctor-patient relationships and the large numbers of medications as deterrence to medication adherence. CONCLUSIONS This study highlights various medication-taking motivators and deterrents. Interdependent relationships between motivators and deterrents determine medication-taking behaviours. Findings from this multi-ethnic group of individuals of various ages and religious faith across the disease trajectory provide a deep insight into adolescents' experiences of medication adherence. This can contribute to the development of unique interventions for such individuals. Key points • Adolescents with systemic lupus erythematosus struggle with conforming to cocktails of medications. • A variety of factors either facilitate or impede their decisions to adhere to medication regimes. • Results suggest that tackling medication adherence among adolescents requires a multi-pronged approach from individual, familial and medical perspectives.
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Affiliation(s)
- Qiu Er Clarice Tan
- Department of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xiaocong Gao
- Department of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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13
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Sloan M, Naughton F, Harwood R, Lever E, D'Cruz D, Sutton S, Walia C, Howard P, Gordon C. Is it me? The impact of patient-physician interactions on lupus patients' psychological well-being, cognition and health-care-seeking behaviour. Rheumatol Adv Pract 2020; 4:rkaa037. [PMID: 32974426 PMCID: PMC7498933 DOI: 10.1093/rap/rkaa037] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/14/2020] [Indexed: 12/15/2022] Open
Abstract
Objective The aim was to explore the impact of patient–physician interactions, pre- and post-diagnosis, on lupus and UCTD patients’ psychological well-being, cognition and health-care-seeking behaviour. Methods Participants were purposively sampled from the 233 responses to a survey on patient experiences of medical support. Twenty-one semi-structured interviews were conducted and themes generated using thematic analysis. Results The study identified six principal themes: (i) the impact of the diagnostic journey; (ii) the influence of key physician(s) on patient trust and security, with most participants reporting at least one positive medical relationship; (iii) disparities in patient–physician priorities, with patients desiring more support with quality-of-life concerns; (iv) persisting insecurity and distrust, which was prevalent and largely influenced by previous and anticipated disproportionate (often perceived as dismissive) physician responses to symptoms and experiences of widespread inadequate physician knowledge of systemic autoimmune diseases; (v) changes to health-care-seeking behaviours, such as curtailing help-seeking or under-reporting symptoms; and (vi) empowerment, including shared medical decision-making and knowledge acquisition, which can mitigate insecurity and improve care. Conclusion Negative medical interactions pre- and post-diagnosis can cause a loss of self-confidence and a loss of confidence and trust in the medical profession. This insecurity can persist even in subsequent positive medical relationships and should be addressed. Key physicians implementing empowering and security-inducing strategies, including being available in times of health crises and validating patient-reported symptoms, might lead to more trusting medical relationships and positive health-care-seeking behaviour.
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Affiliation(s)
- Melanie Sloan
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich
| | - Rupert Harwood
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Elliott Lever
- Department of Rheumatology, University College London, London
| | - David D'Cruz
- The Louise Coote Lupus Unit, Guys' Hospital, London
| | - Stephen Sutton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge
| | | | | | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Science, University of Birmingham, Birmingham, UK
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14
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Dollinger J, Neville C, Pineau CA, Vinet E, Hazel E, Lee JLF, Bernatsky S. Challenges to optimal rheumatology care: a patient-centered focus group study. Clin Rheumatol 2020; 39:3083-3090. [DOI: 10.1007/s10067-020-05091-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 12/30/2019] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
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15
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Twumasi AA, Shao A, Dunlop-Thomas C, Drenkard C, Cooper HL. Exploring the Perceived Impact of the Chronic Disease Self-Management Program on Self-Management Behaviors among African American Women with Lupus: A Qualitative Study. ACR Open Rheumatol 2020; 2:147-157. [PMID: 32037683 PMCID: PMC7077773 DOI: 10.1002/acr2.11117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 12/20/2019] [Indexed: 01/11/2023] Open
Abstract
Objective To qualitatively explore the processes through which the Chronic Disease Self‐Management Program (CDSMP)—a peer‐led, group‐based educational intervention for people with chronic conditions—affects self‐management behaviors among African American women with systemic lupus erythematosus (SLE). Methods Using a longitudinal pre‐ and postintervention design, we conducted two waves of one‐on‐one, semistructured interviews with 24 purposefully sampled participants. Wave 1 interviews explored self‐management behaviors at baseline; wave 2 interviews focused on changes in these behaviors postintervention. Transcripts were analyzed using thematic analysis methods. Results Study participants perceived the CDSMP to be a valuable resource that helped them improve fundamental self‐management behaviors, including exercise, relaxation, diet, and medication adherence. We found, with few exceptions, that in this sample, women's reported changes in self‐management behaviors did not vary by participant age, education, SLE disease severity, or depression status. Our analysis suggests that the CDSMP had the most widespread perceived effects on relaxation and exercise. Strategies that generated improvements in relaxation and exercise included goal setting, action planning, encouragement to pursue low‐impact physical activity, and introduction of mindfulness techniques to better manage SLE symptoms. Conclusion Our findings suggest that African American women with SLE perceived the CDSMP as an effective educational self‐management intervention. The program can potentially catalyze improvements in self‐management behaviors in this population, regardless of demographic or disease characteristics.
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Affiliation(s)
- Abena A Twumasi
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anna Shao
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | | | - Hannah L Cooper
- Emory University Rollins School of Public Health, Atlanta, Georgia
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16
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Twumasi AA, Shao A, Dunlop-Thomas C, Drenkard C, Cooper HLF. Health service utilization among African American women living with systemic lupus erythematosus: perceived impacts of a self-management intervention. Arthritis Res Ther 2019; 21:155. [PMID: 31238992 PMCID: PMC6593601 DOI: 10.1186/s13075-019-1942-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare access, utilization, and quality play critical roles in shaping mortality and morbidity among patients diagnosed with systemic lupus erythematosus (SLE), and yet healthcare access, utilization, and quality can be suboptimal for many people living with SLE. The aim of this qualitative study was to explore the perceived impact of a peer-led, group-based educational intervention (the Chronic Disease Self-Management Program [CDSMP]) on healthcare engagement behaviors among African American women with SLE. METHODS Participants were recruited from the WELL (Women Empowered to Live with Lupus) study, a behavioral trial of the effectiveness of the CDSMP on African American women diagnosed with SLE. We conducted two waves of qualitative, one-on-one, semi-structured interviews with 24 purposively sampled WELL participants; one interview was conducted before CDSMP participation and one after. Wave 1 interviews explored health service use behaviors at baseline; Wave 2 interviews focused on changes in these behaviors post-intervention and women's perceptions of whether and how the CDSMP shaped these changes. Transcripts were analyzed using thematic analysis methods. RESULTS Study participants perceived the CDSMP to be a valuable resource for supporting two distinct health service use behaviors: communicating with doctors (N = 16 [88.9%]) and managing medication side effects (N = 17 [41.2%]). Women perceived that the CDSMP had the most potent and widespread effects on patients' communication with doctors. Strategies that women believed generated improvements in patient-doctor communication included enhancing preparation for appointments and boosting patient participation during doctor's visits. Women's reported post-CDSMP improvements in health service use behaviors varied by disease severity and depression. Insurance coverage, while not probed directly during baseline interviews, emerged organically as a key factor affecting health service use behaviors; the CDSMP did not seem to improve participants' ability to circumvent insurance-related barriers to accessing care. CONCLUSIONS Our findings suggest that the CDSMP may help enhance healthcare service utilization among African American women with SLE by improving doctor/patient communication and medication side effect management. If future research confirms this conclusion, African American women living with SLE should be encouraged to participate in CDSMP workshops to enhance health service use behaviors. TRIAL REGISTRATION NCT02988661 . Registered 12/07/2016.
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Affiliation(s)
- Abena A Twumasi
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Anna Shao
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Cristina Drenkard
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
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17
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Management of Patients with Systemic Lupus Erythematosus at the Stage of Primary Care: Answers to Frequently Asked Questions. Fam Med 2019. [DOI: 10.30841/2307-5112.2.2019.174634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Saketkoo LA, Pauling JD. Qualitative Methods to Advance Care, Diagnosis, and Therapy in Rheumatic Diseases. Rheum Dis Clin North Am 2018; 44:267-284. [PMID: 29622294 PMCID: PMC5890953 DOI: 10.1016/j.rdc.2018.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article provides an overview of the basis, usefulness, and validity of qualitative methods in research. It is aimed to enhance the understanding of a broad spectrum of readers, ranging from those mystified by such approaches, to those wanting a better critical knowledge to apply to literature review, and for health care providers considering developing an interest in the field. Qualitative research is crucial in augmentation of disease knowledge as well as the development of incremental care strategies and operational aspects of care that improves health outcomes.
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Affiliation(s)
- Lesley Ann Saketkoo
- Division of Pulmonary Medicine and Critical Care, Tulane University School of Medicine, Lung Center, 1430 Tulane Avenue, New Orleans, LA 70112, USA; New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; University Medical Center, Comprehensive Pulmonary Hypertension Center, New Orleans, LA 70112, USA.
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Upper Borough Walls, Bath BA1 1RL, UK; Department of Pharmacy and Pharmacology, University of Bath, Bath BA11RL, UK
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19
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Amsden LB, Davidson PT, Fevrier HB, Goldfien R, Herrinton LJ. Improving the quality of care and patient experience of care during the diagnosis of lupus: a qualitative study of primary care. Lupus 2018; 27:1088-1099. [PMID: 29546773 DOI: 10.1177/0961203318763082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To better understand diagnostic delay and doctor-patient communication during the diagnosis of systemic lupus erythematous in patients without malar rash, we conducted a qualitative study of primary care providers' perceptions. Methods We conducted in-depth interviews with a purposive sample of eight primary care physicians in Kaiser Permanente Northern California. Telephone interviews were recorded, transcribed, reviewed, and coded for domains and themes. Results We identified five domains related to diagnosis: initial assessment and tests, initial diagnosis and empiric treatment, timeliness of diagnosis, communicating with the patient, and opportunities for improvement. In the absence of malar rash, the lupus manifestations are common while the disease is rare. Once the primary care provider believes that the disease may be autoimmune, they work with a rheumatologist, but this could take months. Initially, the physician assesses whether the condition is self-limiting or responds to empiric treatments. Over time, as empiric treatments fail or additional lupus manifestations emerge, the primary care provider makes a referral. Doctor-patient communication is critical to help the physician make sense of the symptoms, maintain trust, and assure the patient that he or she is receiving appropriate care. Patient persistence and communication are critically important. Continuing education was deemed essential by each physician. Conclusion In the absence of malar rash, a lupus diagnosis can be difficult. Enhanced doctor-patient communication, patient persistence, physician access to rheumatology and continuing education of primary care might improve time to diagnosis and the patient's experience with primary care. This knowledge is transferable to other rare, complex diseases.
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Affiliation(s)
- L B Amsden
- 1 Division of Research, 214681 Kaiser Permanente Northern California , Oakland, USA
| | - P T Davidson
- 2 44238 Lupus Foundation of America , Washington, USA
| | - H B Fevrier
- 1 Division of Research, 214681 Kaiser Permanente Northern California , Oakland, USA
| | - R Goldfien
- 3 Department of Rheumatology, 214681 Kaiser Permanente Northern California , Oakland, USA
| | - L J Herrinton
- 1 Division of Research, 214681 Kaiser Permanente Northern California , Oakland, USA
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20
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Larsen JL, Hall EOC, Jacobsen S, Birkelund R. The existential experience of everyday life with systemic lupus erythematosus. J Adv Nurs 2018; 74:1170-1179. [PMID: 29350776 DOI: 10.1111/jan.13525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 01/19/2023]
Abstract
AIM To explore from the perspective of women the nature of basic existential conditions while living with systemic lupus erythematosus. BACKGROUND Systemic lupus erythematosus has an unpredictable disease course and is documented to cause an existential rearrangement of life. The significance of changes in existential conditions and related experiences are unclear in the context of nursing and women with systemic lupus erythematosus. DESIGN A qualitative design guided by Van Manen's hermeneutic-phenomenological methodology. METHOD Individual in-depth interviews with 15 women diagnosed with systemic lupus erythematosus and of various ages, disease durations and severities were undertaken from September 2013 - October 2015. Data were analysed following van Manen's phenomenological approach and using drawing as an interpretive tool. FINDINGS The main existential experience was interpreted as a person "moving with the waves of systemic lupus erythematosus" constituted by the themes "oscillating between presence and absence of systemic lupus erythematosus," "recognizing space and bodily possibilities and limitations" and "being enriched through relationships and activities." When systemic lupus erythematosus was flaring, well-being was threatened and a laborious time to escape the feeling of a setback-in-life persisted long after the disease was medically under control. CONCLUSION Daily life with systemic lupus erythematosus is conditioned by a prominent need to be in existential motion, related to the absence and presence of systemic lupus erythematosus. The experience of a setback-in-life by illness might challenge well-being and indicates that periods of disease flares or disturbing symptoms are critical time points to provide support.
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Affiliation(s)
- Janni Lisander Larsen
- Nursing Section, Department of Public Health, Aarhus University, Aarhus, Denmark.,Copenhagen Lupus and Vasculitis Clinic, Rheumatology and Spine Diseases Centre, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth O C Hall
- Nursing Section, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rheumatology and Spine Diseases Centre, Rigshospitalet, Copenhagen, Denmark
| | - Regner Birkelund
- Denmark & Lillebaelt Hospital, Institute of Regional Health Research, University of Southern, Vejle, Denmark
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21
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El Miedany Y, El Gaafary M, El Aroussy N, Bahlas S, Hegazi M, Palmer D, Youssef S. Toward electronic health recording: evaluation of electronic patient reported outcome measures (e-PROMs) system for remote monitoring of early systemic lupus patients. Clin Rheumatol 2017; 36:2461-2469. [PMID: 28567555 DOI: 10.1007/s10067-017-3675-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/27/2017] [Accepted: 05/08/2017] [Indexed: 01/06/2023]
Abstract
The study aimed to assess the value of evaluation of electronic patient reported outcome measures (e-PROMs) in the assessment and management of SLE disease activity flares, its association with adherence to therapy as well as organ damage. A randomized, controlled crossover study was carried out over a 24-month duration. One hundred forty-seven SLE patients meeting the revised American College of Rheumatology (ACR) criteria were enrolled. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was used to assess disease activity, whereas organ damage was scored using the Systemic Lupus International Collaborating Clinics (SLICC)/ACR Damage Index. In the first 12 months, the patients were assessed every 3 months. At 12 months, the patients were randomized into a cohort of 73 patients who continued their care in the same style and 74 patients who completed an online e-PROMs questionnaire on monthly basis for another 12-month period. The data captured were then retrospectively analyzed at the end of the 24-month study period. At the end of the first year of the study, the mean SLEDAI and SDI scores were 8.72 (6.1) and 1.9 (2.2). At the end of the second year, the mean SLEDAI and SDI scores in the e-PROMs cohort were 3.1 (2.6) and 1.2 (1.3), whereas in the control group, the scores were 7.63 (6.7) and 1.8 (2.3), respectively (p < 0.01). Adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (OR 2.03, 95% CI 1.34 to 2.83, p < 0.001). Adherence to therapy was significantly (p < 0.1) higher in the e-PROMs group. e-PROMs was equivalent to PROMs paper format and has a potential disease-modifying effect as it facilitated close monitoring of disease activity with an option of management escalation whenever indicated.
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Affiliation(s)
- Y El Miedany
- Rheumatology, Darent Valley Hospital, Darenth Wood Road, Dartford, England, DA2 8DA, UK.
- Rheumatology & Rehab, School of Medicine St. Abbassia, Ain Shams University, Cairo, 11381, Egypt.
| | - M El Gaafary
- Community and Public Health, School of Medicine St. Abbassia, Ain Shams University, Cairo, 11381, Egypt
| | - Nadia El Aroussy
- Rheumatology & Rehab, School of Medicine St. Abbassia, Ain Shams University, Cairo, 11381, Egypt
| | - S Bahlas
- Rheumatology Department, King Abdulaziz University, Jeddah, 21441, Saudi Arabia
| | - M Hegazi
- Medicine Department, Al Adan Hospital, KW52853, Hadeya, Kuwait
| | - D Palmer
- Rheumatology, North Middlesex University Hospitals, Sterling Way, London, N18 1QX, UK
| | - S Youssef
- Rheumatology & Rehab, School of Medicine St. Abbassia, Ain Shams University, Cairo, 11381, Egypt
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22
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Larsen JL, Hall EO, Jacobsen S, Birkelund R. Being in a standstill-of-life: women's experience of being diagnosed with systemic lupus erythematosus: a hermeneutic-phenomenological study. Scand J Caring Sci 2017; 32:654-662. [DOI: 10.1111/scs.12491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/03/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Janni Lisander Larsen
- Section of Nursing; Department of Public Health; Aarhus University; Aarhus Denmark
- Copenhagen Lupus and Vasculitis Clinic; Rheumatology and Spine Diseases Centre; Rigshospitalet; Copenhagen Denmark
| | - Elisabeth O.C. Hall
- Section of Nursing; Department of Public Health; Aarhus University; Aarhus Denmark
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic; Rheumatology and Spine Diseases Centre; Rigshospitalet; Copenhagen Denmark
| | - Regner Birkelund
- Institute of Regional Health Research; University of Southern Denmark & Lillebaelt Hospital; Vejle Denmark
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23
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Golder V, Kandane-Rathnayake R, Hoi AYB, Huq M, Louthrenoo W, An Y, Li ZG, Luo SF, Sockalingam S, Lau CS, Mok MY, Lateef A, Franklyn K, Morton S, Navarra STV, Zamora L, Wu YJ, Hamijoyo L, Chan M, O'Neill S, Goldblatt F, Nikpour M, Morand EF. Association of the lupus low disease activity state (LLDAS) with health-related quality of life in a multinational prospective study. Arthritis Res Ther 2017; 19:62. [PMID: 28320433 PMCID: PMC5359963 DOI: 10.1186/s13075-017-1256-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/09/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is associated with significant impairment of health-related quality of life (HR-QoL). Recently, meeting a definition of a lupus low disease activity state (LLDAS), analogous to low disease activity in rheumatoid arthritis, was preliminarily validated as associated with protection from damage accrual. The LLDAS definition has not been previously evaluated for association with patient-reported outcomes. The objective of this study was to determine whether LLDAS is associated with better HR-QoL, and examine predictors of HR-QoL, in a large multiethnic, multinational cohort of patients with SLE. METHODS HR-QoL was measured using the Medical Outcomes Study 36-item short form health survey (SF-36v2) in a prospective study of 1422 patients. Disease status was measured using the SLE disease activity index (SLEDAI-2 K), physician global assessment (PGA) and LLDAS. RESULTS Significant differences in SF-36 domain scores were found between patients stratified by ethnic group, education level and damage score, and with the presence of active musculoskeletal or cutaneous manifestations. In multiple linear regression analysis, Asian ethnicity (p < 0.001), a higher level of education (p < 0.001), younger age (p < 0.001) and shorter disease duration (p < 0.01) remained significantly associated with better physical component scores (PCS). Musculoskeletal disease activity (p < 0.001) was negatively associated with PCS, and cutaneous activity (p = 0.04) was negatively associated with mental component scores (MCS). Patients in LLDAS had better PCS (p < 0.001) and MCS (p < 0.001) scores and significantly better scores in multiple individual SF-36 domain scores. Disease damage was associated with worse PCS (p < 0.001), but not MCS scores. CONCLUSIONS Ethnicity, education, disease damage and specific organ involvement impacts HR-QoL in SLE. Attainment of LLDAS is associated with better HR-QoL.
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Affiliation(s)
- Vera Golder
- Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia.
| | - Rangi Kandane-Rathnayake
- Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
| | - Alberta Yik-Bun Hoi
- Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
| | - Molla Huq
- The University of Melbourne, Melbourne, Australia
| | | | - Yuan An
- People's Hospital Peking University Health Sciences Center, Beijing, China
| | - Zhan Guo Li
- People's Hospital Peking University Health Sciences Center, Beijing, China
| | - Shue Fen Luo
- Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | | | | | - Mo Yin Mok
- University of Hong Kong, Pokfulam, Hong Kong
| | - Aisha Lateef
- National University Hospital, Singapore, Republic of Singapore
| | - Kate Franklyn
- Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
| | | | | | - Leonid Zamora
- University of Santo Tomas Hospital, Manila, Philippines
| | - Yeong-Jian Wu
- Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | | | - Madelynn Chan
- Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Sean O'Neill
- University of New South Wales, Sydney, Australia
| | | | | | - Eric Francis Morand
- Monash University School of Clinical Sciences at Monash Health, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
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Golder V, Morand EF, Hoi AY. Quality of Care for Systemic Lupus Erythematosus: Mind the Knowledge Gap. J Rheumatol 2017; 44:271-278. [DOI: 10.3899/jrheum.160334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 02/03/2023]
Abstract
Systemic lupus erythematosus (SLE) is a prototypical chronic multiorgan autoimmune disorder that can lead to significant burden of disease and loss of life expectancy. The disease burden is the result of a complex interplay between genetic, biologic, socioeconomic, and health system variables affecting the individual. Recent advances in biological understanding of SLE are yet to translate to transformative therapies, and genetic and socioeconomic variables are not readily amenable to intervention. In contrast, healthcare quality, a variable readily amenable to change, has been inadequately addressed in SLE, despite evidence in other chronic diseases that quality of care is strongly associated with patient outcomes. This article will analyze the available literature on the quality of care relevant to SLE, identify knowledge gaps, and suggest ways to address this in future research.
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López-Pina JA, Meseguer-Henarejos AB, Gascón-Cánovas JJ, Navarro-Villalba DJ, Sinclair VG, Wallston KA. Measurement properties of the brief resilient coping scale in patients with systemic lupus erythematosus using rasch analysis. Health Qual Life Outcomes 2016; 14:128. [PMID: 27619635 PMCID: PMC5020451 DOI: 10.1186/s12955-016-0534-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 09/08/2016] [Indexed: 12/02/2022] Open
Abstract
Bacground Resilience has been defined as the capacity or the ability to rebound from and positively adapt to significant stressors, despite experiences of significant adversity or trauma. To capture to what extent an individual copes with stress in a resilient fashion the Brief Resilient Coping Scale (BRCS) was developed. This tool was validated in people with chronic disease, such as rheumatoid arthritis using standard psychometric techniques of classical test theory, but not yet in patients with Systemic lupus erythematosus (SLE). The aim of this study was to explore the psychometric properties of the Brief Resilient Coping Scale in patients with SLE using Rasch analysis. Method This study used cross-sectional data. The BRCS was administered to 232 patients with systemic lupus erythematosus. The aspects analyzed were unidimensionality, local independence and differential item functioning (DIF) to construct an interpretative scale of scores with the Rasch model. Results Rating scale mode (RSM) showed that the four categories used in the items of the BRCS are properly ordered. The four items provided a good fit to the polytomous Rasch model. Moreover, the parameters were sufficiently separated to measure resilience in patients with SLE. BRCS is a unidimensional scale (eigenvalue = 1.843) of resilience and the items were locally independent. There was no DIF between males and females in the sample. Only marginally significant differences depending on the level of education were found. The BRCS showed adequate discriminant validity between groups of scores. Conclusions BRCS is a suitable scale for measuring resilience in patients with SLE. This scale might be useful for clinicians to obtain information concerning the degree of resilience that each patient has, allowing individuals with low resilience to be identified who need interventions aimed at developing coping skills.
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Affiliation(s)
- José-Antonio López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, Campus of Espinardo, University of Murcia, 30100, Murcia, Spain.
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Neville C, Da Costa D, Rochon M, Peschken CA, Pineau CA, Bernatsky S, Keeling S, Avina-Zubieta A, Lye E, Eng D, Fortin PR. Development of the Lupus Interactive Navigator as an Empowering Web-Based eHealth Tool to Facilitate Lupus Management: Users Perspectives on Usability and Acceptability. JMIR Res Protoc 2016; 5:e44. [PMID: 27240666 PMCID: PMC4906236 DOI: 10.2196/resprot.4219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background Systemic Lupus Erythematosus (SLE) is a serious, complex, and chronic illness. Similar to most other chronic illness states, there is great interest in helping persons with SLE engage in their disease management. Objective The objectives of this study were to (1) develop the Lupus Interactive Navigator (LIN), a web-based self-management program for persons with SLE, and (2) test the LIN for usability and acceptability. Methods The LIN development platform was based on the results of preliminary comprehensive needs assessments and adapted from the Oncology Interactive Navigator, a web-based tool developed for persons with cancer. Medical researchers, writers, designers, and programmers worked with clinical experts and persons with SLE to develop content for the LIN. Usability and acceptability of the LIN was tested on individuals with SLE meeting American College of Rheumatology criteria, who were recruited from five Canadian SLE clinics. Participants were provided with access to the LIN and were asked to use it over a two-week period. Following the testing period, participants were contacted for a 30-minute telephone interview to assess usability and acceptability. Results The content for the LIN was subdivided into six primary information topics with interview videos featuring rheumatologists, allied health professionals, and persons with SLE. Usability and acceptability of the LIN was tested on 43 females with SLE. Of these, 37 (86%) completed telephone interviews. The average age was 43.6 (SD 15.9) years and disease duration averaged 14.1 (SD 10.8) years. Median time spent on LIN was 16.3 (interquartile range [IQR]:13.7, 53.5) minutes and median number of sessions was 2 (IQR: 1, 3). Overall, Likert ratings (0=strongly disagree; 7=strongly agree) of website usability and content were very high, with 75% scoring >6 out of 7 on all items. All participants agreed that LIN was easy to use, would recommend it to others with SLE, and would refer to it for future questions about SLE. Very high ratings were also given to relevancy, credibility, and usefulness of the information provided. Overall, 73% of the participants rated all topics helpful to very helpful. Participants who reported more prior knowledge about SLE rated items regarding improvement in knowledge and helpfulness relatively lower than persons with less prior knowledge. Most participants commented that the LIN would be very useful to those newly diagnosed with SLE. Minor revisions were recommended. Conclusions This study furthers the understanding of the needs in the SLE community and delivers a unique eHealth tool to promote self-management in persons with SLE. The LIN was found to be highly acceptable in content and usability. The information provided on LIN may be most helpful for individuals with less experience with the disease, such as those newly diagnosed, indicating the need to tailor the content for persons with more SLE experience.
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Affiliation(s)
- Carolyn Neville
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Singh JA, Qu H, Yazdany J, Chatham W, Shewchuk R. Minorities with lupus nephritis and medications: a study of facilitators to medication decision-making. Arthritis Res Ther 2015; 17:367. [PMID: 26680561 PMCID: PMC4704543 DOI: 10.1186/s13075-015-0883-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/30/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Medication decision-making poses a challenge for a significant proportion of patients. This is an even more challenging for patients who have complex, rare, immune conditions that affect them at a young age and are associated with the use of life-long treatment, perceived by some as having significant risk of side effects and toxicity. INTRODUCTION The aim of our study was to examine the perspectives of women with lupus nephritis on facilitators to medication decision-making. METHODS We used the nominal group technique (NGT), a structured formative process to elicit patient perspectives. An NGT expert moderated eight patient group meetings. Participants (n = 52) responded to the question "What sorts of things make it easier for people to decide to take the medicines that doctors prescribe for treating their lupus kidney disease?" Patients nominated, discussed, and prioritized facilitators to medication decisional processes. RESULTS Fifty-two women with lupus nephritis participated in eight NGT meetings (27 African-American, 13 Hispanic, and 12 Caucasian). Average age was 40.6 years (standard deviation (SD) = 13.3), and disease duration was 11.8 years (SD = 8.3); 36.5 % obtained at least a college education, and 55.8 % had difficulty in reading health materials. Patients generated 280 decision-making facilitators (range of 26 to 42 per panel). Of these, 102 (36 %) facilitators were perceived by patients as having relatively more influence in decision-making processes than others. Prioritized facilitators included effective patient-physician communication regarding benefits/harms, patient desire to live a normal life and improve quality of life, concern for their dependents, experiencing benefits and few/infrequent/no harms with lupus medications, and their affordability. Relative to African-Americans, Caucasian and Hispanic patients endorsed a smaller percentage of facilitators as influential. Level of agreement with which patients within panels independently agreed in their selections of the three most influential facilitators ranged from 33 % to 60 %. CONCLUSIONS We identified facilitators to lupus medication decision-making. This information will be used to populate a decision aid for lupus nephritis.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL, USA. .,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. .,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Haiyan Qu
- Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, 1705 University Blvd, Birmingham, AL, 35233, USA.
| | - Jinoos Yazdany
- Department of MedicineUniversity of California at San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Winn Chatham
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA.
| | - Richard Shewchuk
- Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, 1705 University Blvd, Birmingham, AL, 35233, USA.
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Meunier B, Jourde-Chiche N, Mancini J, Chekroun M, Retornaz F, Chiche L. Characteristics and information searched for by French patients with systemic lupus erythematosus: A web-community data-driven online survey. Lupus 2015; 25:370-5. [DOI: 10.1177/0961203315610644] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/16/2015] [Indexed: 11/15/2022]
Abstract
Introduction To provide information about the needs of patients with systemic lupus erythematosus (SLE) using Carenity, the first European online platform for patients with chronic diseases. Methods At one year after its creation, all posts from the Carenity SLE community were collected and analysed. A focused cross-sectional online survey was performed. Results The SLE community included 521 people (93% females; mean age: 39.8 years). Among a total of 6702 posts, 2232 were classified according to disease-related topics. The 10 most common topics were ‘lupus and …’ either ‘treatment’, ‘fatigue’, ‘entourage’, ‘sun exposure’, ‘diagnosis’, ‘autoimmune diseases’, ‘pregnancy’, ‘contraception’, ‘symptoms’ or ‘sexuality’. 112 SLE patients participated in the online survey. At the time of diagnosis, only 17 (15%) patients had heard of SLE and 84 (75%) expressed a need for more information on outcomes (27%), treatments (27%), daily life (14%), patients' associations (11%), symptoms (8%), the disease (8%) and psychosocial aspects (7%). When treatment was initiated, 48 patients (43%) would have liked more information about side effects (46%), long-term effects (21%), treatment duration/cessation (12.5%) and type (10%) and mechanism of action (8%) of treatments. All participants except one had used the internet to find information about SLE. Sources of information included healthcare providers (51%/61%/67%), journals/magazines (7%/12%/6%), lupus Websites (51%/77%/40%), web forums/blogs (34%/53%/19%), patients' associations (11%/23%/9%) accessed at ‘just before diagnosis’, ‘just after diagnosis’ and ‘before treatment initiation’. Conclusions Online patient communities provide original unbiased information that can help improve provision of information to SLE patients.
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Affiliation(s)
- B Meunier
- Service de Médecine Interne, Hôpital de la Conception, Université Aix-Marseille, Marseille, France
| | - N Jourde-Chiche
- Service de Néphrologie, Hôpital de la Conception, Université Aix-Marseille, Marseille, France
| | - J Mancini
- Service de Biostatistiques et Technologie de l’Information et de la Communication (BIOSTIC), Hôpital de la Timone, APHM; Université Aix-Marseille, UMR S912, Inserm, IRD, SESSTIM, Marseille, France
| | | | - F Retornaz
- Service de Médecine Interne, Hôpital Européen, Marseille, France
| | - L Chiche
- Service de Médecine Interne, Hôpital Européen, Marseille, France
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Serrano-Aguilar P, Trujillo-Martin MDM, Pérez de la Rosa A, Cuellar-Pompa L, Saavedra-Medina H, Linertova R, Perestelo-Perez L, Perez-Ramos J, Rivero-Santana A. Patient participation in a Clinical Guideline Development for Systemic Lupus Erythematosus. PATIENT EDUCATION AND COUNSELING 2015; 98:1156-1163. [PMID: 26095343 DOI: 10.1016/j.pec.2015.05.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/08/2015] [Accepted: 05/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To incorporate patients' perspective in the design of a clinical practice guideline (CPG) for Systemic Lupus Erythematosus in Spain. METHODS A systematic review (SR) of literature and a Delphi-based consultation to patients were carried out. RESULTS From the SR, most relevant health problems are classified as physical, psychological, familial, and socio-economic. Dissatisfaction is mainly due to unmet information needs and limited access to care. In the consultation (n=102), most frequently reported health problems were pain, fatigue, photosensitivity, mood disorders, renal damage, poor concentration, and memory loss. Dissatisfaction with poor coordination between primary and specialized care was reported. Information to improve self-management and on alternative therapies was requested. Relevant topics from both sources were merged and discussed by the guideline development group (including a patient representative) to set the key questions underpinning the CPG. CONCLUSION Patient involvement in CPG development by a combination of methods can enhance patient-centered care by achieving clinical practice responsive to their needs. PRACTICE IMPLICATIONS Involving patients in CPG development is feasible and useful to improve the advance of Health Services toward patient-centered care. A multicomponent strategy for involvement is suggested to address the gap between the available evidence and contextual current patient needs and preferences.
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Affiliation(s)
- Pedro Serrano-Aguilar
- Evaluation Service of the Canary Islands Health Service (SESCS), Santa Cruz de Tenerife, Spain; Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain.
| | - Maria del Mar Trujillo-Martin
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain; Canary Foundation for Health Care Research (FUNCANIS), Canary Islands, Spain
| | | | | | | | - Renata Linertova
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain; Canary Foundation for Health Care Research (FUNCANIS), Canary Islands, Spain
| | - Lilisbeth Perestelo-Perez
- Evaluation Service of the Canary Islands Health Service (SESCS), Santa Cruz de Tenerife, Spain; Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain
| | | | - Amado Rivero-Santana
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC), Madrid, Spain; Canary Foundation for Health Care Research (FUNCANIS), Canary Islands, Spain
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Schneider M, Haupt M. [Overcoming disease in systemic lupus erythematosus]. Z Rheumatol 2015; 74:591-6. [PMID: 26286190 DOI: 10.1007/s00393-014-1556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease affecting a broad range of different organ systems and, hence, presenting with multiple symptomatic domains, which considerably reduces the quality of life of patients. Within the last decade the prognosis of the disease has been significantly improved by novel therapies and intensive monitoring; however, non-pharmaceutical strategies for symptom control, self-efficacy and coping abilities for those affected are still insufficiently established. OBJECTIVE This article describes the possibilities and limitations of non-pharmaceutical strategies and makes suggestions for future treatment and research. RESULTS Preliminary interventional studies using psychoeducational, psychosocial and behavioral psychotherapeutic approaches, have consistently shown that the needs and expectations of patients related to help and support by doctors and professional care can be adequately and sustainably met. In addition, coping abilities and the quality of life can be increased.
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Affiliation(s)
- M Schneider
- Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland,
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Singh JA, Qu H, Yazdany J, Chatham W, Dall'era M, Shewchuk RM. Barriers to Medication Decision Making in Women with Lupus Nephritis: A Formative Study using Nominal Group Technique. J Rheumatol 2015; 42:1616-23. [PMID: 26178276 DOI: 10.3899/jrheum.150168] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the perspectives of women with lupus nephritis on barriers to medication decision making. METHODS We used the nominal group technique (NGT), a structured process to elicit ideas from participants, for a formative assessment. Eight NGT meetings were conducted in English and moderated by an expert NGT researcher at 2 medical centers. Participants responded to the question: "What sorts of things make it hard for people to decide to take the medicines that doctors prescribe for treating their lupus kidney disease?" Patients nominated, discussed, and prioritized barriers to decisional processes involving medications for treating lupus nephritis. RESULTS Fifty-one women with lupus nephritis with a mean age of 40.6 ± 13.3 years and disease duration of 11.8 ± 8.3 years participated in 8 NGT meetings: 26 African Americans (4 panels), 13 Hispanics (2 panels), and 12 whites (2 panels). Of the participants, 36.5% had obtained at least a college degree and 55.8% needed some help in reading health materials. Of the 248 responses generated (range 19-37 responses/panel), 100 responses (40%) were perceived by patients as having relatively greater importance than other barriers in their own decision-making processes. The most salient perceived barriers, as indicated by percent-weighted votes assigned, were known/anticipated side effects (15.6%), medication expense/ability to afford medications (8.2%), and the fear that the medication could cause other diseases (7.8%). CONCLUSION Women with lupus nephritis identified specific barriers to decisions related to medications. Information relevant to known/anticipated medication side effects and medication cost will form the basis of a patient guide for women with systemic lupus erythematosus, currently under development.
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Affiliation(s)
- Jasvinder A Singh
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham.
| | - Haiyan Qu
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham
| | - Jinoos Yazdany
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham
| | - Winn Chatham
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham
| | - Maria Dall'era
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham
| | - Richard M Shewchuk
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham
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Mazzoni D, van Leeuw B, Bednarova P, Marchiori F, Lerstrøm K. Patients' participation in research projects as partners. Lupus 2014; 24:776-7. [PMID: 25416697 DOI: 10.1177/0961203314561074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 10/29/2014] [Indexed: 11/15/2022]
Affiliation(s)
- D Mazzoni
- Department of Psychology, University of Bologna, Italy
| | - Be van Leeuw
- LUPUS EUROPE, Romford, UK Association Lupus Erythémateaux, Brussels, Belgium
| | | | - F Marchiori
- LUPUS EUROPE, Romford, UK Lupus-Italy, Piacenza, Italy
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The Lived Experience of Lupus Flares: Features, Triggers, and Management in an Australian Female Cohort. Int J Chronic Dis 2014; 2014:816729. [PMID: 26464865 PMCID: PMC4590935 DOI: 10.1155/2014/816729] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/23/2014] [Indexed: 01/09/2023] Open
Abstract
Individuals living with lupus commonly experience daily backgrounds of symptoms managed to acceptable tolerance levels to prevent organ damage. Despite management, exacerbation periods (flares) still occur. Varied clinical presentations and unpredictable symptom exacerbation patterns provide management and assessment challenges. Patient perceptions of symptoms vary with perceived impact, lifestyles, available support, and self-management capacity. Therefore, to increase our understanding of lupus' health impacts and management, it was important to explore lupus flare characteristics from the patient viewpoint. Lupus flares in 101 Australian female patients were retrospectively explored with the use of a novel flare definition. Qualitative methods were used to explore patient-perceived flare symptoms, triggers, and management strategies adopted to alleviate symptom exacerbations. A mean of 29.9 flare days, with 6.8 discrete flares, was experienced. The study confirmed that patients perceive stress, infection, and UV light as flare triggers and identified new potential triggers of temperature and weather changes, work, and chemical exposure from home cleaning. The majority of flares were self-managed with patients making considered management choices without medical input. Barriers to seeking medical support included appointment timings and past negative experiences reflecting incongruence between clinician and patient views of symptom impact, assessment, and ultimately flare occurrence.
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Alves VLP, Carniel AQ, Costallat LTL, Turato ER. Meanings of the sickening process for patients with systemic lupus erythematosus: a review of the literature. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 55:522-7. [PMID: 25440711 DOI: 10.1016/j.rbr.2014.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 07/12/2014] [Accepted: 08/26/2014] [Indexed: 12/22/2022] Open
Abstract
Systemic lupus erythematosus is an autoimmune disease that causes many psychological repercussions that have been studied through qualitative research. These are considered relevant, since they reveal the amplitude experienced by patients. Given this importance, this study aims to map the qualitative production in this theme, derived from studies of experiences of adult patients of both genders and that had used as a tool a semi-structured interview and/or field observations, and had made use of a sampling by a saturation criterion to determine the number of participants in each study. The survey was conducted in Pubmed, Lilacs, Psycinfo e Cochrane databases, searching productions in English and Portuguese idioms published between January 2005 and June 2012. The 19 revised papers that have dealt with patients in the acute phase of the disease showed themes that were categorized into eight topics that contemplated the experienced process at various stages, from the onset of the disease, extending through the knowledge of the diagnosis and the understanding of the manifestations of the disease, drug treatment and general care, evolution and prognosis. The collected papers also point to the difficulty of understanding, of the patients, on what consists the remission phase, revealing also that this is a clinical stage underexplored by psychological studies.
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Health care in systemic lupus erythematosus (SLE): the patient’s perspective. Clin Rheumatol 2014; 33:1279-87. [DOI: 10.1007/s10067-014-2595-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 01/08/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
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Mazzoni D, Cicognani E, Marchetti L. Metaphors and representations of systemic lupus erythematosus: comment on the article by Sutanto et a. Arthritis Care Res (Hoboken) 2014; 66:647. [PMID: 26038773 DOI: 10.1002/acr.22229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Neville C, Costa DD, Mill C, Rochon M, Aviña-Zubieta JA, Pineau CA, Eng D, Fortin PR. The needs of persons with lupus and health care providers: a qualitative study aimed toward the development of the Lupus Interactive Navigator™. Lupus 2013; 23:176-82. [DOI: 10.1177/0961203313517154] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Systemic lupus erythematosus is an inflammatory autoimmune disease associated with high morbidity and unacceptable mortality. A major challenge for persons with lupus is coping with their illness and complex care. Our objective was to identify the informational and resource needs of persons with lupus, rheumatologists, and allied health professionals treating lupus. Our findings will be applied toward the development of an innovative web-based technology, the Lupus Interactive Navigator (LIN™), to facilitate and support engagement and self-management for persons with lupus. Methods Eight focus groups were conducted: four groups of persons with lupus ( n = 29), three groups of rheumatologists ( n = 20), and one group of allied health professionals ( n = 8). The groups were held in British Columbia, Ontario, and Quebec. All sessions were audio-recorded and transcribed verbatim. Qualitative analysis was performed using grounded theory. The transcripts were reviewed independently and coded by the moderator and co-moderator using 1) qualitative data analysis software developed by Provalis Research, Montreal, Canada, and 2) manual coding. Results Four main themes emerged: 1) specific information and resource needs; 2) barriers to engagement in health care; 3) facilitators of engagement in health care; and 4) tools identified as helpful for the self-management of lupus. Conclusion These findings will help guide the scope of LIN™ with relevant information topics and specific tools that will be most helpful to the diverse needs of persons with lupus and their health care providers.
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Affiliation(s)
- C Neville
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Quebec, Canada
| | - D Da Costa
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Quebec, Canada
| | - C Mill
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Quebec, Canada
| | - M Rochon
- Jack Digital Productions Inc, Ontario, Canada
| | - JA Aviña-Zubieta
- Arthritis Research Centre of Canada, University of British Columbia, Vancouver, Canada
| | - CA Pineau
- Division of Rheumatology, Department of Medicine, McGill University Health Centre, Quebec, Canada
| | - D Eng
- Axe Maladies Infectieuses et Immunitaires, Centre de recherche du CHU de Québec, Canada
| | - PR Fortin
- Axe Maladies Infectieuses et Immunitaires, Centre de recherche du CHU de Québec, Canada
- Division of Rheumatology, CHU de Québec and Department of Medicine, Université Laval, Quebec, Canada
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Smith EMD, Foster HE, Gray WK, Taylor-Robinson D, Beresford MW. Predictors of access to care in juvenile systemic lupus erythematosus: evidence from the UK JSLE Cohort Study. Rheumatology (Oxford) 2013; 53:557-61. [PMID: 24310297 DOI: 10.1093/rheumatology/ket402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate factors that may influence the interval between symptom onset and JSLE diagnosis. METHODS Data from all patients recruited to the UK JSLE Cohort Study between 2006 and 2011 and meeting ACR criteria for lupus were analysed. Variables associated with time between symptom onset and diagnosis were identified using correlation tests. Linear regression was used to identify independent predictors of access to care. RESULTS Two hundred and fifty-seven children with JSLE were included in the analysis (216 females, 41 males, ratio 5.3:1). The median time from symptom onset to diagnosis was 0.4 years (range 0.0-14.1 years, interquartile range 0.2-1.4). A linear regression model identified being of African or Caribbean origin (P = 0.006), Asian (P = 0.045), referred by a paediatrician (P = 0.047) or having nephritis (P = 0.045) at presentation as independent predictors of shorter time to diagnosis. Being of Caribbean or Asian origin, compared with white, was associated with a 56% and 37% reduction in geometric mean time to diagnosis, respectively. Similarly, being referred to paediatric rheumatology by a paediatrician or having nephritis at presentation was also associated with a 32% and 36% reduction in geometric mean time to diagnosis, respectively. CONCLUSION Within this national UK cohort, ethnic origin, initial source of referral and having lupus nephritis at presentation were strong predictors of the interval to establishing a diagnosis of JSLE.
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Affiliation(s)
- Eve M D Smith
- Department of Paediatric Rheumatology, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
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Sutanto B, Singh-Grewal D, McNeil HP, O'Neill S, Craig JC, Jones J, Tong A. Experiences and Perspectives of Adults Living With Systemic Lupus Erythematosus: Thematic Synthesis of Qualitative Studies. Arthritis Care Res (Hoboken) 2013; 65:1752-65. [DOI: 10.1002/acr.22032] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/03/2013] [Accepted: 04/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Bernadet Sutanto
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
| | - Davinder Singh-Grewal
- University of Sydney, The Children's Hospital at Westmead, University of New South Wales, and Liverpool Hospital; Sydney, New South Wales Australia
| | - H. Patrick McNeil
- University of New South Wales and Liverpool Hospital; Sydney, New South Wales Australia
| | - Sean O'Neill
- University of New South Wales and Liverpool Hospital; Sydney, New South Wales Australia
| | - Jonathan C. Craig
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
| | - Julie Jones
- University of Sydney; Sydney, New South Wales Australia
| | - Allison Tong
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
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Abstract
This paper considers the experiences of people with lupus in comparison with those with diabetes, and discusses the impact of lupus specialist nurses in information-giving and education under the guise of 'just in case' vs. 'just in time'. Now recognized as a difficult condition to diagnose, lupus can lead to significant worry and distress especially during delays to diagnosis and times of high disease activity. Providing appropriate, individualized information to people with lupus is embedded in specialist nursing practice and enables individuals to use the tools of self-management approaches in gaining control over everyday symptoms.
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Affiliation(s)
- S Brown
- Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath, UK
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41
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Feldman CH, Bermas BL, Zibit M, Fraser P, Todd DJ, Fortin PR, Massarotti E, Costenbader KH. Designing an intervention for women with systemic lupus erythematosus from medically underserved areas to improve care: a qualitative study. Lupus 2013; 22:52-62. [PMID: 23087258 PMCID: PMC3543784 DOI: 10.1177/0961203312463979] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (lupus) disproportionately affects women, racial/ethnic minorities and low-income populations. We held focus groups for women from medically underserved communities to discuss interventions to improve care. METHODS From our Lupus Registry, we invited 282 women, ≥18 years, residing in urban, medically underserved areas. Hospital-based clinics and support groups also recruited participants. Women were randomly assigned to three focus groups. Seventy-five-minute sessions were recorded, transcribed and coded thematically using interpretative phenomenologic analysis and single counting methods. We categorized interventions by benefits, limitations, target populations and implementation questions. RESULTS Twenty-nine women with lupus participated in three focus groups, (n = 9, 9, 11). 80% were African American and 83% were from medically underserved zip codes. Themes included the desire for lupus education, isolation at the time of diagnosis, emotional and physical barriers to care, and the need for assistance navigating the healthcare system. Twenty of 29 participants (69%) favored a peer support intervention; 17 (59%) also supported a lupus health passport. Newly diagnosed women were optimal intervention targets. Improvements in quality of life and mental health were proposed outcome measures. CONCLUSION Women with lupus from medically underserved areas have unique needs best addressed with an intervention designed through collaboration between community members and researchers.
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Affiliation(s)
- C H Feldman
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Hassett AL, Li T, Radvanski DC, Savage SV, Buyske S, Schiff SA, Katz PP. Assessment of health-related family role functioning in systemic lupus erythematosus: Preliminary validation of a new measure. Arthritis Care Res (Hoboken) 2012; 64:1341-8. [DOI: 10.1002/acr.21676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mattsson M, Möller B, Stamm T, Gard G, Boström C. Uncertainty and opportunities in patients with established systemic lupus erythematosus: a qualitative study. Musculoskeletal Care 2012; 10:1-12. [PMID: 22009870 DOI: 10.1002/msc.220] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Systemic lupus erythematosus (SLE) is a chronic disease which can affect any organ, and the impact of the condition will affect each person differently. There are few qualitative studies including the experiences of both women and men with a diagnosis of SLE corresponding to the American College of Rheumatology (ACR) criteria where both negative and positive impacts of the disease have been presented. PURPOSE The aim was to describe how patients with established SLE experience their illness in everyday life, including both negative and positive aspects. METHOD Four focus group interviews were conducted with 16 women and three men with SLE according to ACR criteria, with varied disease activity and no or little organ damage. The interviews were tape recorded, transcribed verbatim and analysed using qualitative content analysis. RESULTS Two themes emerged: multifaceted uncertainty contained the categories 'an unreliable body', 'obtrusive pain and incomprehensible fatigue', 'mood changes and worries', 'reliance on medication and health care'; Focus on health and opportunities included 'learning process implying personal strength', 'limitations and possibilities in activities and work', 'a challenge to explain and receive support' and 'living an ordinary life incorporating meaningful occupations'. CONCLUSIONS While we expected to find a mainly negative impact, positive aspects were also described. Our findings were complex and showed that patients with established SLE can experience both uncertainty and opportunities. This highlights the importance for healthcare professionals of gaining a better understanding of patients' uncertainty, to enable them to support patients, allowing them to focus on health and opportunities. Measurement instruments that capture different aspects of uncertainty and opportunities needs to be developed.
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Affiliation(s)
- M Mattsson
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
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Waldron N, Brown S, Hewlett S, Elliott B, McHugh N, McCabe C. 'It's more scary not to know': a qualitative study exploring the information needs of patients with systemic lupus erythematosus at the time of diagnosis. Musculoskeletal Care 2011; 9:228-238. [PMID: 21993962 DOI: 10.1002/msc.221] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To identify the information needs of patients newly diagnosed with systemic lupus erythematosus (lupus), to inform the design of a future education package. METHODS Focus groups were conducted in seven rheumatology centres in the UK with 43 purposively selected participants. Data were subjected to thematic inductive analysis. RESULTS The first major theme, 'Impact of early information', describes how for many individuals information was scant and, as most had little prior knowledge of lupus, the information was difficult to absorb, leaving them with feelings of fear and confusion. 'Information received versus information sought' (theme 2) describes how few participants felt they had received clear, consistent information. For most, information was felt to be insufficient, forcing them to seek it elsewhere, which, if unsuitable, resulted in further distress. 'Early education needs' (theme 3) reflects that patients would rather be informed of potential problems than remain naïve. Patients felt that receiving a comprehensive information pack as an adjunct to verbal information from their clinician would be helpful, along with rapid access to knowledgeable professionals when they were ready to ask questions about their lupus. CONCLUSIONS Participants stated information and support currently provided at diagnosis is inadequate for their needs. They would like detailed information, provided through a variety of formats. Crucially this should be supported by professionals and available at whatever point in the patient's journey they want to access such discussions .The challenge is for health professionals to meet these needs in the most beneficial and cost effective way.
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Affiliation(s)
- Nicola Waldron
- The Royal National Hospital for Rheumatic Diseases, Bath, UK.
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Zirkzee EJM, Steup-Beekman GM, Schouffoer AA, Henquet SM, Caljouw MAA, Huizinga TWJ, Vlieland TPMV. Health care usage in Dutch systemic lupus erythematosus patients. Lupus 2011; 20:1147-54. [DOI: 10.1177/0961203311405372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As a first step in the improvement of the organization of care for patients with systemic lupus erythematosus (SLE) we studied their health care usage and its determinants. A questionnaire was sent to 161 outpatients of the rheumatology clinic of a Dutch university hospital. The questionnaire comprised questions on health care usage, quality of life and sociodemographic characteristics. Disease characteristics were extracted from the medical record. Among the 102 responders (63% response rate) the proportions of patients reporting contacts with a rheumatologist because of SLE since onset of the disease and over the past 12 months were 100% and 83%, respectively. These proportions were 93% and 68% for all other medical specialists, 88% and 44% for the general practitioner, 78% and 44% for any health professional, 29% and 9% for care at home, 48% and 17% for hospital admissions and 29% and 2% for day-patient care. Younger age, major organ involvement, the use of immunosuppressants and worse physical functioning were found to be significantly associated with greater health care use. This study demonstrated that health care usage by SLE patients is substantial and involves a variety of health care services. Further research should be directed at patients’ satisfaction and patients’ needs regarding the optimal organization of integrated, multidisciplinary services that are accessible for SLE patients of all ages.
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Affiliation(s)
- EJM Zirkzee
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - GM Steup-Beekman
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - AA Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - SM Henquet
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - MAA Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - TWJ Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - TPM Vliet Vlieland
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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Hale ED, Morris M, Hewlett S, Treharne GJ, Kitas GD. Meeting the needs of children who have parents with chronic inflammatory musculoskeletal diseases. Rheumatology (Oxford) 2011; 50:431-3. [DOI: 10.1093/rheumatology/keq193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Epidemiologic, socioeconomic, and psychosocial factors play an important role in health care and handling of patients with the various clinical forms of lupus erythematosus (LE). Patients with LE are mostly young women; adolescents and some ethnic groups are especially prone to a severe course of disease. The unpredictable and fluctuating flares of disease, the need for longterm treatment, and the side effects and damage caused by the disease itself severely reduce quality of life. Problems arise, involving family members, adherence to medical advice and therapy, communication and self management. Socioeconomically, patients are often unable to take regular employment and to pay for health insurance. Stress factors that arise have a negative impact on the course of disease, increasing both fatigue and the basic burden of illness. Healthcare professionals must pay careful attention to all these items, as they attempt to treat flares, minimize drug side effects, provide pain relief, arrange communication and exercise programs along with behavioral and psychosocial interventions in multidisciplinary cooperation, and also involve and support family members.
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Affiliation(s)
- E Aberer
- Department of Dermatology and Venerology, Medical University of Graz, Auenbrugger Platz 8, A-8036 Graz, Austria.
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48
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Rodham K, Rance N, Blake D. A qualitative exploration of carers' and 'patients' experiences of fibromyalgia: one illness, different perspectives. Musculoskeletal Care 2010; 8:68-77. [PMID: 20229608 DOI: 10.1002/msc.167] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Previous research has largely focused on the lived experience either of those who have fibromyalgia syndrome (FMS) or their spousal carers. This study aimed to explore the lived experiences of both those with FMS and their spousal carers. METHODS Participants were aged between 38 and 65 years and all came from the south-west of England. Semi-structured interviews were conducted with four women with FMS and their spousal carers, who were interviewed separately. The resultant transcripts were analysed using interpretative phenomenological analysis. An overriding theme running throughout was loss of identity, which fed into a sense of isolation. Participants reported feeling isolated from: healthcare professionals, whom they felt they had to convince that they had something 'real', and from friends and family because the unpredictability of their symptoms meant that they were less able to plan ahead and often had to pull out of arranged outings. They also felt isolated from their identity because they no longer recognized the person that they once were, and struggled to recognize the person that they had become. As a consequence, the people with FMS and their carers were both engaged in a process of reassessing who they were, now that FMS had become such a large part of their lives. This sense of isolation was evidenced for the carers as well as the people with FMS and is documented in three sub-themes described in the paper: 'others' attitudes', 'invisible illness' and 'role'. CONCLUSION This study has provided new information regarding the lifeworlds both of people living with FMS and their spousal carers. We identified a number of practical and attitudinal barriers that had led to the diminution of social networks for both members of the couple and have explored the related clinical and theoretical implications of this.
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Affiliation(s)
- Karen Rodham
- Department of Psychology, University of Bath, Bath, UK.
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Robinson D, Aguilar D, Schoenwetter M, Dubois R, Russak S, Ramsey-Goldman R, Navarra S, Hsu B, Revicki D, Cella D, Rapaport MH, Renahan K, Ress R, Wallace D, Weisman M. Impact of systemic lupus erythematosus on health, family, and work: The patient perspective. Arthritis Care Res (Hoboken) 2010; 62:266-73. [DOI: 10.1002/acr.20077] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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Applying psychological interventions in rheumatic disease. Rheumatology (Oxford) 2010. [DOI: 10.1016/b978-0-443-06934-5.00011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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