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Chudleigh J, Holder P. Psychosocial Impact of False-Positive Newborn Screening Results: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:507. [PMID: 38790502 PMCID: PMC11120117 DOI: 10.3390/children11050507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
Psychosocial consequences of false-positive results following newborn bloodspot screening have been identified as a potential risk to this highly successful public health initiative. A scoping review was undertaken in October 2023 underpinned by the Arksey and O'Malley framework. Twenty-four papers were included in the review, many of which focused on cystic fibrosis. The results indicated that impact of false-positive results is variable; some studies suggest false-positive results have the potential to result in negative sequelae including increased stress and changes in parental perceptions of their child, while others suggest these impacts are transient and, in some instances, may even lead to positive outcomes. Further evidence is needed to ensure the representation of other conditions included in newborn bloodspot screening and to support strategies to overcome potential negative sequela.
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Affiliation(s)
- Jane Chudleigh
- Cicely Saunders Institute, King’s College London, London SE5 9PJ, UK;
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2
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Holder P, Clark CC, Moody L, Boardman FK, Cowlard J, Allen L, Walter C, Bonham JR, Chudleigh J. Stakeholder Views of the Proposed Introduction of Next Generation Sequencing into the Cystic Fibrosis Screening Protocol in England. Int J Neonatal Screen 2024; 10:13. [PMID: 38390977 PMCID: PMC10885054 DOI: 10.3390/ijns10010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
The project aimed to gather, analyse, and compare the views of stakeholders about the proposed UK cystic fibrosis (CF) screening protocol incorporating next generation sequencing (NGS). The study design was based on principles of Q-methodology with a willingness-to-pay exercise. Participants were recruited from 12 CF centres in the UK. The study contained twenty-eight adults who have experience with CF (parents of children with CF (n = 21), including parents of children with CF transmembrane conductance regulator (CFTR)-related metabolic syndrome (CRMS)/CF screen positive-inconclusive diagnosis (CFSPID), an uncertain outcome (n = 3), and adults with CF (n = 4)), and nine health professionals involved in caring for children with CF. Parents and health professionals expressed a preference for a sensitive approach to NGS. This was influenced by the importance participants placed on not missing any children with CF via screening and the balance of harm between missing a case of CF compared to picking up more children with an uncertain outcome (CRMS/CFSPID). Given the preference for a sensitive approach, the need for adequate explanations about potential outcomes including uncertainty (CFSPID) at the time of screening was emphasized. More research is needed to inform definitive guidelines for managing children with an uncertain outcome following CF screening.
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Affiliation(s)
- Pru Holder
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London SE5 9PJ, UK;
| | - Corinna C. Clark
- Warwick Medical School, Warwick University, Coventry CV4 7AL, UK; (C.C.C.); (F.K.B.)
| | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry CV1 5FB, UK;
| | - Felicity K. Boardman
- Warwick Medical School, Warwick University, Coventry CV4 7AL, UK; (C.C.C.); (F.K.B.)
| | - Jacqui Cowlard
- Paediatric Respiratory Medicine, Royal London Children’s Hospital, London E1 1FR, UK;
| | - Lorna Allen
- Cystic Fibrosis Trust, London EC3N 1RE, UK; (L.A.); (C.W.)
| | - Claire Walter
- Cystic Fibrosis Trust, London EC3N 1RE, UK; (L.A.); (C.W.)
| | - James R. Bonham
- Pharmacy, Diagnostics and Genetics, Sheffield Children’s NHS Foundation Trust, Sheffield S10 2TH, UK;
| | - Jane Chudleigh
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London SE5 9PJ, UK;
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Ong T, Bell S, Britto MT, Gamel B, McNamara S, Ramsey B, Barton KS. Transforming the nutrition care model for infants with cystic fibrosis: A qualitative study of clinicians' perspectives. Pediatr Pulmonol 2023; 58:1380-1390. [PMID: 36695543 PMCID: PMC10121817 DOI: 10.1002/ppul.26330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/17/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
Clinician perspectives may inform health service strategies to meet optimal nutrition needs for infants with cystic fibrosis (CF). We conducted a qualitative study with CF-specialized dietitians (registered dietitians [RDs]) and physicians between July to December 2020 to characterize the current state of infant nutrition care delivery and organize input into a conceptual model to inform CF care program strategies. Among 42 participants, 36 completed survey responses and 6 completed interviews; 93% were RDs. Three global themes emerged in the current care model: nutrition management, family centered connections, and collaborative care delivery. Within nutrition management, clinicians emphasized providing education, setting goals, and maintaining adequate follow-up with families. Under family centered connections, clinicians expressed the need to foster relationships with families and link families to resources for assistance to social stressors such as food insecurity. Collaborative care delivery for clinicians interviewed was defined by sharing expertise from across the interdisciplinary team. Based on the timing of this study, clinicians reported compelling examples for various modes of telehealth and home weight monitoring to facilitate and support these domains of nutrition care, including potential advantages for education, supporting family needs, and communication. We integrate these themes to propose a conceptual model to organize complementary in-person and telehealth activities and enhance quality infant CF nutrition care delivery. Future implementation can refine this model through testing of practical telehealth interventions to optimize nutrition outcomes for infants with CF.
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Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - Sarah Bell
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - Maria T. Britto
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Breck Gamel
- Children’s Health Pediatric Cystic Fibrosis Center Dallas, UTSW, Dallas, Texas, USA
| | | | - Bonnie Ramsey
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - Krysta S. Barton
- Seattle Children’s Research Institute, Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Seattle, Washington, USA
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Haitjema S, Lubout CMA, Zijlstra JHM, Wolffenbuttel BHR, van Spronsen FJ. Communication of an Abnormal Metabolic New-Born Screening Result in The Netherlands: The Parental Perspective. Nutrients 2022; 14:nu14193961. [PMID: 36235614 PMCID: PMC9571573 DOI: 10.3390/nu14193961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022] Open
Abstract
In the Netherlands, abnormal New-Born Screening (NBS) results are communicated to parents by the general practitioner (GP). Good communication and consequential trust in professionals is of the utmost importance in the treatment of phenylketonuria (PKU). The aim of this study was to assess parental satisfaction regarding the communication of an abnormal NBS result for PKU in the Netherlands. An email containing the link to a web-based questionnaire was sent by the Dutch PKU Association to their members. Responses to open questions were categorized, data of both open and closed questions were analysed with descriptive statistics and the Chi-Square test using SPSS. Out of 113 parents of a child with PKU (born between 1979 and 2020), 68 stated they were overall unsatisfied with the first communication of the NBS result. Seventy-five parents indicated that wrong or no information about PKU was given. A significant decrease was found in the number of parents being contact by their own GP over the course of 40 years (p < 0.05). More than half of all parents were overall unsatisfied with the first communication of the abnormal NBS result for PKU. Further research on how to optimize communication of an abnormal NBS results is necessary.
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Affiliation(s)
- Sietske Haitjema
- Department of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Charlotte M. A. Lubout
- Department of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence:
| | - Justine H. M. Zijlstra
- Department of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Bruce H. R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Francjan J. van Spronsen
- Department of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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Delivering Positive Newborn Screening Results: Cost Analysis of Existing Practice versus Innovative, Co-Designed Strategies from the ReSPoND Study. Int J Neonatal Screen 2022; 8:ijns8010019. [PMID: 35323198 PMCID: PMC8951105 DOI: 10.3390/ijns8010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 01/25/2023] Open
Abstract
Although the communication pathways of Newborn Bloodspot Screening (NBS) are a delicate task, these pathways vary across different conditions and are often not evidence-based. The ReSPoND interventions were co-designed by healthcare professionals alongside parents who had received a positive NBS result for their child. To calculate the cost of these co-designed strategies and the existing communication pathways, we interviewed 71 members of the clinical and laboratory staff of the 13 English NBS laboratories in the English National Health Service. Therefore, a scenario analysis was used to compare the cost of the existing communication pathways to the co-designed strategies delivered by (i) home-visits and (ii) telecommunications. On average, the existing communication pathway cost £447.08 per infant (range: £237.12 to £628.51) or £234,872.75 (£3635.99 to £1,932,986.23) nationally. Implementing the new interventions relying on home-visits exclusively would cost on average £521.62 (£312.84 to £646.39) per infant and £297,816.03 (£4506.37 to £2,550,284.64) nationally, or £447.19 (£235.79 to £552.03) and £231,342.40 (£3923.7 to £1,922,192.22) if implemented via teleconsultations, respectively. The new strategies delivered are not likely to require additional resources compared with current practice. Further research is needed to investigate whether this investment represents good value for money for the NHS budget.
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Holder P, Cheetham T, Cocca A, Chinnery H, Chudleigh J. Processing of Positive Newborn Screening Results for Congenital Hypothyroidism: A Qualitative Exploration of Current Practice in England. Int J Neonatal Screen 2021; 7:ijns7040064. [PMID: 34698074 PMCID: PMC8544504 DOI: 10.3390/ijns7040064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 01/16/2023] Open
Abstract
The objective of this research was to explore current communication practices for positive newborn bloodspot screening results for congenital hypothyroidism from the newborn bloodspot screening laboratory to clinicians and then families, in order to (i) understand how the pathway is implemented in practice, (ii) highlight regional differences and (iii) identify barriers and facilitators. A qualitative exploratory design was employed using semi-structured interviews across 13 newborn bloodspot screening laboratories in England. Participants included 35 clinicians and 17 NBS laboratory staff across the 13 laboratories and 18 members of relevant clinical teams. Findings illuminated variations in how positive newborn bloodspot screening results for congenital hypothyroidism are communicated in practice. This included regional variations due to historical arrangements and local resources. Contacting the appropriate person could be challenging and obtaining feedback from clinical teams to the laboratory after the child has been seen could be time consuming for those involved. Standardised communication model(s) for positive newborn bloodspot screening results for congenital hypothyroidism, which include named contact individuals, defined pathways of care and processes for feeding back to laboratories, may help to ensure the process is less labour intensive, particularly from a laboratory perspective.
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Affiliation(s)
- Pru Holder
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London EC1V 0HB, UK;
- Correspondence: ; Tel.: +44-(0)20-7040-3064
| | - Tim Cheetham
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK;
| | - Alessandra Cocca
- Department of Paediatric Diabetes and Endocrinology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
| | - Holly Chinnery
- Faculty of Sports, Health and Applied Science, St Mary’s University Twickenham, Twickenham TW1 4SX, UK;
| | - Jane Chudleigh
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London EC1V 0HB, UK;
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7
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Chudleigh J, Shakespeare L, Holder P, Chinnery H, Hack G, Gill T, Gould R, Southern KW, Olander EK, Morris S, Bonham JR, Simpson A, Moody L. Co-designing improved communication to parents of newborn bloodspot screening results (Preprint). J Particip Med 2021; 14:e33485. [PMID: 35896023 PMCID: PMC9377474 DOI: 10.2196/33485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Each year in England, almost 10,000 parents are informed of their child’s positive newborn bloodspot screening (NBS) results. This occurs approximately 2 to 8 weeks after birth depending on the condition. Communication of positive NBS results is a subtle and skillful task, demanding thought, preparation, and evidence to minimize potentially harmful negative sequelae. Evidence of variability in the content and the way the result is currently communicated has the potential to lead to increased parental anxiety and distress. Objective This study focused on the development of co-designed interventions to improve the experiences of parents receiving positive NBS results for their children and enhance communication between health care professionals and parents. Methods An experience-based co-design approach was used to explore experiences and co-design solutions with 17 health professionals employed in 3 National Health Service Trusts in England and 21 parents (13/21, 62% mothers and 8/21, 38% fathers) of 14 children recruited from the same 3 National Health Service Trusts. Experiences with existing services were gathered via semistructured interviews with health professionals. Filmed narrative interviews with parents were developed into a composite film. The co-design process identified priorities for improving communication of positive NBS results through separate parent and health professional feedback events followed by joint feedback events. In total, 4 interventions were then co-designed between the participants through a web-based platform. Results Parents and health professionals provided positive feedback regarding the process of gathering experiences and identifying priorities. Themes identified from the parent interviews included impact of initial communication, parental reactions, attending the first clinic appointment, impact of health professionals’ communication strategies and skills, impact of diagnosis on family and friends, improvements to the communication of positive NBS results, and parents’ views on NBS. Themes identified from the health professional interviews included communication between health professionals, process of communicating with the family, parent- and family-centered care, and availability of resources and challenges to effective communication. In response to these themes, 4 interventions were co-designed: changes to the NBS card; standardized laboratory proformas; standardized communication checklists; and an email or letter for providing reliable, up-to-date, condition-specific information for parents following the communication of positive NBS results. Conclusions Parents and health professionals were able to successfully work together to identify priorities and develop co-designed interventions to improve communication of positive NBS results to parents. The resulting co-designed interventions address communication at different stages of the communication pathway to improve the experiences of parents receiving positive NBS results for their children. International Registered Report Identifier (IRRID) RR2-10.1186/s40814-019-0487-5
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Affiliation(s)
- Jane Chudleigh
- Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Lynette Shakespeare
- Pharmacy, Diagnostics and Genetics, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Pru Holder
- Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Holly Chinnery
- Faculty of Sports, Health and Applied Science, St Mary's University, Twickenham, United Kingdom
| | - Gemma Hack
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tanya Gill
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rachel Gould
- Inherited Metabolic Diseases and Newborn Screening, Birmingham Women's and Children's NHS Trust, Birmingham, United Kingdom
| | - Kevin W Southern
- Department of Women's & Children's Health, University of Liverpool, Liverpool, United Kingdom
| | - Ellinor K Olander
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - James R Bonham
- Pharmacy, Diagnostics and Genetics, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Alan Simpson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, United Kingdom
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Chudleigh J, Holder P, Moody L, Simpson A, Southern K, Morris S, Fusco F, Ulph F, Bryon M, Bonham JR, Olander E. Process evaluation of co-designed interventions to improve communication of positive newborn bloodspot screening results. BMJ Open 2021; 11:e050773. [PMID: 34452966 PMCID: PMC8404436 DOI: 10.1136/bmjopen-2021-050773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To implement and evaluate co-designed interventions to improve communication of positive newborn bloodspot screening results and make recommendations for future research and practice. DESIGN A process evaluation underpinned by Normalisation Process Theory. SETTING Three National Health Service provider organisations in England. PARTICIPANTS Twenty-four healthcare professionals (7 newborn screening laboratory staff and 24 clinicians) and 18 parents were interviewed. INTERVENTIONS Three co-designed interventions were implemented in practice: standardised laboratory proformas, communication checklists and an email/letter template. PRIMARY OUTCOME MEASURES Acceptability and feasibility of the co-designed interventions. RESULTS Auditing the implementation of these interventions revealed between 58%-76% of the items on the laboratory proforma and 43%-80% of items on the communication checklists were completed. Interviews with healthcare professionals who had used the interventions in practice provided positive feedback in relation to the purpose of the interventions and the ease of completion both of which were viewed as enhancing communication of positive newborn bloodspot screening results. Interviews with parents highlighted the perceived benefit of the co-designed interventions in terms of consistency, pacing and tailoring of information as well as providing reliable information to families following communication of the positive newborn bloodspot screening result. The process evaluation illuminated organisational and contextual barriers during implementation of the co-designed interventions in practice. CONCLUSION Variations in communication practices for positive newborn bloodspot screening results continue to exist. The co-designed interventions could help to standardise communication of positive newborn screening results from laboratories to clinicians and from clinicians to parents which in turn could improve parents' experience of receiving a positive newborn bloodspot screening result. Implementation highlighted some organisational and contextual barriers to effective adoption of the co-designed interventions in practice. TRIAL REGISTRATION NUMBER ISRCTN15330120.
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Affiliation(s)
- Jane Chudleigh
- School of Health Sciences, City University of London, London, UK
| | - Pru Holder
- School of Health Sciences, City University of London, London, UK
| | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, West Midlands, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | - Kevin Southern
- Paediatrics, University of Liverpool, Liverpool, Merseyside, UK
| | - Stephen Morris
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Francesco Fusco
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona Ulph
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Mandy Bryon
- Paediatric Psychology and Play Services, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - James R Bonham
- Pharmacy, Diagnostics and Genetics, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Ellinor Olander
- School of Health Sciences, City University of London, London, UK
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Chudleigh J, Chinnery H, Holder P, Carling RS, Southern K, Olander E, Moody L, Morris S, Ulph F, Bryon M, Simpson A. Processing of positive newborn screening results: a qualitative exploration of current practice in England. BMJ Open 2020; 10:e044755. [PMID: 33310815 PMCID: PMC7735110 DOI: 10.1136/bmjopen-2020-044755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore current communication practices for positive newborn screening results from the newborn bloodspot screening (NBS) laboratory to clinicians to highlight differences, understand how the pathways are implemented in practice, identify barriers and facilitators and make recommendations for future practice and research. DESIGN A qualitative exploratory design was employed using semi-structured interviews. SETTING Thirteen NBS laboratories in England. PARTICIPANTS Seventy-one clinicians; 22 NBS laboratory staff across 13 laboratories and 49 members of relevant clinical teams were interviewed. RESULTS Assurance of quality and consistency was a priority for all NBS laboratories. Findings indicated variation in approaches to communicating positive NBS results from laboratories to clinical teams. This was particularly evident for congenital hypothyroidism and was largely influenced by local arrangements, resources and the fact individual laboratories had detailed standard operating procedures for how they work. Obtaining feedback from clinical teams to the laboratory after the child had been seen could be challenging and time-consuming for those involved. Pathways for communicating carrier results for cystic fibrosis and sickle cell disease could be ambiguous and inconsistent which in turn could hamper the laboratories efforts to obtain timely feedback regarding whether or not the result had been communicated to the family. Communication pathways for positive NBS results between laboratories and clinical teams could therefore be time-consuming and resource-intensive. CONCLUSION The importance placed on ensuring positive NBS results were communicated effectively and in a timely fashion from the laboratory to the clinical team was evident from all participants. However, variation existed in terms of the processes used to report positive NBS results to clinical teams and the people involved. Variant practice identified may reflect local needs, but more often reflected local resources and a more consistent 'best practice' approach is required, not just in the UK but perhaps globally. TRIAL REGISTRATION NUMBER ISRCTN15330120.
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Affiliation(s)
- Jane Chudleigh
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Holly Chinnery
- Faculty of Sports, Health and Applied Science, St Mary's University Twickenham, Twickenham, UK
| | - Pru Holder
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Rachel S Carling
- Biochemical Sciences, Viapath, Guys & St Thomas' NHS Foundation Trust, GKT School of Medical Education, King's College London, London, UK
| | - Kevin Southern
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Ellinor Olander
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, UK
| | - Stephen Morris
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Fiona Ulph
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Mandy Bryon
- Paediatric Psychology and Play Services, Great Ormond Street Hospital for Children NHS FoundationTrust, London, UK
| | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Barben J, Castellani C, Munck A, Davies JC, de Winter-de Groot KM, Gartner S, Kashirskaya N, Linnane B, Mayell SJ, McColley S, Ooi CY, Proesmans M, Ren CL, Salinas D, Sands D, Sermet-Gaudelus I, Sommerburg O, Southern KW. Updated guidance on the management of children with cystic fibrosis transmembrane conductance regulator-related metabolic syndrome/cystic fibrosis screen positive, inconclusive diagnosis (CRMS/CFSPID). J Cyst Fibros 2020; 20:810-819. [PMID: 33257262 DOI: 10.1016/j.jcf.2020.11.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/30/2020] [Accepted: 11/07/2020] [Indexed: 02/06/2023]
Abstract
Over the past two decades there has been considerable progress with the evaluation and management of infants with an inconclusive diagnosis following Newborn Screening (NBS) for cystic Fibrosis (CF). In addition, we have an increasing amount of evidence on which to base guidance on the management of these infants and, importantly, we have a consistent designation being used across the globe of CRMS/CFSPID. There is still work to be undertaken and research questions to answer, but these infants now receive more consistent and appropriate care pathways than previously. It is clear that the majority of these infants remain healthy, do not convert to a diagnosis of CF in childhood, and advice on management should reflect this. However, it is also clear that some will convert to a CF diagnosis and monitoring of these infants should facilitate their early recognition. Those infants that do not convert to a CF diagnosis have some potential of developing a CFTR-RD later in life. At present, it is not possible to quantify this risk, but families need to be provided with clear information of what to look out for. This paper contains a number of changes from previous guidance in light of developing evidence, but the major change is the recommendation of a detailed assessment of the child with CRMS/CFSPID in the sixth year of age, including respiratory function assessment and imaging. With these data, the CF team can discuss future care arrangements with the family and come to a shared decision on the best way forward, which may include discharge to primary care with appropriate information. Information is key for these families, and we recommend consideration of a further appointment when the individual is a young adult to directly communicate the implications of the CRMS/CFSPID designation.
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Affiliation(s)
- Jürg Barben
- Paediatric Pulmonology & CF Centre, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
| | - Carlo Castellani
- Istituto Giannina Gaslini, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Anne Munck
- CF referent physician for the French Society of Newborn Screening, Hopital Necker Enfants-Malades, AP-HP, CF centre, Université Paris Descartes, France
| | - Jane C Davies
- National Heart & Lung Institute, Imperial College London, UK; Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Karin M de Winter-de Groot
- Department of Paediatric Pulmonology & Allergology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Silvia Gartner
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | - Nataliya Kashirskaya
- Laboratory of genetic epidemiology, Research Centre for Medical Genetics, Moscow, Russian Federation
| | - Barry Linnane
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - Sarah J Mayell
- Regional Paediatric CF Centre, Alder Hey Children's Hospital, Liverpool, UK
| | - Susanna McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Stanley Manne Children's Research Institute, Ann and Robert H Lurie Children's Hospital of Chicago, USA
| | - Chee Y Ooi
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Australia; Department of Gastroenterology and Molecular and Integrative Cystic Fibrosis Research Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Marijke Proesmans
- Division of Woman and Child, Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Clement L Ren
- Department of Pediatrics, Indiana University School of Medicine, Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, USA
| | - Danieli Salinas
- Department of Pediatric Pulmonology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, USA
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
| | - Isabelle Sermet-Gaudelus
- Institut Necker Enfants Malades/INSERM U1151, Service de Pneumologie et Allergologie Pédiatriques Centre de Référence Maladies Rares, Mucoviscidose et maladies de CFTR, Hôpital Necker Enfants Malades Paris. Université de Paris. ERN Lung, France
| | - Olaf Sommerburg
- Paediatric Pulmonology, Allergology & CF Centre, Department of Paediatrics III, and Translational Lung Research Center, German Lung Research Center, University Hospital Heidelberg, Germany
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, UK
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11
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Chudleigh J, Chinnery H, Bonham JR, Olander E, Moody L, Simpson A, Morris S, Ulph F, Bryon M, Southern K. Qualitative exploration of health professionals' experiences of communicating positive newborn bloodspot screening results for nine conditions in England. BMJ Open 2020; 10:e037081. [PMID: 33004391 PMCID: PMC7534703 DOI: 10.1136/bmjopen-2020-037081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore health professionals' experiences of communicating positive newborn bloodspot screening (NBS) results, highlight differences, share good practice and make recommendations for future research. DESIGN Qualitative exploratory design was employed using semi-structured interviews SETTING: Three National Health Service provider organisations in England PARTICIPANTS: Seventeen health professionals involved in communicating positive newborn bloodspot screening results to parents for all nine conditions currently included in the newborn bloodspot screening programme in England. RESULTS Findings indicated variation in approaches to communicating positive newborn bloodspot screening results to parents, largely influenced by resources available and the lack of clear guidance. Health professionals emphasised the importance of communicating results to families in a way that is sensitive to their needs. However, many challenges hindered communication including logistical considerations; difficulty contacting the family and other health professionals; language barriers; parental reactions; resource considerations; lack of training; and insufficient time. CONCLUSION Health professionals invest a lot of time and energy trying to ensure communication of positive newborn bloodspot screening results to families is done well. However, there continues to be great variation in the way these results are communicated to parents and this is largely influenced by resources available but also the lack of concrete guidance. How best to support health professionals undertaking this challenging and emotive task requires further exploration. We recommend evaluation of a more cohesive approach that meets the needs of parents and staff while being sensitive to the subtleties of each condition. TRIAL REGISTRATION NUMBER ISRCTN15330120.
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Affiliation(s)
| | - Holly Chinnery
- Faculty of Sports, Health and Applied Science, St Mary's University Twickenham, Twickenham, London, UK
| | - Jim R Bonham
- Division of Pharmacy, Diagnostics and Genetics, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Ellinor Olander
- School of Health Sciences, City University London, London, UK
| | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, West Midlands, UK
| | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Stephen Morris
- Primary Care Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Fiona Ulph
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, University of Manchester, Manchester, UK
| | - Mandy Bryon
- Paediatric Psychology and Play Services, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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12
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Chudleigh J, Chinnery H. Psychological Impact of NBS for CF. Int J Neonatal Screen 2020; 6:27. [PMID: 33073024 PMCID: PMC7422999 DOI: 10.3390/ijns6020027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/25/2020] [Indexed: 12/29/2022] Open
Abstract
Newborn screening for cystic fibrosis has resulted in diagnosis often before symptoms are recognised, leading to benefits including reduced disease severity, decreased burden of care, and lower costs. The psychological impact of this often unsought diagnosis on the parents of seemingly well children is less well understood. The time during which the screening result is communicated to families but before the confirmatory test results are available is recognised as a period of uncertainty and it is this uncertainty that can impact most on parents. Evidence suggests this may be mitigated against by ensuring the time between communication and confirmatory testing is minimized and health professionals involved in communicating positive newborn screening results and diagnostic results for cystic fibrosis to families are knowledgeable and able to provide appropriate reassurance. This is particularly important in the case of false positive results or when the child is given a Cystic Fibrosis Screen Positive, Inconclusive Diagnosis designation. However, to date, there are no formal mechanisms in place to support health professionals undertaking this challenging role, which would enable them to meet the expectations set out in specific guidance.
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Affiliation(s)
- Jane Chudleigh
- School of Health Sciences, City, University of London, London EC1V 0HB, UK
| | - Holly Chinnery
- Faculty of Sports, Health and Applied Science, St Mary’s University, London TW1 4SX, UK;
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