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Lou S, Jensen AH, Vogel I, Trolle B, Herlin MK. Understanding the Diagnostic Odyssey of Women with Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome in Denmark: A Qualitative Interview Study. J Pediatr Adolesc Gynecol 2024; 37:412-418. [PMID: 38494126 DOI: 10.1016/j.jpag.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
STUDY OBJECTIVE The diagnosis of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is often a lengthy process that typically occurs during late adolescence. To support optimized and patient-centered care, this study aimed to investigate how women with MRKH syndrome experience the diagnostic process. METHODS From January 2021 to March 2021, we conducted in-depth interviews with 18 Danish women (≥25 years) diagnosed with MRKH syndrome. The interviews lasted a median of 92 minutes (range: 67-117). Data were analyzed using thematic analysis. RESULTS As teenagers or young women at the time, all women had experienced the diagnostic process in the nonspecialized healthcare sector as deeply upsetting due to distressing gynecological examinations, use of inappropriate language, and considerable diagnostic delay. When reaching the specialized health care sector, questions could finally be answered, but this information and support did not significantly alter their feelings of being "deviant" or "flawed". The women continued their diagnostic odyssey beyond the health care system and found online communities that gave them valuable support in living with MRKH syndrome. CONCLUSION Women experience the diagnostic odyssey of MRKH syndrome as upsetting and potentially traumatizing beyond the diagnosis. Healthcare professionals can influence young women's understanding and experience of MRKH syndrome by using inclusive language (eg, avoiding "deformity") and addressing all that is normal and functioning (eg, external genitalia and potential for sexual pleasure). In nonurgent conditions, young women should be given the choice to delay a genital examination.
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Affiliation(s)
- Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, 8000 Aarhus, Denmark; DEFACTUM - Public Health Research, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark.
| | | | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, 8000 Aarhus, Denmark; Department of Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark; Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Birgitta Trolle
- Center of Sexology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Morten Krogh Herlin
- Department of Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark; Department of Clinical Genetics, Aarhus University Hospital, 8000 Aarhus, Denmark
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Narang G, Chen YJ, Wedel N, Wu M, Luo M, Atreja A. Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study. JMIR Form Res 2024; 8:e52251. [PMID: 38842924 PMCID: PMC11190623 DOI: 10.2196/52251] [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: 08/29/2023] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Cyclic vomiting syndrome (CVS) is an enigmatic and debilitating disorder of gut-brain interaction that is characterized by recurrent episodes of severe vomiting and nausea. It significantly impairs patients' quality of life and can lead to frequent medical visits and substantial health care costs. The diagnosis for CVS is often protracted and complex, primarily due to its exclusionary diagnosis nature and the lack of specific biomarkers. This typically leads to a considerable delay in accurate diagnosis, contributing to increased patient morbidity. Additionally, the absence of approved therapies for CVS worsens patient hardship and reflects the urgent need for innovative, patient-centric solutions to improve CVS management. OBJECTIVE We aim to develop a digital patient assistant (DPA) for patients with CVS to address their unique needs, and iteratively enhance the technical features and user experience on the initial DPA versions. METHODS The development of the DPA for CVS used a design thinking approach, prioritizing user needs. A literature review and Patient Advisory Board shaped the initial prototype, focusing on diagnostic support and symptom tracking. Iterative development, informed by the design thinking approach and feedback from patients with CVS and caregivers through interviews and smartphone testing, led to significant enhancements in user interaction and artificial intelligence integration. The final DPA's effectiveness was validated using the System Usability Scale and feedback questions, ensuring it met the specific needs of the CVS community. RESULTS The DPA developed for CVS integrates an introductory bot, daily and weekly check-in bots, and a knowledge hub, all accessible via a patient dashboard. This multicomponent solution effectively addresses key unmet needs in CVS management: efficient symptom and impacts tracking, access to comprehensive disease information, and a digital health platform for disease management. Significant improvements, based on user feedback, include the implementation of artificial intelligence features like intent recognition and data syncing, enhancing the bot interaction and reducing the burden on patients. The inclusion of the knowledge hub provides educational resources, contributing to better disease understanding and management. The DPA achieved a System Usability Scale score of 80 out of 100, indicating high ease of use and relevance. Patient feedback highlighted the DPA's potential in disease management and suggested further applications, such as integration into health care provider recommendations for patients with suspected or confirmed CVS. This positive response underscores the DPA's role in enhancing patient engagement and disease management through a patient-centered digital solution. CONCLUSIONS The development of this DPA for patients with CVS, via an iterative design thinking approach, offers a patient-centric solution for disease management. The DPA development framework may also serve to guide future patient digital support and research scenarios.
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Affiliation(s)
| | - Yaozhu J Chen
- Takeda Development Center Americas, Inc, Lexington, MA, United States
| | | | - Melody Wu
- Takeda Development Center Americas, Inc, Lexington, MA, United States
| | - Michelle Luo
- Takeda Development Center Americas, Inc, Lexington, MA, United States
| | - Ashish Atreja
- Rx.Health, New York, NY, United States
- UC Davis Health, University of California, Davis, Davis, CA, United States
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Nguyen CQ, Kariyawasam DST, Ngai TSJ, Nguyen J, Alba-Concepcion K, Grattan SE, Palmer EE, Hetherington K, Wakefield CE, Dale RC, Woolfenden S, Mohammad S, Farrar MA. 'High hopes for treatment': Australian stakeholder perspectives of the clinical translation of advanced neurotherapeutics for rare neurological diseases. Health Expect 2024; 27:e14063. [PMID: 38711219 DOI: 10.1111/hex.14063] [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] [Received: 04/12/2023] [Revised: 03/08/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Advanced therapies offer unprecedented opportunities for treating rare neurological disorders (RNDs) in children. However, health literacy, perceptions and understanding of novel therapies need elucidation across the RND community. This study explored healthcare professionals' and carers' perspectives of advanced therapies in childhood-onset RNDs. METHODS In this mixed-methodology cross-sectional study, 20 healthcare professionals (clinicians, genetic counsellors and scientists) and 20 carers completed qualitative semistructured interviews and custom-designed surveys. Carers undertook validated psychosocial questionnaires. Thematic and quantitative data analysis followed. RESULTS Participants described high positive interest in advanced therapies, but low knowledge of, and access to, reliable information. The substantial 'therapeutic gap' and 'therapeutic odyssey' common to RNDs were recognised in five key themes: (i) unmet need and urgency for access; (ii) seeking information; (iii) access, equity and sustainability; (iv) a multidisciplinary and integrated approach to care and support and (v) difficult decision-making. Participants were motivated to intensify RND clinical trial activity and access to advanced therapies; however, concerns around informed consent, first-in-human trials and clinical trial procedures were evident. There was high-risk tolerance despite substantial uncertainties and knowledge gaps. RNDs with high mortality, increased functional burdens and no alternative therapies were consistently prioritised for the development of advanced therapies. However, little consensus existed on prioritisation to treatment access. CONCLUSIONS This study highlights the need to increase clinician and health system readiness for the clinical translation of advanced therapeutics for RNDs. Co-development and use of educational and psychosocial resources to support clinical decision-making, set therapeutic expectations and promotion of equitable, effective and safe delivery of advanced therapies are essential. PATIENT OR PUBLIC CONTRIBUTION Participant insights into the psychosocial burden and information need to enhance the delivery of care in this formative study are informing ongoing partnerships with families, including co-production and dissemination of psychoeducational resources featuring their voices hosted on the Sydney Children's Hospitals Network website SCHN Brain-Aid Resources.
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Affiliation(s)
- Christina Q Nguyen
- Discipline of Paediatrics and Child Health, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
| | - Didu S T Kariyawasam
- Discipline of Paediatrics and Child Health, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Tsz Shun Jason Ngai
- Discipline of Paediatrics and Child Health, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
| | - James Nguyen
- Discipline of Paediatrics and Child Health, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
| | - Kristine Alba-Concepcion
- Discipline of Paediatrics and Child Health, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Sarah E Grattan
- Discipline of Paediatrics and Child Health, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Kate Hetherington
- Discipline of Paediatrics and Child Health, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
- Behavioural Science Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Discipline of Paediatrics and Child Health, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
- Behavioural Science Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Russell C Dale
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sue Woolfenden
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, Australia
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Shekeeb Mohammad
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michelle A Farrar
- Discipline of Paediatrics and Child Health, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
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Weddell J, Jawad D, Buckley T, Redfern J, Mansur Z, Elliott N, Hanson CL, Gallagher R. Online information for spontaneous coronary artery dissection (SCAD) survivors and their families: A systematic appraisal of content and quality of websites. Int J Med Inform 2024; 184:105372. [PMID: 38350180 DOI: 10.1016/j.ijmedinf.2024.105372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/11/2024] [Accepted: 02/04/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) survivors often seek information online. However, the quality and content of websites for SCAD survivors is uncertain. This review aimed to systematically identify and appraise websites for SCAD survivors. METHODS A systematic review approach was adapted for websites. A comprehensive search of SCAD key-phrases was performed using an internet search engine during January 2023. Websites targeting SCAD survivors were included. Websites were appraised for quality using Quality Component Scoring System (QCSS) and Health Related Website Evaluation Form (HRWEF), suitability using the Suitability Assessment Method (SAM), readability using a readability generator, and interactivity. Content was appraised using a tool based on SCAD international consensus literature. Raw scores from tools were concerted to percentages, then classified variably as excellent through to poor. RESULTS A total of 50 websites were identified and included from 600 screened. Overall, content accuracy/scope (53.3 ± 23.3) and interactivity (67.1 ± 11.5) were poor, quality was fair (59.1 ± 22.3, QCSS) and average (83.1 ± 5.8, HRWEF) and suitability was adequate (54.9 ± 13.8, SAM). The mean readability grade was 11.6 (±2.3), far exceeding the recommendations of ≤ 8. By website type, survivor affiliated and medically peer-reviewed health information websites scored highest. Appraisal tools had limitations, such as overlapping appraisal of similar things and less relevant items due to internet modernity. CONCLUSION Many online websites are available for SCAD survivors, but often have limited and/or inaccurate content, poor quality, are not tailored to the demographic, and are difficult to read. Appraisal tools for health website require consolidation and further development.
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Affiliation(s)
- Joseph Weddell
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Sydney, Australia.
| | - Danielle Jawad
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - Thomas Buckley
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Julie Redfern
- Charles Perkins Centre, The University of Sydney, Sydney, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Zarin Mansur
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Natalie Elliott
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Robyn Gallagher
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Sydney, Australia
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Shukla DP, Cutshall JO, van der Heijden L, Schindewolf E, Sheppard SE. The importance of patient-specific resources for families dealing with prenatal rare diseases. Am J Med Genet A 2024; 194:e63450. [PMID: 37861066 PMCID: PMC10922059 DOI: 10.1002/ajmg.a.63450] [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] [Received: 06/28/2023] [Revised: 08/18/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
Rare diseases (RDs) are defined as diseases that affect a low number of the population. Prenatal diagnoses of RDs can add a lot of unique stress for parents. For example, parents who have prenatal diagnoses experience not only grief of expectation, but are forced to become patient advocates with incomplete information as their child is not yet born, and in many cases parents experience a lot of uncertainty. This typically involves seeking support groups and finding pre- and postnatal specialists all which come with mental and financial cost. Here we discuss the importance of targeted patient resources for parents to help alleviate some of their stress. Patient advocacy organizations can be incredibly useful for parents to navigate the complex healthcare system and help mitigate feelings of isolation, especially when parents can talk to others in a similar situation. We collaborated with a patient organization to create a prenatal parent support guide to address how parental needs such as mental well-being and practicing self-care can be met. We hope that resources such as these can help empower those with a pregnancy affected with a RD diagnosis.
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Affiliation(s)
- Dhyanam P. Shukla
- Unit on Vascular Malformations, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | | | | | - Erica Schindewolf
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sarah E. Sheppard
- Unit on Vascular Malformations, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Hamilton RA, Lond B, Wilde L, Williamson I. Understanding the lived-experience and support-needs of people living with antimicrobial resistance in the UK through interpretative phenomenological analysis. Sci Rep 2024; 14:3403. [PMID: 38337017 PMCID: PMC10858033 DOI: 10.1038/s41598-024-53814-6] [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] [Received: 10/12/2023] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
In the UK nearly 54,000 infections were caused by serious resistant bacteria in 2022 but there is a lack of evidence regarding the long-term impact on patients' lives nor what support they need. This research aimed to answer the question: "What are the key elements of experience and support needs of people living with AMR in the UK?". In-depth semi-structured interviews were undertaken with nine people who had been living with resistant infections or colonisation for 12-months or longer. Interpretive Phenomenological Analysis was used to study the accounts and illustrate individuals' experiences and support-needs. Participants experienced marginalisation and isolation but also empowerment; described across three major themes: (1) I live in fear and stigma: The long-term impact of AMR; (2) I am battling on my own: A journey toward self-advocacy; and (3) I like to share my story: The role of AMR communities. All participants perceived a lack of knowledge, information, and support from clinicians; difficulties accessing reliable and understandable information; and lack of understanding from family and friends. Charities and online groups provided support with coping with their situation and improving mental health and wellbeing. Understandable and relatable information regarding the science of AMR, transmission, prevention, and living with AMR needs to be provided by clinicians and healthcare services around the time of diagnosis to readily available after diagnosis.
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Affiliation(s)
| | - Benjamin Lond
- Department of Psychology, De Montfort University, Leicester, UK
| | - Lucina Wilde
- School of Pharmacy, De Montfort University, Leicester, UK
| | - Iain Williamson
- Department of Psychology, De Montfort University, Leicester, UK
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Domaradzki J, Walkowiak D. Ultra-rare ultra-care: Assessing the impact of caring for children with ultra rare diseases. Eur J Paediatr Neurol 2024; 48:78-84. [PMID: 38071849 DOI: 10.1016/j.ejpn.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND We sought to assesses the impact of caring for children with ultra rare diseases (URDs) on family carers and to analyse the way these experiences differ among the caregivers of children diagnosed through prenatal or newborn screening, and those with symptom-based diagnosis. METHODS A total of 200 caregivers of 219 URDs children completed an on-line survey regarding the challenges and experiences of caregivers of URDs children. RESULTS The majority of URD caregivers felt burdened by their children's health problems, emotional and behavioural changes. 46.5% reported feelings of care overload, 43% coped poorly with the stress, and many experienced a variety of feelings of distress towards the role of caregiver. While most caregivers struggled with the diagnostic odyssey and were dissatisfied with the healthcare services for URD children, caregivers of children diagnosed through prenatal or newborn screening were significantly less burdened than the parents of children with symptom-based diagnoses. CONCLUSION Although caregivers of URDs children experience physical and emotional strain, they are often neglected by the healthcare system. A bio-psychosocial approach to URDs should therefore also include family caregivers' physical and psychosocial needs. Apart from financial and emotional support, enhancing access to genetic testing and newborn screening should be prioritised.
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Affiliation(s)
- Jan Domaradzki
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, Poznań, Poland.
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Pozna&nacute, Poland
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