1
|
Düken ME, Yayan EH. Psychosocial conditions of children after liver transplant: Post-traumatic stress, depression, and anxiety. J Pediatr Nurs 2024; 75:e75-e80. [PMID: 38216348 DOI: 10.1016/j.pedn.2023.12.033] [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: 03/28/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/14/2024]
Abstract
AIM This study aimed to determine psychosocial conditions, post-traumatic stress, depression, and anxiety of children who underwent a liver transplant. METHOD This is a relational descriptive study, which was conducted between March 2019 and December 2020 in the Inonu University Liver Transplantation Institute Pediatric Liver Transplant Clinic. The "Child Information Form," "Child Post-Traumatic Stress Reaction Index," "State-Trait Anxiety Inventory for Children-Trait Form," and "Children's Depression Inventory" were used to collect data. The study was conducted with 71 children who had a previous liver transplant. RESULTS Of the participating children, 56.3% were girls, 63.4% continued their primary school education after the transplant, 32.5% were diagnosed with cirrhosis, 39.4% received the transplant in 2017, 32.4% received it from the mother, and 25.4% received it from a cadaveric donor. Although it had been at least 3 years since the transplant, 47.9% exhibited moderate and 43.7% severe post-traumatic stress responses. There was a significant negative relationship between the age of children with a liver transplant and trait anxiety and post-traumatic stress responses (path coefficients β = -0.268, p = 0.002; β = -0.166, p = 0.023, respectively). There was a significant positive relationship between anxiety and post-traumatic stress responses of the children after the transplant and there was a statistically significant relationship between the path coefficients (β = 0.750; p < 0.001). CONCLUSION Children who underwent a liver transplant had post-traumatic stress disorder, depression, and trait anxiety.
Collapse
Affiliation(s)
- Mehmet Emin Düken
- Harran University, Health Sciences of Faculty -Department of Child Health and Diseases Nursing, Şanlıurfa 63000, Turkey; Inönü University, Faculty of Nursing- Department of Child Health and Diseases Nursing, Malatya 44280, Turkey.
| | - Emriye Hilal Yayan
- Inönü University, Faculty of Nursing- Department of Child Health and Diseases Nursing, Malatya 44280, Turkey.
| |
Collapse
|
2
|
Farre A, Lunt L, Lee R, Verstappen S, McDonagh JE. Addressing education and employment outcomes in the provision of healthcare for young people with physical long-term conditions: A systematic review and mixed methods synthesis. PATIENT EDUCATION AND COUNSELING 2023; 112:107765. [PMID: 37086594 DOI: 10.1016/j.pec.2023.107765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To identify and synthesise the experiences and benefits of addressing vocational issues in the provision of healthcare for young people (YP) with long-term conditions (LTCs). METHODS We searched 10 bibliographic databases. Restrictions were applied on publication date (1996-2020) and language (English). Two reviewers independently screened records against eligibility criteria. Articles reporting relevant qualitative and/or quantitative research were included. Quality appraisal was undertaken following study selection. Qualitative data were synthesised thematically, and quantitative data narratively. A cross-study synthesis integrated qualitative and quantitative findings. RESULTS 43 articles were included. Thematic synthesis of qualitative studies (n = 23) resulted in seven recommendations for intervention (psychological support; information/signposting; skills training; career advice; healthcare-school/workplace collaboration; social support; flexible/responsive care). The narrative synthesis summarised results of 17 interventions (n = 20 quantitative studies). The cross-study synthesis mapped interventions against recommendations. Transitional care was the intervention type that most comprehensively met our proposed recommendations. CONCLUSIONS Evidence from YP perspectives highlights that vocational development is an important area to address in healthcare provision. Robust intervention studies in this area are lacking. PRACTICE IMPLICATIONS Our evidence-based recommendations for intervention can support health professionals to better address vocational issues/outcomes. With minimal adaptations, transitional care interventions would be particularly well suited to deliver this.
Collapse
Affiliation(s)
- Albert Farre
- School of Health Sciences, University of Dundee, Dundee, UK.
| | - Laura Lunt
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rebecca Lee
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Suzanne Verstappen
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK; Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
3
|
van Schelven F, van der Meulen E, Wessels E, Boeije HR. Let Us Talk Treatment: Using a Digital Body Map Tool to Examine Treatment Burden and Coping Strategies Among Young People with a Chronic Condition. Patient Prefer Adherence 2023; 17:517-529. [PMID: 36891325 PMCID: PMC9987530 DOI: 10.2147/ppa.s400702] [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: 12/08/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE Treatment for a chronic condition can pose a heavy burden on young people and affect their quality of life. The present study examined young people's experiences with treatment burden and their coping strategies. PATIENTS AND METHODS The body mapping method was employed, in which a life-sized outline of someone's body is traced and populated with visual representations, symbols and words. For the present study, a digital tool for body mapping was developed. This is a chat robot which helps young people make a body map by asking questions about their lives, wellbeing and the influence of their treatment on this. In two series of three workshops, ten young people (16 to 25 years) with a chronic, somatic condition created individual body maps using this tool. The body maps were discussed in the group to obtain insight into experiences with treatment burden. The findings were analysed using thematic analysis. In all stages of the study, two adolescents with a chronic condition were involved as co-researchers. RESULTS The results show that young people with a chronic condition experience considerable treatment burden. Although treatment reduces their symptoms, it also leads to physical and emotional side-effects, restrictions of meaningful activities, issues with future planning, reduced independence, and autonomy and loneliness. Young people apply several strategies to cope with this burden, such as seeking support from others, focusing on the positive, ignoring treatment advice, and seeing a psychologist. CONCLUSION Treatment burden is a subjective experience and not merely based on the number or types of treatment. It is therefore vital that young people with a chronic condition discuss their experiences with their care provider. This can help to tailor treatment decisions to their lives and needs.
Collapse
Affiliation(s)
- Femke van Schelven
- Department Perspective of Patients and Clients in Healthcare, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Correspondence: Femke van Schelven, Netherlands Institute for Health Services Research, Otterstraat 118, Utrecht, 3513, CR, the Netherlands, Email
| | | | - Elise Wessels
- JongPIT, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Hennie R Boeije
- Department Perspective of Patients and Clients in Healthcare, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| |
Collapse
|
4
|
Duncan-Park S, Danziger-Isakov L, Armstrong B, Williams N, Odim J, Shemesh E, Sweet S, Annunziato R. Posttraumatic stress and medication adherence in pediatric transplant recipients. Am J Transplant 2022; 22:937-946. [PMID: 34837457 PMCID: PMC8897237 DOI: 10.1111/ajt.16896] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 01/25/2023]
Abstract
Adolescent transplant recipients may encounter a range of potentially traumatic events (PTEs) pre- and posttransplant, yet little is known about the relationship between posttraumatic stress symptoms (PTSS) and medication adherence in this population. In the present study, adolescent recipients and caregivers completed psychosocial questionnaires at enrollment. Outpatient tacrolimus trough level data were collected over 1 year to calculate the Medication Level Variability Index (MLVI), a measure of medication adherence. Nonadherence (MLVI ≥2) was identified in 34.8% of patients, and most (80.7%) reported ≥1 PTE exposure. Levels of PTSS indicating likely posttraumatic stress disorder (PTSD) were endorsed by 9.2% of patients and 43.7% of caregivers. PTSS and MLVI were significantly correlated in the liver subgroup (r = .30, p = .04). Hierarchical multivariable linear regression analyses revealed overall patient PTSS were significantly associated with QoL (p < .001). PTEs are common in adolescent recipients; a minority may meet criteria for PTSD. PTSS screening to identify nonadherence risk requires further investigation and addressing PTSS may improve QoL. Caregivers appear at greater risk for PTSD and may require their own supports. The study was approved by each participating center's Institutional Review Board.
Collapse
Affiliation(s)
- Sarah Duncan-Park
- Icahn School of Medicine at Mount Sinai, NY, NY
- Fordham University, Bronx, NY
| | | | | | | | | | | | | | - Rachel Annunziato
- Icahn School of Medicine at Mount Sinai, NY, NY
- Fordham University, Bronx, NY
| |
Collapse
|
5
|
Laneuville L, Ballesteros F, Affdal A, Malo MF, Brassard L, Gagnon Chainey B, Millot P, Mavrikakis C, Harel S, Fortin MC. Perspectives of Kidney Transplant Recipients, Transplant Candidates, and Living Kidney Donors on the Role of Patients’ Self-Narratives and Experiences of Creative Writing Workshops: A Qualitative Study. Can J Kidney Health Dis 2022; 9:20543581221132742. [PMID: 36353517 PMCID: PMC9638699 DOI: 10.1177/20543581221132742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Kidney transplantation is the best treatment for kidney failure but is
associated with medical, psychological, and existential challenges for
patients. Patients’ experiential knowledge can help other patients facing
these challenges. Patients’ self-narratives and creative writings are ways
to operationalize this experiential knowledge. Creative writing has been
described as a therapeutic tool for patients with chronic disease. Over the
past year, we conducted creative writing workshops with kidney transplant
recipients (KTRs), living kidney donors (LKDs), kidney transplant candidates
(KTCs), and professional writers. During these workshops, patients were
invited to explore different aspects of their experiences of their
transplant or donation journey through narrative-writing, poetry, comic art,
and screenwriting. Objective: The objectives of this study were to gather the perspectives of KTRs, KTCs,
and LKDs on the role of patients’ self-narratives and creative writing, and
to collect patients’ experiences of the creative writing workshops. Design: Focus groups and individual interviews. Setting: The Center hospitalier de l’Université de Montréal (CHUM) kidney transplant
program. Participants: KTRs, LKDs, and KTCs attending the CHUM kidney transplant clinic between
February 2020 and January 2021. Methods: We conducted 2 focus groups and 8 semi-structured individual interviews with
7 KTRs, 8 LKDs, and 5 KTCs from the CHUM between June and November 2020,
before the creative writing workshops. We also conducted 10 semi-structured
interviews with 5 KTRs, 1 KTC, and 4 LKDs in March 2021, after their
participation in the creative writing workshops. The interviews were
recorded and transcribed. Thematic and content analyses were conducted. Results: KTRs, LKDs, and KTCs had multiple significant moments to share from their
transplant/donation journey. These moments were highly emotional and marked
by uncertainty. The creative writing workshops were described as therapeutic
by participants, because they offered a safe space for group-facilitated
reflection, including a discovery and learning process, and normalization,
relativization, and appreciation of the transplant/donation experience. The
creative writing workshops also provided an opportunity to give back to
others (helping other patients, promoting kidney donation and continuing
this process in the future through the web platform). Limitations: Our participants came from a single French-speaking urban transplant center
in Quebec and were highly educated. Conclusion: The study set out to capture the perspectives of KTRs, LKDs, and KTCs through
the sharing of self-narratives and their participation in creative writing
workshops related to their transplant or donation journey. A website was set
up to publish patients’ creative writings (https://recitsdudonetdelavie.lorganon.ca/les-recits/).
Further study is needed to assess the website’s impact on other
patients. Trial registration: Not registered.
Collapse
Affiliation(s)
- Laurence Laneuville
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Aliya Affdal
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
| | - Marie-Françoise Malo
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
| | - Léonore Brassard
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
| | - Benjamin Gagnon Chainey
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
| | - Pascale Millot
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département des littératures de langues française, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Catherine Mavrikakis
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département des littératures de langues française, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Simon Harel
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département de littératures et de langues du monde, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du CHUM, Montréal, QC, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Faculté de médecine, Université de Montréal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| |
Collapse
|
6
|
Demir B, Bulbuloglu S. Perceived body image and distress after liver tansplantation in recipients. Transpl Immunol 2021; 69:101483. [PMID: 34688881 DOI: 10.1016/j.trim.2021.101483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study's aim was to determine the relationship between the perception of self-body image and the level of distress in patients who had liver transplantation surgery. METHOD This study was performed as a descriptive and cross-sectional study with the attendance of 120 liver transplant patients hospitalized in the liver transplant center of a training and research hospital. Self-body image was measured based on the Body Image Questionnaire (BIQ) on a scale of 40 (lowest) to 200 (highest) with the optimal BIQ score of 135-200. The level of distress was evaluated by the Distress Thermometer (DT) on a scale of 0 (None) to 10 (High). The data analysis was performed with the IBM Statistical Package for the Social Sciences Statistics 25. RESULTS According to the data attained, 35.8% of the patients were 55 years old or older, 56.7% were male, and 61.7% were married. The mean BIQ score among all tested patients was 81.85 ± 27.31, and this was considered as a low level of self-image. The mean DT score of the patients was 5.45 ± 2.72, which indicated relatively high levels of distress in the transplant recipients. Comparing these two values together (BIQ + DT) by regression analysis, we found a moderate negative relationship between self-body image (BIQ) and distress (DT) in the patients (r: -0.391, p < 0.001). Accordingly, when the distress levels of the patients decreased, their perceptions of self-body image increased. CONCLUSION Even if their liver transplant operation is successful, the problems of the recipients after transplantation do not completely disappear. Liver transplant recipients should be helped in coping with their condition effectively. Patients undergoing liver transplantation should be provided with psychosocial and emotional support.
Collapse
Affiliation(s)
- Bilsev Demir
- Division of Surgical Nursing, Nursing Department, Health Sciences Faculty, Malatya Turgut Özal University, Malatya, Turkey.
| | - Semra Bulbuloglu
- Division of Surgical Nursing, Nursing Department, Health Sciences Faculty, Istanbul Aydın University, Istanbul, Turkey.
| |
Collapse
|
7
|
Davison G, Kelly MA, Conn R, Thompson A, Dornan T. How do children and adolescents experience healthcare professionals? Scoping review and interpretive synthesis. BMJ Open 2021; 11:e054368. [PMID: 34244289 PMCID: PMC8273482 DOI: 10.1136/bmjopen-2021-054368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/22/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Explore children's and adolescents' (CADs') lived experiences of healthcare professionals (HCPs). DESIGN Scoping review methodology provided a six-step framework to, first, identify and organise existing evidence. Interpretive phenomenology provided methodological principles for, second, an interpretive synthesis of the life worlds of CADs receiving healthcare, as represented by verbatim accounts of their experiences. DATA SOURCES Five key databases (Ovid Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Web of Science), from inception through to January 2019, reference lists, and opportunistically identified publications. ELIGIBILITY CRITERIA Research articles containing direct first-person quotations by CADs (aged 0-18 years inclusive) describing how they experienced HCPs. DATA EXTRACTION AND SYNTHESIS Tabulation of study characteristics, contextual information, and verbatim extraction of all 'relevant' (as defined above) direct quotations. Analysis of basic scope of the evidence base. The research team worked reflexively and collaboratively to interpret the qualitative data and construct a synthesis of children's experiences. To consolidate and elaborate the interpretation, we held two focus groups with inpatient CADs in a children's hospital. RESULTS 669 quotations from 99 studies described CADs' experiences of HCPs. Favourable experiences were of forming trusting relationships and being involved in healthcare discussions and decisions; less favourable experiences were of not relating to or being unable to trust HCPs and/or being excluded from conversations about them. HCPs fostered trusting relationships by being personable, wise, sincere and relatable. HCPs made CADs feel involved by including them in conversations, explaining medical information, and listening to CADs' wider needs and preferences. CONCLUSION These findings strengthen the case for making CADs partners in healthcare despite their youth. We propose that a criterion for high-quality child-centred healthcare should be that HCPs communicate in ways that engender trust and involvement.
Collapse
Affiliation(s)
- Gail Davison
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- Children's Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Martina Ann Kelly
- Department of Family Medicine, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Richard Conn
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- General Paediatrics Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Andrew Thompson
- General Paediatrics Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| |
Collapse
|
8
|
Peer Mentoring as an Avenue to Explore in Kidney Transplantation: Kidney Transplant Recipients' Perspectives on Peer Mentoring. Transplant Direct 2021; 7:e672. [PMID: 34104710 PMCID: PMC8183856 DOI: 10.1097/txd.0000000000001130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Kidney transplant recipients (KTRs) face numerous challenges following transplantation. Given that healthcare professionals do not necessarily have first-hand experience living with or waiting for a transplant, it may be hard for them to communicate with and help patients when it comes to transplant-related issues. KTRs have experiential knowledge, which could enable them to help other patients going through similar situations. Peer mentoring involves pairing mentees with individuals who have had similar experiences, to provide training, information, and emotional support. The aim of this study was to gather KTRs’ perspectives on a potential peer mentoring program.
Collapse
|
9
|
Yoo HJ, Suh EE. Lived Experiences of Korean Young Adults After Heart Transplantation: A Phenomenological Approach. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 15:89-95. [PMID: 33065357 DOI: 10.1016/j.anr.2020.10.001] [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: 06/01/2020] [Revised: 09/04/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study aimed to explore and describe the lived experience of young adult heart transplant recipients in Korea. METHODS Fifteen young adult heart transplant recipients participated in this qualitative study. Data were collected from March to August 2019 through in-depth individual interviews and analyzed using Colaizzi's phenomenological method. RESULTS Their experiences about the arduous journey of heart transplant surgery and life after surgery were captured in four themes: (1) unwelcome rebirth without vitality, (2) facing unreachable ordinary tasks in life, (3) lifestyle bordering between burdensome and self-valued, and (4) finding the true meaning of a newly given life. CONCLUSION Young adult heart transplant recipients struggled with the burdens of their health problems, which impacted their employment and relationships. The participants' lifelong challenges and psychological turbulence identified in this study provide guidance for health-care providers to understand this population.
Collapse
Affiliation(s)
- Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, Republic of Korea.
| | - Eunyoung E Suh
- College of Nursing, Seoul National University, Seoul, Republic of Korea; Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea.
| |
Collapse
|
10
|
Demir B, Saritas S. Effect of hand massage on pain and anxiety in patients after liver transplantation: A randomised controlled trial. Complement Ther Clin Pract 2020; 39:101152. [DOI: 10.1016/j.ctcp.2020.101152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 01/15/2023]
|
11
|
Wright J, Elwell L, McDonagh J, Kelly D, McClean P, Ferguson J, Wray J. Healthcare transition in pediatric liver transplantation: The perspectives of pediatric and adult healthcare professionals. Pediatr Transplant 2019; 23:e13530. [PMID: 31240785 DOI: 10.1111/petr.13530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/20/2019] [Accepted: 05/25/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Transition from pediatric to adult services of young people with a liver transplant is an important priority due to increasing numbers of young people surviving into adulthood. There is increased incidence of graft loss and non-adherence following transfer to adult services. Although studies have considered the views and perceptions of young people who have undergone liver transplantation and their parents about transition, there is currently no qualitative research with healthcare professionals working in the field of liver transplantation. The aim of this study was to elicit the views of this group of stakeholders about barriers and facilitators of an effective transition process. METHODS Semi-structured interviews were carried out with 11 HCPs from pediatric and adult liver transplant programs and from a range of professional backgrounds. Interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS Four themes were identified: "non-adherence and psychosocial issues," "need for better psychological support," "the role of parents," and "the emotional impact of transition on healthcare professionals." Within these themes, professionals described factors which hindered or promoted an effective transition process. CONCLUSIONS Screening tools which address psychological and social aspects of the lives of young people should be used in routine practice to identify patients requiring psychosocial support and to identify those at risk of non-adherence. All staff involved with transition should be trained in the use of psychosocial screening strategies. The development of a formal referral pathway so that young people can access psychological support in adult services is recommended.
Collapse
Affiliation(s)
- Jessica Wright
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Laura Elwell
- Health and Wellbeing, National Grid, Warwick, UK
| | - Janet McDonagh
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Deirdre Kelly
- Liver Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Patricia McClean
- Liver Unit, Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | - James Ferguson
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
12
|
Petersen I, Noelle J, Buchholz A, Kroencke S, Daseking M, Grabhorn E. Fatigue in pediatric liver transplant recipients and its impact on their quality of life. Pediatr Transplant 2019; 23:e13331. [PMID: 30588722 DOI: 10.1111/petr.13331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 01/14/2023]
Abstract
The aim of the study was to investigate the occurrence of fatigue in 100 pediatric liver transplant recipients aged 2-18 years and its impact on their health-related quality of life (HRQL). HRQL and fatigue were measured using the PedsQL 4.0 Inventory and the PedsQL Multidimensional Fatigue Scale, which encompasses three subscales: general fatigue, sleep/rest fatigue, and cognitive fatigue. The impact of the different domains of fatigue and of clinical and sociodemographic factors on the HRQL was identified with stepwise multiple regression analyses. Parent proxy-reports were available for all 100 participants (2-18 years), and child self-reports were available for 71 patients (8-18 years). Across all domains, participants and their parents reported significantly more fatigue than healthy peers in a large PedsQL validation study. Thirty-seven percent of patients and 57% of parents scored clinically relevant levels of fatigue. In the multiple regression analyses, none of the clinical and sociodemographic factors contributed to the HRQL for child self-report. Only general and cognitive fatigue were significant predictors of patients' HRQL, explaining 66% of the variance in the PedsQL total score. For parent proxy-report, general and cognitive fatigue also significantly predicted child's HRQL. Further predictors were child's age and family income. The regression model explained 65% of the variance. These findings demonstrate the importance of assessing fatigue during regular follow-up examinations. Further research is urgently needed to better understand the underlying mechanisms of fatigue. Improvement of fatigue symptoms is essential for better HRQL, for cognitive functioning, and for school achievement.
Collapse
Affiliation(s)
- Irene Petersen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janka Noelle
- University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Buchholz
- University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sylvia Kroencke
- University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Daseking
- Department of Educational Psychology, Helmut Schmidt University, Hamburg, Germany
| | - Enke Grabhorn
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
13
|
Namisango E, Bristowe K, Allsop MJ, Murtagh FEM, Abas M, Higginson IJ, Downing J, Harding R. Symptoms and Concerns Among Children and Young People with Life-Limiting and Life-Threatening Conditions: A Systematic Review Highlighting Meaningful Health Outcomes. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 12:15-55. [DOI: 10.1007/s40271-018-0333-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
14
|
Patterson C, So S, DeAngelis M, Ghent E, Southmayd D, Carpenter C. Physical activity experiences in children post-liver transplant: Developing a foundation for rehabilitation interventions. Pediatr Transplant 2018; 22:e13179. [PMID: 29575295 DOI: 10.1111/petr.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/26/2022]
Abstract
Physical Activity (PA) plays an important role in the physical and psychosocial health of children and is beneficial in the treatment and prevention of comorbidities associated with transplantation. Despite this, PA participation in pediatric liver transplant recipients remains low compared to healthy peers. This qualitative-focused mixed-methods study explored the PA experiences and parental perception of these experiences, including perceived facilitators and barriers to PA in children post-liver transplant. Eighteen participants (9 children [median age 10.8 years] and 9 parents) took part in semi-structured interviews and completed the PedsQL Multidimensional Fatigue Scale and PAQ. Most children reported they were physically active (PAQ median 3.08 [IQR] 2.60-3.51), participating in PA for its enjoyment, regardless of their level of motor proficiency. Levels of fatigue (median 65.28 [IQR] 56.25-90.97) were higher than healthy norms and impacted PA participation in some children. Children and parents perceived PA as central to post-transplant recovery and valued its social and mental health benefits; however, parents struggled with ongoing uncertainty and perceived physical vulnerability of their child. This study indicates the need for continuing PA support and education and provides valuable information for family-centered interventions to increase PA and improve health outcomes in children post-transplant.
Collapse
Affiliation(s)
- Catherine Patterson
- Rehabilitation Medicine, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephanie So
- Rehabilitation Medicine, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Maria DeAngelis
- Department of Pediatrics, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Emily Ghent
- Department of Social Work, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Degen Southmayd
- Rehabilitation Medicine, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christine Carpenter
- Graduate Department of Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
15
|
Bogue Kerr S, Soulière M, Bell L. The Transliminal Self: The Ebb and Flow of the Kidney Transplant Experience. QUALITATIVE HEALTH RESEARCH 2018; 28:561-571. [PMID: 29216809 DOI: 10.1177/1049732317743937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
For people with kidney disease, transplantation is considered a better treatment option than dialysis. A kidney transplant does not, however, ensure an illness-free existence. Compared with the wealth of literature produced from a biomedical perspective, there is little qualitative research focused on the young adult transplant experience. This article presents the findings of a phenomenological study exploring young adults' kidney transplant experiences. Using a qualitative phenomenological approach, semidirected interviews were conducted with five people. Analysis of the transcribed interviews revealed that these individuals' kidney transplant experiences were paradoxical in nature: Participants described an existence between sickness and health, self and other, life and death. Consequently, liminality was identified as one of the experience's key elements and used together with the concept of rites of passage in its analysis. To incorporate these experiences, the term transliminal self is proposed.
Collapse
Affiliation(s)
- Stephanie Bogue Kerr
- 1 University of Ottawa, Ottawa, Ontario, Canada
- 2 Jewish General Hospital, Montréal, Québec, Canada
| | - Marguerite Soulière
- 1 University of Ottawa, Ottawa, Ontario, Canada
- 3 Institut du savoir Montford, Ottawa, Ontario, Canada
| | - Lorraine Bell
- 4 McGill University Health Centre, Montréal, Québec, Canada
- 5 McGill Centre for Medical Education, Montréal, Québec, Canada
| |
Collapse
|
16
|
Fisher A, Andreasson A, Chrysos A, Lally J, Mamasoula C, Exley C, Wilkinson J, Qian J, Watson G, Lewington O, Chadwick T, McColl E, Pearce M, Mann K, McMeekin N, Vale L, Tsui S, Yonan N, Simon A, Marczin N, Mascaro J, Dark J. An observational study of Donor Ex Vivo Lung Perfusion in UK lung transplantation: DEVELOP-UK. Health Technol Assess 2018; 20:1-276. [PMID: 27897967 DOI: 10.3310/hta20850] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Many patients awaiting lung transplantation die before a donor organ becomes available. Ex vivo lung perfusion (EVLP) allows initially unusable donor lungs to be assessed and reconditioned for clinical use. OBJECTIVE The objective of the Donor Ex Vivo Lung Perfusion in UK lung transplantation study was to evaluate the clinical effectiveness and cost-effectiveness of EVLP in increasing UK lung transplant activity. DESIGN A multicentre, unblinded, non-randomised, non-inferiority observational study to compare transplant outcomes between EVLP-assessed and standard donor lungs. SETTING Multicentre study involving all five UK officially designated NHS adult lung transplant centres. PARTICIPANTS Patients aged ≥ 18 years with advanced lung disease accepted onto the lung transplant waiting list. INTERVENTION The study intervention was EVLP assessment of donor lungs before determining suitability for transplantation. MAIN OUTCOME MEASURES The primary outcome measure was survival during the first 12 months following lung transplantation. Secondary outcome measures were patient-centred outcomes that are influenced by the effectiveness of lung transplantation and that contribute to the health-care costs. RESULTS Lungs from 53 donors unsuitable for standard transplant were assessed with EVLP, of which 18 (34%) were subsequently transplanted. A total of 184 participants received standard donor lungs. Owing to the early closure of the study, a non-inferiority analysis was not conducted. The Kaplan-Meier estimate of survival at 12 months was 0.67 [95% confidence interval (CI) 0.40 to 0.83] for the EVLP arm and 0.80 (95% CI 0.74 to 0.85) for the standard arm. The hazard ratio for overall 12-month survival in the EVLP arm relative to the standard arm was 1.96 (95% CI 0.83 to 4.67). Patients in the EVLP arm required ventilation for a longer period and stayed longer in an intensive therapy unit (ITU) than patients in the standard arm, but duration of overall hospital stay was similar in both groups. There was a higher rate of very early grade 3 primary graft dysfunction (PGD) in the EVLP arm, but rates of PGD did not differ between groups after 72 hours. The requirement for extracorporeal membrane oxygenation (ECMO) support was higher in the EVLP arm (7/18, 38.8%) than in the standard arm (6/184, 3.2%). There were no major differences in rates of chest radiograph abnormalities, infection, lung function or rejection by 12 months. The cost of EVLP transplants is approximately £35,000 higher than the cost of standard transplants, as a result of the cost of the EVLP procedure, and the increased ECMO use and ITU stay. Predictors of cost were quality of life on joining the waiting list, type of transplant and number of lungs transplanted. An exploratory model comparing a NHS lung transplant service that includes EVLP and standard lung transplants with one including only standard lung transplants resulted in an incremental cost-effectiveness ratio of £73,000. Interviews showed that patients had a good understanding of the need for, and the processes of, EVLP. If EVLP can increase the number of usable donor lungs and reduce waiting, it is likely to be acceptable to those waiting for lung transplantation. Study limitations include small numbers in the EVLP arm, limiting analysis to descriptive statistics and the EVLP protocol change during the study. CONCLUSIONS Overall, one-third of donor lungs subjected to EVLP were deemed suitable for transplant. Estimated survival over 12 months was lower than in the standard group, but the data were also consistent with no difference in survival between groups. Patients receiving these additional transplants experience a higher rate of early graft injury and need for unplanned ECMO support, at increased cost. The small number of participants in the EVLP arm because of early study termination limits the robustness of these conclusions. The reason for the increased PGD rates, high ECMO requirement and possible differences in lung injury between EVLP protocols needs evaluation. TRIAL REGISTRATION Current Controlled Trials ISRCTN44922411. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 85. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Andrew Fisher
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Anders Andreasson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Alexandros Chrysos
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Joanne Lally
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Catherine Exley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jessica Qian
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Watson
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Thomas Chadwick
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kay Mann
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola McMeekin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Tsui
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nizar Yonan
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Andre Simon
- Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Nandor Marczin
- Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Jorge Mascaro
- Queen Elizabeth Hospital NHS Foundation Trust, Birmingham, UK
| | - John Dark
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
17
|
Mehta P, Steinberg EA, Kelly SL, Buchanan C, Rawlinson AR. Medication adherence among adolescent solid-organ transplant recipients: A survey of healthcare providers. Pediatr Transplant 2017; 21. [PMID: 28670855 DOI: 10.1111/petr.13018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 01/14/2023]
Abstract
The aim of this study was to assess healthcare provider perspectives on barriers to medication adherence and to discover recommendations for interventions among providers of pediatric solid-organ transplant patients. An anonymous online survey was administered to a multidisciplinary pool of pediatric transplant providers from February 2015 to March 2016. It consisted of 15 questions regarding transplant providers' attitudes, clinical practice, and beliefs pertaining to medication adherence among teenage solid-organ transplant recipients. Data were analyzed using descriptive statistics. Responses to open-ended questions were coded and categorized into themes. One hundred ten surveys were completed by providers specializing in pediatric heart, kidney, liver, lung, and/or intestinal transplantation. Commonly cited reasons for poor adherence were forgetting/poor planning (94%), the desire to be normal (86%), lack of support (86%), and poor parental monitoring (79%). Suggestions to improve adherence included increasing peer and family support, providing education, and incorporating technology into adherence regimens. Barriers to adherence in transplant patients are recognized by providers and are both similar to and disparate from patient and family identified barriers published in the literature. Providers recognize the importance of education, social support, and technologically driven interventions on improving outcomes in the transplant population.
Collapse
Affiliation(s)
- Pooja Mehta
- Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elizabeth A Steinberg
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah L Kelly
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cindy Buchanan
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | | |
Collapse
|
18
|
Sav A, Salehi A, Mair FS, McMillan SS. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature. BMC Med Res Methodol 2017; 17:140. [PMID: 28899342 PMCID: PMC5596495 DOI: 10.1186/s12874-017-0411-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/31/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although there has been growing research on the burden of treatment, the current state of evidence on measuring this concept is unknown. This scoping review aimed to provide an overview of the current state of knowledge as well as clear recommendations for future research, within the context of chronic disease. METHODS Four health-based databases, Scopus, CINAHL, Medline, and PsychInfo, were comprehensively searched for peer-reviewed articles published between the periods of 2000-2016. Titles and abstracts were independently read by two authors. All discrepancies between the authors were resolved by a third author. Data was extracted using a standardized proforma and a comparison analysis was used in order to explore the key treatment burden measures and categorize them into three groups. RESULTS Database searching identified 1458 potential papers. After removal of duplications, and irrelevant articles by title, 1102 abstracts remained. An additional 22 papers were added via snowball searching. In the end, 101 full papers were included in the review. A large number of the studies involved quantitative measures and conceptualizations of treatment burden (n = 64; 63.4%), and were conducted in North America (n = 49; 48.5%). There was significant variation in how the treatment burden experienced by those with chronic disease was operationalized and measured. CONCLUSION Despite significant work, there is still much ground to cover to comprehensively measure treatment burden for chronic disease. Greater qualitative focus, more research with cultural and minority populations, a larger emphasis on longitudinal studies and the consideration of the potential effects of "identity" on treatment burden, should be considered.
Collapse
Affiliation(s)
- Adem Sav
- School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia. .,, PO Box 456, Virginia, 4014, Australia.
| | - Asiyeh Salehi
- Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, Australia
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Sara S McMillan
- Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, Australia
| |
Collapse
|
19
|
Sarigol Ordin Y, Karayurt Ö, Ünek T, Astarcıoğlu İ. Pediatric liver transplant patients’ transition to adulthood: Patient and parent experiences. Nurs Health Sci 2017; 19:393-399. [DOI: 10.1111/nhs.12358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Yaprak Sarigol Ordin
- Surgical Nursing Department, Faculty of Nursing; Dokuz Eylül University; Izmir Turkey
| | - Özgül Karayurt
- Faculty of Health Science; Izmir University of Economics; Izmir Turkey
| | - Tarkan Ünek
- Department of General Surgery, School of Medicine; Dokuz Eylül University; Izmir Turkey
| | - İbrahim Astarcıoğlu
- Department of General Surgery, School of Medicine; Dokuz Eylül University; Izmir Turkey
| |
Collapse
|
20
|
Coad J, Toft A, Claridge L, Ferguson J, Hind J, Jones R, McClean P, McKiernan P, Samyn M, Taylor R. Using Mobile Phone Technology to Support Young Liver Transplant Recipients Moving to Adult Services. Prog Transplant 2017; 27:207-218. [PMID: 28617171 DOI: 10.1177/1526924817699958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The process and preparation of moving from child to adult services (transition) is a challenging period of time for young people and represents significant changes in care and support systems. The proliferation of mobile phone applications for health purposes suggests that it is an area for further investigation. OBJECTIVE The review explores the potential to use mobile phone technology to help support young liver transplant recipients moving to adult services. It represents the first review conducted in this specialism and considers a new model of support for young liver patients. METHODS A systematic rapid review of the published peer-reviewed literature. RESULTS Two searches were conducted: Search 1: the use of technology to support transition to adult services (6 studies) and Search 2: how best to support liver transplant recipients during transition (6 studies). DISCUSSION Research shows that to achieve positive transition young people need information about their condition and transition. The process needs to be guided by transition readiness, rather than the young persons' age. Although parents and support networks should be in place and are valued, transition should build upon self-management and independence. Results suggest that there appears to be scope to use mobile phone technology to support transition. This is the first time a review has explored the types of issues or concerns facing liver transplant patients and how these can be addressed through mobile phone technology.
Collapse
Affiliation(s)
- Jane Coad
- 1 Children and Families Research (CFR), Centre for Technology Enabled Health Research (CTEHR), Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Alex Toft
- 1 Children and Families Research (CFR), Centre for Technology Enabled Health Research (CTEHR), Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Anderson SM, Wray J, Ralph A, Spencer H, Lunnon-Wood T, Gannon K. Experiences of adolescent lung transplant recipients: A qualitative study. Pediatr Transplant 2017; 21. [PMID: 28145615 DOI: 10.1111/petr.12878] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 11/30/2022]
Abstract
Many young transplant recipients experience psychological distress and adjustment difficulties, yet there is little research investigating lung transplantation from the recipients' perspective. This qualitative study aimed to explore experiences of young people who underwent lung transplantation. Semi-structured interviews were conducted with six lung transplant recipients (aged 15-18). Interviews were analysed using IPA, a qualitative research approach examining how people make sense of their major life experiences. The analysis revealed three master themes: "Living with Dodgy Lungs" outlined how participants dealt with their experiences, managing through accepting or discussing their feelings with others, although talking was often difficult. "The Big Deal" reflected participants' experiences of the process, their expectations, and the contrast of their lives pre- and post-transplant. Inherent in their accounts was the profound meaning ascribed to transplantation, the emotional turmoil, and impact on their lives. "A Sense of Self" illustrated participants' developing identities within their social contexts and at times isolating experiences. The results highlight key areas where adolescent lung transplant recipients could be supported by clinicians, enabling the promotion of psychological well-being. Examples include supporting identity integration post-transplant, facilitating social inclusion, considering alternative means of support, and involving adolescents in healthcare decisions.
Collapse
Affiliation(s)
- S M Anderson
- School of Psychology, University of East London, Stratford, London, UK
| | - J Wray
- Cardiothoracic Transplant Team, Great Ormond Street Hospital, London, UK
| | - A Ralph
- Cardiothoracic Transplant Team, Great Ormond Street Hospital, London, UK
| | - H Spencer
- Cardiothoracic Transplant Team, Great Ormond Street Hospital, London, UK
| | - T Lunnon-Wood
- Cardiothoracic Transplant Team, Great Ormond Street Hospital, London, UK
| | - K Gannon
- School of Psychology, University of East London, Stratford, London, UK
| |
Collapse
|
22
|
Parmar A, Vandriel SM, Ng VL. Health-related quality of life after pediatric liver transplantation: A systematic review. Liver Transpl 2017; 23:361-374. [PMID: 28006876 DOI: 10.1002/lt.24696] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/26/2016] [Indexed: 12/15/2022]
Abstract
With improved survival rates after pediatric liver transplantation (LT), attention is targeting improving the health-related quality of life (HRQOL) as an outcome metric. We conducted a systematic review of the literature to examine HRQOL after pediatric LT, focusing on assessment tools and factors associated with HRQOL. A literature search was conducted through PubMed, Web of Science, Ovid, and Google Scholar for all studies matching the eligibility criteria between January 2004 and September 2016. Titles and abstracts were screened independently by 2 authors and consensus for included studies was achieved through discussion. A total of 25 (2 longitudinal, 23 cross-sectional) studies were reviewed. HRQOL in pediatric LT recipients is lower than healthy controls, but it is comparable to children with chronic diseases or other pediatric solid organ transplant recipients. Domain scores were lowest in school functioning on the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale 4.0 and general health perception on the Child Health Questionnaire, the 2 most commonly used generic HRQOL instruments. Identified predictors of poor HRQOL include sleep disturbances, medication adherence, and older age at transplantation. Two recently validated disease-specific HRQOL tools, Pediatric Liver Transplant Quality of Life tool and the Pediatric Quality of Life Inventory 3.0 Transplant Module, have enabled enhanced representation of patient HRQOL, when used in conjugation with generic tools. Heterogeneity in study design and instruments prevented a quantitative, meta-analysis of the data. In conclusion, continued optimization of durable outcomes for this population mandates prioritization of research focusing on the gap of targeted intervention studies aimed at specific HRQOL subdomains and longitudinal studies to predict the trajectory of HRQOL over time. Liver Transplantation 23 361-374 2017 AASLD.
Collapse
Affiliation(s)
- Arpita Parmar
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Shannon Marie Vandriel
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Vicky Lee Ng
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| |
Collapse
|
23
|
Health-Related Quality of Life after Pediatric Liver Transplantation: A Qualitative Analysis of the Perspectives of Health Care Providers. Can J Gastroenterol Hepatol 2017; 2017:5274923. [PMID: 28713797 PMCID: PMC5496102 DOI: 10.1155/2017/5274923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/28/2017] [Indexed: 11/19/2022] Open
Abstract
With improved survival outcomes after pediatric liver transplantation (LT), health-related quality of life (HRQoL) is an important outcome metric. Understanding the elements contributing to HRQoL after LT in children would enable more targeted strategies towards optimizing best outcomes. This qualitative study aimed to explore health care providers (HCP) perceptions about HRQoL after pediatric LT. Thirteen experienced HCP participated in two focus group discussions. Data analysis via a thematic analysis approach revealed 4 major themes: "LT as a facilitator of better HRQoL," "coping and adapting to LT," "living with a transplanted liver," and "the family context." HCP identified elements that both enhance (improved physical health, peer relationship, and activities of daily living) and challenge (need for immunosuppression, transplant follow-up, and restrictions) the multidimensional domains of HRQoL. HCP perceived LT to be a stressful life-changing event for children and their families. Patients and their parents' ability to cope and adjust positively to LT was perceived as a key contributor to better HRQoL. HCP perspective highlights the importance of promoting psychosocial support and a family-centered care delivery model towards the overarching goal of optimizing durable outcomes.
Collapse
|
24
|
Hames A, Matcham F, Joshi D, Heneghan MA, Dhawan A, Heaton N, Samyn M. Liver transplantation and adolescence: The role of mental health. Liver Transpl 2016; 22:1544-1553. [PMID: 27597423 DOI: 10.1002/lt.24629] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 02/07/2023]
Abstract
Young people (YP) with chronic illness have higher rates of mental health problems than the general population, with psychosocial complexity associated with nonadherence and poorer health outcomes. This study aimed to describe the prevalence of anxiety and depression in YP after liver transplantation, with autoimmune liver disease and other chronic liver diseases, identify the factors YP attribute their distress to and the relationship between anxiety/depression, and describe YP's beliefs about their illness and treatment. An electronically administered questionnaire battery was given routinely to YP attending an outpatient liver transition clinic; 187 YP participated, of which 17.7% screened positive for anxiety or depression. There were no significant differences between disease groups. This is significantly higher than the prevalence of common mental health problems in the general adolescent population. Patients most frequently attributed their distress to fatigue, sleep difficulties, financial concerns, problems at work/school, worry, and low self-esteem. Higher levels of depression and anxiety were significantly associated with specific illness and treatment beliefs but not with perceived understanding of illness or treatment control. In conclusion, the increased prevalence of mental health problems in YP and the intertwined nature of these with their physical health outcomes provide evidence that holistic care should be delivered as standard for this age group. Liver Transplantation 22 1544-1553 2016 AASLD.
Collapse
Affiliation(s)
- Anna Hames
- Institute of Liver Studies, National Health Service Foundation Trust, London, United Kingdom.
| | - Faith Matcham
- Department of Psychological Medicine, National Health Service Foundation Trust, London, United Kingdom
| | - Deepak Joshi
- Institute of Liver Studies, National Health Service Foundation Trust, London, United Kingdom
| | - Michael A Heneghan
- Institute of Liver Studies, National Health Service Foundation Trust, London, United Kingdom
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, United Kingdom
| | - Nigel Heaton
- Institute of Liver Studies, National Health Service Foundation Trust, London, United Kingdom
| | - Marianne Samyn
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, United Kingdom
| |
Collapse
|
25
|
Hanghøj S, Boisen KA, Schmiegelow K, Hølge-Hazelton B. A Photo Elicitation Study on Chronically Ill Adolescents' Identity Constructions During Transition. Glob Qual Nurs Res 2016; 3:2333393616631678. [PMID: 28462329 PMCID: PMC5342639 DOI: 10.1177/2333393616631678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 01/18/2023] Open
Abstract
Adolescence is an important phase of life with increasing independence and identity development, and a vulnerable period of life for chronically ill adolescents with a high occurrence of insufficient treatment adherence. We conducted four photo elicitation focus group interviews with 14 adolescents (12-20 years) with juvenile idiopathic arthritis to investigate identity constructions during transition. Using a discourse analysis approach, six identity types were identified distributed on normal and marginal identities, which were lived either at home (home arena) or outside home with peers (out arena). Most participants positioned themselves as normal in the out arena and as ill in the home arena. Few participants positioned themselves as ill in an out arena, and they described how peers perceived this as a marginal and skewed behavior. This study contributes to a better understanding of why it can be extremely difficult to live with a chronic illness during adolescence.
Collapse
Affiliation(s)
- Signe Hanghøj
- Rigshospitalet and University of Copenhagen, Denmark
| | | | | | | |
Collapse
|
26
|
Patterson C, So S, Schneiderman JE, Stephens D, Stephens S. Physical activity and its correlates in children and adolescents post-liver transplant. Pediatr Transplant 2016; 20:227-34. [PMID: 26893138 DOI: 10.1111/petr.12662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 11/28/2022]
Abstract
The health benefits of PA are well established for healthy and chronically ill children. This study objectively measures physical fitness and PA levels in children PLT and explores potential correlates and perceived barriers impacting their PA. A total of 23 children (16 females, mean 14.01 ± 2.49 yrs) >1 yr PLT were assessed for peak oxygen consumption (VO2 peak), muscle strength, endurance, and flexibility. MVPA and steps/day were determined with accelerometry. Additionally, SE, perceived fatigue, and barriers and benefits of PA were examined. VO2 peak (mean 33. 2 ± 7.61 mL/kg/min; 77.0 ± 15.6% predicted) and PA (average 6841 ± 2299 steps/day) were below healthy norms. MVPA (31.6 ± 16.1 min/day) was lower than national guidelines. Six participants (30%) attained criterion standards for abdominal strength and one participant (5%) for push-ups. Fatigue and SE were lower than reported levels in healthy children. A commonly perceived barrier to PA was "I am tired." A positive correlation was shown between SE and MVPA (r = 0.57, p = 0.007), SE and fatigue (r = 0.54, p = 0.01), and PELD score and fatigue (r = 0.66, p = 0.007). Children PLT demonstrate below normal levels of PA and aerobic capacity. SE is a modifiable correlate of their PA. Further investigation of the impact of PA correlates can guide the development of future innovative PA intervention strategies in children PLT.
Collapse
Affiliation(s)
- Catherine Patterson
- Rehabilitation Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephanie So
- Rehabilitation Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jane E Schneiderman
- Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Derek Stephens
- Clinical Research Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Samantha Stephens
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
27
|
Benson A, Lambert V, Gallagher P, Shahwan A, Austin JK. "I don't want them to look at me and think of my illness, I just want them to look at me and see me": Child perspectives on the challenges associated with disclosing an epilepsy diagnosis to others. Epilepsy Behav 2015; 53:83-91. [PMID: 26520881 DOI: 10.1016/j.yebeh.2015.09.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/15/2015] [Accepted: 09/20/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Disclosure of a concealable stigmatized identity, such as epilepsy, to those external to the nuclear family can be complex. Among children living with epilepsy (CWE), diagnosis disclosure has been identified as a quality-of-life issue and a source of psychosocial distress. Despite this, limited empirical evidence exists regarding the disclosure experiences of CWE. This study aimed to identify the contextual factors that act as challenges for CWE when disclosing their epilepsy diagnosis to others external to the nuclear family. METHOD This qualitative exploratory study consisted of individual interviews with 29 CWE (aged 6-16 years; mean age=11.17 years; S.D.=2.85). Participants were recruited from a tertiary referral unit in the neurology department of a pediatric hospital and through a national epilepsy association. Interviews were audiotaped and transcribed verbatim. Data were thematically analyzed. FINDINGS The five main challenges to epilepsy diagnosis disclosure for children were: 1) CWE's desire for normalcy, 2) out of sight but in the mind, 3) contending with negative responses to disclosure, 4) the complexity of epilepsy, and 5) self and others' perceptions of epilepsy. DISCUSSION These findings provide valuable insight into the factors that present difficulties and impede epilepsy diagnosis disclosure among CWE. Such knowledge is important in informing engagements between health-care professionals (HCPs) and CWE. In particular, HCPs should remain cognisant of the challenges CWE face as they: (i) strive for normalcy and (ii) grapple with comprehending their complex neurological condition. Tackling such disclosure challenges could serve to enhance life quality, improve CWE's openness with others about epilepsy, and consequently work toward reducing epilepsy-related misconceptions and stigma.
Collapse
Affiliation(s)
- Ailbhe Benson
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
| | - Veronica Lambert
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland.
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Faculty of Science and Health, Dublin City University, Dublin 9, Ireland
| | - Amre Shahwan
- Neurology Department, Temple Street Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - Joan K Austin
- Indiana University School of Nursing, Indiana University Purdue University Indianapolis, 3040 N Ramble Road West, Bloomington, IN 47408, USA
| |
Collapse
|
28
|
Fujita A. Daily lives of pre-adolescents/adolescents and their parents after liver transplant. Jpn J Nurs Sci 2015; 13:10-9. [PMID: 25865414 DOI: 10.1111/jjns.12078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/25/2015] [Indexed: 11/27/2022]
Abstract
AIM This mixed methods study describes the post-transplantation daily life of pre-adolescents and adolescents who had undergone living donor liver transplantation and their parents. METHODS Nine parent-child dyads were enrolled and all children were living donor liver transplant recipients. Three participants were pre-adolescents and the six were adolescents. Five of the parents surveyed in this study had been the donors. Members of the parent-child dyads completed the questionnaires and participated in semistructured interviews. An inductive qualitative analysis of the interview data was conducted. RESULTS The post-transplantation daily life of the parent-child dyads had four distinct patterns: (i) pre-adolescents who had undergone transplantation during infancy, who had no understanding of the transplant procedure, and whose care was managed by their parent(s) without any problems; (ii) adolescents who were aware that their physical condition had improved after the transplant and who managed and dealt with the situation on their own; (iii) adolescents who were dissatisfied with the transplantation and associated immunosuppression because transplant procedures were perceived as negative or because they could not remember the transplant procedure; and (iv) one participant could not be categorized because their liver function deteriorated post-transplantation and they were registered for re-transplantation. Patterns were identified that characterized the post-transplantation daily life of pre-adolescents/adolescents who underwent liver transplantation, and that of their parents. Further research for post-transplantation parent-child dyads is warranted.
Collapse
Affiliation(s)
- Ayaka Fujita
- Division of Nursing Science Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
29
|
Wright J, Elwell L, McDonagh JE, Kelly DA, Wray J. 'It's hard but you've just gotta get on with it'--The experiences of growing-up with a liver transplant. Psychol Health 2015; 30:1129-45. [PMID: 25727924 DOI: 10.1080/08870446.2015.1024245] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The successful evolution of paediatric liver transplantation means that increasing numbers of young people survive into adulthood. Non-adherence to medication regimens leading to liver dysfunction, graft loss and patient death are prevalent in this vulnerable group. Insight into young people's experiences of living with a liver transplant (LTx) is vital to improve outcomes and guide future work in this area. Through semi-structured interviews, this study explored the experiences of living with a LTx for 13 young people transplanted as children and adolescents. Interviews were analysed using interpretative phenomenological analysis, revealing that young people felt different from their peers as a result of their LTx. Young people's perceptions of their scar, experiences of illness symptoms and taking medications acted as triggers of differences. This led to an ongoing struggle to be normal when faced with typical activities for young people and to attempts to take back control. Findings support the implementation of routine psychosocial screening to identify additional support needs and the development of a peer mentoring programme to allow young people to gain social support, thus reducing feelings of being different. It is hoped that such initiatives will have positive consequences for quality of life, self-management and adherence to medications.
Collapse
Affiliation(s)
- Jessica Wright
- a Liver Unit , Birmingham Children's Hospital NHS Foundation Trust , Birmingham , UK
| | | | | | | | | |
Collapse
|
30
|
Anthony SJ, Nicholas DB, Regehr C, West LJ. A struggle to survive: the experience of awaiting pediatric heart transplantation. Pediatr Transplant 2014; 18:868-74. [PMID: 25284076 DOI: 10.1111/petr.12368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2014] [Indexed: 11/27/2022]
Abstract
Despite the establishment of heart transplantation as a life-saving therapy for children and adolescents, little research has focused on the biopsychosocial impact of the transplant process. Few studies have captured the subjective experiences of young heart transplant recipients. This study examined the experiences and perspectives of children and adolescents during the pretransplant phase of waiting for a donor organ. Grounded theory methods guided data collection and analysis. A total of 27 adolescents participated in semistructured qualitative interviews. Findings illuminate the waiting period for pediatric heart transplantation to be a pervasive experience, with consequent impact on physical, psychological, and social well-being. Participants described various biopsychosocial processes and experiences that occurred during this time, with data analysis yielding themes reflecting notions of "struggling to survive," including physical limitations, lethargy, social isolation, discomfort with physical appearance, and academic issues. This research identifies the pretransplant experience as a period framed within a text of debilitation and negative self-perceptions related to health and well-being. Supporting children and their families as they navigate this complex and uncertain journey is merited, and results invite further interventional development and research.
Collapse
Affiliation(s)
- Samantha J Anthony
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
31
|
Fredericks EM, Zelikovsky N, Aujoulat I, Hames A, Wray J. Post-transplant adjustment--the later years. Pediatr Transplant 2014; 18:675-88. [PMID: 25220845 PMCID: PMC4179879 DOI: 10.1111/petr.12366] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 01/04/2023]
Abstract
As survival rates for pediatric solid organ transplantation have continued to improve, researchers and healthcare providers have increasingly focused on understanding and enhancing the HRQOL and psychosocial functioning of their patients. This manuscript reviews the psychosocial functioning of pediatric transplant recipients during the "later years," defined as more than three yr post-transplant, and focuses on the day-to-day impact of living with a transplant after the immediate period of adjustment and early years after surgery. Key topics reviewed include HRQOL, cognitive functioning, impact on the family, regimen adherence, and transition of responsibility for self-management tasks. Overall, pediatric transplant recipients evidence impairment in HRQOL, neuropsychological outcomes, and family functioning as compared to non-transplant recipients. However, the degree of impairment is influenced by a variety of factors including, disease severity, age, solid organ type, and study methodologies. Studies are limited by small samples, cross-sectional design, and the lack of universal assessment battery to allow for comparisons across solid organ populations. Areas for future research are discussed.
Collapse
Affiliation(s)
- Emily M. Fredericks
- Department of Pediatrics, University of Michigan and C.S. Mott Children’s Hospital
| | - Nataliya Zelikovsky
- Department of Psychology, La Salle University and The Children’s Hospital of Philadelphia
| | - Isabelle Aujoulat
- Université Catholique de Louvain, Institute of Health & Society (IRSS), Brussels, Belgium
| | - Anna Hames
- Institute of Liver Studies, King’s College Hospital, London UK
| | - Jo Wray
- Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital for Children, London UK
| |
Collapse
|
32
|
Adams J, Evangeli M, Lunnon-Wood T, Burch M. Restriction and dependence to autonomy and freedom: transformation in adolescent heart transplant recipients. Pediatr Transplant 2014; 18:637-50. [PMID: 24923539 DOI: 10.1111/petr.12287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 11/30/2022]
Abstract
The process of heart transplantation poses numerous challenges and adaptive tasks for paediatric patients and their families. Few studies have examined how the experience of transplant interacts with developmental transitions such as adolescence, a period of significant change, and adjustment in itself. We explored adolescent heart transplant recipients' and their parents' experience of transplant from the point at which their heart condition was diagnosed to several months after transplantation. We adopted a developmental focus, to consider how participants negotiated the tasks of adolescence in the context of their transplant experiences. A qualitative approach was used to interview five adolescent-parent dyads, who reported few post-transplant complications, and the data were analysed according to the principles of IPA. Our findings revealed transplant to be a transformative experience, with two themes marking a contrast between pre- and post-transplant states: "Restriction and Dependence" and "Autonomy and Freedom." The themes are considered in relation to adolescent development. We propose that clinicians working with paediatric heart transplant recipients and their families need to consider the particular developmental challenges faced by adolescent patients and view the attainment of developmental milestones alongside physical and psychological markers of successful adjustment.
Collapse
Affiliation(s)
- Joanna Adams
- Department of Psychology, University of Bath, Bath, UK
| | | | | | | |
Collapse
|
33
|
Hanghøj S, Boisen KA. Self-reported barriers to medication adherence among chronically ill adolescents: a systematic review. J Adolesc Health 2014; 54:121-38. [PMID: 24182940 DOI: 10.1016/j.jadohealth.2013.08.009] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/15/2013] [Accepted: 08/15/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate self-reported barriers to medication adherence among chronically ill adolescents, and to investigate whether barriers are unique to specific chronic diseases or more generic across conditions. METHODS A systematic search of Web of Science, PubMed, Embase, PsycINFO, and CINAHL from January 2000 to May 2012 was conducted. Articles were included if they examined barriers to medication intake among chronically ill adolescents aged 13-19 years. Articles were excluded if adolescent's views on barriers to adherence were not separated from younger children's or caregiver's views. Data was analyzed using a thematic synthesis approach. RESULTS Of 3,655 records 28 articles with both quantitative, qualitative, and q-methodology study designs were included in the review. The synthesis led to the following key themes: Relations, adolescent development, health and illness, forgetfulness, organization, medicine complexity, and financial costs. Most reported barriers to adherence were not unique to specific diseases. CONCLUSION Some barriers seem to be specific to adolescence; for example, relations to parents and peers and adolescent development. Knowledge and assessment of barriers to medication adherence is important for both policy-makers and clinicians in planning interventions and communicating with adolescents about their treatment.
Collapse
Affiliation(s)
- Signe Hanghøj
- Center of Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten A Boisen
- Center of Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
34
|
Samples and Sampling. Nurs Res 2014. [DOI: 10.1007/978-1-137-28127-2_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
35
|
|
36
|
Haavisto A, Korkman M, Sintonen H, Holmberg C, Jalanko H, Lipsanen J, Qvist E. Risk factors for impaired quality of life and psychosocial adjustment after pediatric heart, kidney, and liver transplantation. Pediatr Transplant 2013; 17:256-65. [PMID: 23442166 DOI: 10.1111/petr.12054] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2012] [Indexed: 12/12/2022]
Abstract
Few studies compare HRQOL and PSA in children who have undergone different types of solid organ Tx. In this cross-sectional study, HRQOL and PSA were assessed in 74 Tx patients (16 heart, 44 kidney, 14 liver) at a mean age of 11.5 (range 6.3-16.7), 7.2 yr post-Tx (range 1.0-15.0). HRQOL was self-assessed using standardized health utility questionnaires (15D-17D). The patients' PSA was evaluated using the Child Behavior Checklist for parents, Youth Self-Report for patients aged 11-16 yr, and Teacher Report Form. Outcomes did not differ significantly between Tx groups. Preadolescents (8-11 yr) reported poorer HRQOL compared with same-age peers (p = 0.020). In contrast, adolescents reported similar HRQOL and PSA compared to the general population. Proxy-reports revealed more PSA problems compared with age expectations (p < 0.01), mainly in internalizing behavior (p < 0.01). Lower HRQOL was associated with shorter follow-up time since Tx, congenital disease, and a psychiatric or neurological diagnosis. PSA problems were associated with family-related variables, neurological diagnosis, shorter follow-up time, and in teacher-reports longer disease duration before Tx. Different pediatric Tx groups have similar outcome. Neurological comorbidity and shorter follow-up time are important risk factors, but the impact of family-related variables on PSA indicate the need of family interventions.
Collapse
Affiliation(s)
- Anu Haavisto
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
| | | | | | | | | | | | | |
Collapse
|
37
|
Freedman R, Sahhar M, Curnow L, Lee J, Peters H. Receiving enzyme replacement therapy for a lysosomal storage disorder: a preliminary exploration of the experiences of young patients and their families. J Genet Couns 2013; 22:517-32. [PMID: 23536258 DOI: 10.1007/s10897-013-9579-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Abstract
Medical intervention for lysosomal storage disorders becomes part of life, shaping the reality of the condition for affected individuals and families. Enzyme replacement therapy (ERT) is available to treat some lysosomal storage disorders. ERT is costly and time consuming, requiring frequent hospital visits to receive intravenous infusions. This qualitative study sought to explore the impact of receiving ERT for a lysosomal storage disorder on the health related quality of life (HRQoL) of young patients and their families. Fifteen semi-structured interviews were conducted with young people and parents and siblings of young people accessing ERT for Pompe disease, Gaucher disease or mucopolysaccharidosis types I or II living in Victoria, Australia. Interviews were transcribed then analyzed thematically. The biopsychosocial model assisted in interpreting themes. Findings revealed positive attitudes towards ERT, with noticed improvements in physical and psychosocial well-being. Participants prioritised intervention over other activities and provided suggestions for improving current service delivery. Communication with family members and professionals was deemed important, especially in respect to information provision. Participants described challenges associated with living with a lysosomal storage disorder and receiving ERT and coping strategies, such as positive thinking and ways to manage uncertainty. These findings provide valuable insights into the impact of living with a chronic genetic condition and receiving intensive treatment on HRQoL.
Collapse
Affiliation(s)
- R Freedman
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
| | | | | | | | | |
Collapse
|
38
|
|
39
|
Developing a conceptual model of teenage and young adult experiences of cancer through meta-synthesis. Int J Nurs Stud 2012; 50:832-46. [PMID: 23044049 DOI: 10.1016/j.ijnurstu.2012.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 09/09/2012] [Accepted: 09/10/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To systematically identify and analyse published research exploring teenage and young adult experience of cancer to inform the development of a patient-reported outcome survey intended to explore if a correlation exists between specialist cancer care and quality of life for young people with cancer. DESIGN Systematic review and meta-synthesis. DATA SOURCES Medline, CINAHL Plus and PsycInfo were searched for literature published between 1987 and 2011. REVIEW METHODS Search terms included those for: population (e.g. teen, young adult); intervention (e.g. cancer); outcome (e.g. experience); and study type (e.g. qualitative). INCLUSION CRITERIA adolescents and young adults were both represented; diagnosis of cancer; published in English; and used qualitative methods to report an aspect of the cancer experience. Studies were excluded if they were reporting: palliative care experience; secondary data; or proxy views, i.e. parent or health professional perspective. Methodological quality was assessed using Cesario criteria and meta-synthesis involved deconstruction and decontextualising findings to identify common themes. RESULTS Three hundred and fifteen studies were identified, 17 fulfilled the inclusion criteria. Of these, most (59%), were assessed as being high quality, none were rated poor. Nine common themes were identified: psychosocial function, importance of peers, experience of healthcare, importance of support, impact of symptoms, striving for normality, impact of diagnosis, positive experiences, and financial consequences. CONCLUSIONS The conceptual model developed from the meta-synthesis depicts the mediators and consequences of cancer care that impact on young people's quality of life after a cancer diagnosis. The model highlights areas that require further exploration.
Collapse
|
40
|
Scholes C, Mandleco B, Roper S, Dearing K, Dyches T, Freeborn D. A qualitative study of young people's perspectives of living with type 1 diabetes: do perceptions vary by levels of metabolic control? J Adv Nurs 2012; 69:1235-47. [DOI: 10.1111/j.1365-2648.2012.06111.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2012] [Indexed: 11/29/2022]
|
41
|
Lerret SM, Stendahl G. Working together as a team: adolescent transplant recipients and nurse practitioners. Prog Transplant 2012. [PMID: 22548989 DOI: 10.7182/prtr.21.4.v1qu71831k931w47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Nurse practitioners are a critical part of the transplant team, enhancing the quality of patient care with their knowledge and skill with respect to disease-specific populations of patients. Adolescent transplant recipients are a vulnerable population and require specific considerations. Nurse practitioners can successfully tailor care to the adolescent developmental stages in order to promote quality of life, adherence to the medical regimen, and successful transition to adult transplant centers and to minimize risk-taking behaviors. Teamwork between the patient's family and the entire transplant team is important to optimize not only the patient's health but also to ensure quality of life after transplant. Adolescents can be especially challenging after transplant, given their complex and evolving psychosocial and cognitive development. Nurse practitioners are in a unique position to be central in adolescents' successful adaptation to their medical condition. Facilitating identification and management of medication-related side effects, awareness of emotional health and quality of life, adherence to the medical regimen, and eventual transition to adult caregivers all remain critically important steps in care that are ideally suited for advance practice leadership.
Collapse
Affiliation(s)
- Stacee M Lerret
- Medical College of Wisconsin Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
| | | |
Collapse
|
42
|
Lerret SM, Stendahl G. Working Together as a Team: Adolescent Transplant Recipients and Nurse Practitioners. Prog Transplant 2011; 21:288-93, 298. [DOI: 10.1177/152692481102100406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Nurse practitioners are a critical part of the transplant team, enhancing the quality of patient care with their knowledge and skill with respect to disease-specific populations of patients. Adolescent transplant recipients are a vulnerable population and require specific considerations. Nurse practitioners can successfully tailor care to the adolescent developmental stages in order to promote quality of life, adherence to the medical regimen, and successful transition to adult transplant centers and to minimize risk-taking behaviors. Teamwork between the patient's family and the entire transplant team is important to optimize not only the patient's health but also to ensure quality of life after transplant. Adolescents can be especially challenging after transplant, given their complex and evolving psychosocial and cognitive development. Nurse practitioners are in a unique position to be central in adolescents' successful adaptation to their medical condition. Facilitating identification and management of medication-related side effects, awareness of emotional health and quality of life, adherence to the medical regimen, and eventual transition to adult caregivers all remain critically important steps in care that are ideally suited for advance practice leadership.
Collapse
Affiliation(s)
- Stacee M. Lerret
- Medical College of Wisconsin (SML), Children's Hospital of Wisconsin (SML, GS), Milwaukee
| | - Gail Stendahl
- Medical College of Wisconsin (SML), Children's Hospital of Wisconsin (SML, GS), Milwaukee
| |
Collapse
|
43
|
Jones BL, Parker-Raley J, Barczyk A. Adolescent cancer survivors: identity paradox and the need to belong. QUALITATIVE HEALTH RESEARCH 2011; 21:1033-1040. [PMID: 21447805 DOI: 10.1177/1049732311404029] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Adolescent cancer survivors face psychological effects that can include isolation, poor peer relations, anxiety, depression, and fear of recurrence, which can increase their risk for psychological late effects and poor health posttreatment. The purpose of this exploratory analysis was to understand the experiences of adolescent cancer survivors, with a particular focus on identity, health promotion, and meaning making. In-depth interviews were conducted with 12 adolescent cancer survivors. Constant comparative analysis was used to identify core themes from the data. Findings revealed that adolescent survivors might experience an identity paradox when making the transition to "survivor," which can contribute to their sense of isolation and risk of health-detracting behaviors. Health promotion, prevention, and supportive programs need to be developed for health care professionals to address the isolation and identity transition needs of adolescent cancer survivors.
Collapse
|
44
|
Harder M, Christensson K, Coyne I, Söderbäck M. Five-year-old children's tuning-in and negotiation strategies in an immunization situation. QUALITATIVE HEALTH RESEARCH 2011; 21:818-829. [PMID: 21343432 DOI: 10.1177/1049732311400629] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this article, we have explored 5-year-old children's expressions when they as actors took part in an immunization situation in the Primary Child Health Care (PCHC) service in Sweden. Although children's health and development are the main concern in the PCHC service, their perspectives in such a setting have not been explored fully. To capture children's perspectives we used a hermeneutic design and video observations. The findings revealed children as competent and active participants, contributing to the construction of the PCHC situation in mutuality with the nurse and the parent. The conceptualization of children's expressions and actions revealed how they influenced and dealt with a PCHC situation by using strategies of tuning-in, affirmative negotiation, and delaying negotiation. Understanding children's actions will assist nurses to act with sensitivity when they encounter and support children.
Collapse
|
45
|
Taylor RM, Grieve A, Gibson F, Dhawan A, Franck LS. Parental assessment of adolescent quality of life: can it replace self-assessment? Qual Life Res 2011; 20:1715-20. [DOI: 10.1007/s11136-011-9904-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2011] [Indexed: 01/29/2023]
|
46
|
Nicholas DB, Otley AR, Taylor R, Dhawan A, Gilmour S, Ng VL. Experiences and barriers to Health-Related Quality of Life following liver transplantation: a qualitative analysis of the perspectives of pediatric patients and their parents. Health Qual Life Outcomes 2010; 8:150. [PMID: 21176211 PMCID: PMC3024277 DOI: 10.1186/1477-7525-8-150] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 12/22/2010] [Indexed: 12/01/2022] Open
Abstract
This paper examines health-related quality of life (HRQOL) experiences and barriers facing young people who have received a liver transplant (LT). Semi-structured qualitative interviews were conducted with children and adolescents who have undergone LT and their parents. Findings indicate that LT fosters substantially improved child and adolescent HRQOL; however, young people also experience challenges such as difficulties with medication compliance, self-management of care routines, physical activity restrictions, and undesirable medical procedures. Implications and recommendations for clinical practice and research are discussed.
Collapse
Affiliation(s)
- David B Nicholas
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
47
|
Taylor RM, Wray J, Gibson F. Measuring quality of life in children and young people after transplantation: methodological considerations. Pediatr Transplant 2010; 14:445-58. [PMID: 20345615 DOI: 10.1111/j.1399-3046.2010.01316.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The measurement of QoL has become an important area for research in paediatric transplantation over the past 15 yr. While much of this work remains descriptive and exploratory, advances in treatment and the trend towards outcomes being patient centred and not just survival based suggest the measurement of QoL will be of far more importance and relevance in the future. In this discussion article, we will outline some of the issues that need to be considered when embarking on a QoL study. The aim of our account is not to be prescriptive, rather to present researchers and clinicians with questions and possible solutions to help increase the scientific robustness of future studies. We have included summary tables of instruments that are currently available as a resource for those wanting to evaluate QoL in paediatric transplantation.
Collapse
Affiliation(s)
- Rachel M Taylor
- Department of Children's Nursing, Faculty of Health and Social Care, London South Bank University, and Great Ormond STreet Hospital for Children NHS Trust, London, UK.
| | | | | |
Collapse
|