1
|
Salamon G, Field-Werners U, Strobl S, Hübl V, Diem A. Facing the complex challenges of people with epidermolysis bullosa in Austria: a mixed methods study on burdens and helpful practices. Orphanet J Rare Dis 2024; 19:211. [PMID: 38773622 PMCID: PMC11110252 DOI: 10.1186/s13023-024-03163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/30/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND With approximately 500 people affected in Austria, epidermolysis bullosa (EB) is a rare genetic skin disease reducing the quality of life of those affected and their relatives. The intensive efforts of the patient organisation DEBRA Austria during the last decades have led to a unique situation of those affected and their relatives, with increased support and broader knowledge about the disease in the general population. The aim of the study is to evaluate the current situation of patients and their relatives living in Austria, with a focus on burdens and helpful practices. RESULTS The mixed-methods study consisted of two parts: a qualitative interview study to identify psychosocial aspects of EB in those affected and their relatives, and a subsequent online survey to further assess those aspects in a larger sample, resulting in a total of n=78 Austrian participants. The impact of EB on the quality of life of EB patients and their relatives in Austria is related to the current health status, psychological burden, mobility, visibility, financial situation as well as job prospects. Personal and social resources and external support have a significant influence on the individual situation. CONCLUSIONS The outcome is mapped to concrete implications regarding targeted support for EB patients and their relatives on an individual level and their needs in regard to the Austrian health care system.
Collapse
Affiliation(s)
- Gudrun Salamon
- Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria.
| | - Ursula Field-Werners
- Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria
| | - Sophie Strobl
- Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria
| | - Vinzenz Hübl
- Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria
| | - Anja Diem
- EB House Austria, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
2
|
Jones J, Cruddas M, Simpson A, Meade N, Pushparajah D, Peter M, Hunter A. Factors affecting overall care experience for people living with rare conditions in the UK: exploratory analysis of a quantitative patient experience survey. Orphanet J Rare Dis 2024; 19:77. [PMID: 38373961 PMCID: PMC10877794 DOI: 10.1186/s13023-024-03081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Although individually rare, collectively, rare conditions are common and affect a large number of people and are often chronic, life threatening and affect multiple body systems; the majority of them have no effective treatment. The literature has identified many specific challenges for those living with rare conditions, however, we do not know which of these in combination are most likely to impact how someone rates their overall experience of care. The aim of this study is to do further exploratory analysis of the Genetic Alliance UK 2020 Rare Experience survey data to identify which variables are most strongly associated with respondents' overall care experience. RESULTS There were strong associations between most of the selected survey variables and the overall rated experience of care variable. In the multiple linear regression only nine variables remained in the best fit model: 'Trust and confidence in hospital staff involved in ongoing care'; 'Satisfaction with information provided by healthcare professionals-following diagnosis'; 'The professionals providing care work as a team'; 'Feel care is coordinated effectively'; 'The timing and frequency of appointments are convenient for the patient/carer/family'; 'Whether or not there is a specific healthcare professional to ask questions of about the rare/undiagnosed condition'; 'Experience of searching for a diagnosis'; 'Knowledge of whether there is a specialist centre for the condition'; and 'Number of different clinics attend for the condition'. CONCLUSIONS Our findings indicate the challenges that play the largest part in explaining the varied experiences with rare disease healthcare in the UK for our survey respondents. These challenges should be further investigated with a broader sample of people affected by rare conditions, ideally through the implementation of a comprehensive national rare condition patient registry. Our findings highlight an important potential gap in the Framework, 'trust and confidence in healthcare professionals'; further research is required to fully understand the foundations of trust and confidence.
Collapse
Affiliation(s)
- Jennifer Jones
- Genetic Alliance UK, Creative Works, 7 Blackhorse Road, London, E17 6DS, UK.
- Department of Population Health Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Marie Cruddas
- Genetic Alliance UK, Creative Works, 7 Blackhorse Road, London, E17 6DS, UK
| | - Amy Simpson
- Institute of Public Care, Oxford Brookes University, Harcourt Hill Campus, Oxford, OX2 9AT, UK
| | - Nick Meade
- Genetic Alliance UK, Creative Works, 7 Blackhorse Road, London, E17 6DS, UK
| | - Daphnee Pushparajah
- ALEXION PHARMA UK LTD, 3 Furzeground Way, Stockley Park, Uxbridge, UB11 1EZ, UK
| | - Michelle Peter
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, Level 5, Barclay House, 37 Queen Square, London, WC1N 3BH, UK
| | - Amy Hunter
- Genetic Alliance UK, Creative Works, 7 Blackhorse Road, London, E17 6DS, UK
| |
Collapse
|
3
|
Kentish-Barnes N, Souppart V, Cohen-Solal Z, Benhamou Y, Coppo P, Veyradier A, Azoulay E. The Metamorphosis, struggling to adapt to a new condition. The lived experience of patients with Thrombotic microangiopathies diagnosed in the ICU. A qualitative study. J Crit Care 2023; 78:154366. [PMID: 37453271 DOI: 10.1016/j.jcrc.2023.154366] [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: 09/09/2022] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Using qualitative interviews, our objective was to better understand the experience of patients with Thrombotic microangiopathies (TMA), from discovering their disease in the ICU to the psychological, emotional, and social specifics of living with this rare disorder. MATERIAL AND METHODS Patients were recruited at seven TMA centers belonging to the French national TMA referral network. A total of 15 patients, 15 relatives and 12 healthcare professionals participated. A majority of patients (n = 11/15) were women, median age was 41 (range 29-62) years, and median time elapsed since diagnosis was 6 (range 2-11) years. Interviews were analysed using thematic analysis. RESULTS We derived 3 major themes from qualitative analysis: 1) Discovering TMA: experiencing a life-threatening emergency with open eyes; 2) TMA: a complex and diverse disease and care plan; 3) Living with TMA: taming fear and loneliness. CONCLUSIONS Patients with TMA share common experiences with patients with other rare diseases, but also specific experiences related to their illness. Improved information at the onset and during the course of the illness, associated with enhanced care coordination plans would help TMA patients better cope with their illness and adhere to their care projects.
Collapse
Affiliation(s)
- Nancy Kentish-Barnes
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France.
| | - Virginie Souppart
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Zoé Cohen-Solal
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Ygal Benhamou
- French Reference Center for Thrombotic Microangiopathies, France; CHU Charles Nicolle, Internal Medicine Department, Rouen, France
| | - Paul Coppo
- French Reference Center for Thrombotic Microangiopathies, France; AP-HP, Saint-Antoine Hospital, Hematology Department, Paris, France
| | - Agnès Veyradier
- French Reference Center for Thrombotic Microangiopathies, France; AP-HP, Lariboisière Hospital, Biological Hematology, Paris, France
| | - Elie Azoulay
- AP-HP, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; French Reference Center for Thrombotic Microangiopathies, France
| |
Collapse
|
4
|
Chateau AV, Aldous C, Dlova N, Blackbeard D. 'It breaks my heart': Healthcare practitioners' caring for families with epidermolysis bullosa. Health SA 2023; 28:2355. [PMID: 37927945 PMCID: PMC10623493 DOI: 10.4102/hsag.v28i0.2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/11/2023] [Indexed: 11/07/2023] Open
Abstract
Background Epidermolysis bullosa (EB) is a painful genodermatosis presenting with skin fragility and blisters. There is no cure; the prognosis is guarded and depends on the subtype of the disease. Managing these patients can be emotionally challenging for healthcare practitioners. Aim To determine the perceptions, impact, and needs of healthcare practitioners (HCP) caring for patients and their families with EB. Setting Nelson Mandela School of Medicine, Durban and Grey's Hospital, Pietermaritzburg, KwaZulu-Natal. Methods The study was guided by interpretative phenomenological analysis. Individual in-depth interviews were conducted with 10 healthcare practitioners. Guba's trustworthiness framework was used to ensure rigour. Results Six global themes were identified, each related primarily to the perceptions, impact, and needs of healthcare practitioners. The experiences and perceptions of healthcare practitioners were that caring for patients with an incurable disease such as EB could negatively impact healthcare practitioners. There were divergent views among the disciplines of HCPs regarding the extent of care in a resource-limited environment. This resulted in negative emotions, ethical concerns, and a need for continued medical education and the application of coping strategies. Healthcare practitioners observed that patients and their families were vulnerable, requiring comprehensive biopsychosocial care. Conclusion Healthcare practitioners should be aware of their emotional challenges, seek support where necessary, and use effective coping strategies and self-care. Contribution The concerns and needs of healthcare practitioners are highlighted and interventional strategies to assist healthcare practitioners are suggested which will ultimately improve patient care.
Collapse
Affiliation(s)
- Antoinette V Chateau
- Department of Dermatology, Grey's Hospital, Pietermaritzburg, South Africa
- Department of Dermatology, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Colleen Aldous
- School of Clinical Medicine, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Ncoza Dlova
- Department of Dermatology, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - David Blackbeard
- Department of Psychology, Grey's Hospital, Pietermaritzburg, South Africa
- Department of Psychiatry, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
5
|
Popenhagen MP, Genovese P, Blishen M, Rajapakse D, Diem A, King A, Chan J, Pellicer Arasa E, Baird S, Ferreira da Rocha AC, Stitt G, Badger K, Zmazek V, Ambreen F, Mackenzie C, Price H, Roberts T, Moore Z, Patton D, Murphy P, Mayre-Chilton K. Consensus-based guidelines for the provision of palliative and end-of-life care for people living with epidermolysis bullosa. Orphanet J Rare Dis 2023; 18:268. [PMID: 37667330 PMCID: PMC10476410 DOI: 10.1186/s13023-023-02870-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Inherited epidermolysis bullosa (EB) is a cluster of rare, genetic skin and mucosal fragility disorders with multi-system and secondary effects, in which blistering and erosions occur in response to friction/mechanical trauma. Considering the incurable and potentially life-limiting nature of the condition and the challenges posed by its symptoms, a palliative approach to EB-related care is necessary. However, knowledge and experience related to the provision of EB palliative care is minimal. Evidence-based, best care guidelines are needed to establish a base of knowledge for practitioners to prevent or ease suffering while improving comfort at all stages of the illness, not just the end of life. METHODS This consensus guideline (CG) was begun at the request of DEBRA International, an international organization dedicated to improvement of care, research, and dissemination of knowledge for EB patients, and represents the work of an international panel of medical experts in palliative care and EB, people living with EB, and people who provide care for individuals living with EB. Following a rigorous, evidence-based guideline development process, the author panel identified six clinical outcomes based on the results of a survey of people living with EB, carers, and medical experts in the field, as well as an exhaustive and systematic evaluation of literature. Recommendations for the best clinical provision of palliative care for people living with EB for each of the outcomes were reached through panel consensus of the available literature. RESULTS This article presents evidence-based recommendations for the provision of palliative healthcare services that establishes a base of knowledge and practice for an interdisciplinary team approach to ease suffering and improve the quality of life for all people living with EB. Any specific differences in the provision of care between EB subtypes are noted. CONCLUSIONS Because there is yet no cure for EB, this evidence-based CG is a means of optimizing and standardizing the IDT care needed to reduce suffering while improving comfort and overall quality of life for people living with this rare and often devastating condition.
Collapse
Affiliation(s)
- Mark P Popenhagen
- Department of Anesthesiology B090, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, 13123 E 16Th Ave, Aurora, CO, 80045, USA.
- Section of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, CO, USA.
| | | | - Mo Blishen
- DEBRA New Zealand, Newtown, Wellington, New Zealand
| | | | - Anja Diem
- EB House Austria, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | | | - Jennifer Chan
- Lucile Packard Children's Hospital, Stanford, Menlo Park, CA, USA
| | | | - Simone Baird
- DEBRA Australia, Pittsworth, QLD, Australia
- , Melbourne, Australia
| | | | - Gideon Stitt
- Division of Clinical Pharmacology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Faiza Ambreen
- DEBRA Pakistan, Lahore, Punjab, Pakistan
- , London, UK
| | - Caroline Mackenzie
- Guys and St Thomas' Foundation NHS Foundation Trust, EB Adult Service, East Hampshire, England, UK
| | | | - Toni Roberts
- DEBRA South Africa, Western Cape, Cape Town, South Africa
- , Cape Town, South Africa
| | - Zena Moore
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Murphy
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | |
Collapse
|
6
|
Anderson S, Clarke V, Thomas Z. The problem with picking: Permittance, escape and shame in problematic skin picking. Psychol Psychother 2023; 96:83-100. [PMID: 36117429 PMCID: PMC10087923 DOI: 10.1111/papt.12427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/25/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Problematic skin picking (SP) is a poorly understood experience characterised by a drive to pick the skin and related psychosocial impact. In the DSM-5, problematic SP is classified as 'excoriation (skin picking) disorder'. The aim of this article is to present a rare qualitative perspective on the lived experience of problematic SP, prioritising participants' voices and sense-making. DESIGN An in-depth qualitative study of individuals who self-identified as picking their skin problematically and experienced related distress. METHODS Seventeen UK-based participants were recruited online and interviewed about their SP. Participants were given choice of interview modality, including instant messenger platforms, telephone, email and Skype, to maximise comfort and improve the accessibility of the study. Transcripts were analysed using thematic analysis. RESULTS Three themes offering novel insight into the phenomenology of participants' SP are highlighted and explored: (1) how cognitions and circumstances drove and permitted SP, (2) how participants 'zoned out' while SP and the escape or relief that this attentional experience offered and (3) participants' feelings of shame and distress in how they felt their SP may appear to others. CONCLUSIONS This study contributes in-depth and novel ideas to the understanding of SP phenomenology and identifies how environmental factors, cognitions, contextual distress and shame may be considerations in therapeutic intervention. It presents the complexity of SP sense-making and demonstrates the need for individual formulation.
Collapse
Affiliation(s)
- Suzy Anderson
- School of Social Sciences, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Victoria Clarke
- School of Social Sciences, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Zoe Thomas
- School of Social Sciences, College of Health, Science and Society, University of the West of England, Bristol, UK
| |
Collapse
|
7
|
Understanding the socioeconomic costs of dystrophic epidermolysis bullosa in Europe: a costing and health-related quality of life study. Orphanet J Rare Dis 2022; 17:346. [PMID: 36068590 PMCID: PMC9450448 DOI: 10.1186/s13023-022-02419-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background Dystrophic epidermolysis bullosa (EB) is a family of rare genetic dermatological conditions. Recent evidence indicated that in addition to its detrimental implications on patient health-related quality of life (HRQoL), there are substantial socioeconomic cost implications, especially regarding direct non-medical costs. This study aims to understand the burden of dystrophic EB (DEB) in Europe, using a primary EB patient-level dataset.
Methods A bottom-up, cross-sectional, study design was adopted for non-institutionalised patients diagnosed with EB who received outpatient care across EU5 countries: France, Germany, Italy, Spain, and the United Kingdom. A prevalence-based approach was used to estimate resource utilisation from a societal perspective, including direct (medical and non-medical) and indirect costs for patients and caregivers. Patient and caregiver outcomes were obtained using the EQ-5D questionnaire. Results A sample of 91 DEB patients was analysed. Overall, average EU5 annual cost per patient was estimated at €53,359, ranging from €18,783 (France) to €79,405 (Germany). Average EU5 annual direct medical costs were estimated at €8357 (15.7% of total), ranging from €5658 (France) to €12,576 (Germany); average direct non-medical costs were estimated at €41,353 (77.5% of total), ranging from €11,961 (France) to €57,000 (Germany); and average indirect costs were estimated at €3649 (6.8% of total), ranging from €1025 (Italy) to €9930 (United Kingdom). Costs varied across patients with different disability but also between children and adults. The mean EQ-5D index score for adult DEB patients ranged between 0.304 (United Kingdom) and 0.541 (Germany), with an EU5 average of 0.456, whereas the mean EQ-5D visual analogue scale score ranged between 47.5 (Germany) and 70.0 (France), with an EU5 average of 61.9. Limitations included potential patient selection bias, recall bias, and exclusion of bandaging and related costs. Conclusions The study revealed a substantial socioeconomic burden for DEB in Europe, attributable mostly to high direct non-medical costs, with the majority of patients requiring support from caregivers at home. Compared to the average economic burden of the overall EB patient population, costs for DEB patients are higher across all components of direct medical, direct non-medical and indirect costs. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02419-1.
Collapse
|
8
|
Daae E, Feragen KB, Sitek JC, von der Lippe C. It's more than just lubrication of the skin: parents' experiences of caring for a child with ichthyosis. Health Psychol Behav Med 2022; 10:335-356. [PMID: 35402085 PMCID: PMC8986293 DOI: 10.1080/21642850.2022.2053685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The ichthyoses are a group of genetic skin disorders, characterized by excessive amounts of dry, thickened skin, which may be fragile, inelastic and prone to fissures and infection. Skin care is time consuming and demanding, and, usually performed by the parents. Methods: We aimed to explore parental experience of caring for a child with ichthyosis, and collected data using semistructured interview, and thematic analysis. Results: Our analysis revealed four main themes: Parents' and others' reactions to the child's difference, Experiences with healthcare services, It's all skin care, and Impact on relationships. Conclusion: After birth of a child with severe ichthyosis, the parents experienced emotional distress and stigmatization due to the different appearance of the skin and healthcare professionals' lack of knowledge. Skin care caused pain in the child, was time consuming, and caused financial burdens. This study can guide healthcare professionals on where to focus future efforts in meeting the clinical and psychological needs of parents caring for a child with ichthyosis.
Collapse
Affiliation(s)
- Elisabeth Daae
- Center for Rare Disorders, Oslo University Hospital HF, Oslo, Norway
| | | | - Jan C Sitek
- Department of Dermatology, Oslo University Hospital HF, Oslo, Norway
| | | |
Collapse
|
9
|
Chogani F, Parvizi MM, Murrell DF, Handjani F. Assessing the quality of life in the families of patients with epidermolysis bullosa: The mothers as main caregivers. Int J Womens Dermatol 2022; 7:721-726. [PMID: 35028371 PMCID: PMC8714583 DOI: 10.1016/j.ijwd.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 01/15/2023] Open
Abstract
Background Epidermolysis bullosa (EB) is an uncommon group of inherited disorders characterized by skin blistering after friction or mechanical trauma. EB affects patients and their families physically, socially, and emotionally. Objective This study aimed to assess the family quality of life of these patients using the Family Dermatology Life Quality Index (FDLQI) questionnaire. Methods In this cross-sectional study, we enrolled caregivers of patients with EB registered at the Molecular Dermatology Research Center, affiliated with Shiraz University of Medical Sciences, up to 2020. Participants filled out a demographic data collection form and the FDLQI questionnaire. The data were analyzed using SPSS software, version 22. Results Overall, 80 participants, consisting of 65 mothers (81.2%) and 15 fathers (18.7%) as primary caregivers, were enrolled in this study. The average FDLQI score was 19.88 ± 4.71. The FDLQI scores of caregivers of patients with EB simplex was significantly lower than scores observed in those with other types of EB (p < .001). There was a significant positive association between the number of patients with EB in the family and FDLQI score (p = .049). FDLQI scores were lower in caregiving mothers who had a higher education (p < .001) and those who were employed (p < .001). Conclusion Family quality of life is affected in patients with EB. Families with lower socioeconomic status and unemployed caregivers require special attention. More studies are needed to determine the parameters involved in the quality of life of patients with EB and their families.
Collapse
Affiliation(s)
- Fatemeh Chogani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author.
| | - Dedee F. Murrell
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
10
|
Barbosa NG, Silva CB, Carlos DM, Brosso L, Levada AF, Okido ACC. Inclusão escolar de crianças e adolescentes com epidermólise bolhosa: a perspectiva materna. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0271pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RESUMO Objetivo: compreender a inclusão escolar de crianças e adolescentes com epidermólise bolhosa na perspectiva materna. Método: estudo qualitativo, fundamentado na Teoria Bioecológica do Desenvolvimento de Urie Bronfenbrenner, realizado entre setembro e novembro de 2021. Foram realizadas entrevistas com seis mães de diferentes localidades brasileiras, áudio e vídeogravadas, utilizando a plataforma Google Meet®. Os depoimentos foram analisados mediantes análise temática. Resultados: Foram identificadas duas categorias: i) O microssistema escolar: desafios e adaptações para inclusão de crianças e adolescentes com epidermólise bolhosa; ii) O mesossistema família-escola: possibilidades para promover maior inclusão escolar. As mães destacaram os desafios da inclusão escolar, bem como os benefícios proporcionados pela interação social. A fim de facilitar a inclusão, o microssistema escolar promove adaptações do processo de ensino aprendizagem, mudanças estruturais, contratação de cuidadores e interlocução com os familiares. Conclusão A inclusão escolar foi inicialmente permeada por sentimentos como medo e angústia, mas as adaptações contribuíram para promover bem-estar, acolhimento e integração social das crianças e adolescentes.
Collapse
|
11
|
Barbosa NG, Silva CB, Carlos DM, Brosso L, Levada AF, Okido ACC. School inclusion of children and adolescents with epidermolysis bullosa: The mothers’ perspective. Rev Esc Enferm USP 2022; 56:e20220271. [PMID: 36541598 PMCID: PMC10116876 DOI: 10.1590/1980-220x-reeusp-2022-0271en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT Objective: to understand the school inclusion of children and adolescents with Epidermolysis Bullosa from the mothers’ perspective. Method: qualitative study, based on Urie Bronfenbrenner’s Bioecological Theory of Development, conducted between September and November 2021. Interviews were conducted with six mothers from different Brazilian locations, recording audio and video using the Google Meet® platform. The statements were analyzed using thematic analysis. Results: two categories were identified: i) The school microsystem: challenges and adaptations for inclusion of children and adolescents with Epidermolysis Bullosa; ii) The school-family mesosystem: possibilities to promote better school inclusion. Mothers highlighted the challenges in school inclusion as well as the benefits provided by social interaction. In order to facilitate the inclusion, the school microsystem promoted adaptations in the teaching-learning process, structural changes, hiring of caregivers, and dialogues with family members. Conclusion: initially, school inclusion was permeated by feelings such as fear and anguish, but the adaptations contributed to promote well-being, welcoming, and social integration of children and adolescents.
Collapse
|
12
|
Foji S, Mohammadi E, Sanagoo A, Jouybari L. The Patients' Experiences of Burden of Neurofibromatosis: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:342-348. [PMID: 34422615 PMCID: PMC8344627 DOI: 10.4103/ijnmr.ijnmr_178_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/11/2020] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
Background: Neurofibromatosis Type 1 (NF1) is a common autosomal disorder; the criteria for the diagnosis of NF1 includes café au lait spots, freckling, and Neurofibromas (NF). Skin symptoms have a major impact on patients' Quality of Life (QOL) but little is known about the burden of the disease on patients. The aim of this study was to explore the experiences of patients with NF. Materials and Methods: Using purposive sampling, 20 participants were enrolled in this qualitative content analysis study. The study was carried out between 2019 and 2020. Unstructured interviews and field notes were used to gather data. Data collection was stopped when data saturation was achieved. Results: Data analysis revealed 14 subcategories and 4 categories including “failing and falling behind in life”, “deprivation and restriction”, “social isolation”, and “ineffective adaptation to the disease”, which indicate the perception of patients with NF. Conclusions: In addition to the physical burden due to physical complications and problems, NF imposes a high degree of psychological and social burden on patients causing mental conflicts, which in turn results in them failing and falling behind in life. These findings illustrate the need to develop strategies and use multidisciplinary approaches to support patients, and thus to reduce the burden of NF.
Collapse
Affiliation(s)
- Samira Foji
- School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Akram Sanagoo
- School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Leila Jouybari
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| |
Collapse
|
13
|
Long JC, Best S, Hatem S, Theodorou T, Catton T, Murray S, Braithwaite J, Christodoulou J. The long and winding road: perspectives of people and parents of children with mitochondrial conditions negotiating management after diagnosis. Orphanet J Rare Dis 2021; 16:310. [PMID: 34256797 PMCID: PMC8276535 DOI: 10.1186/s13023-021-01939-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022] Open
Abstract
Background The diagnostic odyssey for people with a rare disease is well known, but difficulties do not stop at diagnosis. Here we investigate the experience of people, or parents of children with a diagnosed mitochondrial respiratory chain disorder (MRCD) in the management of their disease. The work complements ongoing projects around implementation of consensus recommendations for management of people with MRCD. People with or caring for a child with a formally diagnosed MRCD were invited to take part in an hour-long focus group held via videoconference. Questions elicited experiences of receiving management advice or information specific to their MRCD in four areas drawn from the consensus recommendations: diet and supplements, exercise, access to social services, and mental health. Sessions were audio-recorded, transcribed and analysed using a combination of inductive and deductive coding. Results Focus groups were conducted with 20 participants from five Australian states in June–September 2020. Fourteen adults with a MRCD (three of whom also had a child with a MRCD), and six who cared for a child with a MRCD took part. The overarching finding was that of the need for ongoing negotiation to access the advice and service required to manage their condition. The nature of these negotiations varied across contexts but mostly related to joint decision-making, and more commonly, the need to advocate for their care with non-specialist services (e.g., dieticians, schools). The effort required for this self-advocacy was a prominent theme. While most participants reported receiving adequate advice around supplements, and to a lesser extent diet and exercise, the majority reported no formal advice around mental health or practical assistance accessing social services. Conclusion These focus groups have revealed several gaps in the system for people with a MRCD, interacting with care providers after diagnosis. Focus group participants had to negotiate with a range of different stakeholders in order to secure appropriate advice or services. Notable was the gap in appropriate generalist services (e.g., dieticians) with sufficient knowledge of MRCD to support people with their day-to-day challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01939-6.
Collapse
Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Australian Genomics Health Alliance, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Tahlia Theodorou
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | | | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - John Christodoulou
- Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| |
Collapse
|
14
|
Sangha N, MacLellan AN, Pope E. Psychosocial impact of epidermolysis bullosa on patients: A qualitative study. Pediatr Dermatol 2021; 38:819-824. [PMID: 34152033 DOI: 10.1111/pde.14656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidermolysis bullosa (EB) is an inherited disorder that results in painful skin blisters requiring daily wound care. The psychosocial impact of EB is one of the most significant concerns for patients, but there is minimal research addressing these concerns or ways to improve patient quality of life (QoL). OBJECTIVE To examine the psychosocial impact of EB on affected patients and ways to improve their QoL. METHODS Eight EB participants were selected from the 2006 DEBRA Family Conference Day in Toronto. Participants were interviewed by a social worker and a field evaluator. The transcript of each interview was assessed using qualitative content analysis. RESULTS Four themes were identified: school interaction, daily life, family interactions, and societal interactions. Participants reported being teased and avoided by peers, and they felt their conditions were misunderstood by the general public. School absenteeism resulted in some patients falling behind in school, which may have been misinterpreted as intellectual impairment. Patients acknowledged significant dependence on others and felt they were contributing to caregiver burden. CONCLUSIONS Our findings highlight the psychosocial impact of EB on patients. As EB awareness and resources to support patients and caregivers have improved since this study was conducted, more studies exploring the current landscape and opportunities to improve quality of life are needed.
Collapse
Affiliation(s)
- Nimrita Sangha
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Elena Pope
- Section of Dermatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
The relationship between quality of life and coping strategies of children with EB and their parents. Orphanet J Rare Dis 2021; 16:53. [PMID: 33516244 PMCID: PMC7847038 DOI: 10.1186/s13023-021-01702-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 01/21/2021] [Indexed: 12/30/2022] Open
Abstract
Background Epidermolysis bullosa (EB) is a group of rare genetic skin disorders that primarily manifest as blisters and erosions following mild mechanical trauma. Despite the crucial role of the parents of children with EB in managing the disease, studies focusing on the parent–child relationship remain a gap in the literature. To address this gap, the current quantitative study, involving 55 children with all types of EB and 48 parents, assessed the relationship between their quality of life and coping strategies. Quality of life was measured with the Pediatric Quality of Life Inventory and TNO-AZL Questionnaire for Adult’s Health- related Quality of Life, and coping strategies were assessed with the Coping with a Disease Questionnaire. The majority of the analyses were descriptive and the results were interpreted qualitatively because of the small sample size. Results Overall, the quality of life of children with EB and that of their parents was somewhat lower compared with the quality of life of healthy children and adults. Children with EB who more frequently used emotional reactions and cognitive-palliative strategies to cope with the disease demonstrated lower levels of emotional and social functioning, while children who showed more acceptance and distancing showed higher levels of functioning on all domains. Parents who frequently demonstrated emotional reactions reported lower levels of social functioning and experienced more depressive emotions and anger. Parents who used more avoidance showed higher levels of positive emotions. Within parent–child dyads, acceptance, cognitive-palliative strategies and distancing were positively related. Children’s emotional and social functioning were negatively associated with their parents’ depressive emotions. Parents’ acceptance was linked to higher physical functioning in children, whereas children’s avoidance was linked to a lower level of anger in parents. Conclusion Children who are able to accept the disease or distance themselves from it appear to be better off in contrast to those who tend to engage in the cognitive-palliative strategies and expressing emotional reactions. Parents seem to be better off when they are able to use avoidance in contrast to those who tend to show emotional reactions. Further research is needed to substantiate these findings.
Collapse
|
16
|
King A, Hanley H, Popenhagen M, Perez F, Thompson K, Purvis D, Garcia N, Steinlein I, Werkentoft M, Lightfoot M, Lahat M, Begum K, Tanabe J. Supporting sexuality for people living with epidermolysis bullosa: clinical practice guidelines. Orphanet J Rare Dis 2021; 16:9. [PMID: 33407706 PMCID: PMC7789698 DOI: 10.1186/s13023-020-01640-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/09/2020] [Indexed: 12/21/2022] Open
Abstract
This article presents evidence-based Clinical Practice Guidelines (CPG) for the provision of healthcare services to address sexuality for people living with epidermolysis bullosa (EB). Currently, a lack of EB-specific research limits these services to sexual health assessment and intervention strategies designed for the general population. Due to the unique challenges of EB, a rare skin-fragility condition causing blistering responses to minor skin trauma and other systemic and secondary complications, condition-specific strategies are needed to support people with EB in achieving valued sexual lifestyles. This CPG represents the work of an international panel comprised of thirteen members including a medical doctor, nurses, psychologists, a social worker, an occupational therapist, and patient population involvement members living with EB. It describes the development of EB-specific recommendations for two primary domains of assessment and intervention related to sexuality: psychosocial and mechanical. Following a rigorous evidence-based guideline development process, this CPG establishes the first internationally actionable clinical practice recommendations for sexuality-related assessment and intervention for this population. Future research priorities are identified. Supplemental materials included provide additional support to clinicians in developing the necessary understanding and skills to promote equity and efficacy in this care domain.
Collapse
Affiliation(s)
- Alex King
- Department of Rehabilitation, Phoenix Children's Hospital, 1919 East Thomas Rd, Phoenix, AZ, 85016, USA.
| | - Humphrey Hanley
- DEBRA New Zealand, 123 Daniell Street, Newtown, Wellington, 6021, New Zealand
| | - Mark Popenhagen
- Department of Rehabilitation, Phoenix Children's Hospital, 1919 East Thomas Rd, Phoenix, AZ, 85016, USA
| | - Florencia Perez
- DEBRA Chile, Francisco de Villagra 392, 7760099, Ñuñoa, Santiago, Chile
| | - Kerry Thompson
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Diana Purvis
- Starship Children's Hospital, Park Road, Grafton, Auckland, 1023, New Zealand
| | - Nora Garcia
- DEBRA Spain, Asociación DEBRA-Piel de Mariopsa, C/ Jacinto Benavente No 12, 29601, Marbella, Málaga, Spain
| | | | | | - Matthew Lightfoot
- DEBRA UK, The Capitol Building, Oldbury, Bracknell, Berkshire, RG12 8FZ, UK
| | - Michelle Lahat
- Children's Hospital of Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA
| | - Kalsoom Begum
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | | |
Collapse
|
17
|
Stuttgen K, McCague A, Bollinger J, Dvoskin R, Mathews D. Whether, when, and how to communicate genetic risk to minors: 'I wanted more information but I think they were scared I couldn't handle it'. J Genet Couns 2020; 30:237-245. [PMID: 32700788 DOI: 10.1002/jgc4.1314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 06/14/2019] [Accepted: 06/22/2019] [Indexed: 11/09/2022]
Abstract
Genetic test results are often relevant not only to persons tested, but also to their children. Questions of whether, when, and how to disclose parental test results to children, particularly minors, can be difficult for parents to navigate. Currently, limited data are available on these questions from the perspective of minors. In this qualitative study, semi-structured interviews were conducted with parents affected by or at risk for hereditary cancer (N = 17) or Huntington's disease (N = 14) and their mature minor children aged 15-17 (N = 34). Parents and mature minors were interviewed separately. Genetic counselors (GCs; N = 19) were also interviewed. Most parents interviewed wanted to protect minors from genetic risk information (GRI) and feared minors would not be able to handle GRI. However, most mature minors reported they did not receive enough information and wished their parent was more forthcoming. Parents recommended taking time to process one's own test results before communicating with minors, and mature minors recommended parents communicate GRI in an honest, hopeful way. Most parents and GCs felt additional resources on communicating with minors about GRI and various genetic conditions are needed. This study includes the experiences and perspectives of a well-informed cohort, and results should be taken into careful consideration by parents, GCs, and others who are faced with communicating GRI to minors.
Collapse
Affiliation(s)
- Kelsey Stuttgen
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.,Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison McCague
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.,Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Juli Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Dvoskin
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Debra Mathews
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
18
|
Clarke EN, Thompson AR, Norman P. Depression in people with skin conditions: The effects of disgust and self‐compassion. Br J Health Psychol 2020; 25:540-557. [DOI: 10.1111/bjhp.12421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/07/2020] [Indexed: 10/24/2022]
|
19
|
Quality of life in people with epidermolysis bullosa: a systematic review. Qual Life Res 2020; 29:1731-1745. [DOI: 10.1007/s11136-020-02495-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2020] [Indexed: 12/12/2022]
|
20
|
Abstract
Winning entry to the Student Voice 2019. The article focuses on a personal encounter that I had as a medical student when I was sent off to ‘study’ a patient with a rare disease who had been admitted to hospital.
Collapse
|
21
|
Kearney S, Donohoe A, McAuliffe E. Living with epidermolysis bullosa: Daily challenges and health-care needs. Health Expect 2019; 23:368-376. [PMID: 31868299 PMCID: PMC7104643 DOI: 10.1111/hex.13006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & OBJECTIVE Epidermolysis bullosa (EB) is the term used for a group of genetic skin fragility disorders. For those living with EB, pain represents a constant challenge, with blistering and tasks such as changing dressings, adding to the distress. This paper focuses on describing and exploring the health-care needs of children, adults and families who are affected by EB. The specific aim of the paper is to identify the needs of the EB population with a view towards informing the development of a community liaison service to support adults living with EB and the parents/carers of children living with EB. SETTING AND PARTICIPANTS Interviews with six adults and the parents of eight children with EB were conducted. The data were analysed thematically. All participants were resident on the island of Ireland and are therefore reflecting on services in this geographic region. RESULTS Participants' needs were grouped into five themes: support managing physical health-care issues; access to community/home-based services; EB-specific information and psychosocial support; effective interaction with health-care professionals; and advice regarding benefits and entitlements. DISCUSSION AND CONCLUSIONS This article represents the health-care needs and preferences of a broad spectrum of those with EB, highlighting the need for a comprehensive service regardless of the severity of the condition.
Collapse
Affiliation(s)
- Sandra Kearney
- IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Ann Donohoe
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eilish McAuliffe
- IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| |
Collapse
|
22
|
How Can Stoic Philosophy Inspire Psychosocial Genetic Counseling Practice? An Introduction and Exploration. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2019. [DOI: 10.1007/s10942-019-00330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
23
|
Mooney J, Graham K, Watts RA. Impact of caring for someone with a rare rheumatic condition, views from patients and informal carers-the need for cat-like vigilance. Rheumatol Adv Pract 2019; 3:rkz003. [PMID: 31431991 PMCID: PMC6649977 DOI: 10.1093/rap/rkz003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/25/2019] [Indexed: 12/22/2022] Open
Abstract
Objective ANCA-associated vasculitis (AAV) is a rare multisystem disease. Modern therapeutic protocols have turned AAV from an acute, frequently fatal disease into a chronic disease requiring long-term immunosuppression. Patients must often manage substantial burdens related to chronic illness and treatment-related side effects, requiring help from informal carers. This study aimed to explore the experience of patients and of informal carers of patients with AAV about the impact of managing a rare rheumatic condition. Methods A qualitative approach using semi-structured interviews was used. Interviews were conducted with a purposeful sample of 18 pairs of patients with AAV and their informal carers. The interviews were used to explore the participants' experience and effects of caring. The interviews were recorded and transcribed as verbatim text and analysed using the framework technique. Results Eighteen patients (seven female; disease: 10 granulomatosis with polyangiitis; four microscopic polyangiitis; four eosinophilic granulomatosis with polyangiitis; age range 34-78 years; disease duration 1-20 years). Caregiver and patient perspectives were shared. The emerging themes were the physical and psychological impacts of the disease, the need for constant vigilance and fear of the future. Conclusion Both patients and carers faced a range of challenges in managing a rare condition, including the seriousness of the illness, dealing with the emotional toll and knowing what to expect. This study offers insight into the experiences of patients and informal carers, and health-care professionals should address individuals' fears and expectations for recovery.
Collapse
Affiliation(s)
- Janice Mooney
- School of Health and Social Care, University of Staffordshire, Stafford, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Karly Graham
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
24
|
Martin K, Geuens S, Asche JK, Bodan R, Browne F, Downe A, García García N, Jaega G, Kennedy B, Mauritz PJ, Pérez F, Soon K, Zmazek V, Mayre-Chilton KM. Psychosocial recommendations for the care of children and adults with epidermolysis bullosa and their family: evidence based guidelines. Orphanet J Rare Dis 2019; 14:133. [PMID: 31186066 PMCID: PMC6560722 DOI: 10.1186/s13023-019-1086-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Abstract
Epidermolysis Bullosa (EB) is a group of rare genetic disorders resulting in skin fragility and other symptoms. Commissioned by DEBRA International and funded by DEBRA Norway, this evidence-bases guideline provides recommendations to optimise psychosocial wellbeing in EB. An international multidisciplinary panel of social and health care professionals (HCP) and people living with EB was formed. A systematic international literature review was conducted by the panel following the Scottish Intercollegiate Guidelines Network (SIGN) methodology. The resulting papers underwent systematic selection and critique processes. Included papers were allocated to 6 different outcome groups to allow data synthesis and exploration: quality of life, coping, family, wellbeing, access to HCP and pain. Based on the evidence in those papers, recommendations were made for individuals living with EB, family and caregivers and HCP working in the field. Few studies have investigated interventions and which factors lead to better outcomes, but general recommendations can be made. EB is a complex disease impacting enormously on every aspect of psychosocial life. People and families living with EB need access to multidisciplinary support, including psychological guidance, in order to improve quality of life and psychosocial wellbeing. Interventions should stimulate social participation to prevent isolation. People with EB and their families should be able to access a supportive network. HCP should be well supported and educated about the complexity of EB. They should work collaboratively with those around the individual with EB (e.g. schools, employers etc.) to provide psychosocial opportunity and care. Attention should be paid to the psychosocial impact of EB as well as physical needs. Directions for research are indicated.
Collapse
Affiliation(s)
- K Martin
- University Hospitals Birmingham NHS Trust, Solihull Hospital, Solihull, B91 2JL, UK.
| | - S Geuens
- Universital Hospitals Leuven, Leuven, Belgium
| | - J K Asche
- DEBRA Norge and person living with JEB, Stavanger, Norway
| | - R Bodan
- California State University, Fullerton, CA, USA
| | - F Browne
- Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - A Downe
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - G Jaega
- Psychology graduate and person living with EBS, Liverpool, UK
| | - B Kennedy
- Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - P J Mauritz
- The University Medical Center Groningen, Groningen, the Netherlands
| | - F Pérez
- DEBRA Chile, Santiago, Chile
| | - K Soon
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | - K M Mayre-Chilton
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.,DEBRA International, Vienna, Austria
| |
Collapse
|
25
|
Chan JM, Weisman A, King A, Maksomski S, Shotwell C, Bailie C, Weaver H, Bodan R, Guerrero E, Zmazek M, Khuu P. Occupational therapy for epidermolysis bullosa: clinical practice guidelines. Orphanet J Rare Dis 2019; 14:129. [PMID: 31174559 PMCID: PMC6556021 DOI: 10.1186/s13023-019-1059-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/08/2019] [Indexed: 12/20/2022] Open
Abstract
The purpose of this article is to summarize the Dystrophic Epidermolysis Bullosa Research Association (DEBRA) International evidence-based Clinical Practice Guidelines (CPGs) for the provision of occupational therapy (OT) for children and adults living with inherited epidermolysis bullosa (EB). This is a rare genetic disorder characterized by skin fragility leading to blister formation occurring spontaneously or following minor trauma. Current OT practice for persons with EB is based on anecdotal care, clinical expertise and trial and error with collaboration between caregiver and patient. Intervention based on research is needed to establish a foundation of knowledge to guide international practitioners to create and improve standards of care and to be able to work effectively with those living with the rare diagnosis of this condition. This CPG was created by an international panel with expertise working with persons with EB. The panel was made up of 11 members including OT’s, a physiotherapist, a medical doctor, social worker, person with EB and a carer of a person with EB. It describes the development of recommendations for 5 outcomes determined by survey of persons with EB, caregivers, and experienced healthcare professionals. The outcomes include independence in activities of daily living (ADL), independence in instrumental ADL, maximization of hand function (non-surgical), fine motor development and retention, and oral feeding skills. The recommendations are supplemented with additional files that include photos and specific examples to further guide occupational therapists or, in situations where an OT is not available, other members of the healthcare team. As the disorder of EB is rare, evidence-based CPGs are needed to provide a base of knowledge and practice for OTs throughout the world with the goal of providing quality care to patients, while improving their functional independence and quality of life. In addition, this information is valuable as a basis for further research.
Collapse
Affiliation(s)
- Jennifer M Chan
- Department of Rehabilitation, Lucile Packard Children's Hospital Stanford, 321 Middlefield Road, Menlo Park, CA, 94025, USA.
| | - Amy Weisman
- Department of Rehabilitation, Lucile Packard Children's Hospital Stanford, 321 Middlefield Road, Menlo Park, CA, 94025, USA
| | - Alex King
- Phoenix Children's Hospital, Phoenix, USA
| | | | | | | | | | - Rebecca Bodan
- School of Nursing, California State University Fullerton, Fullerton, USA
| | | | | | - Phuong Khuu
- Department of Rehabilitation, Lucile Packard Children's Hospital Stanford, 321 Middlefield Road, Menlo Park, CA, 94025, USA
| |
Collapse
|
26
|
Saltnes SS, Geirdal AØ, Saeves R, Jensen JL, Nordgarden H. Experiences of daily life and oral rehabilitation in oligodontia - a qualitative study. Acta Odontol Scand 2019; 77:197-204. [PMID: 30646789 DOI: 10.1080/00016357.2018.1535137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Quantitative research indicate increased anxiety and poorer mental health related quality of life (QoL) in individuals with oligodontia (congenital absence of six or more teeth). The aim of this qualitative study was to complement and explore the individuals' experiences of life and oral rehabilitation, hopefully improving the care for these patients. MATERIAL AND METHODS Twelve participants (6 females, 6 males, aged 21-48) with oligodontia and experiences of comprehensive dental treatments, consented to participate in a semi-structured interview. The questions in the interview guide were based on previous research and clinical experience and included both open (i.e. how is your life?) and specific questions (i.e. do health care personnel know enough about your condition?). The interview transcripts were coded and analysed using a phenomenological method of analysis. The Regional Ethics Committee approved the study. RESULTS The following themes grew out of the data; 'feeling of being different', 'the burden of treatment', 'shared decision-making', 'treatment increases self-esteem' and 'use of coping strategies'. Psychological distress and reduced QoL seemed to be related to negative aspects of the themes, which covered unacceptable aesthetics, reduced orofacial function, the long-term process of oral rehabilitation, and negative experiences with healthcare services. The informants used problem focused and emotionally focused strategies to meet these challenges. Finalizing oral rehabilitation and shared decision making were positive aspects of the themes. CONCLUSION All themes expressed by the participants were of importance for experienced QoL and psychological distress, and should be acknowledged by health care personnel when planning and performing treatment.
Collapse
Affiliation(s)
- Solfrid Sørgjerd Saltnes
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
- TAKO-centre Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Amy Østertun Geirdal
- Department of Social Sciences, OsloMet – Oslo Metropolitan University, Oslo, Norway
| | | | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | | |
Collapse
|
27
|
“It's just more personal”: Using multiple methods of qualitative data collection to facilitate participation in research focusing on sensitive subjects. Appl Nurs Res 2018; 43:30-35. [DOI: 10.1016/j.apnr.2018.06.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/18/2018] [Accepted: 06/23/2018] [Indexed: 11/19/2022]
|
28
|
Versteegh JJ, Dulfer K, Stuvel K, Pasmans SG, Utens EM. Netherton syndrome; neuropsychological and psychosocial functioning of child and adult patients and their parents. J Health Psychol 2018; 25:2296-2316. [PMID: 30129381 PMCID: PMC7583452 DOI: 10.1177/1359105318790052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Netherton syndrome is a rare severe skin disease. Clinical experience showed considerable psychosocial burdens among Netherton syndrome patients/families. Their (neuro)psychological functioning has never been investigated. Objective: To investigate neuropsychological/psychosocial functioning of Netherton syndrome patients and parents. Methods: A total of 12 Netherton syndrome patients and/or parents completed neuropsychological tests, semi-structured-interviews, and psychological-questionnaires. Results: Intelligence results showed disharmonic profiles, with below-average scores on processing speed. Neuropsychological problems and unfavorable outcomes on health-related quality of life, illness-appearance-related problems, and negative social consequences among patients/parents were found. Psychopathological (emotional) problems were reported; stigmatization, bullying was common among Netherton syndrome patients. Conclusion: Compared with normative data, Netherton syndrome patients showed neuropsychological and psychosocial problems. Standard follow-up is necessary to identify problems at early stage.
Collapse
Affiliation(s)
| | - Karolijn Dulfer
- Erasmus University Medical Center-Sophia Children's Hospital, The Netherlands
| | - Kira Stuvel
- Erasmus University Medical Center-Sophia Children's Hospital, The Netherlands
| | - Suzanne Gma Pasmans
- Erasmus University Medical Center-Sophia Children's Hospital, The Netherlands
| | - Elisabeth Mwj Utens
- Erasmus University Medical Center-Sophia Children's Hospital, The Netherlands.,University of Amsterdam, The Netherlands.,The Bascule - Academic Center for Child Psychiatry, The Netherlands.,Academic Medical Center, The Netherlands
| |
Collapse
|
29
|
Rumsey N. Psychosocial adjustment to skin conditions resulting in visible difference (disfigurement): What do we know? Why don't we know more? How shall we move forward? Int J Womens Dermatol 2018; 4:2-7. [PMID: 29872669 PMCID: PMC5986108 DOI: 10.1016/j.ijwd.2017.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 11/18/2022] Open
Abstract
This article offers an overview of the current understanding of the psychological factors and processes that play a part in the continuum of distress and positive adjustment in people who are affected by dermatological conditions that affect appearance. Despite research demonstrating the significant psychosocial challenges posed by visible difference and mounting evidence of the role played by psychosocial variables in the etiology, exacerbation, and treatment of skin conditions, current healthcare provisions focus predominantly on the amelioration of physical manifestations. Impediments to progress in the understanding of psychological adjustment, blocks to the development of effective interventions, and challenges to the implementation of integrated psychological and medical care are reviewed. A route map to advance current understanding and care provision is proposed.
Collapse
Affiliation(s)
- N. Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| |
Collapse
|
30
|
Jain SV, Murrell DF. Psychosocial impact of inherited and autoimmune blistering diseases. Int J Womens Dermatol 2018; 4:49-53. [PMID: 29872677 DOI: 10.1016/j.ijwd.2017.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 12/31/2022] Open
Abstract
Inherited and autoimmune blistering diseases are rare, chronic, and often severe disorders that have the potential to significantly affect patients' quality of life. The effective management of these conditions requires consideration of the physical, emotional, and social aspects of the disease. Self-esteem is integral to patients' ability to cope with their illness, participate in treatment, and function in society. This article discusses quality-of-life studies of patients with blistering diseases with a particular focus on self-esteem issues that patients may face.
Collapse
Affiliation(s)
- Swaranjali V Jain
- Department of Dermatology, St George Hospital, Gray Street, Kogarah NSW, Sydney, Australia.,Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Gray Street, Kogarah NSW, Sydney, Australia.,Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia
| |
Collapse
|
31
|
Li AW, Prindaville B, Bateman ST, Gibson TE, Wiss K. Inpatient management of children with recessive dystrophic epidermolysis bullosa: A review. Pediatr Dermatol 2017; 34:647-655. [PMID: 28944966 DOI: 10.1111/pde.13276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Recessive dystrophic epidermolysis bullosa is a disorder marked by skin and mucosal blistering after minimal trauma. Even the most routine procedures in the hospital, if done incorrectly, can precipitate extensive skin loss, pain, and scarring. Most providers have little experience working with patients with this degree of skin fragility. When a person with recessive dystrophic epidermolysis bullosa is admitted to the hospital, there are multiple considerations to keep in mind while strategizing an effective care plan: avoidance of new blisters with a "hands-off" approach; careful consideration of all indwelling devices; symptomatic management of pain, itch, and anxiety; coordination of dressing changes; aggressive treatment of skin infections; environmental and staffing considerations; and awareness of other chronic complications that affect care, such as anemia, malnutrition, and chronic pain. To minimize discomfort for patients with recessive dystrophic epidermolysis bullosa during the hospital stay, inpatient care teams should understand these considerations and modify the care plan accordingly. Prior preparation by the hospital facility and inpatient care team will facilitate the delivery of safe and effective care and greatly improve the overall patient experience.
Collapse
Affiliation(s)
- Alvin W Li
- School of Medicine, Yale University, New Haven, CT, USA
| | - Brea Prindaville
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Scot T Bateman
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Timothy E Gibson
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
32
|
von der Lippe C, Diesen PS, Feragen KB. Living with a rare disorder: a systematic review of the qualitative literature. Mol Genet Genomic Med 2017; 5:758-773. [PMID: 29178638 PMCID: PMC5702559 DOI: 10.1002/mgg3.315] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 12/14/2022] Open
Abstract
Background Individuals with rare diseases may face challenges that are different from those experienced in more common medical conditions. A wide range of different rare conditions has resulted in a myriad of studies investigating the specificities of the diagnosis in focus. The shared psychological experiences of individuals with a rare condition, however, have not been reviewed systematically. Methods We performed a systematic review, including qualitative studies on adults, published between 2000 and 2016. Papers including more than one rare genetic or nongenetic diagnosis were included. Studies based on single diagnoses were excluded except for four specific conditions: hemophilia (bleeding disorder), phenylketonuria (metabolic disorder), Fabry disease (lysosomal storage disorder), and epidermolysis bullosa (skin disorder). Results The review identified 21 studies. Findings were synthesized and categorized according to three main themes: (1) Consequences of living with a rare disorder, (2) Social aspects of living with a rare disorder, and (3) Experiences with the health care system. Findings point to several unique challenges, such as the psychological, medical, and social consequences of a lack of knowledge about the condition in health care and social settings. Conclusion The findings highlight the need for more research on the shared psychological and social impact of living with a rare diagnosis across conditions, in order to identify risk factors and inform clinical practice.
Collapse
Affiliation(s)
- Charlotte von der Lippe
- Centre for Rare Disorders, Oslo University Hospital, Rikshospitalet, P.B. 4950 Nydalen, Oslo, 0424, Norway
| | - Plata S Diesen
- Centre for Rare Disorders, Oslo University Hospital, Rikshospitalet, P.B. 4950 Nydalen, Oslo, 0424, Norway
| | - Kristin B Feragen
- Centre for Rare Disorders, Oslo University Hospital, Rikshospitalet, P.B. 4950 Nydalen, Oslo, 0424, Norway
| |
Collapse
|
33
|
Angelis A, Kanavos P, López-Bastida J, Linertová R, Oliva-Moreno J, Serrano-Aguilar P, Posada-de-la-Paz M, Taruscio D, Schieppati A, Iskrov G, Brodszky V, von der Schulenburg JMG, Chevreul K, Persson U, Fattore G. Social/economic costs and health-related quality of life in patients with epidermolysis bullosa in Europe. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17 Suppl 1:31-42. [PMID: 27107597 PMCID: PMC4869727 DOI: 10.1007/s10198-016-0783-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 01/13/2016] [Indexed: 05/04/2023]
Abstract
BACKGROUND The aim of this study was to determine the social/economic costs and health-related quality of life (HRQOL) of patients with epidermolysis bullosa (EB) in eight EU member states. METHODS We conducted a cross-sectional study of patients with EB from Bulgaria, France, Germany, Hungary, Italy, Spain, Sweden and the United Kingdom. Data on demographic characteristics, health resource utilisation, informal care, labour productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) questionnaire. RESULTS A total of 204 patients completed the questionnaire. Average annual costs varied from country to country, and ranged from €9509 to €49,233 (reference year 2012). Estimated direct healthcare costs ranged from €419 to €10,688; direct non-healthcare costs ranged from €7449 to €37,451 and labour productivity losses ranged from €0 to €7259. The average annual cost per patient across all countries was estimated at €31,390, out of which €5646 accounted for direct health costs (18.0 %), €23,483 accounted for direct non-healthcare costs (74.8 %), and €2261 accounted for indirect costs (7.2 %). Costs were shown to vary across patients with different disability but also between children and adults. The mean EQ-5D score for adult EB patients was estimated at between 0.49 and 0.71 and the mean EQ-5D visual analogue scale score was estimated at between 62 and 77. CONCLUSION In addition to its negative impact on patient HRQOL, our study indicates the substantial social/economic burden of EB in Europe, attributable mostly to high direct non-healthcare costs.
Collapse
Affiliation(s)
- Aris Angelis
- Department of Social Policy and LSE Health, London School of Economics and Political Science, London, UK.
| | - Panos Kanavos
- Department of Social Policy and LSE Health, London School of Economics and Political Science, London, UK
| | - Julio López-Bastida
- University of Castilla-La Mancha, Talavera de la Reina, Toledo, Spain
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Renata Linertová
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Las Palmas de Gran Canaria, Spain
| | - Juan Oliva-Moreno
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- University of Castilla-La Mancha, Toledo, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Evaluation and Planning Service at Canary Islands Health Service, Santa Cruz de Tenerife, Spain
| | | | - Domenica Taruscio
- National Center for Rare Diseases, Istituto superiore di sanità (ISS), Rome, Italy
| | - Arrigo Schieppati
- Centro di Ricerche Cliniche per Malattie Rare Aldo e Cele Daccò, Istituto di Ricerche Farmacologiche Mario Negri, Ranica (Bergamo), Italy
| | - Georgi Iskrov
- Institute of Rare Diseases, Plovdiv, Bulgaria
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | | | - Karine Chevreul
- URC Eco Ile de France, AP-HP, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- INSERM, ECEVE, U1123, Paris, France
| | - Ulf Persson
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| |
Collapse
|
34
|
Experiences of Being Heterozygous for Fabry Disease: a Qualitative Study. J Genet Couns 2016; 25:1085-92. [PMID: 26948256 DOI: 10.1007/s10897-016-9941-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/18/2016] [Indexed: 12/18/2022]
Abstract
Little is known about the experiences of women with Fabry disease. The aim of this study was to explore women's experiences of being heterozygous for Fabry disease. We used an explorative qualitative study design and selected ten Norwegian women who were known heterozygous for Fabry disease to participate. We conducted in-depth semi-structured interviews and analyzed the interviews using inductive thematic analysis. We found that learning about one's heterozygous status may be devastating for some. However, for most of the participants, heterozygous status, as well as doctors' acceptance of symptoms in women heterozygous for Fabry disease, provided an explanation and relief. Although many women did not consider themselves ill, they wished to be acknowledged as more than "just carriers." The participants were grateful for enzyme replacement therapy, although it had its burdens regarding time, planning, and absences from school or work. Women with Fabry disease felt that the lack of knowledge among healthcare professionals about Fabry disease was frustrating and worrisome. These findings suggest that healthcare professionals should acknowledge the different ways women react to their diagnosis, and be aware of the personal costs of receiving treatment.
Collapse
|
35
|
|
36
|
Tadakamadla J, Kumar S, Johnson NW. Quality of life in patients with oral potentially malignant disorders: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:644-55. [PMID: 25956217 DOI: 10.1016/j.oooo.2015.01.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 12/29/2014] [Accepted: 01/05/2015] [Indexed: 12/12/2022]
Abstract
There is a paucity of literature on quality of life (QoL) in patients with oral potentially malignant disorders (OPMDs) despite these conditions being relatively common, chronic, and potentially debilitating. The aim of this paper is to systematically review the literature on QoL in patients with OPMDs. A search from electronic databases PUBMED, MEDLINE, and CINAHL Plus retrieved 180 titles after removing duplicates, and a further 4 papers were identified by hand searching. Study of the abstracts identified 25 truly relevant articles, which were studied in full. Of these, 14 met our strict inclusion criteria. Most studies were cross-sectional; most were from Europe and have evaluated QoL in patients with oral lichen planus (OLP). The findings differ but, overall, do not provide evidence that patients with OPMDs have a poorer QoL compared with healthy patients. Several things may explain this apparently surprising conclusion. First, the quality of most articles was moderate or weak; second, most studies assessed QoL only in patients with OLP and cannot be generalized to all patients with OPMDs; last, direct comparisons between patients with OPMD and healthy controls were rarely included. The validity of the QoL instrument used for patients with OLP was frequently inadequate.
Collapse
Affiliation(s)
- Jyothi Tadakamadla
- Population and Social Health Research Programme, Menzies Health Institute Queensland, School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia.
| | - Santhosh Kumar
- Population and Social Health Research Programme, Menzies Health Institute Queensland, School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - Newell W Johnson
- Professor of Dental Research, Population and Social Health Research Programme, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| |
Collapse
|
37
|
Stevens LJ, McKenna S, Marty J, Cowin AJ, Kopecki Z. Understanding the outcomes of a home nursing programme for patients with epidermolysis bullosa: an Australian perspective. Int Wound J 2014; 13:863-9. [PMID: 25469719 DOI: 10.1111/iwj.12394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 10/16/2014] [Indexed: 12/30/2022] Open
Abstract
Epidermolysis bullosa (EB) consists of a spectrum of genodermatoses characterised by skin fragility and various degrees of skin and mucous membrane blistering. Minimal trauma and friction can cause extensive blistering in patients with EB, resulting in a number of complications. However, wound management is the main challenge for these patients because of a high risk of infection, fluid loss and potential development of aggressive squamous cell carcinoma (SCC). Indeed, patients with EB have an increased risk for developing skin cancers compared to the general population. In 2012, a home nursing programme was established in Australia to provide assistance to families or patients with severe forms of EB. Nursing care was provided to patients with severe EB during dressing changes in their homes over a period of 2 years. Both families of patients and nurses were surveyed periodically using a developed questionnaire to assess the benefits of this home nursing and its impact on the patients, their families and the nurses. Key findings included a perceived improvement in quality of life, a better provision of support and improved family life management. These findings are the first to highlight the benefits of this national home nursing programme for EB patients within Australia and demonstrate the continued need and benefit of home nursing for patients with severe skin blistering disorders.
Collapse
Affiliation(s)
| | - Sue McKenna
- Dystrophic Epidermolysis Bullosa Research Association - Australia, Pittsworth, QLD, Australia
| | - Jennifer Marty
- Dystrophic Epidermolysis Bullosa Research Association - Australia, Pittsworth, QLD, Australia
| | - Allison J Cowin
- Regenerative Medicine, Mawson Institute, University of South Australia, Adelaide, SA, Australia
| | - Zlatko Kopecki
- Dystrophic Epidermolysis Bullosa Research Association - Australia, Pittsworth, QLD, Australia. .,Regenerative Medicine, Mawson Institute, University of South Australia, Adelaide, SA, Australia.
| |
Collapse
|
38
|
Adopting a Sustainable Community of Practice Model when Developing a Service to Support Patients with Epidermolysis Bullosa (EB): A Stakeholder-Centered Approach. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 8:51-63. [DOI: 10.1007/s40271-014-0097-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
39
|
Curry WB, Thompson JL. Comparability of accelerometer- and IPAQ-derived physical activity and sedentary time in South Asian women: A cross-sectional study. Eur J Sport Sci 2014; 15:655-62. [PMID: 25252088 DOI: 10.1080/17461391.2014.957728] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is limited research documenting objectively measured physical activity (PA) and sedentary time (ST) in South Asian (SA) women, with no published evidence of the validity of self-report methods for assessment of PA/ST in SA. The purpose of this study was to compare accelerometer- and International Physical Activity Questionnaire (IPAQ)-derived PA/ST among SA women in the United Kingdom (UK) via a mixed-methods approach. One hundred and forty SA women wore an accelerometer for seven consecutive days; a sub-sample (n = 50) completed the IPAQ-Short Form (IPAQ-SF) and a brief structured interview. Accelerometer-derived metabolic equivalent (MET) minutes per week (min/wk) moderate-to-vigorous physical activity (MVPA) (mean ± SD) for the full sample was 793.94 (±519.44) and mean accelerometer-derived ST wk was 530.20 (±81.76). IPAQ-SF-derived MVPA (MET min/wk) was 636.80 (±2113.56) and mean ST wk was 315.31 (±266.98). Pearson correlations were not significant between accelerometer- and IPAQ-SF-assessed MVPA (r = -.119, p = .579) and ST (r = -.140, p = .229). Major themes synthesised from interviews included inability to recall sitting time and limited general knowledge of real-life examples of MVPA. These results suggest that the IPAQ-SF may not accurately measure PA/ST in the UK SA women. These findings are supported by qualitative evidence indicating several issues with interpretation and recall of PA/ST as assessed via this questionnaire.
Collapse
Affiliation(s)
| | - Janice L Thompson
- b School of Sport, Exercise & Rehabilitation Sciences , University of Birmingham , Birmingham , UK
| |
Collapse
|
40
|
Borghi CA, Rossato LM, Damião EBC, Guedes DMB, Silva EMRD, Barbosa SMDM, Polastrini RT. Living with pain: the experience of children and adolescents in palliative care. Rev Esc Enferm USP 2014; 48 Spec No:67-73. [DOI: 10.1590/s0080-623420140000600010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/06/2014] [Indexed: 11/22/2022] Open
Abstract
A qualitative study was conducted with semi-structured interviews with the aim of understanding the experience of children and adolescents under palliative care when managing pain daily and how they describe the intensity, quality and location of pain. We used Piaget’s theory of cognitive development as a theoretical framework and oral history as a methodological framework. We found four themes: describing pain; seeking a life closer to normality, despite pain and disease; using a variety of alternatives for pain control; and living with damaged physical appearance. Although pain is a limiting factor in the lives of children and adolescents, we found that they faced their daily pain and still had a life beyond pain and illness. In addition, we highlight the relevance of nurses’ understanding that effective management of pain in children is essential for a normal life and less suffering.
Collapse
|
41
|
Multicentre consensus recommendations for skin care in inherited epidermolysis bullosa. Orphanet J Rare Dis 2014; 9:76. [PMID: 24884811 PMCID: PMC4110526 DOI: 10.1186/1750-1172-9-76] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/16/2014] [Indexed: 12/22/2022] Open
Abstract
Background Inherited epidermolysis bullosa (EB) comprises a highly heterogeneous group of rare diseases characterized by fragility and blistering of skin and mucous membranes. Clinical features combined with immunofluorescence antigen mapping and/or electron microscopy examination of a skin biopsy allow to define the EB type and subtype. Molecular diagnosis is nowadays feasible in all EB subtypes and required for prenatal diagnosis. The extent of skin and mucosal lesions varies greatly depending on EB subtype and patient age. In the more severe EB subtypes lifelong generalized blistering, chronic ulcerations and scarring sequelae lead to multiorgan involvement, major morbidity and life-threatening complications. In the absence of a cure, patient management remains based on preventive measures, together with symptomatic treatment of cutaneous and extracutaneous manifestations and complications. The rarity and complexity of EB challenge its appropriate care. Thus, the aim of the present study has been to generate multicentre, multidisciplinary recommendations on global skin care addressed to physicians, nurses and other health professionals dealing with EB, both in centres of expertise and primary care setting. Methods Almost no controlled trials for EB treatment have been performed to date. For this reason, recommendations were prepared by a multidisciplinary team of experts from different European EB centres based on available literature and expert opinion. They have been subsequently revised by a panel of external experts, using an online-modified Delphi method to generate consensus. Results Recommendations are reported according to the age of the patients. The major topics treated comprise the multidisciplinary approach to EB patients, global skin care including wound care, management of itching and pain, and early diagnosis of squamous cell carcinoma. Aspects of therapeutic patient education, care of disease burden and continuity of care are also developed. Conclusion The recommendations are expected to be useful for daily global care of EB patients, in particular in the community setting. An optimal management of patients is also a prerequisite to allow them to benefit from the specific molecular and cell-based treatments currently under development.
Collapse
|
42
|
Adni T, Martin K, Mudge E. The psychosocial impact of chronic wounds on patients with severe epidermolysis bullosa. J Wound Care 2013; 21:528, 530-6, 538. [PMID: 23413491 DOI: 10.12968/jowc.2012.21.11.528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore the lived experience of individuals with chronic wounds associated with dystrophic and junctional epidermolysis bullosa (EB),to improve understanding and, therefore, enhance the care provided to this group of patients by acquiring in depth data on the psychosocial issues that affect them. METHOD A phenomenological study using interpretive phenomenological analysis was employed. A purposive sampling method was used with six individuals replying to postal invitation to participate. RESULTS Following one-to-one interviews, six superordinate themes were identified. These were: coping, pain, perceptions, emotional impact, social impact and support network, each with subordinate themes. All of the superordinate themes have been identified by previous research into chronic wounds, burns and disfiguring conditions; however, new subordinate themes arose. CONCLUSION This study highlighted the need for individuals with EB to have a multidisciplinary approach to their care with a particular need for pain management, psychological intervention and nursing support from those whom clients perceive as understanding the requirements of patients with EB. Further research into identity issues in individuals with EB is advocated. DECLARATION OF INTEREST There were no external sources of funding for this study.The authors have no conflicts of interest to declare.
Collapse
Affiliation(s)
- T Adni
- EB Service, Dermatology Department, Heart of England NHS Foundation Trust, UK.
| | | | | |
Collapse
|
43
|
|
44
|
Dures E, Rumsey N, Morris M, Gleeson K. A Cross Sectional, Observational Survey to Assess Levels and Predictors of Psychological Wellbeing in Adults with Epidermolysis Bullosa. Health Psychol Res 2013; 1:e4. [PMID: 26973893 PMCID: PMC4768606 DOI: 10.4081/hpr.2013.e4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/03/2012] [Accepted: 12/04/2012] [Indexed: 12/23/2022] Open
Abstract
Epidermolysis bullosa (EB) describes a cluster of genetically determined skin disorders. Symptoms can be painful, disabling and disfiguring, yet there is little research on the psychological impact of the disease. The study aim was to measure psychological wellbeing in adults with EB; and to examine the association between psychological wellbeing and self efficacy, health locus of control and adjustment to appearance in an observational, cross sectional survey. Questionnaire packs comprising the General Health Questionnaire (GHQ-12), the General Self Efficacy Scale (GSE), the Multidimensional Health Locus of Control Scale (MHLOC), and the Derriford Appearance Scale (DAS-24), were sent to approximately 385 adults with EB. The data were analysed using SPSS. Eighty-seven participants responded. Scores on the GHQ-12 showed non-problematic psychological health in 36% of the sample; levels bordering on clinical disorder in 32.1% and severe psychological distress in 31.9%. No correlations were found between demographic factors (age and sex) or clinical factors (EB type and perceived severity) and psychological well-being. Scores on the GSE, the internal locus of control sub-scale of the MHLOC and the DAS-24 showed them to be statistically significant correlates of psychological wellbeing (P<0.001; P<0.018; and P<0.001 respectively). In a regression analysis, adjustment to appearance and self efficacy accounted for 24% of the variation in psychological wellbeing. Adults with EB might be at risk of experiencing poor psychological health. Interventions designed to enhance disease self management, self efficacy and improve body image are likely to be beneficial in this clinical group.
Collapse
Affiliation(s)
- Emma Dures
- University of the West of England , Bristol, UK
| | | | | | | |
Collapse
|
45
|
Grocott P, Blackwell R, Weir H, Pillay E. Living in dressings and bandages: findings from workshops with people with Epidermolysis bullosa. Int Wound J 2012; 10:274-84. [PMID: 22487531 DOI: 10.1111/j.1742-481x.2012.00973.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Epidermolysis bullosa (EB) is an inherited disorder causing extensive, painful skin blistering and wounds. Currently, there is no cure and the focus of care is on the clinical management of the skin and other affected body systems, together with supportive care to individuals and families. The wound care for Epidermolysis bullosa (WEB) project is a collaboration with adults with EB, carers, clinical nurse specialists, a designer and manufacturers to develop novel products for EB wound care. This article reports the findings from workshops with adults with EB, their carers and clinical nurse specialists, together with observations of dressing changes. A cluster of significant limitations were revealed in the performance of wound care products, designed to cover a single wound, when they are used to cover extensive and whole body wounds. A working hypothesis for EB wound care was developed from the findings, together with design concepts and new products for EB wound care. In addition, a model of user engagement in medical device development and evaluation has been tested.
Collapse
Affiliation(s)
- Patricia Grocott
- King's College London, Florence Nightingale School of Nursing and Midwifery, London SE1 8WA, UK.
| | | | | | | |
Collapse
|
46
|
Sebaratnam DF, Frew JW, Davatchi F, Murrell DF. Quality-of-Life Measurement in Blistering Diseases. Dermatol Clin 2012; 30:301-7, ix. [DOI: 10.1016/j.det.2011.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|