Presurgical Infant Orthopedic Videos on YouTube™: A Thematic Analysis of Caregiver Narratives

OBJECTIVE

Information regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers' perspectives and experiences with contemporary PSIO treatment.

DESIGN

PSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019).

RESULTS

Two themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits.

CONCLUSION

Multifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.

Strategies to communicate pregnancy complications: a systematic review and practical points for healthcare professionals

PURPOSE/METHODS

This systematic review aims to provide an overview of strategies available for healthcare professionals (HCPs) to effectively communicate unexpected news in pregnancy, specifically for the most common pregnancy complications. Three medical databases and grey literature were searched until March 2023 using subject headings and keywords. Snowball techniques were also used. The articles were reviewed at each stage of screening independently by two separate authors. Qualitative, quantitative and mixed methods studies were included.

RECENT FINDINGS

Forty-three studies were included and grouped according to the gestational age of the pregnancy complication - miscarriage, increased risk screening, foetal conditions, stillbirth. The main key points for communication were outlined at each specific complication and eventually the six common themes that emerged from all the categories were included in the acronym PRICES (Preparation - Referral - Individualized care - Clarity - Empowerment - Sensitivity).

SUMMARY

Given the negative impact of failed communications both in pregnancy outcomes and patients' experience, we advocate that communication training for HCP providing pregnancy care should be mandatory, and skills should be updated at regular intervals. Tools like our acronym PRICES can be used during teaching HCPs how to communicate more effectively.

Parental response to the feeding behavior problems in children with cleft lip and palate: A systematic review

OBJECTIVE

To assess and analyze the global status of parental responses to feeding problems in patients with cleft lip and palate (CLP) and to provide recommendations for future research.

DESIGN

A priori protocol was formulated according to PRISMA guidelines and registered. The predefined search strategy was used in established search engines up to July 27, 2020 without any restriction of language or year of publication. Studies evaluating the parental responses to feeding problems in patients with CLP were included. The data extraction was performed with a self-designed form, and risk of bias (ROB) was assessed.

RESULTS

Out of 27 identified papers, eight studies could be included. Most were from Europe, conducted between 1994 and 2020, and had utilized valid and reliable questionnaires. The included studies showed moderate or low ROB. The majority of the studies reported parental dissatisfaction with the knowledge provided. The presence of anxiety and low self-esteem among parents was also highlighted.

CONCLUSIONS

There was general consensus regarding lack of medical advice and support for CLP families, along with the presence of anxiety and low self-esteem among parents. Well-designed studies from different regions of the world must be conducted in the future for an accurate global picture to be presented.

The Cleft Nurse Specialist: A Key Building Block in the Cleft Multidisciplinary Team

INTRODUCTION

The cleft nurse specialist (CNS) plays a key role in counselling and supporting parents from the diagnosis onward. The CNS started in 2012 and we aimed to perform a qualitative study to determine the benefits this brought to the cleft community from the parents' perspective.

METHODS

The cleft database was used to locate babies born in 2010/2011 and 2013/2014. Parents were contacted by phone by 2 authors and completed a questionnaire on the care and support they received following the diagnosis, in the early days and around the time of surgery.

RESULTS

Parents of 38 babies completed the survey. In 2010/2011, only 21% had an antenatal diagnosis compared to 47% in 2013/2014.2011/2012: 3 unilateral cleft lip and palate (UCLP), 3 bilateral cleft lip and palate (BCLP), 4 CLO, 9 cleft palate only (CPO).2013/2014: 5 UCLP, 7 BCLP, 7 CPO.2011/2012: 68% were counselled by a surgeon, 42% were seen >1 week after birth, with some over a month.2013/2014: 84% were counselled by the CNS, 53% were seen within 48 hours, and 100% within 7 days.Parents in 2013/2014 felt more supported by the cleft team throughout pregnancy and the early days, with home visits being particularly advantageous.

CONCLUSION

The introduction of the CNS to the cleft multidisciplinary team has significantly improved the pathway for parents and is a key link with the wider cleft team. With the improvement in antenatal diagnosis, counselling occurs at an earlier stage and prepares parents for the difficulties commonly experienced in the early days. Key themes included; home visits and direct contact with the CNS.

Exploring the Experiences of Adults With Microtia: A Qualitative Study

OBJECTIVE

Microtia is a medically complex condition, with the option of surgery to address hearing and reconstruct the ear. The current study explored adults' experiences of microtia, with a particular focus on the psychosocial impact and experiences of ear reconstruction. The ultimate aim was to identify areas for support and future research that could improve patient care.

DESIGN

Fifteen adults (12 females) aged between 20 and 62 years took part in semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis.

RESULTS

Three main themes were identified in the data: microtia as an invisible difference, surgery as a welcome opportunity, and living well with microtia. Participants had incorporated microtia into their self-concept and did not report a lasting negative impact on their lives. However, some psychosocial challenges were reported, including anxiety about showing their ears (even after reconstruction), disclosing their diagnosis to romantic partners, surgical decision-making, and feeling unsupported in the work environment.

CONCLUSION

Individuals with microtia may benefit from psychosocial interventions to increase confidence, access to support for treatment decision-making, and guidance around disclosing microtia to employers.

Satisfaction With Health Care in Families Following a Diagnosis of Cleft Lip and/or Palate in the United Kingdom

OBJECTIVE

Having a child born with a cleft lip and/or palate (CL/P) poses several challenges for new parents and can have a significant psychological impact on the family as a whole. Previous research has indicated that dissatisfaction with health care is a risk factor for poor parental adjustment and family functioning. Yet, knowledge is lacking in regard to which aspects of care parents may be dissatisfied with. The current study aimed to comprehensively evaluate health-care satisfaction in families following a diagnosis of CL/P by utilizing data collected from a UK-wide birth cohort.

METHODS

Self-reported questionnaire data were obtained from 517 parent dyads enrolled in The Cleft Collective Birth Cohort Study. The "Pediatric Quality of Life Inventory-Healthcare Satisfaction Generic Module" was used as the primary outcome measure.

RESULTS

Overall, parents were satisfied with the care they had received. However, less favorable scores were identified in relation to the information parents had been given. A good degree of agreement between mothers and fathers was observed. However, marginal evidence suggested that fathers were significantly more dissatisfied than mothers regarding the "Communication" and "Inclusion of Family" subscales.

CONCLUSIONS

Although the findings of this large-scale study reflect overall health-care satisfaction, issues are raised in relation to the quality of information families received, particularly for fathers. In addition, fathers may feel less included in their child's treatment pathway. These findings offer practical suggestions as to which areas of care could be targeted by all health professionals to improve parents' health-care experiences and promote overall familial adjustment.

Provision of Care for Families Affected by Craniofacial Conditions: The Views of Nonspecialist Health Professionals

OBJECTIVE

A diagnosis of a congenital craniofacial condition can have a significant impact on the psychological well-being of the affected family. As the first health professionals likely to come into contact with families, nonspecialists, such as diagnostic sonographers, midwives, and health visitors play a crucial role in facilitating familial adjustment. Yet, previous research has demonstrated parental dissatisfaction with the care delivered by nonspecialists. The aim of this study was to investigate the provision of care for families affected by craniofacial conditions from the perspective of nonspecialist health professionals, with a view to informing the development of educational materials.

DESIGN

Individual semistructured telephone interviews (n = 14) were conducted with 3 diagnostic sonographers, 2 fetal medicine consultants, 3 midwives, 4 health visitors, and 2 children's nurses.

RESULTS

Participants identified a range of barriers to the delivery of optimal care, including dealing with parental reactions, time pressure, hospital protocols and resources, a lack of contact with specialist craniofacial teams, and the emotional impact of delivering a diagnosis. Most participants had received no prior training in the area of congenital craniofacial conditions, while those who had felt current training materials were insufficient. All participants expressed a desire for further training and provided guidance regarding preferred content and format.

CONCLUSIONS

This study provides insight into the challenges faced by nonspecialists, as well as a range of information and training needs that could improve their knowledge and confidence. Suggestions for the development of educational materials for nonspecialist health professionals are made.