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Jones JT, Black LL, Black WR. Patient and Parent Knowledge, Understanding, and Concerns After a New Diagnosis of Ehlers Danlos Syndrome. RESEARCH SQUARE 2024:rs.3.rs-4433259. [PMID: 38946955 PMCID: PMC11213229 DOI: 10.21203/rs.3.rs-4433259/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Introduction After diagnosis of Ehlers Danlos Syndrome (EDS), it is unclear what information patients and parents need and understand about EDS. The objective of this study is to characterize patient and parent knowledge and concerns about EDS after a diagnosis of EDS is made to determine patient and parent concerns and identify barriers that cause discomfort with the diagnosis. Methods A convenience sample of patient and parent dyads were recruited after new diagnosis of EDS. Patients and parents completed questionnaires that assessed knowledge, comfort, and barriers of EDS before and after diagnosis, EDS education materials accessed, and additional clinical needs and concerns. Results Seventy-two dyads completed the survey. Conclusion Many respondents actively seek information on the diagnosis and management of EDS. Parents and patients look for information about EDS differently. Parents have more concerns after diagnosis and both want well-constructed, empirically supported educational materials delivered via multiple modalities, which makes clinical guidelines more essential.
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Affiliation(s)
| | | | - William R Black
- Abigail Wexner Research Institute at Nationwide Children's Hospital
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Black WR, Black LL, Jones JT. Barriers to the Diagnosis, Care, and Management of Pediatric Patients With Ehlers-Danlos Syndrome in the United States: A Qualitative Analysis. Glob Pediatr Health 2023; 10:2333794X231212081. [PMID: 38024462 PMCID: PMC10666714 DOI: 10.1177/2333794x231212081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives: Ehlers-Danlos Syndromes (EDS) are a family of heritable connective tissue diseases. Primary practitioners are capable of diagnosing and managing EDS; however, few are knowledgeable and comfortable enough to see patients with EDS, resulting in delays in diagnosis and care. This study explores the barriers physicians experience with diagnosing, managing, and caring for patients with EDS, and potential resolutions to those barriers. Methods: As part of a larger online study, providers (n = 107) in the United States were asked to specify "What information would improve (their) comfort" in diagnosing, caring for, and managing EDS via open-ended questions. Results: Providers reported wanting clinical practice guidelines, in formats that were easily accessible and usable, information on their roles in the management of EDS, the best ways to coordinate with specialty care, and available specialty consultation. Conclusions: Providers overall are willing to diagnose and treat EDS; however, additional supports and training are needed.
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Affiliation(s)
- William R. Black
- University of Kansas School of Medicine, Kansas City, KS, USA
- Center for Children’s Healthy Lifestyles and Nutrition, Kansas City, MO, USA
- The Ohio State University, Columbus, OH, USA
| | - Lora L. Black
- University of Kansas School of Medicine, Kansas City, KS, USA
- The Ohio State University, Columbus, OH, USA
| | - Jordan T. Jones
- Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
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Black WR, Jones JT, Rush ET, Malloy Walton L, Harding A. Development of a Multidisciplinary Clinic for Patients with Ehlers Danlos Syndromes: Considerations and Strategies. J Multidiscip Healthc 2023; 16:191-195. [PMID: 36714240 PMCID: PMC9875570 DOI: 10.2147/jmdh.s396221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/08/2023] [Indexed: 01/21/2023] Open
Abstract
Ehlers-Danlos Syndromes (EDS) is a group of connective tissue disorders often encountered within rheumatology clinics and is associated with several overlapping symptoms, which may require attention from other medical subspecialities. Barriers exist to implementing multidisciplinary care for EDS, including a lack of knowledge, comfort, and time managing EDS. In the absence of multidisciplinary care, patients are often forced to self-coordinate care. This can lead to gaps in care and a lack of clarity of medical ownership over the patient's care. Integrated multidisciplinary clinics are sorely needed, but the development and implementation of such clinics is limited by resources and personnel. As such, the development of a multidisciplinary clinic can be daunting and may serve to discourage providers with competencies in EDS from attempting to develop this service. In this editorial, we share our experiences in developing a multidisciplinary clinic for EDS at a moderately-sized children's hospital, relying on several core disciplines with established EDS clinical loads (ie, rheumatology, cardiology, genetics, and psychology). We discuss considerations for the expansion of this service, pitfalls, and barriers throughout the development of the clinic, and our rationale underlying our process-related decisions. Development of a greater number of multidisciplinary EDS clinics, even in the potential absence of larger institutional support, is both possible and imperative for improving EDS care globally.
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Affiliation(s)
- William R Black
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, KS, USA,Center for Children’s Healthy Lifestyles and Nutrition, Children’s Mercy Kansas City, Kansas City, MO, USA,Correspondence: William R Black, Department of Pediatrics, University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS, 66103, USA, Tel +1 913 588 6323, Email
| | - Jordan T Jones
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, KS, USA,Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Eric T Rush
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, KS, USA,Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Lindsey Malloy Walton
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, KS, USA,Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Jones JT, Black WR, Moser CN, Rush ET, Malloy Walton L. Gender dysphoria in adolescents with Ehlers-Danlos syndrome. SAGE Open Med 2022; 10:20503121221146074. [PMID: 36600979 PMCID: PMC9806399 DOI: 10.1177/20503121221146074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives Ehlers-Danlos Syndrome represents a family of heritable connective tissue disorders that include joint hypermobility, tissue fragility, and skin hyperextensibility. Ehlers-Danlos Syndrome presents with clinical sequela across multiple body systems that require multidisciplinary care. Little is known about adolescents with Ehlers-Danlos Syndrome who are transgender and gender diverse. To date, there have been no reports of transgender and gender diverse youth in pediatric patients with Ehlers-Danlos Syndrome. The objective of this study was to characterize transgender and gender diverse adolescents with Ehlers-Danlos Syndrome seen in a pediatric multidisciplinary specialty clinic. Methods A retrospective chart review was performed and it was found that 28 patients were seen in the Ehlers-Danlos Syndrome multidisciplinary clinic were reported being transgender and gender diverse. Chart review included analysis of all documents in the electronic medical record, including demographic data, gender identity, chosen pronouns, specialty care previously received for Ehlers-Danlos Syndrome, symptoms and conditions related to it, and medications. Results Of the 166 total adolescents seen in the pediatric multidisciplinary Ehlers-Danlos Syndrome clinic during the study period, 17% reported gender dysphoria. The average age at Ehlers-Danlos Syndrome diagnosis was 13.5 years (range 8-17 years). Most (61%) reported their gender identity as transgender, followed by nonbinary (14%). Most had preferred male (he/him) pronouns (47%), followed by nonbinary (they/them) pronouns (39%). The vast majority reported fatigue (75%), musculoskeletal issues (96%), psychiatric issues (86%), cardiac issues (71%), gastrointestinal issues (68%), and neurologic issues (79%). Conclusions Here we report the first cohort of transgender and gender diverse adolescents in the Ehlers-Danlos syndrome population and show an association between the two. This report increases awareness for providers who care for patients with Ehlers-Danlos Syndrome. As care for those with Ehlers-Danlos Syndrome is often complex and multidisciplinary, providers should adopt practices of gender-affirming medical care that contribute to improved care and outcomes.
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Affiliation(s)
- Jordan T. Jones
- Children’s Mercy Kansas City, Kansas
City, MO, USA,University of Missouri-Kansas City
School of Medicine, Kansas City, MO, USA,University of Kansas School of
Medicine, Kansas City, KS, USA,Jordan T. Jones, Department of Pediatrics,
Division of Rheumatology, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas
City, MO 64108, USA.
| | - William R. Black
- University of Kansas School of
Medicine, Kansas City, KS, USA,Center for Children’s Healthy
Lifestyles and Nutrition, Kansas City, MO, USA
| | - Christine N. Moser
- Children’s Mercy Kansas City, Kansas
City, MO, USA,University of Missouri-Kansas City
School of Medicine, Kansas City, MO, USA
| | - Eric T. Rush
- Children’s Mercy Kansas City, Kansas
City, MO, USA,University of Missouri-Kansas City
School of Medicine, Kansas City, MO, USA,University of Kansas School of
Medicine, Kansas City, KS, USA
| | - Lindsey Malloy Walton
- Children’s Mercy Kansas City, Kansas
City, MO, USA,University of Missouri-Kansas City
School of Medicine, Kansas City, MO, USA,University of Kansas School of
Medicine, Kansas City, KS, USA
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Jones JT, Black WR, Cogan W, Callen E. Resource utilization and multidisciplinary care needs for patients with Ehlers-Danlos syndrome. Mol Genet Genomic Med 2022; 10:e2057. [PMID: 36151850 PMCID: PMC9651604 DOI: 10.1002/mgg3.2057] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/23/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) represents a family of heritable connective tissue disorders with overlapping phenotypic features, frequently including joint hypermobility, tissue fragility, and skin hyperextensibility. Comorbid symptoms are common for patients with EDS and include multiple body systems marked by neurologic, cardiovascular, gastrointestinal, musculoskeletal issues, chronic pain, headaches, and anxiety and depression. The many comorbidities lead to high disease burden, which requires greater healthcare utilization. METHODS This survey of families examines healthcare utilization, of adults and minors, through evaluation of subspecialty care appointments across many healthcare systems in one region. RESULTS There were 155 adults and 83 minors with a diagnosis of EDS with a total of 693 unique visits across 27 different specialties at over 20 different hospitals or clinics in the surveyed area. Cardiology, neurology, and gastroenterology were the most utilized subspecialties for adults, while rheumatology, cardiology, and neurology were most utilized by minors. Many respondents (67%) reported their medical care needs are not being met, and 87% reported interest in a multidisciplinary clinic for EDS with the most interest in pain management, physical and occupational therapy, and rheumatology. CONCLUSION Understanding healthcare utilization and needs of those with EDS can provide the foundation for improved care for those with EDS through a coordinated multidisciplinary care model.
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Affiliation(s)
- Jordan T. Jones
- Department of PediatricsChildren's Mercy Kansas CityKansas CityMissouriUSA,Department of PediatricsUniversity of Missouri‐Kansas City School of MedicineKansas CityMissouriUSA,Department of PediatricsUniversity of Kansas School of MedicineKansas CityKansasUSA
| | - William R. Black
- Department of PediatricsUniversity of Kansas School of MedicineKansas CityKansasUSA,Center for Children's Healthy Lifestyles and NutritionChildren's Mercy Kansas CityKansas CityMissouriUSA
| | - Wendy Cogan
- EDSKC Collaboration Inc, A Non‐Profit Patient Advocacy OrganizationKansas CityMissouriUSA
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