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Wu JG, Guha C, Hughes A, Torrisi LG, Craig JC, Sinha A, Dart A, Eddy AA, Bockenhauer D, Yap HK, Groothoff J, Alexander SI, Furth SL, Samuel S, Carter SA, Walker A, Kausman J, Jaure A. Patient, Parental, and Health Professional Perspectives on Growth in Children With CKD. Am J Kidney Dis 2024:S0272-6386(24)00906-5. [PMID: 39127401 DOI: 10.1053/j.ajkd.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/09/2024] [Accepted: 06/18/2024] [Indexed: 08/12/2024]
Abstract
RATIONALE & OBJECTIVE Growth failure is a common problem among children with chronic kidney disease (CKD). Reduced height is associated with psychosocial burden, social stigma, and impaired quality of life. This study aimed to describe the aspects of growth impairment that are most impactful from the perspectives of children with CKD, their parents, and health professionals. STUDY DESIGN Qualitative study. SETTINGS & PARTICIPANTS 120 children with CKD (aged 8-21 years), 250 parents, and 445 health professionals from 53 countries participated in 16 focus groups, two consensus workshops, and a Delphi survey. ANALYTICAL APPROACH A thematic analysis of all qualitative data concerning growth from the Standardized Outcomes in Nephrology - Children and Adolescents (SONG-Kids) initiative. RESULTS We identified five themes: diminishing psychological wellbeing (compared to and judged by peers, tired of explaining to others, damaging self-esteem), constrained life participation and enjoyment (deprived of normal school experiences, excluded from sports or competing at a disadvantage, impaired quality of life in adulthood); grappling with impacts of symptoms and treatment (difficulty understanding short stature and accessing help, lack of appetite, uncertainty regarding bone pains, medication side effects, burden of growth hormone treatment); facilitating timely interventions and optimizing outcomes (early indicator of disease, assessing management, maximizing transplant outcomes, minimizing morbidity); and keeping growth and health priorities in perspective (quality of life and survival of utmost priority, achieved adequate height). LIMITATIONS Only English-speaking participants were included. CONCLUSIONS Impaired growth may diminish psychological wellbeing, self-esteem, and participation in daily activities for children with CKD. Balancing different treatments that can affect growth complicates decision-making. These findings may inform the psychosocial support needed by children with CKD and their caregivers to address concerns about growth.
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Affiliation(s)
- Justin G Wu
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Anastasia Hughes
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Luca G Torrisi
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Aditi Sinha
- Department of Pediatrics, Division of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Allison A Eddy
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Detlef Bockenhauer
- Paediatric Nephrology, University Hospital Leuven, Leuven, Belgium and UCL Department of Renal Medicine and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC Academic Medical Center, Amsterdam, The Netherlands
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan Samuel
- Section of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon A Carter
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Department of Nephrology and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Amanda Walker
- Department of Nephrology and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Joshua Kausman
- Department of Nephrology and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia. https://twitter.com/allisonjaure
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Storch B, Reigada LC. Utilizing a multisystemic model of resilience to synthesize research in youth with inflammatory bowel disease: a narrative review. Transl Gastroenterol Hepatol 2024; 9:45. [PMID: 39091650 PMCID: PMC11292072 DOI: 10.21037/tgh-24-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/23/2024] [Indexed: 08/04/2024] Open
Abstract
Background and Objective The study of resilience in youth with inflammatory bowel disease (IBD) is in early stages. The current review aims to illustrate how the use of a multisystemic framework may serve as a developmental and disease-appropriate framework for conceptualizing and designing resilience research for youth with IBD. Methods This is a narrative review; therefore, a comprehensive and systematic literature search was not conducted. Rather, the current paper aims to map selected existing literature to a multisystemic model as exemplars of how the model may be used in youth with IBD. Relevant literature was reviewed, synthesized, and mapped onto the proposed multi-systemic framework. Key Content and Findings The current review considers existing literature across three proposed dimensions of resilience: contexts of risk exposure, protective and promotive factors/processes, and desired outcomes. Review of each dimension includes consideration of selected existing literature to explain what is known about each dimension currently, as well as to propose additional potential future areas to broaden understanding. Specific key takeaways include: (I) understanding risk exposure in young people with IBD requires consideration of disease-specific, demographic, and sociocultural factors; (II) protective and promotive factors and processes for these young people span individual, familial, peer, school, and community levels; and (III) desired outcomes encompass both the absence of negative and the presence of positive indicators. Conclusions A multisystemic approach to the study of resilience in young people with IBD may not only clarify current gaps in the field, but also allow for additional future considerations to best understand how and for whom outcomes characterized as resilient may occur in this population.
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Affiliation(s)
- Barbara Storch
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA
| | - Laura C. Reigada
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA
- Brooklyn College, City University of New York, New York, NY, USA
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Silveira Bianchim M, Caes L, Forbat L, Jordan A, Noyes J, Thomson K, Turley R, Uny I, France EF. Understanding how children and young people with chronic non-cancer pain and their families experience living with pain, pain management and services: a meta-ethnography. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-218. [PMID: 39046284 DOI: 10.3310/utpm7986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Background Childhood chronic pain is a widespread public health issue. We need to understand how children with chronic pain and their families experience chronic pain and its management. Objectives To conduct a meta-ethnography on the experiences and perceptions of children with chronic pain and their families of chronic pain, treatments and services. We investigated how children and their families conceptualise and live with chronic pain; what they think of and want from health and social care services; and what they conceptualise as 'good' pain management. Design Meta-ethnography with stakeholder and patient and public involvement in the design, search and sampling strategies, analysis and dissemination. Review strategy: comprehensive searches of 12 bibliographic databases and supplementary searches in September 2022, to identify qualitative studies with children aged 3 months to 18 years with chronic non-cancer pain and their families. We included studies with rich explanatory data; appraised methodological limitations using the Critical Appraisal Skills Programme tool; and extracted, analysed and synthesised studies' findings. We used Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research to assess confidence in review findings. We integrated findings with 14 Cochrane treatment effectiveness reviews on children's chronic non-cancer pain. Results We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Studies had minor (n = 24) or moderate (n = 19) methodological limitations. Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research assessments of review findings were high (n = 22), moderate (n = 13) or very low confidence (n = 1). Moderate and severe chronic pain had profound adverse impacts on family members' well-being, autonomy and self-identity; family dynamics; parenting approaches; friendships and socialising; children's education and parental paid employment. Most children and families sought a biomedical cure for pain. They experienced difficulties seeking and receiving support from health services to manage pain and its impacts. Consequently, some families repeatedly visited health services. Cochrane reviews of intervention effects and trials did not measure some outcomes important to children and families, for example effects of pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work. Limitations There were limited data on common pain conditions like migraine/headache, abdominal pain; some rarer conditions; children with learning disabilities and under-fives; siblings; fathers and experiences of treatments/services. We excluded studies on cancer, end-of-life pain and experiences of healthcare professionals. Conclusions We developed the family-centred theory of children's chronic pain management, integrating health and social care with community support. Future work Future research should explore families' experiences of services and treatments, including opioids, and social care services; experiences of children with autism and learning disabilities, under 5 years old and with certain common pain conditions. We need development and testing of family-centred interventions and services. Study registration This study is registered as PROSPERO (CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (623). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Mayara Silveira Bianchim
- Nursing Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Abbie Jordan
- Department of Psychology and Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Jane Noyes
- School of Health Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Katie Thomson
- Nursing Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Ruth Turley
- Freelance Researcher, Nursing Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Emma F France
- Nursing Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Pascoe LA, Mikhail ME, Burt SA, Culbert KM, Klump KL. Shared genetic influences between eating disorders and gastrointestinal disease in a large, population-based sample of adult women and men. Psychol Med 2024; 54:1184-1195. [PMID: 37920985 DOI: 10.1017/s003329172300301x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Some preliminary research suggests higher rates of gastrointestinal disease in individuals with eating disorders (EDs). However, research is limited, and it remains unknown what etiologic factors account for observed associations. This was the first study to examine how EDs and dimensional ED symptoms (e.g. body dissatisfaction, binge eating) are phenotypically and etiologically associated with gastrointestinal disease in a large, population-based twin sample. METHODS Adult female (N = 2980) and male (N = 2903) twins from the Michigan State University Twin Registry reported whether they had a lifetime ED (anorexia nervosa, bulimia nervosa, or binge-eating disorder) and completed a measure of dimensional ED symptoms. We coded the presence/absence of lifetime gastrointestinal disease (e.g. inflammatory bowel disease) based on responses to questions regarding chronic illnesses and medications. We first examined whether twins with gastrointestinal disease had higher rates of EDs and ED symptoms, then used correlated factors twin models to investigate genetic and environmental contributions to the overlap between disorders. RESULTS Twins with gastrointestinal disease had significantly greater dimensional ED symptoms (β = 0.21, p < 0.001) and odds of a lifetime ED (OR 2.90, p = 0.001), regardless of sex. Shared genetic factors fully accounted for the overlap between disorders, with no significant sex differences in etiologic associations. CONCLUSIONS Comorbidity between EDs and gastrointestinal disease may be explained by overlap in genetic influences, potentially including inflammatory genes implicated in both types of disorders. Screening for gastrointestinal disease in people with EDs, and EDs in those with gastrointestinal disease, is warranted.
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Affiliation(s)
- Laura A Pascoe
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Megan E Mikhail
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - S Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Kristen M Culbert
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Turner ST, Focht G, Orlanski-Meyer E, Lev-Tzion R, Ledder O, Yogev D, Assa A, Shaoul R, Crowely E, Otley A, Griffiths AM, Turner D. Fatigue in pediatric inflammatory bowel diseases: A systematic review and a single center experience. J Pediatr Gastroenterol Nutr 2024; 78:241-251. [PMID: 38374545 DOI: 10.1002/jpn3.12039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES We aimed to review the literature on fatigue in pediatric inflammatory bowel diseases (PIBD), to explore how it is measured, and approximate its rate in an inception pediatric cohort. METHODS Studies on fatigue were systematically reviewed and selected by two authors. Next, we retrieved the two fatigue-related questions of the IMPACT-III questionnaire at 4 and 12 months after diagnosis from a prospectively maintained cohort of PIBD patients, each scoring 0-100 (lower scores imply more fatigue), and 44 healthy controls. RESULTS The systematic review identified 14 studies reporting fatigue in children, of which nine had fatigue as the primary outcome and only two provided rates of fatigue. No standalone index was identified for measuring fatigue specifically for PIBD. Of 80 children included in the inception cohort, 62 (78%) scored an average of ≤75 on the two IMPACT-III questions (approximating at least mild fatigue), 26 (33%) scored ≤50 (at least moderate fatigue) and nine (11%) scored ≤25 (severe fatigue). In comparison, only four (9%) healthy children scored at least moderate fatigue (p = 0.007). Fatigue rates at 12 months were only slightly and nonsignificantly lower. Fatigue of any severity was reported in 92% children with active disease versus 63% of those in clinical remission (p = 0.01). CONCLUSION Literature reporting on fatigue in PIBD is scarce, and no PIBD-specific tool is available to measure fatigue. In our cohort, fatigue-related questions were frequently scored low in children with IBD, mainly among children with active disease but also during clinical remission.
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Affiliation(s)
- Shira T Turner
- Department of Psychology, Ben Gurion University of the Negev, Beersheba, Israel
| | - Gili Focht
- The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Orlanski-Meyer
- The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raffi Lev-Tzion
- The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Oren Ledder
- The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dotan Yogev
- The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Assa
- The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ron Shaoul
- Faculty of Medicine, Pediatric Gastroenterology & Nutrition Institute, Ruth Children's Hospital of Haifa, Rambam Medical Center, Technion, Haifa, Israel
| | - Eileen Crowely
- Schulich School of Medicine and Dentistry, Division of Pediatric Gastroenterology, Western University, Children's Hospital of Western Ontario, London Health Sciences Center, and Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Anthony Otley
- Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne M Griffiths
- Department of Gastroenterology, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Dan Turner
- The Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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Dotson JL, Bricker J, Chisolm DJ, Mackner LM. Patient, Parent, and Provider Perceptions of Barriers to Pediatric Inflammatory Bowel Disease Care. JPGN REPORTS 2023; 4:e386. [PMID: 38034447 PMCID: PMC10684132 DOI: 10.1097/pg9.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 07/15/2023] [Indexed: 12/02/2023]
Abstract
Objectives Children with inflammatory bowel disease (IBD) have a significant life-long burden as a result of disease, impacted by environmental and individual barriers. Successful health system interventions require a comprehensive approach, informed by various stakeholders. The main objective was to identify health system barriers and potential solutions from existing patients, families, and providers via focus groups. Methods Participants for the focus groups were existing English-speaking patients (ages 9-18) with IBD, their caregiver(s), and providers including multiple professions (eg, physician, nurse, pediatrician, social worker, care coordinator, scheduler, and psychologist). Separate focus groups were led by experienced personnel for parents, children, and providers, using a standardized interview guide. Sessions were recorded, transcribed, and verified. Using content analysis, we systematically classified data through coding and identified themes. Results Focus groups comprised (a) 3 patient groups (n = 20, 50% female, including 2 younger; mean age = 11.4 ± 1.5 years) and 1 older group (mean age = 15.6 ± 1.3 years), (b) 3 parent groups (n = 24, 83% female), and (c) 2 multidisciplinary provider groups (n = 19). Families shared several common concerns with providers (eg, school, care delay, psychosocial, and financial) but varied on specifics. Some barriers may be addressable through family or staff education, improved communication (eg, care delay/ access, transition), or training (eg, labs and diet), while others may require change at an institutional or policy level (eg, insurance). Conclusions This qualitative analysis identified several barriers to IBD care, some shared, some unique to patients, parents, and providers, highlighting the importance of obtaining multiple stakeholder perspectives when exploring barriers to care.
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Affiliation(s)
- Jennifer L. Dotson
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
- The Center for Child Health Equity and Outcomes Research, The Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Josh Bricker
- The Center for Child Health Equity and Outcomes Research, The Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Deena J. Chisolm
- The Center for Child Health Equity and Outcomes Research, The Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Laura M. Mackner
- The Center for Biobehavioral Health, The Research Institute, Nationwide Children’s Hospital, Columbus, OH
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France E, Uny I, Turley R, Thomson K, Noyes J, Jordan A, Forbat L, Caes L, Silveira Bianchim M. A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments. Cochrane Database Syst Rev 2023; 10:CD014873. [PMID: 37795766 PMCID: PMC10552070 DOI: 10.1002/14651858.cd014873.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.
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Affiliation(s)
- Emma France
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Turley
- Development Directorate, Cochrane Central Executive, Cochrane, London, UK
| | - Katie Thomson
- Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Line Caes
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Mayara Silveira Bianchim
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Centre for Population Health and Wellbeing Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Wang Y, Zhang C, Zhou Y. Reconstructing self from the illness: a constructivist grounded theory study of posttraumatic growth in patients with Crohn's disease. BMC Gastroenterol 2023; 23:244. [PMID: 37464276 DOI: 10.1186/s12876-023-02878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Some patients with Crohn's disease report posttraumatic growth, which can promote reductions in anxiety and depression, and improve the patient's quality of life. However, the process of posttraumatic growth remains unclear. The objectives of this study were to explore the social-psychological process of posttraumatic growth in patients with Crohn's disease in the context of Chinese culture and construct an interpretive understanding based on the perspectives of patients. METHODS This research adopted Charmaz's constructivist grounded theory. Nineteen participants with Crohn's disease were selected by purposive and theoretical sampling from three hospitals in Hangzhou, Zhejiang Province, as well as from the China Crohn's & Colitis Foundation. In-depth interviews were conducted. Data analysis was based on initial, focused and theoretical coding strategies, and methods such as constant comparison and memo writing were adopted. The Consolidated Criteria for Reporting Qualitative Research, a 32-item checklist for interviews and focus groups, was utilised. RESULTS An interpretive understanding of posttraumatic growth in patients with Crohn's disease was constructed. The core category was "reconstructing self from the illness", which included the following four categories: "suffering from the illness", "accepting the illness", "dancing with the illness" and "enriching life beyond the illness". However, not every patient reached the last phase. Before patients enter the next stage, they might begin a new cycle by experiencing new suffering or discovering new unacceptable facts about the illness. CONCLUSIONS This interpretive understanding reveals a growth process centred on "reconstructing self from the illness". These findings provide knowledge on the process of posttraumatic growth in patients with Crohn's disease within the wider sociocultural context.
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Affiliation(s)
- Ying Wang
- School of Nursing, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang, China
| | - Chen Zhang
- School of Nursing, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang, China.
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Brown SC, Wall CL, Gearry RB, Day AS. Exclusive Enteral Nutrition for the Treatment of Pediatric Crohn's Disease: The Patient Perspective. Pediatr Gastroenterol Hepatol Nutr 2023; 26:165-172. [PMID: 37214167 PMCID: PMC10192588 DOI: 10.5223/pghn.2023.26.3.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/16/2023] [Accepted: 02/12/2023] [Indexed: 05/24/2023] Open
Abstract
Crohn's disease (CD) is a chronic, incurable and relapsing disease involving any part of the gastrointestinal tract and exclusive enteral nutrition (EEN) is first-line therapy. Few studies have examined the patient experience of EEN. The aim of this study was to assess the child' s experiences of EEN, to identify problematic themes and understand the child's mindset. Children with CD who previously completed EEN were recruited to complete a survey. All data were analyzed using Microsoft Excel and reported as N (%). Forty-four children (mean age 11.3 years) consented to participate. Sixty-eight percent of children reported limited formula flavors as the most challenging aspect and 68% of children identified 'support' to be important. This study highlights the psychological impact of chronic disease and its therapies on children. Providing adequate support is essential to insure EEN is successful. Further studies are required to determine psychological support strategies for children taking EEN.
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Affiliation(s)
| | - Catherine L Wall
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Richard B Gearry
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
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10
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Chen L, Wang D, Zhou Y. The Illness Experiences of Chinese Adolescent Patients Living with Crohn Disease: A Descriptive Qualitative Study. Gastroenterol Nurs 2023; 46:95-106. [PMID: 36882914 DOI: 10.1097/sga.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 11/18/2022] [Indexed: 03/09/2023] Open
Abstract
The purpose of this qualitative study was to explore the illness experience of adolescent patients with Crohn disease and describe the impact of the disease on the everyday lives of these individuals within the Chinese social and cultural context to provide references for targeted interventions for the healthcare team. A descriptive qualitative design was adopted. Purposive sampling was used to select Chinese adolescent patients with Crohn disease to participate in face-to-face in-depth interviews. Data analysis was performed using the conventional content analysis method. Through the analysis of data from 14 adolescent patients with Crohn disease, four themes were formed: (1) I am different from others, (2) I am a burden to my parents, (3) I want to be the master of my own body, and (4) I grow up suffering from illness. Healthcare providers should offer more psychological support to adolescent Crohn disease patients and advise parents to shift more attention to the mental health of their children.
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Affiliation(s)
- Lingxi Chen
- Lingxi Chen, MSN, is RN, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Danyan Wang, MSN, is RN, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Yunxian Zhou, PhD, is Professor, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Danyan Wang
- Lingxi Chen, MSN, is RN, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Danyan Wang, MSN, is RN, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Yunxian Zhou, PhD, is Professor, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yunxian Zhou
- Lingxi Chen, MSN, is RN, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Danyan Wang, MSN, is RN, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Yunxian Zhou, PhD, is Professor, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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11
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Malloy C, Rawl SM, Miller WR. Inflammatory Bowel Disease Self-Management: Exploring Adolescent Use of an Online Instagram Support Community. Gastroenterol Nurs 2022; 45:254-266. [PMID: 35833744 PMCID: PMC9425855 DOI: 10.1097/sga.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022] Open
Abstract
The purpose of this qualitative study was to explore the challenges adolescents with inflammatory bowel disease (IBD) experience with disease self-management as expressed in an online Instagram social support community. Public Instagram posts between January and December 2019 were manually collected from an online IBD support community. To focus on adolescent self-management needs, only posts from Instagram users who (1) indicated they had inflammatory bowel disease, (2) were 13-24 years old, or were in middle school, high school, or college were collected. Using thematic analysis, authors independently coded and identified emerging themes about self-management. Of 2,700 Instagram posts assessed for eligibility, 83 posts met inclusion criteria. Six major themes about inflammatory bowel disease self-management emerged: Desire for Normalcy, Dietary Changes, Education and Career, Healthcare System, Relationships With Others, and Symptoms and Complications. As the first thematic analysis of Instagram posts in an online inflammatory bowel disease community, results provide a crucial perspective of the concerns of adolescents with inflammatory bowel disease. Self-management challenges were wide-ranging and complex, underscoring the importance of IBD self-management in the adolescent population. Nurses should take a holistic approach to assess self-management challenges and tailor care to the specific needs of adolescents living with inflammatory bowel disease.
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12
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Sunavsky A, Moreau J, Tripp DA. Understanding Perceived Stress in Adolescent Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2022; 5:79-85. [PMID: 35368321 PMCID: PMC8972323 DOI: 10.1093/jcag/gwab036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) is a chronic and debilitating illness associated with psychosocial comorbidities. Adolescents are vulnerable to the additive stress of managing IBD and navigating developmental milestones. Psychosocial factors, such as catastrophizing, illness stigma, illness uncertainty, and illness-related shame, often contribute to perceived stress in chronic illnesses. However, the combination of these variables on perceived stress in adolescents with IBD has not been examined. Methods Participants completed a cross-sectional online self-report survey. Model 4 of PROCESS Macro in SPSS was used to test the parallel mediation model of the relationship between disease severity and perceived stress using catastrophizing, stigma, uncertainty, and shame as mediators using 10,000 bootstrap samples. T-tests were run to assess systematic differences in the dependent variable between subjects. Results One hundred and thirty-one adolescents (Mage = 18.95 years; 100 females) completed the survey. Females had higher stress scores than males (P =0.002), and there were no difference in stress between younger and older participants (P = 0.085), location (P = 0.484), or IBD type (P = 0.515). The total effect of disease stress on perceived stress operating through the mediators was significant, b = 0.168, SE = 0.028, 95% CI [0.112, 0.224]. Helplessness catastrophizing, illness uncertainty, and illness-related shame, but not illness stigma, were equally strong, positive mediators. Conclusions The present results suggest that helplessness catastrophizing, illness uncertainty, and illness-related shame are central elements to target in stress interventions for adolescents with IBD.
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Affiliation(s)
- Adam Sunavsky
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Julia Moreau
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Dean A Tripp
- Departments of Psychology, Anesthesiology and Urology, Queen's University, Kingston, Ontario, Canada
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13
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Explaining the Disease Management Experiences of Patients With Inflammatory Bowel Disease: A Qualitative Study. Gastroenterol Nurs 2022; 45:52-58. [PMID: 35108242 DOI: 10.1097/sga.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022] Open
Abstract
Inflammatory bowel disease is an unpredictable, chronic, recurrent gastrointestinal disorder with a wide range of social, physical, and psychological problems experienced by patients. The identification of these concerns is important to provide better healthcare. The purpose of this study was to understand the experiences and concerns of these patients. This study was conducted using a qualitative content analysis approach. The participants were 20 inflammatory bowel disease patients. Data were collected through unstructured interviews with purposive sampling and continued until data saturation. Data were comparatively analyzed continuously and simultaneously with data collection. Data analysis revealed two themes of "tension due to possible recurrence" and "fear of decline and deterioration." The integration of these concepts suggested that patients experience "sinking into the marsh of recurrence" as a major concern that disrupts their successful management of inflammatory bowel disease. Identifying the concerns of inflammatory bowel disease patients regarding their cultural and social context is of paramount importance. The integration of such concerns into treatment can improve patients' coping abilities and improve their quality of life.
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14
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Balbale SN, Schäfer WLA, Davis T, Blake SC, Close S, Perry JE, Zarate RP, Ingram MC, Strople J, Johnson JK, Holl JL, Raval MV. Age- and Sex-Specific Needs for Children Undergoing Inflammatory Bowel Disease Surgery: A Qualitative Study. J Surg Res 2022; 274:46-58. [PMID: 35121549 DOI: 10.1016/j.jss.2021.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/10/2021] [Accepted: 12/27/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The use of enhanced recovery protocols (ERP) is extending to pediatric surgical populations, such as patients with inflammatory bowel diseases (IBDs). Given the variation in age- and sex-specific characteristics of pediatric IBD patients, it is important to understand the unique needs of subgroups, such as male versus female or preadolescent versus older patients, when implementing ERPs. We gathered clinician, patient, and caregiver perspectives on age- and sex-specific needs for children undergoing IBD surgery. METHODS We used semistructured interviews and focus groups to assess ERP needs and perceived differences in needs between preadolescent (10-13 y), older (14-19 y), male, and female IBD patients. Participants included clinicians, patients who had recent IBD surgery, and patients' caregivers. RESULTS Forty-eight clinicians, six patients, and eight caregivers participated. Three broad categories of themes emerged: concerns, needs, and experiences related to the (1) surgical care process; (2) continuum of IBD care; and (3) suggestions to make surgical care more patient centered. With regard to surgical care processes, stakeholders reported different communication needs for preadolescent and older children. Key themes about the continuum of IBD care were the need (1) for support from child life specialists and (b) to address young women's health issues. Suggestions to make surgical care more patient centered included providing older children with patient experiences that reflect their perspective as young adults. CONCLUSIONS The findings highlight the need to adopt a patient-centered approach for ERP use that actively addresses age- and sex-specific factors while engaging patients and caregivers as partners with clinicians to improve surgical care for children with IBD.
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Affiliation(s)
- Salva N Balbale
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Willemijn L A Schäfer
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Teaniese Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Sarah C Blake
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sharron Close
- Department of Pediatric Advanced Practice Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Joseph E Perry
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Raul Perez Zarate
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Martha-Conley Ingram
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jennifer Strople
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Julie K Johnson
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jane L Holl
- Department of Neurology, Biological Sciences Division and Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, Illinois
| | - Mehul V Raval
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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15
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Barned C, Fabricius A, Stintzi A, Mack DR, O'Doherty KC. "The Rest of my Childhood was Lost": Canadian Children and Adolescents' Experiences Navigating Inflammatory Bowel Disease. QUALITATIVE HEALTH RESEARCH 2022; 32:95-107. [PMID: 34818940 DOI: 10.1177/10497323211046577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Children and adolescents with Inflammatory Bowel Disease (IBD) face significant and unique challenges related to their condition. The aim of this study was to better understand some of these challenges, and to explore how Canadian youth respond to them. We interviewed 25 pediatric patients with IBD, ranging in age from 10-17, to find out about their illness experiences. Using a thematic analysis, we discerned three themes: challenges related to diagnosis, making sense of change, and navigating sociability. Taken together, they paint a picture of young people facing great uncertainty prior to diagnosis, pronounced changes to selfhood as they make lifestyle adjustments, and facing difficulties with the implications of reduced sociability because of their disease. We conclude by providing recommendations for the development of resources aimed at helping newly diagnosed pediatric patients navigate these issues.
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Affiliation(s)
- Claudia Barned
- UHN Bioethics Program, 7989University Health Network, Toronto, Canada
- Pragmatic Health Ethics Research Unit, 5598Institut de recherches Cliniques de Montreal, Montreal, Canada
| | - Alexis Fabricius
- Department of Psychology, 3653University of Guelph, Guelph, Canada
| | - Alain Stintzi
- Ottawa Institute of Systems Biology and Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, 6363University of Ottawa, Ottawa, Canada
| | - David R Mack
- Children's Hospital of Eastern Ontario (CHEO) IBD Centre and Department of Pediatrics, 27338University of Ottawa, Ottawa, Canada
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16
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Tempchin J, Storch B, Reigada LC. Systematic review: Psychosocial factors of resilience in young people with inflammatory bowel disease. J Psychosom Res 2021; 148:110558. [PMID: 34280678 DOI: 10.1016/j.jpsychores.2021.110558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/10/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Inflammatory bowel disease (IBD) affects a growing number of young people. While factors associated with poor disease experience in pediatric IBD have garnered much attention in the literature, less attention has focused on the factors associated with the resilient outcomes seen in the majority of young people with IBD. This review seeks to contribute to the literature by synthesizing research on the psychosocial factors that promote resilience in pediatric IBD and by offering future directions for the field. METHODS Systematic searches of the MEDLINE, Embase, PsychInfo, and CINAHL databases were performed for quantitative English-language studies with keywords for IBD, resilience or factors of resilience, and pediatric populations, with no date restrictions. Reference lists of all included articles were searched. Quality assessments were performed using an NIH tool. RESULTS Of 3315 articles identified, 17 were included. Studies were heterogeneous, with 19 psychosocial factors identified and analyzed for associations with over two dozen indicators of resilience. A narrative synthesis of included studies was performed. Study details were organized into three domains-individual, social, and family. Preliminary data indicate that resilience in pediatric IBD may be associated with positive body image, increased mindfulness, and improved social functioning, among other potential factors. CONCLUSIONS Resilience in pediatric IBD is largely unstudied. Only one study pursued an understanding of resilience as an aim, and no studies incorporated validated measures of resilience. Future prospective, theory-driven research is needed to elucidate the network of factors and mechanisms that can foster resilience in children and adolescents with IBD.
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Affiliation(s)
- Jacob Tempchin
- Quantitative Methods in the Social Sciences, The Graduate Center, City University of New York, New York, NY, USA.
| | - Barbara Storch
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA.
| | - Laura C Reigada
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA; Psychology Department, Brooklyn College, City University of New York, Brooklyn, NY, USA.
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17
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Gelech J, Desjardins M, Mazurik K, Duerksen K, McGuigan-Scott K, Lichtenwald K. Understanding Gut Feelings: Transformations in Coping With Inflammatory Bowel Disease Among Young Adults. QUALITATIVE HEALTH RESEARCH 2021; 31:1918-1936. [PMID: 33980095 PMCID: PMC8446882 DOI: 10.1177/10497323211011442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Past studies have revealed a dizzying array of coping techniques employed by persons living with inflammatory bowel disease (IBD). Unfortunately, research has provided little insight into when and why individuals adopt or abandon particular coping strategies. Using a retrospective narrative approach, we explored how participants made sense of changes in their approach to coping over time. Shifts in coping strategies were associated with particular illness experiences that wrought new understandings of IBD and novel identity challenges. They followed a common processual form and were marked by a movement away from techniques of purification, normalization, and banalization toward the development of a more communicative body. This was accompanied by notable shifts in identity work. Notably, participants moved from a preoccupation with maintaining continuity and sameness to permitting their extraordinary bodies to occupy a place in their public and personal identities. Implications of this process for theory and practice are discussed.
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Affiliation(s)
- Jan Gelech
- University of Saskatchewan,
Saskatoon, Saskatchewan, Canada
| | | | | | - Kari Duerksen
- University of Victoria, Victoria,
British Columbia, Canada
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18
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Muse K, Johnson E, David AL. A Feeling of Otherness: A Qualitative Research Synthesis Exploring the Lived Experiences of Stigma in Individuals with Inflammatory Bowel Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158038. [PMID: 34360327 PMCID: PMC8345596 DOI: 10.3390/ijerph18158038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/18/2022]
Abstract
Inflammatory bowel disease (IBD) consists of Crohn’s disease and ulcerative colitis, chronic conditions involving inflammation and ulceration of the gastrointestinal tract. Individuals with IBD may be susceptible to experiencing health-related stigma: experienced, perceived, or internalised social exclusion, rejection, blame, or devaluation resulting from negative social judgements based on the disease. This qualitative research synthesis draws together findings from 38 studies describing lived experiences to develop a unified interpretative account of the experience of stigma in IBD. Analysis developed two categories: ‘The IBD journey’ explores the dynamic ways in which having IBD impacted on individuals’ self-identity and ‘a need to be understood’ examines the tension between wanting to be understood whilst feeling their true experiences needed to be hidden from or were misjudged by the social sphere. The overarching concept ‘feeling of otherness’ highlights that, rather than a static, binary experience, individuals moved across a continuum ranging from the excluding experience of feeling stigmatised and othered, to the inclusive experience of integration. Individuals fluctuated along this continuum across different physical, social, and health contexts. Psychological adjustment to IBD, drawing on experience of adaptive coping, and reconnecting with valued others through illness disclosure strengthened stigma resistance during more challenging times.
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Affiliation(s)
- Kate Muse
- School of Psychology, University of Worcester, Worcester WR2 6AJ, UK
- Correspondence:
| | - Emma Johnson
- Children’s Psychological Medicine, Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; (E.J.); (A.L.D.)
| | - Annabel L. David
- Children’s Psychological Medicine, Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; (E.J.); (A.L.D.)
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Fisher K, Byham-Gray L, Rothpletz-Puglia P. Characterizing the Parental Perspective of Food-Related Quality of Life in Families After Pediatric Inflammatory Bowel Disease Diagnosis. Gastroenterol Nurs 2021; 44:E69-E77. [PMID: 34149042 DOI: 10.1097/sga.0000000000000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
Food-related quality of life is defined as achieving adequate nutrition, deriving pleasure, and maintaining social activities through eating and drinking. The objective of this qualitative study was to characterize the parental perspective about eating experiences and family functioning after diagnosis of inflammatory bowel disease in their child in order to describe how these experiences may impact food-related quality of life. Semistructured interviews were completed with 10 parents of a child with inflammatory bowel disease. Conventional content analysis was conducted with steps to ensure trustworthiness. Family Systems Theory was the interpretive framework. Ambiguous nutrition information emerged as the main theme. Families experienced various and conflicting viewpoints regarding the role of diet, which presented a challenge after diagnosis. Parents reported frustration regarding the lack of uniform and personalized nutrition guidance. Our results support that families desire shared decision-making in regard to medication and diet, which is an important clinical practice implication for the entire gastroenterology medical team. Understanding the challenges faced by families after a major medical diagnosis in a child provides insight into designing medical interventions that maintain optimal quality of life in families.
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Affiliation(s)
- Kelly Fisher
- Kelly Fisher, DCN, RD, CSP, LD, is Assistant Professor of Professional Practice, Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas
- Laura Byham-Gray, PhD, RD, LD, FNKF, is Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
- Pamela Rothpletz-Puglia, EdD, RD, LD, is Associate Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
| | - Laura Byham-Gray
- Kelly Fisher, DCN, RD, CSP, LD, is Assistant Professor of Professional Practice, Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas
- Laura Byham-Gray, PhD, RD, LD, FNKF, is Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
- Pamela Rothpletz-Puglia, EdD, RD, LD, is Associate Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
| | - Pamela Rothpletz-Puglia
- Kelly Fisher, DCN, RD, CSP, LD, is Assistant Professor of Professional Practice, Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas
- Laura Byham-Gray, PhD, RD, LD, FNKF, is Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
- Pamela Rothpletz-Puglia, EdD, RD, LD, is Associate Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
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20
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Shih S, Cushman G, Reed B. Temperament and Health-Related Quality of Life in Newly Diagnosed Pediatric Inflammatory Bowel Disease. J Pediatr Psychol 2021; 46:404-412. [PMID: 33270892 DOI: 10.1093/jpepsy/jsaa116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Health-related quality of life (HRQOL) is typically examined from a deficit standpoint, meaning that little is known about factors associated with higher HRQOL in pediatric illness samples. The aim of the current study was to investigate demographic, disease, and temperamental factors associated with child and parent-report of HRQOL in youth newly diagnosed with inflammatory bowel disease (IBD). METHODS Participants included 52 youth ages 8-17 diagnosed with IBD and their caregivers who each completed ratings of the child's HRQOL. Parents rated their child's emotional reactivity, conceptualized as a temperamental risk factor, and adaptability, conceptualized as a temperamental protective factor. Disease symptoms were rated by youth, and physician global assessment of disease activity was obtained. RESULTS HRQOL was rated lower by children and their parents as self-reported disease symptoms and parent-rated emotional reactivity increased. Conversely, total HRQOL was higher for children with higher parent-ratings of adaptability. In multiple regression analyses, higher levels of adaptability along with male sex and lower child-reported disease symptoms were associated with higher child and parent-reported HRQOL. CONCLUSIONS Higher HRQOL at time of diagnosis in pediatric IBD is associated with greater adaptability when accounting for variability due to child sex and disease symptoms. Consideration of temperament, including emotional reactivity and adaptability, may offer insight into patients' typical ways of responding when stressed and provide preliminary information about factors related to post-diagnosis HRQOL. Attention should be given to both protective and risk factors to inform future intervention development, including strengths-based approaches.
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21
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Kum DJ, Bang KS. Body image, self-esteem, and quality of life in children and adolescents with inflammatory bowel disease in a tertiary hospital in South Korea. CHILD HEALTH NURSING RESEARCH 2021; 27:181-189. [PMID: 35004508 PMCID: PMC8650903 DOI: 10.4094/chnr.2021.27.2.181] [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] [Received: 02/22/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE This study aimed to examine body image, self-esteem, and quality of life (QOL) in children and adolescents with inflammatory bowel disease (IBD) and to analyze factors influencing QOL. METHODS This descriptive study involved 87 participants at a tertiary hospital aged 10 to 18 years who were diagnosed with IBD. Body image, self-esteem, and QOL were measured. Descriptive analysis, the independent t-test, the Mann-Whitney U test, analysis of variance, Pearson correlation analysis, and stepwise multiple regression were used for data analysis. RESULTS The average score was 16.95±3.55 for body image, 31.32±5.25 for self-esteem, and 78.64±15.98 for QOL. Height, weight, hospitalization experience, current symptoms, and consumption of oral steroids showed statistically significant effects on QOL. The most significant predictors of QOL were self-esteem (β=.31, p=.002), body image (β=.28, p=.005), number of symptoms (β=-.25, p=.004), and number of hospitalizations in the last year (β=-.24, p=.004). CONCLUSION To improve the QOL of children and adolescents with IBD, it is necessary to evaluate self-esteem, body image, and physical problems. In addition, various intervention strategies to improve self-esteem and body image and to reduce physical discomfort should be developed.
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Affiliation(s)
- Da Jeong Kum
- Doctoral Candidate, College of Nursing, Seoul National University, Seoul, Korea
| | - Kyung-Sook Bang
- Professor, College of Nursing · Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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Shaygan M, Jaberi A. The effect of a smartphone-based pain management application on pain intensity and quality of life in adolescents with chronic pain. Sci Rep 2021; 11:6588. [PMID: 33758322 PMCID: PMC7988051 DOI: 10.1038/s41598-021-86156-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/11/2021] [Indexed: 11/09/2022] Open
Abstract
The development, implementation, and qualitative evaluation of smartphone-based pain management applications may provide an opportunity for more optimal management of pediatric pain in the homesetting. The present mixed-method study was conducted to assess a smartphone-based pain management application regarding the feasibility, adherence, participant satisfaction, and effectiveness on pain intensity and quality of life in adolescents with chronic pain. The study was carried out in the quantitative and qualitative stages using a mixed-method approach. The quantitative stage included 128 adolescents who met the ICD-11 criteria of chronic pain. After random allocation, adolescents allocated to the intervention group received a pain management program through a smartphone-based application. No education was given to the adolescents in the control group. The adolescents were assessed regarding pain intensity and different dimensions of quality of life at pre-intervention, post-intervention, and three-month follow-up. The findings in the quantitative stage were explained by qualitative interviews. The findings of the quantitative stage showed significant improvements in the pain intensity, emotional, social, and school functioning but not in the physical functioning of the adolescents. A high level of adherence (78.12%) and satisfaction (Mean = 26.45, SD = 6.45) with thes martphone-based pain management program was found. Based on the qualitative interviews, adolescents' pain management strategies can be classified in three main categories: physical management, psychological management, and interpersonal resources. The results confirm the positive effect of a smartphone-based pain management program on the pain intensity and different dimensions of quality of life of adolescents with chronic pain. Within the context of chronic pain management, a mobile application incorporating both the psychological and physical management of pain may help adolescents with chronic pain to reduce the negative impacts of pain on their life.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Jaberi
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Touma N, Varay C, Baeza-Velasco C. Determinants of quality of life and psychosocial adjustment to pediatric inflammatory bowel disease: A systematic review focused on Crohn's disease. J Psychosom Res 2021; 142:110354. [PMID: 33465493 DOI: 10.1016/j.jpsychores.2020.110354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Crohn's disease is a chronic and unpredictable inflammatory bowel disease that leads to important psychosocial difficulties especially during sensitive developmental stages such as childhood and adolescence. While risk factors for mood disorders have been identified in the literature, those for quality of life and psychosocial functioning have not. OBJECTIVE This systematic review explored the determinants of quality of life and psychosocial adjustment to pediatric Crohn's disease. METHOD Four international databases were consulted in March 2020: PubMed, PsychInfo, PubPsych and Cochrane Library. A series of keywords were entered in each database to identify the most recent relevant studies. RESULTS One hundred and sixty-eight articles were identified, of which twenty-nine met the inclusion criteria. The majority explored the determinants of quality of life, depression and anxiety, with a few focusing on psychosocial functioning. Consistently with the literature on psychological morbidity, disease activity and parental stress were also strong predictors of quality of life and psychosocial functioning. New evidence showed that abdominal pain, negative illness perceptions and internalizing symptoms were also common predictors of these outcomes. CONCLUSIONS Some risk factors of quality of life, distress and psychosocial functioning are similar, which could indicate that some patients could be at risk of presenting an accumulation of difficulties adjusting to the disease. The identification of these risk factors is fundamental to propose appropriate interventions. Therapeutic education, therapies focused on pain management or on the parent-child relationship can be considered to allow a better adjustment or prevent difficulties.
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Affiliation(s)
- Nathalie Touma
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France.
| | - Caroline Varay
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France
| | - Carolina Baeza-Velasco
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France; Department of Psychiatric Emergency and Post-Emergency, Montpellier University Hospital Center, 371 Av du Doyen Gaston Giraud, 34090 Montpellier, France
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Cushman G, Stolz MG, Shih S, Listernick Z, Talmadge C, Gold BD, Reed B. Age, Disease Symptoms, and Depression are Associated With Body Image Dissatisfaction in Newly Diagnosed Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2021; 72:e57-e62. [PMID: 32925551 PMCID: PMC7870553 DOI: 10.1097/mpg.0000000000002943] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Body image refers to the subjective, mental representation one makes regarding their physical appearance. Children and adolescents with inflammatory bowel disease (IBD) may be prone to experiencing negative self-evaluations regarding their body image given disease-related symptoms and treatment side-effects. In this study, we aimed to examine demographic, medical, and psychosocial variables related to body image dissatisfaction (BID) in pediatric patients diagnosed with IBD and to determine which variables are most predictive of higher dissatisfaction. METHODS A total of 52 youth newly diagnosed with IBD (Crohn's disease, ulcerative colitis, indeterminate colitis) ages 8 to 17 years completed questionnaires regarding their psychosocial functioning (ie, depression, anxiety, health-related quality of life, stress), disease symptoms, and BID. BID was assessed using the modified Adapted Satisfaction with Appearance questionnaire, yielding a total score and subscale scores assessing Perceived Social Impact and Subjective Dissatisfaction. Physician global assessment of disease activity and demographic and medical characteristics were abstracted from electronic chart review. RESULTS Youth endorsed low overall BID concerns but noted the highest dissatisfaction with their abdomen, chest, and arms. Older child age, greater patient-reported disease symptoms, and worse depression symptoms were most strongly associated with overall body dissatisfaction when evaluated in a hierarchical regression model. CONCLUSIONS Demographic, disease-related, and psychosocial factors are associated with BID in youth newly diagnosed with IBD. Given associations between BID and adverse health outcomes in healthy youth, these findings highlight a unique opportunity to improve screening and interventions for BID in patients with IBD.
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25
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Roberts CM, Gamwell KL, Baudino MN, Grunow JE, Jacobs NJ, Tung J, Gillaspy SR, Hommel KA, Mullins LL, Chaney JM. The Contributions of Illness Stigma, Health Communication Difficulties, and Thwarted Belongingness to Depressive Symptoms in Youth with Inflammatory Bowel Disease. J Pediatr Psychol 2020; 45:81-90. [PMID: 31633787 DOI: 10.1093/jpepsy/jsz084] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/21/2019] [Accepted: 09/22/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Youth with inflammatory bowel disease (IBD) often experience difficulties communicating about their disease. It is suspected that the stigmatizing nature of IBD symptoms contributes to youths' health communication difficulties, leaving youth feeling disconnected from their social environment and potentially resulting in decreased social belongingness and poorer emotional functioning. In this study, we tested an illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms serial mediation model. It was anticipated that youth illness stigma would confer a serial indirect effect on youth depressive symptoms through the sequential effects of stigma on health communication difficulties and thwarted social belongingness. METHODS Seventy-five youth with IBD between the ages of 10 and 18 completed measures of perceived illness stigma, health communication difficulties, thwarted belongingness, and depressive symptoms. RESULTS Results indicated a significant illness stigma → thwarted belongingness → depressive symptoms simple mediation path. Importantly, findings also revealed a significant serial mediation path for illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms. CONCLUSIONS Youth who perceive greater IBD stigma appear to experience increased difficulty communicating about their IBD with others, which in turn is associated with feelings of thwarted social belongingness and ultimately elevated depressive symptoms. These findings suggest that difficulty communicating about IBD is one potential route by which illness stigma has a negative impact on youth adjustment outcomes. Results could also inform clinical interventions to address IBD stigma and health communication difficulties associated with the social and emotional challenges in youth with IBD.
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Affiliation(s)
- Caroline M Roberts
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Kaitlyn L Gamwell
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | | | | | - Jeanne Tung
- University of Oklahoma Health Sciences Center
| | | | | | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - John M Chaney
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
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26
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Qualter P, Rouncefield-Swales A, Bray L, Blake L, Allen S, Probert C, Crook K, Carter B. Depression, anxiety, and loneliness among adolescents and young adults with IBD in the UK: the role of disease severity, age of onset, and embarrassment of the condition. Qual Life Res 2020; 30:497-506. [PMID: 32997335 PMCID: PMC7886765 DOI: 10.1007/s11136-020-02653-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 12/23/2022]
Abstract
Purpose Adolescents and young adults (AYA) with Inflammatory Bowel Disease (IBD) report higher depressive symptoms and anxiety compared to healthy controls, with disease severity and abdominal pain being important factors. In the current study, building on what young people had told us in our previous work, we examined whether embarrassment of the condition, social self-efficacy, and friendship quality mediated the relationship between abdominal pain and disease severity, and mental health/well-being. We also included loneliness as a component of well-being. Methods Data on depression, anxiety, loneliness, friendship quality, social self-efficacy, and disease embarrassment were collected from 130 AYA with IBD ages 14–25 years; data on disease severity and abdominal pain were taken from their medical records. Structural Equation Modeling (SEM) was used to test the relationships between the variables. Results Using SEM, we established that higher IBD disease activity negatively impacted how AYA felt about their friendships and how embarrassed they were about their condition; embarrassment then influenced reports of mental health, including loneliness. Abdominal pain, disease onset, and social self-efficacy directly predicted internalising problems. Conclusion In this sample of 14–25-year-old patients with IBD, specifics about the disease (severity and pain) predicted poorer mental health, suggesting discussion of mental health should be part of the clinical dialogue between patient and consultant. In addition, embarrassment about their condition increased depression, anxiety, and loneliness, mediating the relationship between disease severity and well-being. Thus, it is important to consider how perceived stigma affects those with chronic illness, and those issues should be explored in clinic.
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Affiliation(s)
- Pamela Qualter
- Institute of Education, University of Manchester, Manchester Oxford Road, Manchester, M13 9PL, UK.
| | - Alison Rouncefield-Swales
- Children, Young People and Families, Faculty of Health, Social Care & Medicine, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, UK
| | - Lucy Bray
- Children, Young People and Families, Faculty of Health, Social Care & Medicine, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, UK
| | - Lucy Blake
- Children, Young People and Families, Faculty of Health, Social Care & Medicine, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, UK
| | - Steven Allen
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Chris Probert
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kay Crook
- St Marks & Northwick Park, London North West University Healthcare NHS Trust, London, UK
| | - Bernie Carter
- Children, Young People and Families, Faculty of Health, Social Care & Medicine, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, UK.
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Sustaining, Forming, and Letting Go of Friendships for Young People with Inflammatory Bowel Disease (IBD): A Qualitative Interview-Based Study. Int J Chronic Dis 2020; 2020:7254972. [PMID: 32953877 PMCID: PMC7487095 DOI: 10.1155/2020/7254972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 01/09/2023] Open
Abstract
Inflammatory bowel disease (IBD) is an incurable, chronic, gastrointestinal condition that can constrain young people's social relationships. Few studies have specifically explored friendships of people with IBD. This qualitative, participatory study used interviews, photographs, and friendship maps to explore friendships and friendship networks of young people with IBD. An online Young Person's Advisory Group was actively engaged throughout the study. Thirty-one young people participated (n = 16 males, n = 15 female; n = 24 Crohn's disease, n = 6 ulcerative colitis, n = 1 IBD-unclassified; the mean age at study was 18.7 years; range 14-25 years). Findings present a metatheme “The importance and meaning of friendships” and three interwoven subthemes of “Sustaining friendships,” “Forming new friendships,” and “Letting go of friendships.” Friendship was important to the young people with IBD, providing support, but associated with challenges such as disclosure. Such challenges could be mitigated by clearer conversations with clinicians about friendships and more extensive conversations about friendships and long-term conditions in education settings.
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Arai K, Kunisaki R, Kakuta F, Hagiwara SI, Murakoshi T, Yanagi T, Shimizu T, Kato S, Ishige T, Aomatsu T, Inoue M, Saito T, Iwama I, Kawashima H, Kumagai H, Tajiri H, Iwata N, Mochizuki T, Noguchi A, Kashiwabara T, Shimizu H, Suzuki Y, Hirano Y, Fujiwara T. Phenotypic characteristics of pediatric inflammatory bowel disease in Japan: results from a multicenter registry. Intest Res 2020; 18:412-420. [PMID: 32806870 PMCID: PMC7609396 DOI: 10.5217/ir.2019.00130] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS There are few published registry studies from Asia on pediatric inflammatory bowel disease (IBD). Registry network data enable comparisons among ethnic groups. This study examined the characteristics of IBD in Japanese children and compared them with those in European children. METHODS This was a cross-sectional multicenter registry study of newly diagnosed Japanese pediatric IBD patients. The Paris classification was used to categorize IBD features, and results were compared with published EUROKIDS data. RESULTS A total of 265 pediatric IBD patients were initially registered, with 22 later excluded for having incomplete demographic data. For the analysis, 91 Crohn's disease (CD), 146 ulcerative colitis (UC), and 6 IBD-unclassified cases were eligible. For age at diagnosis, 20.9% of CD, 21.9% of UC, and 83.3% of IBD-unclassified cases were diagnosed before age 10 years. For CD location, 18.7%, 13.2%, 64.8%, 47.3%, and 20.9% were classified as involving L1 (ileocecum), L2 (colon), L3 (ileocolon), L4a (esophagus/stomach/duodenum), and L4b (jejunum/proximal ileum), respectively. For UC extent, 76% were classified as E4 (pancolitis). For CD behavior, B1 (non-stricturing/non-penetrating), B2 (stricturing), B3 (penetrating), and B2B3 were seen in 83.5%, 11.0%, 3.3%, and 2.2%, respectively. A comparison between Japanese and European children showed less L2 involvement (13.2% vs. 27.3%, P< 0.01) but more L4a (47.3% vs. 29.6%, P< 0.01) and L3 (64.8% vs. 52.7%, P< 0.05) involvement in Japanese CD children. Pediatric perianal CD was more prevalent in Japanese children (34.1% vs. 9.7%, P< 0.01). CONCLUSIONS Upper gastrointestinal and perianal CD lesions are more common in Japanese children than in European children.
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Affiliation(s)
- Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Fumihiko Kakuta
- Department of General Pediatrics and Gastroenterology, Miyagi Children's Hospital, Sendai, Japan
| | - Shin-Ichiro Hagiwara
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Takatsugu Murakoshi
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Tadahiro Yanagi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Toshiaki Shimizu
- Department of Pediatric and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Japan
| | - Sawako Kato
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tomoki Aomatsu
- Department of Pediatrics, Osaka Medical College, Takatsuki, Japan
| | - Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takeshi Saito
- Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Itaru Iwama
- Department of Pediatrics, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
| | | | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Hitoshi Tajiri
- Department of Pediatrics, Osaka General Medical Center, Osaka, Japan
| | - Naomi Iwata
- Division of Infectious Disease and Immunology, Aichi Children's Health and Medical Center, Obu, Japan
| | | | - Atsuko Noguchi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Toshihiko Kashiwabara
- Department of Gastroenterology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Hirotaka Shimizu
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Japan
| | - Yasuo Suzuki
- Inflammatory Bowel Disease Center, Toho University Sakura Medical Center, Sakura, Japan
| | - Yuri Hirano
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan
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Child and Family Perspectives on Adjustment to and Coping With Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2020; 71:e16-e27. [PMID: 32142001 DOI: 10.1097/mpg.0000000000002693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Children with inflammatory bowel disease (IBD) are at increased risk for poor mental health. The etiology of this risk is not clear, though may be related to the disease, its treatment, and/or the experience of these. We sought to describe the challenges that children with IBD and their families face in living with a chronic condition and undergoing repeated intravenous infusions; and identify coping mechanisms to understand how medical systems may support resilience. METHODS Semistructured qualitative interviews with 18 patient-guardian dyads at a tertiary outpatient infusion center, explored feelings related to IBD, the infusion process, and coping. Interviews were recorded, transcribed, and analyzed in ATLAS.ti. Two coders identified themes; developed a codebook and coded transcripts using the constant comparative method; and described themes/patterns. RESULTS Participants identified challenges related to IBD (unpredictable nature, disrupted normalcy, treatment decisions, managing relationships, life transitions) and a subset of challenges related to the infusion procedure (anxiety of unknown, managing pain/anxiety during IV placement, logistics). Participants coped through social support, cognitive strategies (positive attitude) and/or behavioral strategies for managing emotions (preparation for intravenous [IV] placement), and confidence in the medical care. By employing these coping strategies, participants came to accept IBD, adapt to the "new norm," and learned life lessons and resilience. CONCLUSIONS To support coping, clinical teams might provide anticipatory guidance to decrease anxiety of the unknown and identify cognitive-behavioral strategies for managing emotions. Delivery systems that build relationships, maintain normalcy, and consider needs of the family may further facilitate coping.
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Barnes C, Ashton JJ, Borca F, Cullen M, Walker DM, Beattie RM. Children and young people with inflammatory bowel disease attend less school than their healthy peers. Arch Dis Child 2020; 105:671-676. [PMID: 31937567 DOI: 10.1136/archdischild-2019-317765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Chronic diseases, such as inflammatory bowel disease (IBD), can impact negatively on education and social development. Examining the impact of IBD on school/college attendance for children and young people (CYP) is vital to provide targeted support to patients, families and schools. METHODS We performed a cross-sectional survey to determine the school/college attendance rates, the reasons for absence related to IBD and facilitators or barriers to school/college attendance. In a subset of patients followed up locally, we performed a detailed review of hospital attendance data to assess healthcare burden. RESULTS Two hundred and thirty-one questionnaires were given to CYP with IBD aged 5-17 years. Response rate was 74% (final sample 169). The median school/college attendance rate was 92.5%, significantly lower than all children in England (95.2%). 39.6% of children with IBD were persistently absent, defined nationally as missing 10% or more of school. Only five children (3%) had a 100% attendance record. Increasing age and use of monoclonal therapy were predictors of poor school attendance. Concerns about feeling unwell at school/college, access to toilets, keeping up with work and teachers' understanding of IBD are the main issues for CYP with IBD. There was a significant negative correlation between number of days in hospital and school attendance. CONCLUSION IBD has a significant impact on school/college attendance, with hospital attendance, disease burden and school difficulties being major factors. Employing strategies to minimise healthcare burden and developing a partnership between health and education to support children with IBD will serve to facilitate school/college attendance.
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Affiliation(s)
- Claire Barnes
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - James John Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK .,Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Florina Borca
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Mick Cullen
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | | | - Robert Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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Vejzovic V, Örmon K. Undergoing colonoscopy as experienced by adolescents. J SPEC PEDIATR NURS 2020; 25:e12290. [PMID: 32125083 DOI: 10.1111/jspn.12290] [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: 11/06/2019] [Revised: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to describe the phenomenon of undergoing colonoscopy as experienced by adolescents. DESIGN This study was a qualitative study in which data were collected and analyzed in accordance with the methodological principles of Reflective Lifeworld Research with a phenomenological approach. METHODS Face-to-face interviews were performed with 17 adolescents after undergoing the first colonoscopy. RESULTS The phenomenon of undergoing colonoscopy as experienced by adolescents can be described as a collision between emotions and a desire to obtain answers to questions about the examination, as well as concerns about its result and the meaning of undergoing colonoscopy. The essential meaning is additionally described through its constituents: a sense of vulnerability, an opportunity for symptom explanation, and sensibility regarding information. CONCLUSIONS The results can be concluded in terms of the knowledge that for adolescents a colonoscopy means more than an examination. Although colonoscopy is not experienced as painful, it evokes different emotions that affect adolescents. Therefore, a psychological preparation, on an individual level, is required before the colonoscopy. Our results showed that adolescents need to understand the connection between their symptoms, their body, and the colonoscopy.
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Affiliation(s)
- Vedrana Vejzovic
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Karin Örmon
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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"I Don't Like to Make a Big Thing out of It": A Qualitative Interview-Based Study Exploring Factors Affecting Whether Young People Tell or Do Not Tell Their Friends about Their IBD. Int J Chronic Dis 2020; 2020:1059025. [PMID: 32577420 PMCID: PMC7305549 DOI: 10.1155/2020/1059025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/04/2020] [Indexed: 12/23/2022] Open
Abstract
Inflammatory Bowel Disease (IBD) describes a group of conditions that includes Crohn's disease and ulcerative colitis. Unlike some chronic conditions, to a greater or lesser extent, IBD is hidden from or invisible to others which enables concealment of the condition, especially when stigma is associated with the condition. Concealment or nondisclosure allows a means of identity management. Disclosure of a chronic condition is not a single event, and it is dependent on many factors. There is little literature that specifically addresses stigma and/or disclosure in relation to children and young people with IBD. An in-depth qualitative study was undertaken, framed by Interpretive Description and using interviews, friendship maps, and photographs within a participatory framework. Public and patient involvement and engagement (PPIE) was undertaken throughout (inception to dissemination) the study. Young people aged 14-25 years with IBD who had participated in the survey phase of the larger study self-selected to participate in interviews that focused broadly on friendship and feelings of social connectedness. Data were analysed using an iterative, interpretive approach. Preliminary themes were developed and these were explored further, and then tentative theoretical connections about friendship were developed. One superordinate theme focused on disclosure. Thirty-one young people (16 males, 15 females, mean age 18.7 years; 24 Crohn's, 7 colitis) participated in the interviews (of these, five created friendship maps and six utilised photographs). Three discrete, but interlinked, themes were generated, revealing young people's experiences of disclosure: to tell or not to tell; controlling the flow: the who, when, what, and how of telling; and reactions and responses to telling: anticipated and actual. Decisions about telling friends about having IBD are challenging for many young people. Having control over disclosure is not always possible, and the potential consequences can feel risky. However, most young people had positive experiences of disclosure and gained support from friends and romantic partners. Most young people downplayed the seriousness of their IBD, revealing some facets of their condition, aiming to sustain their self-identity. Only one young person had been given professional support to disclose. Provision of support and opportunities to discuss whether, when, who, and how to tell friends and what the risks and benefits may be is something that could be woven into an ongoing and wider person-centred dialogue between young people and health professionals within routine clinic visits.
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Baudino MN, Gamwell KL, Roberts CM, Grunow JE, Jacobs NJ, Gillaspy SR, Edwards CS, Mullins LL, Chaney JM. Disease Severity and Depressive Symptoms in Adolescents With Inflammatory Bowel Disease: The Mediating Role of Parent and Youth Illness Uncertainty. J Pediatr Psychol 2020; 44:490-498. [PMID: 30551150 DOI: 10.1093/jpepsy/jsy091] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The objective of this study is to examine parent and youth appraisals of illness uncertainty as potential serial mediators in the relation between disease severity and youth depressive symptoms in adolescents with inflammatory bowel disease (IBD). METHODS Participants were 85 adolescents 13-18 years of age (Mage = 15.75, SD =1.51) with a confirmed diagnosis of IBD (Crohn's disease, 59%; ulcerative colitis, 41%) and a primary caregiver. At a scheduled outpatient visit, caregivers completed a measure of illness uncertainty, while adolescents completed measures of illness uncertainty and depressive symptoms. Pediatric gastroenterologists provided global estimates of disease severity. RESULTS Path analysis revealed several significant direct and indirect associations among the modeled variables. Importantly, results provided support for the hypothesized disease severity→parent illness uncertainty→youth illness uncertainty→youth depressive symptoms serial mediation path (95% confidence interval = 0.04 to 1.10). CONCLUSIONS Results indicate that increased disease activity may serve to magnify the unpredictable nature of IBD for parents, reflected in heightened perceptions of illness uncertainty. Our findings also suggest that increased parent illness uncertainty has a significant influence on youth illness uncertainty appraisals, which in turn translates into elevated depressive symptoms in adolescents with IBD. The clinical implications of our findings and suggestions for future studies are discussed.
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Cushman GK, Stolz MG, Shih S, Blount R, Otley A, Talmadge C, Grant A, Reed B. Parent IMPACT-III: Development and Validation of an Inflammatory Bowel Disease-specific Health-related Quality-of-life Measure. J Pediatr Gastroenterol Nutr 2020; 70:205-210. [PMID: 31978018 PMCID: PMC7189420 DOI: 10.1097/mpg.0000000000002540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The present study aimed to validate the parent-proxy IMPACT-III (IMPACT-III-P) in a sample of youth diagnosed with inflammatory bowel disease (IBD). Parent-proxy report measures are standard for pediatric psychosocial assessment, and the IMPACT-III-P will provide a more comprehensive representation of HRQOL. Reliability and validity analyses were conducted. METHODS Parents (N = 50) of youth 8 to 17 years with IBD reported on their child's HRQOL (IMPACT-III-P and PedsQL-4.0) and depression (BASC-2); youth reported on their HRQOL (child IMPACT-III), pain interference (PROMIS Pain Interference), and disease symptoms; and physicians completed measures of disease activity. RESULTS Criterion validity was established as the IMPACT-III-P was strongly, positively associated with the PedsQL (r = 0.59, P < 0.001). Convergent validity was supported as higher IMPACT-III-P scores were associated with less pain interference (r = -0.41, P < 0.01) and lower depression (r = -0.41, P < 0.01). Discriminant validity was partially supported, as higher IMPACT-III-P scores were associated with lower child-reported symptoms (r = -0.41, P < 0.01), but scores did not differ based on inactive, mild, or moderate/severe disease activity groups as rated by physicians. Internal consistency, parent-child agreement, and item-level analyses revealed strong reliability. CONCLUSIONS The IMPACT-III-P demonstrated strong validity and reliability. Parents and children had similar reports of HRQOL, with parents rating child HRQOL slightly lower. Findings support the use of the IMPACT-III-P for youth 8 to 17 years old to use in accordance with the child IMPACT-III to provide valuable information regarding HRQOL in youth with IBD.
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Affiliation(s)
| | | | | | | | | | | | | | - Bonney Reed
- GI Care for Kids, Atlanta, GA
- Emory University/Children’s Pediatric Institute, Atlanta, GA
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Lai C, Sceats LA, Qiu W, Park KT, Morris AM, Kin C. Patient decision-making in severe inflammatory bowel disease: the need for improved communication of treatment options and preferences. Colorectal Dis 2019; 21:1406-1414. [PMID: 31295766 DOI: 10.1111/codi.14759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023]
Abstract
AIM Patients with inflammatory bowel disease and their physicians must navigate ever-increasing options for treatment. The aim of this study was to elucidate the key drivers of treatment decision-making in inflammatory bowel disease. METHODS We conducted qualitative semi-structured in-person interviews of 20 adult patients undergoing treatment for inflammatory bowel disease at an academic medical centre who either recently initiated biologic therapy or underwent an operation or surgical evaluation. Interviews were audio-recorded, transcribed verbatim, iteratively coded, and discussed to consensus by five researchers. We used thematic analysis to explore factors influencing decision-making. RESULTS Four major themes emerged as key drivers of treatment decision-making: perceived clinical state and disease severity, the patient-physician relationship, knowledge, attitudes and beliefs about treatment options, and social isolation and stigma. Patients described experiencing a clinical turning point as the impetus for proceeding with a previously undesired treatment such as infusion medication or surgery. Patients reported delays in care or diagnosis, inadequate communication with their physicians, and lack of control over their disease management. Patients often stated that they considered surgery to be the treatment of last resort, which further compounded the complexity of making treatment decisions. CONCLUSION Patients described multiple barriers to making informed and collaborative decisions about treatment, especially when considering surgical options. Our study reveals a need for more comprehensive communication between the patient and their physician about the range of medical and surgical treatment options. We recommend a patient-centred approach toward the decision-making process that accounts for patient decision-making preferences, causes of social stress, and clinical status.
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Affiliation(s)
- C Lai
- Stanford University School of Medicine, Stanford, California, USA
| | - L A Sceats
- Department of Surgery, S-SPIRE Center, Stanford University School of Medicine, Stanford, California, USA
| | - W Qiu
- Stanford University School of Medicine, Stanford, California, USA
| | - K T Park
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - A M Morris
- Department of Surgery, S-SPIRE Center, Stanford University School of Medicine, Stanford, California, USA
| | - C Kin
- Department of Surgery, S-SPIRE Center, Stanford University School of Medicine, Stanford, California, USA
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Griggs S, Baker H, Chiodo LM. Nursing student perceptions of hope in children: A qualitative descriptive study. Nurs Forum 2019; 54:441-447. [PMID: 31141187 PMCID: PMC6693973 DOI: 10.1111/nuf.12352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 04/07/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
Hope has been linked to positive health outcomes in the literature. Hope is abstract, multidimensional, future oriented, and occurs cognitively making it difficult to assess in children. Most of the research on hope has been conducted with adults and adolescents. Therefore, it is essential to analyze the concept of hope in children to provide nurses with tools to identify hope behaviors in children. The aim of this qualitative descriptive study was to describe hope behaviors in children from a nursing student perspective. Data were gathered from three focus groups (N = 19) of nursing students enrolled in a pediatric clinical rotation using a semistructured interview technique. Three themes of hope behaviors emerged from the three focus groups and were (a) future oriented, (b) goal oriented-getting up and doing things, and (c) pathways thinking processes-getting from point A to point B. Health care providers should consider hope behavioral cues, which can warrant interventions to increase hope in their young patients. Current findings demonstrate the need for the development of hope interventions that involve younger patients, thereby making their effects more sustainable across the lifespan.
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Affiliation(s)
- Stephanie Griggs
- Yale University School of Nursing
- University of Massachusetts Amherst College of Nursing
| | - Hallie Baker
- University of Massachusetts Amherst College of Nursing
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Robertson N, Gunn S, Piper R. Psychological and Social Factors Associated with Pain in Inflammatory Bowel Disease: A Systematic Literature Review of the Evidence in Adult and Pediatric Studies. CROHN'S & COLITIS 360 2019. [DOI: 10.1093/crocol/otz003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pain is commonly experienced in both active and dormant inflammatory bowel disease (IBD). Psychological and social factors, which can be key to pain experience, have been relatively neglected; the only prior comprehensive review focused solely on studies of adults. The present review, therefore, sought to systematically examine relationships between pediatric and adult experience of pain and psychosocial variables.
Method
Systematic searches of 5 databases were conducted to identify studies including measures of pain and psychosocial variables, in pediatric or adult IBD populations. Quality appraisal of studies was undertaken using a qualified assessment tool.
Results
Twenty-three articles met the inclusion criteria. Ten examined relationships between pain and psychosocial variables in adults, and 13 examined in pediatric populations. Inverse relationships were identified between pain and quality of life (QOL) in both populations, with potential differences in pain localization between the two populations. Psychological distress, notably depression, was also important in both populations, with inconsistent evidence for a role for anxiety in pediatric samples. Specific coping styles, and familial responses to communications, also appeared relevant, but with weaker evidence. There was substantial heterogeneity in measures, statistical analyses and sample characteristics, and quality appraisal revealed methodological weaknesses.
Conclusions
Significant relationships were found between pain and various psychological indices, notably QOL and depression. However, most studies were underpowered, did not sufficiently control for key confounds, and almost exclusively reported on Western participants. Adequately powered, statistically sound studies encompassing diverse populations are required to further clarify relationships between pain and psychosocial variables in IBD.
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Affiliation(s)
- Noelle Robertson
- Neuroscience, Psychology and Behaviour, College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Rebecca Piper
- Neuroscience, Psychology and Behaviour, College of Life Sciences, University of Leicester, Leicester, UK
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McCormick M, Cushman G. Happiness When the Body Hurts: Achieving Well-Being in Chronic Health Conditions. Child Adolesc Psychiatr Clin N Am 2019; 28:147-156. [PMID: 30832949 DOI: 10.1016/j.chc.2018.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This article provides a framework for understanding the application of positive psychology, in particular, Seligman's PERMA, in the context of chronic childhood illness. In particular, inflammatory bowel disease is a chronic illness that is often associated with social and emotional challenges for youth diagnosed with this lifelong condition. Specific disease factors that seemingly work against happiness are explained, and traditional notions of happiness are discussed and redefined. With PERMA as a guide, adult caregivers (eg, psychiatrists, psychologists, parents, gastroenterologists) can help youth living with chronic illness practice acceptance, adjust expectations, and find meaning, fulfillment, and psychological well-being.
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Affiliation(s)
- Megan McCormick
- Georgetown University, 2115 Wisconsin Avenue Northwest, Suite 200, Washington, DC 20007, USA.
| | - Grace Cushman
- University of Georgia, 125 Baldwin Street, Athens, GA 30602, USA
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Tran L, Mulligan K. A Systematic Review of Self-Management Interventions for Children and Adolescents With Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:685-698. [PMID: 30295786 DOI: 10.1093/ibd/izy299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Self-management of inflammatory bowel disease is complex. Children and adolescents (CA) with inflammatory bowel disease (IBD) often have difficulty with managing aspects of their condition, resulting in treatment nonadherence and impaired psychosocial function. Self-management interventions are developed to help support patients and their parents/carers to effectively self-manage. The aim of this systematic review was to evaluate the efficacy of self-management interventions in children and adolescents with IBD. METHODS The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search of the following databases was conducted to identify controlled trials of interventions aiming to enhance IBD self-management in CA: Medline, Embase, Cochrane, CINAHL, and PsychINFO. Two reviewers screened articles for inclusion. RESULTS Nine trials (11 articles) met the inclusion criteria. Most were underpowered, with 7 recruiting fewer than 50 participants. The interventions aimed to enhance psychological well-being (n = 5), medication adherence (n = 3), or calcium intake (n = 1). There was considerable heterogeneity in intervention content and outcomes assessment. Some benefits were reported in disease activity, adherence, and psychological well-being, but findings were inconsistent. CONCLUSIONS Self-management is difficult for CA with IBD; however, this review identified only a small number of interventions to support self-management, most of which were underpowered and only 1 that was conducted outside the United States. Clinical consensus is required on which self-management activities should be recommended to patients and targeted in interventions and which core outcomes should be assessed. Adequately powered trials of interventions are required to identify how best to support self-management in CA with IBD.
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Affiliation(s)
- Lien Tran
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK
| | - Kathleen Mulligan
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK.,East London NHS Foundation Trust, London, UK
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Van de Vijver E, Van Gils A, Beckers L, Van Driessche Y, Moes ND, van Rheenen PF. Fatigue in children and adolescents with inflammatory bowel disease. World J Gastroenterol 2019; 25:632-643. [PMID: 30774277 PMCID: PMC6371006 DOI: 10.3748/wjg.v25.i5.632] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To identify factors other than active disease and anemia that contribute to fatigue in pediatric inflammatory bowel disease (IBD). METHODS We performed an electronic search in Medline and EMBASE from their inception to May 2017 using the search term "fatigue" or the related keywords "physical impairment" and "inflammatory bowel disease" with the filter "child" (age 0-18 years). Cross-sectional and case-control studies were included. We restricted our search to studies published in English. We used the PRISMA checklist and flow diagram. Duplicate articles were manually deleted in End Note. To identify further relevant studies, we checked the reference lists of the selected articles. RESULTS We identified 149 papers, of which 19 were retrieved for full text review. Eleven studies were subsequently excluded because fatigue was not evaluated as an outcome measure. Eight papers focused on the desired topic and were discussed in the final analysis. A lack of uniformity of outcome measures made the pooling of data impossible. In all but one study, questionnaires were used to evaluate fatigue. In the remaining study, an accelerometer was used to measure daily activities, sleeping time and their relationships with fatigue in a more quantifiable manner. Adolescents with IBD are significantly more fatigued than healthy controls. In addition to active disease, increased anxiety or depression and disturbed family relationships were frequently reported predictors of fatigue. Quantitative measurement of physical activity in patients with Crohn's disease showed a reduction in the number of steps per day, and patients with ulcerative colitis had a shorter duration of physical activity during the day. CONCLUSION Fatigue in pediatric IBD is related to a combination of biological, functional and behavioral factors, which should all be taken into account when managing fatigue.
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Affiliation(s)
- Els Van de Vijver
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Antwerp University Hospital, Edegem B-2650, Belgium
| | - Ann Van Gils
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Antwerp University Hospital, Edegem B-2650, Belgium
| | - Laura Beckers
- Department of Anesthesiology, Antwerp University Hospital, Edegem B-2650, Belgium
| | | | - Nicolette Dorien Moes
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Antwerp University Hospital, Edegem B-2650, Belgium
| | - Patrick Ferry van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
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Harland MR, Parslow RM, Anderson N, Byrne D, Crawley E. Paediatric chronic fatigue syndrome patients' and parents' perceptions of recovery. BMJ Paediatr Open 2019; 3:e000525. [PMID: 32500105 PMCID: PMC7245384 DOI: 10.1136/bmjpo-2019-000525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common in children and adolescents; however, little is known about how we should define recovery. This study aims to explore perceptions of recovery held by paediatric patients with CFS/ME and their parents. METHODS Children with CFS/ME and their parents were recruited through a single specialist paediatric CFS/ME service. Data were collected through semistructured interviews with children and parents. The interview questions explored how participants would know if they/their child had recovered from CFS/ME. Thematic analysis was used to identify patterns within the data. RESULTS Twenty-one children with CFS/ME, twenty mothers and two fathers were interviewed. Some children found it hard to define recovery as the illness had become a 'new normal'. Others thought recovery would indicate returning to pre-morbid levels of activity or achieving the same activity level as peers (socialising, education and leisure activities). Increased flexibility in routines and the absence of payback after activities were important. The interviews highlighted the concept of recovery as highly individual with wide variation in symptoms experienced, type and level of activity that would signify recovery. Parents describe how changes in mood and motivation would signify their child's recovery, but children did not reflect on this. CONCLUSION Some parents and children struggle to define what would constitute complete recovery. However, signs of recovery were more easily identifiable. Definitions of recovery went far beyond symptom reduction and were focused towards rebuilding lives.
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Affiliation(s)
| | | | - Nina Anderson
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Danielle Byrne
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Esther Crawley
- Centre for Academic Child Health, University of Bristol, Bristol, UK
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Luo D, Lin Z, Shang XC, Li S. "I can fight it!": A qualitative study of resilience in people with inflammatory bowel disease. Int J Nurs Sci 2018; 6:127-133. [PMID: 31406881 PMCID: PMC6608668 DOI: 10.1016/j.ijnss.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/24/2018] [Accepted: 12/20/2018] [Indexed: 12/16/2022] Open
Abstract
Objectives This study aimed to understand the resilience experiences in patients with inflammatory bowel disease (IBD) and develop the resilience framework for them. Methods Semistructured interviews were conducted with 15 patients with IBD who were purposefully recruited from the gastroenterology department of two hospitals in Jiangsu, China to gain diversity in the demographic and clinical characteristics. The data were analyzed using a directed content analysis approach based on the Kumpfer's resilience framework. Results The resilience framework for patients with IBD was formed from the analysis. This framework was composed of four themes, as follows: (1) complicated factors in the environment, (2) change the environment into a protective one, (3) personality traits, and (4) resilience-related coping. Conclusions The resilience framework for patients with IBD can effectively characterize the resilience experience of patients during the disease and assist healthcare professionals to understand how patients recover from the disease. More quantitative studies are needed to further explore the influencing factors of resilience and improve resilience in patient with inflammatory Bowel Disease.
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Affiliation(s)
- Dan Luo
- School of Nursing, Nanjing Medical University, NanJing, China
| | - Zheng Lin
- School of Nursing, Nanjing Medical University, NanJing, China
- Administrative Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, NanJing, China
- Corresponding author. School of Nursing, Nanjing Medical University, NanJing, China.
| | - Xing-Chen Shang
- School of Nursing, Nanjing Medical University, NanJing, China
| | - Sha Li
- School of Nursing, Nanjing Medical University, NanJing, China
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Abstract
Inflammatory bowel disease (IBD) is increasing in children. When this lifelong illness is diagnosed in childhood, especially during adolescence, it may have a negative impact on children's quality of life. The aim of the present study was to illuminate the meaning of children's lived experience of ulcerative colitis. Seven children aged between 10 and 18 years were recruited from University Hospital South Sweden and interviewed about the phenomenon under scrutiny. Data were analyzed by means of a phenomenological hermeneutical method. The meaning of the children's lived experience of ulcerative colitis was summed up as a main theme. A daily struggle to adapt and be perceived as normal consisted of 4 subthemes: being healthy despite the symptoms, being healthy despite being afraid, being healthy despite a sense of being different, and being healthy despite needing support. The children strove to perceive themselves as healthy, and they needed to be perceived as healthy, especially when experiencing symptoms of inflammatory bowel disease. Children with inflammatory bowel disease confront various problems, such as ambitions and goals that are hard to achieve, due to reduced abilities as a result of the illness or an insufficiently adapted environment.
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Fourie S, Jackson D, Aveyard H. Living with Inflammatory Bowel Disease: A review of qualitative research studies. Int J Nurs Stud 2018; 87:149-156. [DOI: 10.1016/j.ijnurstu.2018.07.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022]
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Gamwell KL, Baudino MN, Bakula DM, Sharkey CM, Roberts CM, Grunow JE, Jacobs NJ, Gillaspy SR, Mullins LL, Chaney JM. Perceived Illness Stigma, Thwarted Belongingness, and Depressive Symptoms in Youth With Inflammatory Bowel Disease (IBD). Inflamm Bowel Dis 2018; 24:960-965. [PMID: 29688469 DOI: 10.1093/ibd/izy011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Studies have begun to identify psychosocial factors associated with depressive symptoms in youth with IBD. However, despite considerable speculation in the literature regarding the role of perceived stigma in both social and emotional adjustment outcomes, youth appraisals of stigma have yet to receive empirical attention. The primary purpose of this study was to examine the indirect effect of perceived illness stigma on depressive symptoms through its impact on social belongingness. METHODS Eighty youth (Mage = 14.96) with IBD completed measures of illness stigma, thwarted belongingness, and depressive symptoms during a scheduled clinic visit. Pediatric gastroenterologists provided estimates of disease activity. Analyses examined the direct and indirect effects of illness stigma on perceived thwarted belongingness and depressive symptoms. RESULTS Bootstrapped regression results revealed significant illness stigma → depressive symptoms (β = 0.33, 95% CI, 0.108 to 0.526), illness stigma → thwarted belongingness (β =0.41, 95% CI, 0.061 to 0.739), and thwarted belongingness → depressive symptoms (β =0.32, 95% CI, 0.143 to 0.474) direct paths. Mediation analyses revealed a significant illness stigma → thwarted belongingness → depressive symptoms indirect path (β = 0.14, 95% CI, 0.034 to 0.310), suggesting increased appraisals of illness stigma impede youths' perceptions of social belongingness, which in turn, contribute to elevated depressive symptoms. CONCLUSIONS Youth perceptions of illness stigma negatively impact social belongingness and depressive symptoms in youth with IBD. Further, decreased perceptions of social belongingness may be one potential route through which stigma influences emotional adjustment outcomes. Results support clinical observations regarding the relevance of illness stigma and social functioning as targets of intervention for improving emotional adjustment in youth with IBD. 10.1093/ibd/izy011_video1izy011.video15775252424001.
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Affiliation(s)
| | | | - Dana M Bakula
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | | | | | - John E Grunow
- University of Oklahoma Health Sciences Center Children's Hospital, Oklahoma City, OK
| | - Noel J Jacobs
- University of Oklahoma Health Sciences Center Children's Hospital, Oklahoma City, OK
| | - Stephen R Gillaspy
- University of Oklahoma Health Sciences Center Children's Hospital, Oklahoma City, OK
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | - John M Chaney
- Department of Psychology, Oklahoma State University, Stillwater, OK
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Gray WN, Reed-Knight B, Morgan PJ, Holbrook E, Kugathasan S, Saeed SA, Denson LA, Hommel KA. Multi-Site Comparison of Patient, Parent, and Pediatric Provider Perspectives on Transition to Adult Care in IBD. J Pediatr Nurs 2018. [PMID: 29525216 DOI: 10.1016/j.pedn.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This multi-site study examines patient, parent, and pediatric provider perspectives on what is most important for successful transition. DESIGN AND METHODS Using the Transition Readiness Assessment Questionnaire, 190 participants recruited from two pediatric IBD centers selected the top five skills they considered "most important for successful transition." Rankings were summarized and compared by group. RESULTS While patients, parents, and clinicians all identified "calling the doctor about unusual changes in health" and "taking medications correctly and independently" as being important, each stakeholder group qualitatively and statistically differed in terms of transition readiness skills emphasized. Patients endorsed "calling the doctor about unusual changes in health" and "being knowledgeable about insurance coverage," as being most important to successful transition while parents emphasized health monitoring and problem solving. Pediatric providers emphasized adherence to treatment and reporting unusual changes in health. There were statistically significant differences in endorsement rates across participants for seven transition readiness skills. Patients agreed with providers 80% of the time and with their parents 40% of the time. Parent-provider agreement was 60%. CONCLUSIONS Although there was some overlap across groups, areas of emphasis differed by informant. Patients emphasized skills they need to learn, parents emphasized skills they most likely manage for their children, and providers emphasized skills that directly impact their provision of care. PRACTICE IMPLICATIONS Patient, parent, and provider beliefs all need to be considered when developing a comprehensive transition program. Failure to do so may result in programs that do not meet the needs of youth with IBD.
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Affiliation(s)
- Wendy N Gray
- Auburn University, Department of Psychology, Auburn, AL, United States; Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, OH, United States.
| | - Bonney Reed-Knight
- Children's Healthcare of Atlanta, Atlanta, GA, United States; Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, United States; GI Care for Kids, Atlanta, GA, United States
| | - Pamela J Morgan
- Dayton Children's Hospital, Department of Pediatric Gastroenterology, Dayton, OH, United States
| | - Erin Holbrook
- Cincinnati Children's Hospital Medical Center, Schubert-Martin Pediatric IBD Center, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati, OH, United States
| | - Subra Kugathasan
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, United States
| | - Shehzad A Saeed
- Dayton Children's Hospital, Department of Pediatric Gastroenterology, Dayton, OH, United States
| | - Lee A Denson
- Cincinnati Children's Hospital Medical Center, Schubert-Martin Pediatric IBD Center, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, United States
| | - Kevin A Hommel
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, United States
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Barned C, Dobson J, Stintzi A, Mack D, O'Doherty KC. Children's perspectives on the benefits and burdens of research participation. AJOB Empir Bioeth 2018; 9:19-28. [PMID: 29369013 DOI: 10.1080/23294515.2018.1430709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Participation in research is associated with benefits and burdens for individual research participants. Children living with a chronic illness are considered particularly vulnerable as they are already burdened with symptoms of their illness. In particular contexts, such as learning health care systems (LHS), where research and clinical care are integrated, children with chronic illnesses may be asked to participate in research related to their illness. A growing body of literature has focused on children's perspectives as research subjects; however, a relatively understudied aspect concerns children's experiences of research in clinics where they are also patients. METHODS We interviewed 25 Canadian children and adolescents living with inflammatory bowel disease (IBD) about their experiences of research participation. RESULTS Our participants described aspects of the research process and particular experiences as benefits and others as burdens. Benefits included helping others, receiving incentives, receiving the results of previous studies, and participating in fun activities. Burdens included the time required for particular types of research, physical and psychological discomfort, and feelings of obligation. CONCLUSIONS Our study describes the experiences of children participating in research at a site that integrates research and clinical care. Our participants described experiences that often go unreported (such as feelings of obligation); we mention these as important considerations to be mindful of when interacting with children as (potential) research participants in an LHS and when thinking about research ethics protocols or the assent/consent process.
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Affiliation(s)
| | | | - Alain Stintzi
- b Ottawa Institute of Systems Biology and Department of Biochemistry, Microbiology and Immunology, University of Ottawa
| | - David Mack
- c Children's Hospital of Eastern Ontario (CHEO) Inflammatory Bowel Disease Centre and CHEO Research Institute
- d Department of Pediatrics , University of Ottawa
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Rohde JA, Wang Y, Cutino CM, Dickson BK, Bernal MC, Bronda S, Liu A, Priyadarshini SI, Guo L, Reich JS, Farraye FA. Impact of Disease Disclosure on Stigma: An Experimental Investigation of College Students' Reactions to Inflammatory Bowel Disease. JOURNAL OF HEALTH COMMUNICATION 2017; 23:91-97. [PMID: 29283816 DOI: 10.1080/10810730.2017.1392653] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Inflammatory bowel disease (IBD) is a serious chronic illness that affects 1 in 200 people in the United States with the majority of new cases of IBD diagnosed in young people under the age of 35. Despite the growing number of people who are diagnosed each year, the consequences of health-related stigma faced by young people grappling with the effects of IBD are understudied. This experimental investigation explored the existence of enacted stigma among college students, a population that faces many social and psychological challenges due to the added emotional stresses brought about by the transition from high school and adolescence to college and adulthood. Results indicate that enacted stigma among college students toward other students with IBD decreases when disclosure of the disease is present. Results also suggest that greater knowledge of the nature and symptoms of IBD positively correlates to decreased stigma.
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Affiliation(s)
- Jacob A Rohde
- a School of Media and Journalism , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Yue Wang
- b Boston University, College of Communication , Boston , Massachusetts , USA
| | - Chelsea M Cutino
- b Boston University, College of Communication , Boston , Massachusetts , USA
| | - Bonnie K Dickson
- b Boston University, College of Communication , Boston , Massachusetts , USA
| | - Marisa C Bernal
- b Boston University, College of Communication , Boston , Massachusetts , USA
| | - Serena Bronda
- b Boston University, College of Communication , Boston , Massachusetts , USA
| | - Aizhou Liu
- b Boston University, College of Communication , Boston , Massachusetts , USA
| | | | - Ling Guo
- c Boston Medical Center, Section of Gastroenterology , Boston , Massachusetts , USA
| | - Jason S Reich
- c Boston Medical Center, Section of Gastroenterology , Boston , Massachusetts , USA
| | - Francis A Farraye
- c Boston Medical Center, Section of Gastroenterology , Boston , Massachusetts , USA
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49
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Reigada LC, Moore MT, Martin CF, Kappelman MD. Psychometric Evaluation of the IBD-Specific Anxiety Scale: A Novel Measure of Disease-Related Anxiety for Adolescents With IBD. J Pediatr Psychol 2017; 43:413-422. [DOI: 10.1093/jpepsy/jsx121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/05/2017] [Indexed: 12/24/2022] Open
Affiliation(s)
- Laura C Reigada
- Department of Psychology, City University of New York at Brooklyn College
| | | | - Christopher F Martin
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill
| | - Michael D Kappelman
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill
- Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill
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50
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Plevinsky JM, Gumidyala AP, Poulopoulos N, Kahn SA, Guilfoyle SM, Hommel KA, Greenley RN. Illness-related parenting stress among parents of adolescents and young adults with inflammatory bowel diseases. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2017.1316200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jill M. Plevinsky
- Department of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, IL
| | - Amitha P. Gumidyala
- Department of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, IL
| | - Natasha Poulopoulos
- Department of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, IL
| | - Stacy A. Kahn
- Division of Gastroenterology, Boston Children’s Hospital, Boston, MA
| | - Shanna M. Guilfoyle
- Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Kevin A. Hommel
- Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Rachel N. Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, IL
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