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Greiner MV, Muntz G. Who Consents? Medical Decision Making for Children in Foster Care. Pediatrics 2024:e2023065110. [PMID: 39233665 DOI: 10.1542/peds.2023-065110] [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: 12/01/2023] [Accepted: 03/29/2024] [Indexed: 09/06/2024] Open
Abstract
Children in foster care have complexity around medical decision making because of their unique custody status. When medical decision making is necessary for a child in foster care, what perspectives are important? What if opinions are not aligned? Who makes the final decision for consent? This Ethics Rounds focuses on a young child in foster care who has had repeated ear infections. Foster caregivers and family of origin are not in agreement on the treatment plan. Two experts, a foster care pediatrician and a child welfare professional, comment on the important considerations for the case, including involvement of legal representation and best interest representation in medical decision making as well as the variability in child welfare response by state.
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Affiliation(s)
- Mary V Greiner
- Cincinnati Children's Hospital, Cincinnati, Ohio
- University of Cincinnati, Cincinnati, Ohio
| | - Grace Muntz
- Hamilton County Job and Family Services, Cincinnati, Ohio
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Yu H, Bonett S, Oyiborhoro U, Aryal S, Kim A, Kornides ML, Jemmott JB, Glanz K, Villarruel AM, Bauermeister JA. Psychosocial correlates of parents' willingness to vaccinate their children against COVID-19. PLoS One 2024; 19:e0305877. [PMID: 38913679 PMCID: PMC11195945 DOI: 10.1371/journal.pone.0305877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 06/05/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Public health guidance recommended that children who are 6 months or older be vaccinated against COVID-19 in June of 2022. In the U.S., 56% of children under 17 had not received the COVID-19 vaccination in 2023. We examine parents' willingness to vaccinate their children against COVID-19 using the theory of planned behavior in order to design effective strategies to promote vaccine uptake. METHODS The Philadelphia Community Engagement Alliance is part of an NIH community-engaged consortium focused on addressing COVID-19 disparities across the U.S. We surveyed 1,008 Philadelphia parents (mean age 36.86, SD 6.55; 42.3% racial/ethnic minorities) between September 2021 and February 2022, a period when guidance for child vaccination was anticipated. Structural Equation Modeling analysis examined associations between parental willingness and vaccine-related attitudes, norms, and perceived control. Covariates included parents' COVID-19 vaccination status, race/ethnicity, gender, and survey completion post-CDC pediatric COVID-19 vaccination guidelines. Subgroup analyses by race/ethnicity and gender were conducted. RESULTS Our model demonstrated good fit (χ2 = 907.37, df = 419, p<0.001; comparative fit index [CFI] = 0.951; non-normed fit index [NNFI] = 0.946; root mean square error of approximation [RMSEA] = 0.034 with 95% CI = 0.030-0.038). Attitudes ([Formula: see text] = 0.447, p<0.001) and subjective norms ([Formula: see text] = 0.309, p = 0.002) were predictors of intention. Racial/ethnic minority parents exhibited weaker vaccination intentions ([Formula: see text] = -0.053, p = 0.028) than non-Hispanic White parents. CONCLUSIONS Parents' attitudes and norms influence their vaccination intentions. Despite the survey predating widespread child vaccine availability, findings are pertinent given the need to increase and sustain pediatric vaccinations against COVID-19. Interventions promoting positive vaccine attitudes and prosocial norms are warranted. Tailored interventions and diverse communication strategies for parental subgroups may be useful to ensure comprehensive and effective vaccination initiatives.
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Affiliation(s)
- Hyunmin Yu
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ufuoma Oyiborhoro
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Subhash Aryal
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Andrew Kim
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Melanie L. Kornides
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - John B. Jemmott
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Karen Glanz
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Antonia M. Villarruel
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - José A. Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Downs J, Keeley J, Skoss R, Mills J, Nevill T, Schippers A, Lindly O, Thompson S. Perspectives on the essential skills of healthcare decision making in children and adolescents with intellectual disability. Int J Equity Health 2024; 23:119. [PMID: 38849806 PMCID: PMC11162048 DOI: 10.1186/s12939-024-02204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Involvement in healthcare decisions is associated with better health outcomes for patients. For children and adolescents with intellectual disability, parents and healthcare professionals need to balance listening to a child's wishes with the responsibility of keeping them safe. However, there is a scarcity of literature evaluating how to effectively involve them in decision making. In this context, we review the concept of health literacy, focusing on the skills of healthcare decision making for children and adolescents with intellectual disability. METHODS We describe the concept of health literacy and models explaining shared decision making (individuals and healthcare professionals collaborate in decision making process) and supported decision making (when a trusted person supports the individual to collaborate with the healthcare professional in the decision-making process), and a rapid review of the literature evaluating their efficacy. We discuss healthcare decision making for children and adolescents with intellectual disability in the context of relevant recommendations from the recent Disability Royal Commission into Violence, Abuse, Neglect, and Exploitation of People with Disability in Australia. RESULTS Health literacy skills enable individuals to access, understand, appraise, remember and use health information and services. Shared decision making has been described for children with chronic conditions and supported decision making for adults with intellectual disability. Decision-making contributes to how individuals appraise and use healthcare. The rapid review found very limited evidence of outcomes where children and adolescents with intellectual disability have been supported to contribute to their healthcare decisions. Recommendations from the Disability Royal Commission highlight current needs for greater efforts to support and build the capacity of individuals with disability to be involved in the decisions that affect their life, including healthcare decision making. CONCLUSIONS Existing rights frameworks and healthcare standards confirm the importance of providing all people with the opportunities to learn and practise health literacy skills including decision making. There is little literature examining interventions for healthcare decision making for children with intellectual disability. Childhood is a critical time for the development of skills and autonomy. Evidence for how children and adolescents with intellectual disability can learn and practice healthcare decision-making skills in preparation for adulthood is needed to reduce inequities in their autonomy.
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Affiliation(s)
- Jenny Downs
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia.
- Curtin School for Allied Health, Curtin University, Perth, Australia.
| | - Jessica Keeley
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Rachel Skoss
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Institute for Health Research, University of Notre Dame, Fremantle, Australia
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | | | - Thom Nevill
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Alice Schippers
- Disability Studies, Department of Care Ethics, University of Humanistic Studies, Utrecht, the Netherlands
| | - Olivia Lindly
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
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Nemetz ETA, Huang RS, Das S. No adults allowed: Adolescents and Medical Decision Making. Paediatr Child Health 2024; 29:171-173. [PMID: 38827364 PMCID: PMC11141595 DOI: 10.1093/pch/pxad068] [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: 06/09/2023] [Accepted: 09/21/2023] [Indexed: 06/04/2024] Open
Abstract
The majority of the literature focused on whether consent should be extended to the adolescent population arises from themes adapted from American tort law. In contrast to the USA, Ontario does not delineate an age of consent for medical treatment and relying on American guidelines to guide practice in Ontario is problematic. While the literature is saturated with discussions for and against seeking adolescent consent, there are currently no bioethical guidelines on adolescent consent in the province of Ontario. This paper explores adolescent refusal of care and adolescent request for care in opposition to parental wishes. The paper seeks to answer the following questions: What is the difference between an adolescent and an adult in medical decision-making? What are the barriers to seeking adolescent consent? And, can the neurobiological argument be an accurate guide for obtaining adolescent consent?
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Affiliation(s)
| | - Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sunit Das
- Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
- Centre for Ethics, University of Toronto, Toronto, Canada
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Ravindranath O, Perica MI, Parr AC, Ojha A, McKeon SD, Montano G, Ullendorff N, Luna B, Edmiston EK. Adolescent neurocognitive development and decision-making abilities regarding gender-affirming care. Dev Cogn Neurosci 2024; 67:101351. [PMID: 38383174 PMCID: PMC11247355 DOI: 10.1016/j.dcn.2024.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
Recently, politicians and legislative bodies have cited neurodevelopmental literature to argue that brain immaturity undermines decision-making regarding gender-affirming care (GAC) in youth. Here, we review this literature as it applies to adolescents' ability to make decisions regarding GAC. The research shows that while adolescence is a time of peak risk-taking behavior that may lead to impulsive decisions, neurocognitive systems supporting adult-level decisions are available given deliberative processes that minimize influence of short-term rewards and peers. Since GAC decisions occur over an extended period and with support from adult caregivers and clinicians, adolescents can engage adult-level decision-making in this context. We also weigh the benefits of providing GAC access during adolescence and consider the significant costs of blocking or delaying GAC. Transgender and non-binary (TNB) adolescents face significant mental health challenges, many of which are mitigated by GAC access. Further, initiating the GAC process during adolescence, which we define as beginning at pubertal onset, leads to better long-term mental health outcomes than waiting until adulthood. Taken together, existing research indicates that many adolescents can make informed decisions regarding gender-affirming care, and that this care is critical for the well-being of TNB youth. We highlight relevant considerations for policy makers, researchers, and clinicians.
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Affiliation(s)
- Orma Ravindranath
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Maria I Perica
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashley C Parr
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amar Ojha
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shane D McKeon
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gerald Montano
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Naomi Ullendorff
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Beatriz Luna
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - E Kale Edmiston
- Department of Psychiatry, University of Massachusetts Chan School of Medicine, USA
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Gallant AJ, Johnson C, Steenbeek A, Parsons Leigh J, Halperin SA, Curran JA. Stakeholders' experiences with school-based immunization programs during the COVID-19 pandemic in the Canadian Maritimes: A qualitative study. PUBLIC HEALTH IN PRACTICE 2024; 7:100505. [PMID: 38807702 PMCID: PMC11130716 DOI: 10.1016/j.puhip.2024.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/26/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
Background School-based immunization programs (SBIP) support access to routine vaccines for adolescents. Across Canada, the COVID-19 pandemic and subsequent public health measures affected SBIP and vaccine uptake. The objectives of this study were to explore 1.) stakeholders' experiences with SBIP and changes to programs during COVID-19 in Nova Scotia, Prince Edward Island and New Brunswick, and 2.) how the pandemic affected parents' and adolescents' vaccine views. Study design Semi-structured interviews with decision makers, healthcare providers, teachers, parents and adolescents between February-August 2023. Methods The COM-B model and Theoretical Domains Framework informed interview guides. Deductive and inductive analyses saw participant quotes mapped to relevant model components and domains by two coders. Belief statements were generated within each stakeholder group then compared to identify themes and subthemes. Results Participants (n = 39) identified five themes: 1) enablers to SBIP delivery, 2) barriers to SBIP delivery, 3) desired changes to SBIP delivery, 4) student anxiety, and 5) vaccination views and changes since the COVID-19 pandemic. Public health measures facilitated more space for clinics, as did taking smaller cohorts of students. School staff-healthcare provider relationships could help or hinder programs, particularly with high turnover in both professions during the pandemic. Adolescents played a passive role in vaccine decision making, with mothers often being the sole decision maker. We did not identify any changes in hesitancy towards routine vaccines since the pandemic. Conclusions We identified a range of barriers and enablers to SBIP, many of which were exacerbated by the pandemic. Efforts are needed to ensure SBIP and catch-up programming remains accessible for all adolescents to catch-up on missed vaccines before graduation. Parents and adolescents' vaccination views suggest changes in vaccine coverage since the pandemic may be due to accessibility of services rather than vaccine hesitancy. Future research is needed to engage adolescents in their vaccine decisions.
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Affiliation(s)
- Allyson J. Gallant
- Faculty of Health, Dalhousie University, 5968 College Street, PO BOX 15000, Halifax, NS, B3H 4R2, Canada
| | - Catie Johnson
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, NS, Canada
| | | | | | - Scott A. Halperin
- Dalhousie University, Canadian Center for Vaccinology, Halifax, NS, Canada
| | - Janet A. Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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Beiter K, Sable K, Arkin L. Ethical considerations when preadolescents request elective or cosmetic dermatologic interventions. J Am Acad Dermatol 2024; 90:1321-1322. [PMID: 37321486 DOI: 10.1016/j.jaad.2023.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Kaylin Beiter
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
| | - Kimberly Sable
- Department of Dermatology, University of Wisconsin Madison School of Medicine, Madison, Wisconsin
| | - Lisa Arkin
- Department of Dermatology, University of Wisconsin Madison School of Medicine, Madison, Wisconsin
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Taylor GD, Exley C, Innes N, Vernazza CR. Young people's and adults' views and experiences of decision-making to manage compromised first permanent molars: a qualitative study. Int J Paediatr Dent 2024. [PMID: 38803044 DOI: 10.1111/ipd.13217] [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: 10/25/2023] [Revised: 03/27/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Little information on young people's and adults' views and experiences on decision-making for managing compromised first permanent molars (cFPM) exists. AIM To establish young people's and adults' views and experiences of decision-making for managing cFPM. DESIGN Face-to-face (online) semi-structured interviews were undertaken using an iteratively designed topic guide. Participants aged 12-65 were purposively sampled with recruitment from different dental clinics (three primary care, an out-of-hours emergency and one dental hospital). Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Three themes were generated from young people's interviews (n = 9): (i) influencing factors; (ii) long-term considerations; and (iii) shared decision-making. Three themes were generated from adults' interviews (n = 13): (i) influences that affect decisions; (ii) perceptions of the specialist's role; and (iii) importance of shared decision-making for children and young people. CONCLUSION Several factors influenced decision-making; for young people, professional opinions were important, and parental/peer influences less so. For adults, it was based on decisions on their prior experiences. Adults felt young people were abnormal if referred to a specialist. Young people wanted autonomy in decision-making to be respected; in reality, their views were rarely heard. There is potential to increase young people's involvement in shared decision-making for cFPM, which aligns with their aspirations.
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Affiliation(s)
- Greig D Taylor
- School of Dental Sciences, Newcastle University, Newcastle, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Nicola Innes
- School of Dentistry, Cardiff University, Cardiff, UK
| | - Christopher Robert Vernazza
- School of Dental Sciences, Newcastle University, Newcastle, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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Sharbini S, Awang Damit NAD, Maddess T, Abdullah SN. Parental Awareness of the Preschool Orthoptics Visual Screening in Brunei-Muara District and Factors Contributing to Defaulters. Br Ir Orthopt J 2024; 20:154-164. [PMID: 38799230 PMCID: PMC11122692 DOI: 10.22599/bioj.349] [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: 10/31/2023] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Background The preschool orthoptics visual screening program began in Brunei Darussalam in 2004 to detect amblyopia, a common cause of treatable visual disorders in children. Amblyopia can be asymptomatic, easily missed, and cause permanent adverse visual consequences; hence, it is necessary to be screened. The parental role in ensuring timely visual screening is pivotal to their child's visual well-being and educational success. This study explored parental awareness and reasons for their nonattendance. Methods A cross-sectional study of 401 parents was conducted in the Brunei-Muara district in private kindergarten schools and maternal and child health clinics. A self-designed and self-administered questionnaire was used. Data collected was analysed using RStudio in the form of descriptive and analytic statistics. Results The study findings showed that 52.8% defaulted their screening and there was a significant association between parental awareness and the defaulters (p < 0.05). Only 39.9% of parents were aware of the screening service availability, and 50.1% had not taken their children for an eye check. The most significant sociodemographic factor that influenced awareness of the importance of vision screening was parental employment status (p = 0.013), revealing a 4.43 times higher likelihood of default if the father was unemployed. This study found that with each additional child, parents are 1.25 times less likely to seek eye screening (p < 0.05). Conclusions The main reason for nonattendance was a lack of awareness of the situation and parents believed that their children were seeing well. Mitigating child visual screening defaults requires a community-focused approach.
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Affiliation(s)
- Sharimawati Sharbini
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
| | | | - Ted Maddess
- Eccles Institute of Neuroscience, John Curtin School of Medical Research (Bldg. 131), Australian National University, Canberra, ACT, 2601, Australia
| | - Siti Nurliyana Abdullah
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
- Eccles Institute of Neuroscience, John Curtin School of Medical Research (Bldg. 131), Australian National University, Canberra, ACT, 2601, Australia
- RIPAS Hospital, Brunei Darussalam
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Ronde E, van de Lücht VA, Lachkar N, Ubbink DT, Breugem CC. Stakeholders' Views on Information Needed in a Patient Decision Aid for Microtia Reconstruction. Cleft Palate Craniofac J 2024; 61:854-869. [PMID: 36604964 PMCID: PMC10981206 DOI: 10.1177/10556656221146584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To assess which information about microtia and the possible reconstructive options health care providers (HCPs), patients and parents believe should be included in a patient decision aid (PtDA). DESIGN A mixed-methods study comprised of an online survey of HCPs and focus group discussions with patients and parents. PARTICIPANTS Survey respondents were members of the International Society for Auricular Reconstruction (ISAR). Focus group participants were patients with microtia and their parents, recruited through the microtia outpatient clinic at Amsterdam UMC, and through a Dutch patient organization for cleft and craniofacial conditions. METHODS An online, investigator-made survey was sent to ISAR members in December 2021. Semi-structured focus group discussions were held in February 2022. Quantitative results were summarized, and qualitative results were thematically grouped. RESULTS Thirty-two HCPs responded to the survey (response rate 41%). Most respondents (n = 24) were plastic surgeons, who had a median of 15 years of experience (IQR: 7-23 years). Two focus groups were held with a total of five patients and two parents. HCPs, patients and parents generally agreed on the information needed in a PtDA, emphasizing the importance of realistic expectation management. Patients and parents also considered psychosocial and functional outcomes, patient experiences, as well as patients' involvement in decision-making important. CONCLUSIONS A PtDA for microtia reconstruction should target all patients with microtia, and include information on at least technique-related information, expected esthetic results, possible adverse effects, psychosocial and functional outcomes and patient experiences. Preference eliciting questions should be developed for both pediatric patients and their parents.
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Affiliation(s)
- E.M. Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Veronique A.P. van de Lücht
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - N. Lachkar
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Dirk T. Ubbink
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Personalized Medicine, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Corstiaan C. Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
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Bon SBB, Wouters RHP, Bakhuizen JJ, Jongmans MCJ, van den Heuvel-Eibrink MM, Grootenhuis MA. Experiences of pediatric cancer patients (age 12-18 years) with extensive germline sequencing for cancer predisposition: a qualitative study. Eur J Hum Genet 2024; 32:567-575. [PMID: 38409533 PMCID: PMC11061193 DOI: 10.1038/s41431-024-01565-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
This study explored the experiences and needs of adolescents, ranging from 12 to 18 years old, who have recently been diagnosed with cancer and participated in a nationwide germline genetic sequencing study within the context of pediatric oncology. The 21 adolescents in this qualitative interview study viewed genetic sequencing as an integral part of their cancer journey. They often characterized germline sequencing as "good-to-know" without specifying immediate utility. While the adolescents comprehended the significance of germline genetic sequencing, they were less focused on its potential long-term implications. Adolescents expressed a strong desire to be actively engaged in decisions related to genetics. They advocated for a participatory role in genetic decision-making from a young age onwards. They recommended that re-consent should be sought before re-analysis of their genetic data is performed and believe that patients should have the opportunity to provide (re-)consent once they reach adulthood. Moreover, the adolescents emphasized the importance of developing counseling materials that are not only concise but also visually attractive. In conclusion, this study underscores the positive perception that adolescents diagnosed with cancer hold regarding germline genetic sequencing. They articulate a strong interest in being actively involved in genetic decision-making. To address these articulated needs and preferences, we recommend the development of visually engaging counseling materials. These materials should effectively convey both the immediate and long-term implications of genetic sequencing, enabling adolescents with cancer to make informed decisions about genetic sequencing.
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Affiliation(s)
- Sebastian B B Bon
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Roel H P Wouters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jette J Bakhuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolijn C J Jongmans
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Child Health, UMCU-Wilhelmina's Children's Hospital, Utrecht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Child Health, UMCU-Wilhelmina's Children's Hospital, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Child Health, UMCU-Wilhelmina's Children's Hospital, Utrecht, The Netherlands
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Joseph PL, Gonçalves C, Applewhite J, Fleary SA. Examining provider anticipatory guidance for adolescents' preventive health: A latent class approach. J Pediatr Nurs 2024; 76:e117-e125. [PMID: 38429211 DOI: 10.1016/j.pedn.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Low rates of anticipatory guidance (AG) are reported across studies with adolescents, and little is known about how these conversations differ across early versus middle adolescence. This study explored adolescent-provider AG conversations for preventive health skills; the study objectives were to (1) identify patterns of provider-adolescent AG conversations across early and middle adolescence and (2) determine socio-demographic characteristics associated with these AG conversations. DESIGN AND METHOD Data from the 2019 National Survey of Children's Health were used to identify patterns of provider-adolescent AG conversations. The sample included 5500 early and 6730 middle adolescents (Mage = 14.67 years old, SD = 1.71, 51.7% boys, 79% White). Multiple group latent class analysis and multinomial regressions were estimated using four indicators of AG conversations (i.e., skills to manage health and healthcare, changes in healthcare that happen at 18, making positive choices about health, and receiving a medical history summary). RESULTS Three types of AG conversations were identified: high AG, low AG, and parent unaware. Among early and middle adolescents, adolescents that were older, girls, had private health insurance, and a personal provider were less likely to receive high AG compared to other types of AG. CONCLUSIONS Policies and strategies to engage adolescents in AG conversations during and outside of the medical appointment are needed. PRACTICE IMPLICATIONS Tools, such as brief screeners, can be used to ensure all adolescents are receiving high AG. School-based health centers, community centers and organizations, and telehealth appointments with medical professionals may be additional opportunities for adolescents to receive AG.
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Affiliation(s)
- Patrece L Joseph
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599, USA.
| | | | - Janelle Applewhite
- Department of Educational Foundations and Exceptionalities, James Madison University, USA
| | - Sasha A Fleary
- Graduate School of Public Health and Health Policy, City University of New York, USA
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Ashwin A, Cherukuri SD, Rammohan A. The psychology, legality, ethics and medical aspects of organ donation by minors. Transplant Rev (Orlando) 2024; 38:100832. [PMID: 38340552 DOI: 10.1016/j.trre.2024.100832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
Any individual who has not attained the chronological age of legal majority as per national law is termed a minor. The concept of living donation (LD) has always been a subject of ethical debate and further compounding the controversy is the question of LD by minors. The decision for a minor to donate poses a special challenge as it involves a close family unit of parent-child relationship. Such an emotionally loaded situation wherein questions of attachment, perceived duties, moral obligation are likely to cloud a truly informed consent on the part of the minor to donation, who may find themselves in a vulnerable position. Furthermore, a minor's cognitive ability to comprehend the gravity of LD and when required defy parental coercion need to be elucidates before a minor is accepted for LD. Experts have set out stringent conditions which need to be met prior to the exceptional circumstance that a minor is considered for organ donation. Such donations should require parental permission, child's assent and the involvement of a paediatric-trained donor advocacy team. This article debates the question of minors acting as live donors from ethical, medical, psychosocial and legal viewpoints with an aim to present internationally defined circumstances when a minor may morally participate as a LD, thereby laying the foundation for future deliberations in this regard using traditional metrics to juxtapose divergent courses of action.
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Affiliation(s)
- A Ashwin
- Wellington School, Wellington, UK
| | | | - A Rammohan
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
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Siegel B, Taylor LS, Alizadeh F, Barreto JA, Daniel D, Alexander PMA, Lipsitz S, Moynihan K. Formal Ethics Consultation in Extracorporeal Membrane Oxygenation Patients: A Single-Center Retrospective Cohort of a Quaternary Pediatric Hospital. Pediatr Crit Care Med 2024; 25:301-311. [PMID: 38193777 DOI: 10.1097/pcc.0000000000003422] [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] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To examine characteristics associated with formal ethics consultation (EC) referral in pediatric extracorporeal membrane oxygenation (ECMO) cases, and document ethical issues presented. DESIGN Retrospective cohort study using mixed methods. SETTING Single-center quaternary pediatric hospital. PATIENTS Patients supported on ECMO (January 2012 to December 2021). INTERVENTIONS We compared clinical variables among ECMO patients according to the presence of EC. We defined optimal cutoffs for EC based on run duration, ICU length of stay (LOS), and sum of procedures or complications. To identify independent explanatory variables for EC, we used a forward stepwise selection multivariable logistic regression model. EC records were thematically characterized into ethical issues. MEASUREMENTS AND MAIN RESULTS Of 601 ECMO patients and 225 patients with EC in 10 years, 27 ECMO patients received EC (4.5% of ECMO patients, 12% of all ECs). On univariate analysis, use of EC vs. not was associated with multiple ECMO runs, more complications/procedures, longer ICU LOS and ECMO duration, cardiac admissions, decannulation outcome, and higher mortality. Cutoffs for EC were ICU LOS >52 days, run duration >160 hours, and >6 complications/procedures. Independent associations with EC included these three cutoffs and older age. The model showed good discrimination (area under the curve 0.88 [0.83, 0.93]) and fit. The most common primary ethical issues were related to end-of-life, ECMO discontinuation, and treatment decision-making. Moral distress was cited in 22 of 27 cases (82%). CONCLUSION EC was used in 4.5% of our pediatric ECMO cases, with most ethical issues related to end-of-life care or ECMO discontinuation. Older age, longer ICU LOS, prolonged runs, and multiple procedures/complications were associated with greater odds for EC requests. These data highlight our single-center experience of ECMO-associated ethical dilemmas. Historical referral patterns may guide a supported decision-making framework. Future work will need to include quality improvement projects for timely EC, with evaluation of impacts on relevant endpoints.
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Affiliation(s)
- Bryan Siegel
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Lisa S Taylor
- Office of Ethics, Boston Children's Hospital, Boston, MA
| | - Faraz Alizadeh
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Jessica A Barreto
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Dennis Daniel
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Anesthesia and Critical Care, Boston Children's Hospital, Boston, MA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Peta M A Alexander
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Stuart Lipsitz
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Katie Moynihan
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Koiwa Y, Shishido E, Horiuchi S. Factors Influencing Abortion Decision-Making of Adolescents and Young Women: A Narrative Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:288. [PMID: 38541288 PMCID: PMC10970290 DOI: 10.3390/ijerph21030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Globally, about half of all induced abortions have been estimated to be unsafe, which results in 13% of maternal deaths yearly. Of these induced abortions, 41% of unsafe abortions have been reported in young women who are dependent on their parents for their livelihood. They are often left in a vulnerable position and may have difficulty in making a decision regarding abortion. This study aimed to (1) characterize and map factors that influence abortion decision-making of adolescents and young women, and (2) identify the care and support that they need in their decision-making process. METHODS We conducted a scoping review following the JBI method and PRISMA-ScR checklist. We comprehensively searched MEDLINE (PubMed), Embase, Cochrane Library, CINAHL, and PsycInfo, and hand searched publications in the Google Scholar database between November 2021 and October 2023. The search included all English language qualitative and mixed methods research articles published on the database up to October 2023 that included participants aged 10-24 years. The CASP checklist was used as a guide for the qualitative analysis. NVivo was used to synthesize the findings. RESULTS There were 18 studies from 14 countries (N = 1543 young women) that met the inclusion criteria. Three domains and eleven categories were included as follows: personal (desire for self-realization and unwanted pregnancy), interpersonal (parental impact, reaction of partner, roles of peers and friends, existence of own child, and lack of support), and social circumstances (sexual crime, financial problem, limitation of choice, and underutilized healthcare services). Decision-making factors regarding abortions were also found across all three domains. CONCLUSION The abortion decision-making of young women is influenced by various external factors regardless of country. Parents are especially influential and tend to force their daughters to make a decision. Young women experienced suffering, frustration, and lack of autonomy in making decisions based on their preference. This emphasizes the importance of autonomous decision-making. In this regard, healthcare services should be used. However, there are barriers to accessing these services. To improve such access, the following are required: staff training to provide adolescent and youth-friendly health services, counseling based on women's needs, counseling including the parents or guardians that is confidential and ethical, promotion of decision aids, and affordable accessible care.
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Affiliation(s)
- Yui Koiwa
- Makita General Hospital, Nishikamata, Ota-ku, Tokyo 144-8501, Japan;
| | - Eri Shishido
- Department of Midwifery, Graduate School of Nursing Science, St. Luke’s International University, Akashicho, Chuo-ku, Tokyo 104-0044, Japan;
| | - Shigeko Horiuchi
- Department of Midwifery, Graduate School of Nursing Science, St. Luke’s International University, Akashicho, Chuo-ku, Tokyo 104-0044, Japan;
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16
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Quirke MB, Alexander D, Cassidy L, Walsh C, Masterson K, Hill K, Brenner M. Adolescents with Rett syndrome at critical care pathway junctures: Examining clinicians' decision to initiate invasive long-term ventilation. Eur J Paediatr Neurol 2024; 49:113-119. [PMID: 38484415 DOI: 10.1016/j.ejpn.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The initiation of invasive long-term ventilation (I-LTV) for an adolescent with Rett Syndrome (RTT) involves many serious bioethical considerations. In moving towards a more inclusive model of patient participation, transparency surrounding the main influencing factors around this decision is important. OBJECTIVE We aimed to identify the main drivers influencing a clinician's decision to support initiation of I-LTV for an adolescent with RTT. METHOD We used an anonymous online vignette-based factorial survey. The survey was distributed internationally through eight professional multi-disciplinary organisations to reach clinicians working in paediatrics. RESULTS We analysed 504 RTT vignettes completed by 246 clinicians using mixed effect regression modelling. The main three significant influencing factors identified were: parental agreement with the decision to support initiation, the family's support network, and proximity to a tertiary care centre. Additional comments from participants focused on family support, and the importance of on-going communication with the family. CONCLUSION As the rights of those with disabilities improve and participation of adolescents in decision-making becomes more established, effective communications with the family around goals of care and particular sensitivity and reflective practice around methods of consensus building will likely contribute to a positive decision-making process at this difficult time.
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Affiliation(s)
- Mary Brigid Quirke
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Denise Alexander
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Lorna Cassidy
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Kate Masterson
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Katie Hill
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
| | - Maria Brenner
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland.
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17
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Johnston EE, Rosenberg AR. Palliative Care in Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:755-763. [PMID: 37862672 DOI: 10.1200/jco.23.00709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 08/25/2023] [Indexed: 10/22/2023] Open
Abstract
Palliative care (PC) aims to improve quality of life (QOL) for patients with serious illness and their families by recognizing and alleviating the physical, emotional, social, existential, and spiritual suffering of patients and their communities. Because adolescents and young adults (AYAs, age 15-39 years) with cancer commonly report distress across all these domains and because that distress translates to their QOL during and after their cancers, PC is particularly relevant for this population. Here, we review the evidence for PC among AYAs with cancer, including its rationale, gaps, opportunities, and implications for care delivery. For example, nearly 90% of AYAs with cancer report distressing symptoms during their treatment, those who survive report ongoing unmet psychosocial and physical health needs, and those who die from their cancers are highly likely to receive medically intense care that is discordant with their goals and values. AYA communication and decision making can be challenging because of ethical and developmental considerations regarding the patient's autonomy and competing priorities of patients and caregivers. PC interventions (including primary PC delivered by oncologists, routine PC subspecialty care, symptom tracking, advance care planning, and psychosocial programs promoting AYA resilience) are all associated with improved patient-centered outcomes. However, PC is inconsistently integrated into AYA oncology care, and access to PC programs is not equitable; marginalized groups continue to experience poorer outcomes. Ongoing and future research and clinical initiatives must continue to bridge these gaps. Improving the QOL of AYAs with cancer is a shared goal of the larger clinical oncology community, and including PC in AYA cancer care delivery can help attain that goal.
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Affiliation(s)
- Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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18
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Khalil R, Kellett S, Petrushkin H, Twomey C, Rahi J, Solebo AL. Show don't tell: assessing the impact of co-developed patient information videos in paediatric uveitis. Eye (Lond) 2024; 38:246-252. [PMID: 37460691 PMCID: PMC10810776 DOI: 10.1038/s41433-023-02659-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/26/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND/OBJECTIVES There is a paucity of online educational content targeting children and young people with uveitis. We evaluated the impact of a co-designed patient education video on subjective and objective understanding of childhood uveitis. SUBJECTS/METHODS Co-designed patient education media were produced in collaboration with the Childhood Uveitis Studies steering group and the Great Ormond Street Hospital Generation R Young People's Advisory Group and narrated by children. Patients managed within the Uveitis service at GOSH were invited to take part in a pre-post survey, undertaken immediately prior to and following viewing of a patient education video. RESULTS Forty-three patients participated. These were stratified according to age, duration of disease, and treatment type for analysis. Self-rated knowledge improved across all groups (p = 0.001), particularly in those with a new diagnosis of uveitis (Z = -8.124, p < 0.001). Objective knowledge scores improved across all questions, especially in younger children, those with new disease, and those on steroid only treatment (Z = -3.847, p < 0.001, Z = -3.975, p < 0.001, Z = -3.448, p < 0.001; respectively). Most participants reported the videos to be easy to understand and with the right amount of information. All stated that they learned something new. CONCLUSIONS Patient understanding of disease and treatment is crucial to achieving the best possible outcomes for this chronic, relapsing remitting and potentially blinding disorder. Our findings data shows the potential value of co-designed patient information videos, specifically in our study benefitting younger patients and those recently diagnosed. We suggest that other clinical teams could collaborate fruitfully with patient groups to develop similar videos to target possible misinformation and potentially improve patient outcomes.
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Affiliation(s)
- Rana Khalil
- Royal College of Surgeons, Dublin, Ireland
- Moorfields Eye Hospital NHS Trust, London, UK
- Population, Policy and Practice Programme Department of Research and Teaching, UCL GOS Institute of Child Health, London, UK
| | - Salomey Kellett
- Population, Policy and Practice Programme Department of Research and Teaching, UCL GOS Institute of Child Health, London, UK
| | - Harry Petrushkin
- Moorfields Eye Hospital NHS Trust, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
- Moorfield Eye Hospital Biomedical Research Centre, London, UK
| | | | - Jugnoo Rahi
- Population, Policy and Practice Programme Department of Research and Teaching, UCL GOS Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
- Moorfield Eye Hospital Biomedical Research Centre, London, UK
| | - Ameenat Lola Solebo
- Population, Policy and Practice Programme Department of Research and Teaching, UCL GOS Institute of Child Health, London, UK.
- Great Ormond Street Hospital for Children NHS Trust, London, UK.
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19
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Marino JL, Peate M, McNeil R, Orme LM, McCarthy MC, Glackin A, Sawyer SM. Experiences of Family and Partner Support in Fertility Decision-Making Among Adolescents and Young Adults with Cancer: A National Australian Study. J Adolesc Young Adult Oncol 2024; 13:180-188. [PMID: 37339458 DOI: 10.1089/jayao.2023.0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Purpose: To understand how adolescents and young adults (AYAs) with cancer experience family and partner involvement in fertility preservation (FP) decision-making. Methods: As part of a nationally representative Australian cross-sectional study of 15-25-year olds with cancer, 196 participants (mean age 19.9 [standard deviation 3.2] years at diagnosis; 51% male) were surveyed regarding FP decision-making. Results: One hundred sixty-one (83%) participants reported discussion of potential effects of cancer and its treatment on fertility, of whom 57 (35%) did not undertake FP (51% of females; 19% of males). Parental involvement (mothers 62%, fathers 45%) in decision-making was considered helpful, including for 73% of 20-25-year olds with partners. Sisters and brothers were involved less often, yet rated helpful in 48% and 41% of cases, respectively. Older participants were more likely than younger ones to have involved partners (47% vs. 22%, p = 0.001) and less likely to have involved mothers (56% vs. 71%, p = 0.04) or fathers (39% vs. 55%, p = 0.04). Conclusion: This is the first quantitative study to explore family and partner involvement in AYA FP decision-making in both females and males in a nationally representative sample. Parents are important resources who commonly assist AYAs with these complex decisions. Although many AYAs will be the main decision-makers when it comes to FP, particularly as AYAs mature, these data suggest that resources and support should be available for and inclusive of parents, partners, and siblings.
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Affiliation(s)
- Jennifer L Marino
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Specialty of Child and Adolescent Health, The University of Sydney, Westmead, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
| | - Robyn McNeil
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Lisa M Orme
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- ONTrac at Peter Mac, Victorian Youth Cancer Service, Peter MacCallum Hospital, Parkville, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Maria C McCarthy
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Aoife Glackin
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
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20
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Ott MA. Confidentiality in Primary Care Pediatrics. Pediatr Clin North Am 2024; 71:49-58. [PMID: 37973306 DOI: 10.1016/j.pcl.2023.08.002] [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: 11/19/2023]
Abstract
Confidentiality is a core component of adolescent health. Confidentiality is shown to be a basic human right that is in the best interest of the adolescent, addresses health inequities, and supports adolescents' developing capacity. Practical aspects of confidentiality are discussed, resources provided to navigate a changing legal landscape, and threats to confidentiality addressed. Although confidentiality can be a source of conflict with parents and caregivers, pediatric providers can use confidentiality to assist parents and caregivers in shifting from making decisions for the adolescent to supporting the adolescent in making their own health decisions, thus facilitating a healthy transition to adulthood.
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Affiliation(s)
- Mary A Ott
- Indiana University School of Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA.
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21
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Walker KK, Clare A, Kumar A, Gaviria-Agudelo C. A scoping review of the use of parent-adolescent dyads in HPV vaccination research. PATIENT EDUCATION AND COUNSELING 2024; 118:108007. [PMID: 37847989 DOI: 10.1016/j.pec.2023.108007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Parental vaccine hesitancy is a significant contributor to low adolescent HPV vaccination. Shared HPV vaccination decision-making among adolescents and parents is an important determinant of vaccination uptake. We performed a scoping review to identify studies that used parent-adolescent dyads in HPV vaccination research. METHODS We searched peer-reviewed articles in PubMed, Embase, and PsychInfo from 2012 to 2023. Randomized or observational studies with parent-adolescent dyads related to HPV vaccination were eligible for inclusion. Articles were coded for the main themes related to use of parent-adolescent dyads in HPV vaccination research. RESULTS Fifteen articles met the inclusion criteria and were categorized into two main themes: qualitative decision-making and quantitative vaccination intentions. Dyad members reported substantially different roles, barriers, and facilitators of HPV vaccine decisions and intentions. Dyad members disagreed on who made the final decision. Provider recommendation style and content were important to parental confidence in the vaccine decision. CONCLUSION The recent evidence for parent-adolescent HPV vaccination dyad research is sparse but indicates that factors that account for dyad vaccination decisions and intentions often differ between dyad members. PRACTICE IMPLICATIONS Studies in this review support ongoing research with parent-adolescent dyads to target HPV vaccine interventions at individual dyad members to increase HPV vaccination.
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Affiliation(s)
- Kimberly K Walker
- Zimmerman School of Advertising and Mass Communications, University of South Florida, Tampa, FL, USA.
| | - Alyssa Clare
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Ambuj Kumar
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Claudia Gaviria-Agudelo
- Pediatric Infectious Diseases, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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McArdle E, Teelin KL, Borschuk A, Brown AEC. When Parents Request Nondisclosure: Rights of Adolescents to Access Their Health Information and Implications of the 21st Century Cures Act Final Rule. THE JOURNAL OF CLINICAL ETHICS 2024; 35:85-92. [PMID: 38728697 DOI: 10.1086/729413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
AbstractDespite broad ethical consensus supporting developmentally appropriate disclosure of health information to older children and adolescents, cases in which parents and caregivers request nondisclosure continue to pose moral dilemmas for clinicians. State laws vary considerably regarding adolescents' rights to autonomy, privacy, and confidentiality, with many states not specifically addressing adolescents' right to their own healthcare information. The requirements of the 21st Century Cures Act have raised important ethical concerns for pediatricians and adolescent healthcare professionals regarding the protection of adolescent privacy and confidentiality, given requirements that chart notes and results be made readily available to patients via electronic portals. Less addressed have been the implications of the act for adolescents' access to their health information, since many healthcare systems' electronic portals are available to patients beginning at age 12, sometimes requiring that the patients themselves authorize their parents' access to the same information. In this article, we present a challenging case of protracted disagreement about an adolescent's right to honest information regarding his devastating prognosis. We then review the legal framework governing adolescents' rights to their own healthcare information, the limitations of ethics consultation to resolve such disputes, and the potential for the Cures Act's impact on electronic medical record systems to provide one form of resolution. We conclude that although parents in cases like the one presented here have the legal right to consent to medical treatment on their children's behalf, they do not have a corresponding right to direct the withholding of medical information from the patient.
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Brandt S, Lennerz BS, Wiegand S, Schirmer M, Kleger P, Weyhreter H, Holle R, Hüttl TP, Dietl O, von Schnurbein J, Holl RW, Wabitsch M. Twelve-Month Outcomes after Metabolic and Bariatric Surgery among Youths Participating in a Structured Preparation and Follow-Up Program: Results of the Youth with Extreme Obesity Study. Obes Facts 2023; 17:59-71. [PMID: 38081152 PMCID: PMC10836940 DOI: 10.1159/000535104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/19/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION While invasive and associated with risks, metabolic and bariatric surgery (MBS) can promote sustained weight loss and substantial health benefits in youths with extreme obesity. The path toward informed decision making for or against MBS is poorly characterized and postoperative follow-up to assess risks and benefits is inconsistent. In youths with extreme obesity, we aimed to evaluate decision making toward MBS, as well as MBS outcomes and adherence with follow-up and recommendations in the setting of a structured pre- and post-MBS program. METHODS Participants were recruited in the setting of the multicenter "Youth with Extreme Obesity Study" (YES). YES is a cohort study in adolescents and young adults aged 14-24 years with obesity (BMI ≥30.0 kg/m2) who were recruited at four medical centers and one job center in Germany between 2012 and 2018. Participants at two medical centers with BMI ≥35 kg/m2, aged 14-24 years, and interested in pursuing MBS were included in the subproject 3 "Safety and effectiveness of weight loss surgery in adolescents with severe obesity within a structured pre- and post-surgery treatment program - an observational study" that comprised a 2-months pre- and 12-months post-MBS program. RESULTS Twenty-eight of 169 youths (17%) with BMI ≥35 kg/m2 were interested in MBS. Twenty-six fulfilled published eligibility criteria for MBS and participated in the structured pre-MBS preparation program. Of these, 9 participants (2 females) decided against, and 17 (n = 11 females) decided for MBS (sleeve gastrectomy). The 12-month follow-up rate was high (16/17 [94%]) and all participants achieved significant weight reduction (ΔBMI: -16.1 ± 5.6 kg/m2). Eleven of 16 participants (69%) reported taking the prescribed dietary supplements in the first year after MBS, but only five of them (31%) did so daily. In contrast to the high 12-month retention rate, follow-up after completion of the structured program was low at 24-months (9/16 [56%]) and at 36-months (5/15 [36%]), respectively. CONCLUSION Participants demonstrated active decision making for or against MBS and high adherence with the structured pre- and 12 months post-MBS program, but participation was low thereafter. These findings endorse the need for longer term structured post-MBS programs to capture long-term outcomes and provide adequate care in this vulnerable group at the transition to adulthood.
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Affiliation(s)
- Stephanie Brandt
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany,
| | - Belinda S Lennerz
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susanna Wiegand
- Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Melanie Schirmer
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Pauline Kleger
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Helmut Weyhreter
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Rolf Holle
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Thomas P Hüttl
- Department of General and Visceral Surgery, Dr. Lubos Kliniken Bogenhausen Pasing, Munich, Germany
| | - Otto Dietl
- Department of General and Visceral Surgery, Dr. Lubos Kliniken Bogenhausen Pasing, Munich, Germany
| | - Julia von Schnurbein
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Martin Wabitsch
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
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Sánchez MC, Hernández Clemente JC, García López FJ. Public and Patients' Perspectives Towards Data and Sample Sharing for Research: An Overview of Empirical Findings. J Empir Res Hum Res Ethics 2023; 18:319-345. [PMID: 37936410 DOI: 10.1177/15562646231212644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
We aimed to review the attitudes and perspectives of the public and patients towards the sharing of data and biospecimens for research and to identify common dimensions, regardless of setting. Our review included systematic, scoping or thematic reviews of empirical studies retrieved from Medline (PubMed interface), Web of Science, Scopus, ProQuest and Cochrane Reviews. The main themes identified and synthesised across the 14 reviews were readiness and motivations; potential risks and safeguards; trust, transparency and accountability; autonomy and preferred type of consent; and factors influencing data and biospecimen sharing and consent. Sociodemographic factors and research and individual context remain relevant influencing factors in all settings, while preferences for types of consent are highly heterogeneous. Trusted environments and adapted consent options with participant engagement are relevant to improve research participation.
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Rodríguez-Domínguez FJ, Osuna-García T, Guillén A, Pérez-Cárceles MD, Osuna E. Involvement and Autonomy of Minors in Medical Settings: Perceptions of Children Undergoing Surgery and Parents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1844. [PMID: 38136046 PMCID: PMC10742034 DOI: 10.3390/children10121844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
Informed consent presupposes competence and represents a formal decision by an informed person who has the legal capacity to accept medical action or participate in research. Our aim was to analyze the perceptions of minors and their parents about the age at which they consider that a minor is competent for making health decisions. A descriptive observational study was carried out in 302 minors between 12 and 17 years of age undergoing elective surgery, and 302 parents (range 30 to 62 years). Two semistructured questionnaires were designed, one for the minors and the other, for the parents. A total of 20.1% of minors and 31.1% of parents believe that patients should not make decisions related to their health until they are 18 years old. A total of 74.9% of the minors surveyed consider that from 16 years of age, the minor is empowered to make decisions. In parents, this percentage is 60%. In the pediatric setting, each case and situation must be examined individually to determine if the minor meets the condition of maturity to decide. The ideal is to promote the minor's participation in decision-making, giving them the opportunity to participate in the process in a manner appropriate to their capacity.
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Affiliation(s)
| | - Teresa Osuna-García
- Service of Pediatrics, University Hospital of Caravaca de la Cruz (Murcia), 30400 Murcia, Spain;
| | - Alberto Guillén
- Service of Otorhinolaryngology, University Hospital of Cartagena (Murcia), 30202 Murcia, Spain; (F.J.R.-D.); (A.G.)
| | | | - Eduardo Osuna
- Department of Legal and Forensic Medicine, University of Murcia, 30120 Murcia, Spain;
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Ou L, Chen ACC, Amresh A. The Effectiveness of mHealth Interventions Targeting Parents and Youth in Human Papillomavirus Vaccination: Systematic Review. JMIR Pediatr Parent 2023; 6:e47334. [PMID: 37988155 PMCID: PMC10698656 DOI: 10.2196/47334] [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: 03/17/2023] [Revised: 09/18/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The prevalence of human papillomavirus (HPV) and its related cancers is a major global concern. In the United States, routine HPV vaccination is recommended for youth aged 11 or 12 years. Despite HPV being the most common sexually transmitted infection and the vaccine's proven efficacy, the vaccination rate among US youth remains below the recommended 80% completion rate. Mobile health (mHealth) interventions have demonstrated promise in improving health. Examining and synthesizing the current evidence about the impact of mHealth interventions on vaccination coverage in youth and intervention characteristics could guide future mHealth interventions aimed at mitigating the vaccination gap and disease burden. OBJECTIVE This study aims to conduct a systematic review to assess the effectiveness of mHealth interventions on parental intent to vaccinate youth against HPV and youth's vaccine uptake. METHODS We searched empirical papers through databases including Google Scholar, PubMed, CINAHL, PsycINFO, and Cochrane Library. The inclusion criteria were the following: (1) published between January 2011 and December 2022; (2) using mHealth aimed to improve HPV vaccination rate; (3) targeted unvaccinated youth or their parents; and (4) measured HPV-related knowledge, vaccination intention, or vaccine uptake. Overall, 3 researchers screened and appraised the quality of the eligible papers using the Melnyk Levels of Evidence and the Cochrane Grading of Recommendations Assessment, Development, and Evaluation methodology. Disagreements in search results and result interpretation were resolved through consensus. RESULTS Overall, 17 studies that met the inclusion criteria were included in the final review. Most studies were conducted in the United States (14/17, 82%), used a randomized controlled trial design (12/17, 71%), and adopted behavior change theories or a culture-centric approach (10/17, 59%). mHealth interventions included SMS text message reminders, motivational SMS text messages, computer-tailored or tablet-tailored interventions, smartphone apps, web-based tailored interventions, social media (Facebook) campaigns, digital videos, and digital storytelling interventions. Approximately 88% (15/17) of the mHealth interventions demonstrated positive effects on knowledge, intention, or behaviors related to HPV vaccination. Overall, 12% (2/17) reported limited or no intervention impact on vaccine uptake or vaccine series completion. Effective vaccine uptake was commonly seen in interventions based on behavior change theories and those that provided culturally relevant information. CONCLUSIONS This systematic review identified the impact of mHealth interventions among unvaccinated youth and their parents, which showed improvement in HPV-related knowledge, vaccination intention, or vaccine initiation. The interventions that incorporated theories and culture-centric approaches revealed the most promising results. Although these outcomes are encouraging, future studies are needed to investigate factors associated with the success of interventions using SMS text messaging or social media. More studies are also needed for a better understanding of the intervention elements that boost the responses of age-specific and ethnicity-specific populations.
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Affiliation(s)
- Lihong Ou
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | | | - Ashish Amresh
- College of Engineering, Informatics, and Applied Sciences, Northern Arizona University, Flagstaff, AZ, United States
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Vrouenraets LJJJ, de Vries ALC, Arnoldussen M, Hannema SE, Lindauer RJL, de Vries MC, Hein IM. Medical decision-making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians. Eur Child Adolesc Psychiatry 2023; 32:2343-2361. [PMID: 36115898 PMCID: PMC10576681 DOI: 10.1007/s00787-022-02076-6] [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: 01/29/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
According to international transgender care guidelines, transgender adolescents should have medical decision-making competence (MDC) to start puberty suppression (PS) and halt endogenous pubertal development. However, MDC is a debated concept in adolescent transgender care and little is known about the transgender adolescents', their parents', and clinicians' perspectives on this. Increasing our understanding of these perspectives can improve transgender adolescent care. A qualitative interview study with adolescents attending two Dutch gender identity clinics (eight transgender adolescents who proceeded to gender-affirming hormones after PS, and six adolescents who discontinued PS) and 12 of their parents, and focus groups with ten clinicians was conducted. From thematic analysis, three themes emerged regarding transgender adolescents' MDC to start PS: (1) challenges when assessing MDC, (2) aspects that are considered when assessing MDC, and (3) MDC's relevance. The four criteria one needs to fulfill to have MDC-understanding, appreciating, reasoning, communicating a choice-were all, to a greater or lesser extent, mentioned by most participants, just as MDC being relative to a specific decision and context. Interestingly, most adolescents, parents and clinicians find understanding and appreciating PS and its consequences important for MDC. Nevertheless, most state that the adolescents did not fully understand and appreciate PS and its consequences, but were nonetheless able to decide about PS. Parents' support of their child was considered essential in the decision-making process. Clinicians find MDC difficult to assess and put into practice in a uniform way. Dissemination of knowledge about MDC to start PS would help to adequately support adolescents, parents and clinicians in the decision-making process.
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Affiliation(s)
- Lieke Josephina Jeanne Johanna Vrouenraets
- Department of Medical Psychology, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Emma Children's Hospital, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Marijn Arnoldussen
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam and Levvel, Amsterdam, The Netherlands
| | - Martine C de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Irma M Hein
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam and Levvel, Amsterdam, The Netherlands
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Durmaz N, Ulukol B, Şahinoğlu S. Perceptions of pediatric residents and pediatricians about ethical dilemmas: The case of Turkey. Arch Pediatr 2023; 30:537-543. [PMID: 37714736 DOI: 10.1016/j.arcped.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 11/30/2022] [Accepted: 06/21/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND This study determined the knowledge, attitudes, and behaviors of pediatricians and pediatric residents regarding issues of ethics, professional education, clinical ethical principles, and consent they encounter in health service delivery. METHODS Participants in the study were 134 pediatricians and pediatric residents from three hospitals in Ankara, Turkey. Participants were asked questions regarding their sociodemographic characteristics, their knowledge and views of ethics and ethical education, whether they had ever encountered an ethical problem, their beliefs about obtaining consent from pediatric patients and their families, and case-based questions. All data were collected and evaluated. RESULTS Of the participants in the study, 82 (61.2%) were residents, 41 (30.6%) were pediatricians, and 11 (8.2%) were faculty lecturers. The data revealed that 10% of the pediatricians and pediatric residents received ethical education, apart from medical ethics/deontology education at medical school, and 90.3% required further education on children and ethical problems. It was determined that 89% of residents and 78% of pediatricians needed help with the ethical problems they encountered during the diagnostic and treatment processes. Overall, 65.7% of the participants stated that the ethical problems they encountered affected the efficiency of health service delivery. It was observed that residents were more affected by ethical issues than pediatricians were. The present study revealed that pediatric residents and pediatricians need ethics education and there is a need to establish ethics counseling centers in hospitals. There is also a need for further studies in pediatrics and ethics.
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Affiliation(s)
- Nihal Durmaz
- Gulhane Training and Research Hospital, Ankara, Turkey.
| | - Betül Ulukol
- Ankara University Faculty of Medicine, Ankara, Turkey
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Hwang JW, Chien SJ, Wang CC, Kuo KC, Tang KS, Lee Y, Chen YC, Lo MH, Lee IK, Chuah SK, Lee CT, Kung CT, Wang LJ. Perception and Mental Health Status Regarding COVID-19 Vaccination Among Taiwanese Adolescents and Their Caregivers. Adolesc Health Med Ther 2023; 14:195-204. [PMID: 37822558 PMCID: PMC10562508 DOI: 10.2147/ahmt.s429238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
Background Vaccinating adolescents is a vital strategy to enhance population protection without imposing overly restrictive measures on our daily lives during the COVID-19 pandemic. As teenagers gain more independence, their willingness to get vaccinated may depend on their own understanding of the pandemic, vaccines, and mental well-being, as well as that of their caregivers. Our study aimed to examine how Taiwanese adolescents and their caregivers perceive COVID-19 vaccination and assess their mental health status. Methods We invited a total of 138 vaccinated adolescents and their caregivers to complete several questionnaires, including the Drivers of COVID-19 Vaccination Acceptance Scale (DrVac-COVID19S), Impact of Event Scale (IES), and Chinese Health Questionnaire (CHQ). Results Among the adolescents, 76.8% considered the BNT162b2 vaccine (Pfizer-BioNTech) as the ideal option for COVID-19 vaccination, while 27.5% of caregivers expressed acceptance of any available vaccine. Adolescents scored higher than caregivers in terms of vaccine value (p<0.001) and autonomy (p<0.001), but lower in knowledge (p<0.001), as assessed by the DrVac-COVID19S subscales. The adolescents' intention to get vaccinated against COVID-19 (DrVac-COVID19S total score) showed a positive correlation with their perception of the pandemic's impact (IES scores, r=0.214, p=0.012) and their caregivers' vaccination intention (r=0.371, p<0.001). Furthermore, adolescents' mental health demonstrated a positive association with the mental health of their caregiver (CHQ total scores, r=0.481, p<0.001). Conclusion During the COVID-19 outbreak, caregivers have encountered heightened levels of mental stress, and this stress has been found to be positively correlated with the mental stress experienced by adolescents and their intentions regarding vaccination. These findings can serve as crucial references for healthcare providers and governments when formulating vaccination policies for adolescents in the future.
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Affiliation(s)
- Jade Winjei Hwang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Shao Ju Chien
- Division of Pediatric Cardiology, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung, 83301, Taiwan
| | - Chih-Chi Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Kuang-Che Kuo
- Division of Pediatric Infection, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan
| | - Kuo-Shu Tang
- Division of Pediatric Emergency, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Yi-Chun Chen
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Mao-Hung Lo
- Division of Pediatric Cardiology, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung, 83301, Taiwan
| | - Ing-Kit Lee
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Chien-Te Lee
- Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Chia-Te Kung
- Department of Emergency, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
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30
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Santos-Beneit G, Fernández-Alvira JM, Tresserra-Rimbau A, Bodega P, de Cos-Gandoy A, de Miguel M, Ramírez-Garza SL, Laveriano-Santos EP, Arancibia-Riveros C, Carral V, Orrit X, Rodríguez C, Carvajal I, Haro D, Peyra C, Martínez-Gómez J, Álvarez-Benavides A, Estruch R, Lamuela-Raventós RM, Fernández-Jiménez R, Fuster V. School-Based Cardiovascular Health Promotion in Adolescents: A Cluster Randomized Clinical Trial. JAMA Cardiol 2023; 8:816-824. [PMID: 37531100 PMCID: PMC10398546 DOI: 10.1001/jamacardio.2023.2231] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/30/2023] [Indexed: 08/03/2023]
Abstract
Importance School-based interventions offer an opportunity for health promotion in adolescence. Objective To assess the effect of 2 multicomponent educational health promotion strategies of differing duration and intensity on adolescents' cardiovascular health (CVH). Design, Setting, and Participants The SI! Program for Secondary Schools is a 4-year cluster randomized clinical intervention trial conducted in 24 secondary schools from Barcelona and Madrid, Spain, from September 7, 2017, to July 31, 2021. Eligible participants were adolescents enrolled in the first grade of secondary school. Interventions Schools and their participants were randomized to receive a health promotion intervention (SI! Program) over 4 school years (long-term intervention [LTI], 8 schools, 412 adolescents) or 2 school years (short-term intervention [STI], 8 schools, 504 adolescents) or to receive the standard curriculum (control, 8 schools, 441 adolescents). Main outcome and Measures The primary end point was the between-group difference at 2 and 4 years in the change from baseline of the overall CVH score, as defined by the American Heart Association (range, 0-14 points, with a higher score indicating a healthier CVH profile). Intervention effects were tested with multilevel mixed-effects models. A complete-case intention-to-treat analysis was performed as the primary analysis. Results Of the randomized students, the study enrolled 1326 adolescents (684 [51.6%] boys, mean [SD] age, 12.5 [0.4] years at recruitment) with a study completion rate of 86.0%. Baseline overall CVH scores were 10.3 points in the LTI group, 10.6 points in the STI group, and 10.5 points in the control group. After 2 years, at halfway through the LTI and at the end of the STI, the difference in the CVH score change was 0.44 points (95% CI, 0.01-0.87; P = .04) between the LTI group and the control group and 0.18 points (95% CI, -0.25 to 0.61; P = .39) between the STI group and the control group. At 4 years, differences for the LTI and STI groups vs control were 0.12 points (LTI: 95% CI, -0.19 to 0.43; P = .42) and 0.13 points (STI: 95% CI, -0.17 to 0.44; P = .38). No adverse events were reported. Conclusions and Relevance Overall, the tested school-based health promotion strategies in this randomized clinical trial had a neutral effect on the CVH of the adolescents. Although there was evidence of a marginal beneficial effect at a point halfway through implementation in the LTI group, such a benefit was not noted at 4 years. Further research is warranted into the efficacy of school-based health promotion programs. Trial Registration ClinicalTrials.gov Identifier: NCT03504059.
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Affiliation(s)
- Gloria Santos-Beneit
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Anna Tresserra-Rimbau
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària, Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària, Universitat de Barcelona, 08921 Santa Coloma de Gramenet, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Patricia Bodega
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Amaya de Cos-Gandoy
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Mercedes de Miguel
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Sonia L. Ramírez-Garza
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària, Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària, Universitat de Barcelona, 08921 Santa Coloma de Gramenet, Spain
| | - Emily P. Laveriano-Santos
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària, Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària, Universitat de Barcelona, 08921 Santa Coloma de Gramenet, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Camila Arancibia-Riveros
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària, Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària, Universitat de Barcelona, 08921 Santa Coloma de Gramenet, Spain
| | - Vanesa Carral
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
| | - Xavier Orrit
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
| | - Domenec Haro
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
| | - Carles Peyra
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Antonio Álvarez-Benavides
- Departamento de Sociología III: Tendencias Sociales, Facultad de Ciencias Políticas y Sociología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Ramón Estruch
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Rosa M. Lamuela-Raventós
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària, Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària, Universitat de Barcelona, 08921 Santa Coloma de Gramenet, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Centro de Investigación Biomédica En Red en enfermedades CardioVasculares, Madrid, Spain
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Valentín Fuster
- Foundation for Science, Health and Education, 08011 Barcelona, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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31
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Lai K, Rubalcava NS, Weidler EM, van Leeuwen K. Paediatric surgeons' current knowledge and practices of obtaining assent from adolescents for elective reconstructive procedures. JOURNAL OF MEDICAL ETHICS 2023; 49:602-606. [PMID: 36543529 DOI: 10.1136/jme-2022-108525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Adolescents develop their decision-making ability as they transition from childhood to adulthood. Participation in their medical care should be encouraged through obtaining assent, as recommended by the American Academy of Pediatrics (AAP). In this research, we aim to define the current knowledge of AAP recommendations and surgeon practices regarding assent for elective reconstructive procedures. METHODS An anonymous electronic survey was distributed to North American paediatric surgeons and fellows through the American Pediatric Surgical Association (n=1353). RESULTS In total, 220 surgeons and trainees responded (16.3%). Fifty per cent of the surgeons who are familiar with the concept of assent had received formal training; 12% of the respondents had not heard of assent before the survey. Forty-seven per cent were aware of the 2016 AAP policy statement regarding assent in paediatric patients. Eighty-nine per cent always include adolescents as part of the consent discussion. Seventy-seven per cent solicit an expression of willingness to accept the proposed care from the patient. The majority (74%) of the surgeons perceived patient cooperation/understanding as the biggest barrier to obtaining assent. Over half of the respondents would consider proceeding with elective surgery despite the adolescent patient's refusal. Reasons cited for proceeding with elective surgery include surgeons' perception of medical necessity, perceptions of disease urgency, and lack of patient maturity. CONCLUSION Paediatric surgeons largely acknowledge the importance of assent, but variably practice the principles of obtaining assent from adolescent patients undergoing elective reconstructive procedures. Fewer surgeons are explicitly aware of formal policy statements or received formal training. Additional surgeon education and institutional policies are warranted to maximise inclusion of adolescents in their medical care.
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Affiliation(s)
- Krista Lai
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Nathan S Rubalcava
- Department of Surgery, Creighton University School of Medicine Phoenix Regional Campus, Phoenix, Arizona, USA
| | - Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Kathleen van Leeuwen
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA
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Aasen ERHV, Søvik ML, Størdal K, Lee A. Are We on the Same Page? Exploring Pediatric Patients' Involvement With Advance Care Planning. J Pain Symptom Manage 2023; 66:e353-e363. [PMID: 37054956 DOI: 10.1016/j.jpainsymman.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND According to the UN Convention on the Rights of the Child, children have a right to be heard. This also applies to patients in pediatric palliative care (PPC). The aim of this literature review was to explore what is known about the involvement of children (<14 years of age), adolescents and young adults (AYAs) in advance care planning (ACP) in PPC. METHODS A search was conducted in PubMed including publications from January 1, 2002 until December 31, 2021. The identified citations had to report on ACP or related terms in any PPC context. RESULTS A total of n = 471 unique reports were identified. Final inclusion criteria were met by n = 21 reports, including children and AYAs with diagnoses related to oncology, neurology, HIV/AIDS and cystic fibrosis. Nine reports were from randomized controlled studies, investigating ACP methodology. The main findings were: 1) caregivers are included more often than children and adolescents in ACP, 2) some studies indicate an incongruence between AYAs and their caregivers regarding ACP and treatment preferences, 3) although the process evokes a wide range of emotions, ACP is perceived as helpful by many AYAs CONCLUSION: The majority of studies about ACP in PPC do not include children and AYAs. Whether incongruence reported in some studies between AYAs and their caregivers regarding treatment preferences could be reduced by ACP should be further explored, including the involvement of children and adolescents in ACP, and the impact of pediatric ACP on patient outcomes in PPC.
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Affiliation(s)
| | - Marte Løvaas Søvik
- Faculty of Medicine (E.R.H.V.A., M.L.S.), University of Oslo, Oslo, Norway
| | - Ketil Størdal
- Department of Pediatric Research (K.S.), Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Pediatric and Adolescent Medicine (K.S., A.L.), Oslo University Hospital, Oslo, Norway
| | - Anja Lee
- Division of Pediatric and Adolescent Medicine (K.S., A.L.), Oslo University Hospital, Oslo, Norway.
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Nihlén Fahlquist J. Taking Risks to Protect Others-Pediatric Vaccination and Moral Responsibility. Public Health Ethics 2023; 16:127-138. [PMID: 37547911 PMCID: PMC10401494 DOI: 10.1093/phe/phad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Indexed: 08/08/2023] Open
Abstract
The COVID-19 pandemic during 2020-2022 raised ethical questions concerning the balance between individual autonomy and the protection of the population, vulnerable individuals and the healthcare system. Pediatric COVID-19 vaccination differs from, for example, measles vaccination in that children were not as severely affected. The main question concerning pediatric vaccination has been whether the autonomy of parents outweighs the protection of the population. When children are seen as mature enough to be granted autonomy, questions arise about whether they have the right to decline vaccination and who should make the decision when parents disagree with each other and/or the child. In this paper, I argue that children should be encouraged to not only take responsibility for themselves, but for others. The discussion of pediatric vaccination in cases where this kind of risk-benefit ratio exists extends beyond the 2020-2022 pandemic. The pandemic entailed a question that is crucial for the future of public health as a global problem, that is, to what extent children should be seen as responsible decision-makers who are capable of contributing to its management and potential solution. I conclude that society should encourage children to cultivate such responsibility, conceived as a virtue, in the context of public health.
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Affiliation(s)
- Jessica Nihlén Fahlquist
- Corresponding author: Jessica Nihlén Fahlquist, Centre for Research Ethics and Bioethics, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden. Tel.: +46 18 471 65 65;
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Ruggeri SY, Emerson A, Russell CL. A concept analysis of routines for improving health behaviors. Int J Nurs Sci 2023; 10:277-287. [PMID: 37545771 PMCID: PMC10401352 DOI: 10.1016/j.ijnss.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/09/2023] [Accepted: 06/17/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Chronic disease patients often have unhealthy routines, especially when away from health care professionals. These patients need clear guidance about establishing and maintaining routines. This study aimed to synthesize a definition of the concept of routines for improving health behaviors based on its uses in the literature. Methods We searched CINAHL, Medline, Scopus, and Google Scholar from January to May, 2022 for articles that included definitions of routines in the context of improving health behavior. We applied no date restriction. The systematic analytic method and Rodgers' evolutionary concept analysis method were used. We charted the attributes, antecedents, and consequences of routines for improving health behaviors, analyzed their uses in the literature, and synthesized the results in a definition of the concept. Result At total of 24 articles were included. Attributes of the concept were repeated patterns, controllable by the patient, goal-oriented health, and integration into an overarching lifestyle. Antecedents were individual characteristics and environmental factors. Consequences were psychological, physical, and social well-being at individual and environmental levels. Conclusion This clarified definition of routines for improving health behaviors will provide a starting point for future research and, eventually, a basis for clinical nursing interventions to support patients in developing and maintaining healthy routines to promote better patient outcomes.
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Affiliation(s)
- Sunny Y. Ruggeri
- School of Nursing and Health Studies, University of Missouri-Kansas City, Missouri, USA
- Dr. Lillian R. Goodman Department of Nursing, Worcester State University, Massachusetts, USA
| | - Amanda Emerson
- University of Kansas Medical Center, University of Kansas School of Nursing, Kansas, USA
| | - Cynthia L. Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Missouri, USA
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Sangngam J, Prasopkittikun T, Nookong A, Pacharn P, Chamchan C. Causal relationships among self-management behaviors, symptom control, health-related quality of life and the influencing factors among Thai adolescents with asthma. Int J Nurs Sci 2023; 10:309-317. [PMID: 37545770 PMCID: PMC10401355 DOI: 10.1016/j.ijnss.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To examine causal relationships among asthma self-management behaviors, asthma symptom control, health-related quality of life and the influencing factors among Thai adolescents. Methods A cross-sectional study was conducted using convenience sampling. A total of 240 adolescent-caregiver dyads from three tertiary hospitals in Bangkok, Thailand was ultimately included. Interviews and self-administered questionnaires assessing health-related quality of life, asthma symptom control, asthma self-management behaviors, health literacy, depression, comorbidities, family support, peer support, home environmental management, and relationships with health care providers were administered between November 2020 and July 2021. A hypothesized model based on the revised self- and family-management framework was proposed. Data were analyzed using descriptive statistics and path analysis. Results It was shown that the proposed model was a good fit for the empirical data and accounted for 67.2% of the variance in health-related quality of life. Depression and asthma symptom control directly affected quality of life (β = -0.132, P < 0.05; and β = 0.740, P < 0.05, respectively), while asthma self-management behaviors did not. Both depression and asthma self-management behaviors had indirect effects on the quality of life through asthma symptom control (β = -0.382, P < 0.05; and β = 0.225, P < 0.05, respectively). Health literacy (β = 0.343, P < 0.05), family support (β = 0.167, P < 0.05), peer support (β = 0.163, P < 0.05), and relationships with health care providers (β = 0.181, P < 0.05) also showed direct effects on asthma self-management behaviors. Conclusion The findings confirmed the causal relationships among asthma symptom control, self-management behaviors, depression and health-related quality of life. Health literacy, support from family and peers, and relationships with health care providers were also found to influence asthma self-management behaviors. To achieve effective asthma control and good quality of life, a nursing intervention promoting asthma self-management for Thai adolescents should be developed. Early detection and intervention of depressive symptoms are also suggested.
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Affiliation(s)
| | | | - Apawan Nookong
- Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Punchama Pacharn
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalermpol Chamchan
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
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Parker AE, Scull TM, Kennedy KL. Efficacy of DigiKnowItNews: Teen, a multimedia educational website for adolescents about pediatric clinical trials: study protocol for a randomized controlled trial. Trials 2023; 24:436. [PMID: 37391773 DOI: 10.1186/s13063-023-07464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Pediatric research is crucial for the development of new scientific advancements, treatments, and therapies for adolescents. Yet relatively few pediatric clinical trials are conducted due to barriers to successful recruitment and retention, including knowledge and attitudes about clinical trials. Adolescents tend to experience greater autonomy to make decisions and have expressed interest in being part of the decision to participate in clinical trials. Increasing knowledge, positive attitudes, and self-efficacy related to clinical trials could positively impact the decision to participate in a pediatric clinical trial. However, there are currently few interactive, developmentally appropriate, web-based resources available to educate adolescents about clinical trials. DigiKnowItNews: Teen was created as a multimedia educational website to address the relatively low levels of enrollment in pediatric clinical trials and need for information to empower adolescents to make decisions about participating in clinical trials. METHODS This is a parallel group randomized controlled superiority trial to test the effectiveness of DigiKnowItNews: Teen, for improving factors related to clinical trial participation among adolescent and parents. Eligible parent-adolescent (ages 12 to 17 years) pairs will be randomly assigned to one of two conditions: intervention or wait-list control. All participants will complete pre- and post-test questionnaires and participants assigned to the intervention will receive access to review the DigiKnowItNews: Teen content for 1 week. Wait-list control participants will have the option to review DigiKnowItNews: Teen after study completion. The primary outcomes are knowledge about clinical research, attitudes, and beliefs toward pediatric clinical trials, self-efficacy for making decisions related to clinical trial participation, willingness to participate in a future clinical trial, procedural fears, and parent-adolescent communication quality. Overall feedback and satisfaction related to DigiKnowItNews: Teen will also be collected. DISCUSSION The trial will evaluate the effectiveness of DigiKnowIt News: Teen, an educational website about pediatric clinical trials for adolescents. If found effective in promoting factors related to future pediatric clinical trial participation, DigiKnowIt News: Teen could be used by adolescents, along with their parents, as they make the decision to participate in a clinical trial. Clinical trial researchers can also use DigiKnowIt News: Teen to aid their participant recruitment efforts. TRIAL REGISTRATION ClinicalTrials.gov NCT05714943. Registered on 02/03/2023.
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Cestonaro C, Aprile A. Legal, deontological, and ethical basis of the physician-minor patient care relationship. Front Med (Lausanne) 2023; 10:1186414. [PMID: 37305135 PMCID: PMC10248435 DOI: 10.3389/fmed.2023.1186414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/26/2023] [Indexed: 06/13/2023] Open
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Ricci G, Gibelli F, Bailo P, Caraffa AM, Nittari G, Sirignano A. Informed Consent in Paediatric Telemedicine: Challenge or Opportunity? A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11101430. [PMID: 37239716 DOI: 10.3390/healthcare11101430] [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: 02/20/2023] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
The fundamental importance of informed consent as a prerequisite for the lawfulness of the medical act is an indisputable cornerstone of clinical practice. However, the provision of effective information and the collection of informed consent presents important critical issues in the underage patient, even considering that in general terms he or she does not have the power to directly express consent, which must be provided by parents or legal guardians. These critical issues are amplified in the context of telemedicine. The present study aims, through a scoping review of the literature of the past 10 years, to outline the operational practices adopted in the collection of informed consent from children in the context of telemedicine and to identify solutions devised to address the critical issues related to the provision of adequate information to the child in this particular care setting. The results of the research show that the activity of delivering adequate information to the child, itself complex, is made even more complex by the particular setting of telemedicine, which, however, could be effectively exploited to facilitate communication with the child patient.
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Affiliation(s)
- Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Anna Maria Caraffa
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
| | - Giulio Nittari
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Ascanio Sirignano
- Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy
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Yun J, Shin J, Lee H, Kim DJ, Choi IY, Kim M. Characteristics and Potential Challenges of Digital-Based Interventions for Children and Young People: Scoping Review. J Med Internet Res 2023; 25:e45465. [PMID: 37058340 PMCID: PMC10148209 DOI: 10.2196/45465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Digital health technologies are becoming increasingly available to children and young people and their families. However, there are no scoping reviews that provide both an overview of the characteristics of digital interventions for children and young people and potential challenges to be considered when developing and implementing them. OBJECTIVE This study aimed to systematically review scientific publications to identify the current characteristics and potential complications of digital interventions for children and young people. METHODS This scoping review was conducted using the framework of Arksey and O'Malley and adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. A search of 5 databases (PubMed, Scopus, Embase, MEDLINE, and CINAHL) and Google Scholar was performed for eligible clinical trials published between January 1, 2018, and August 19, 2022. RESULTS The initial search of the 5 databases yielded 3775 citations; duplicates and those not meeting the inclusion criteria were eliminated. In total, 34 articles were included in the final review and relevant information, such as the descriptive characteristics and potential challenges, were classified. Mental health (26/34, 76%) was the most common target for the digital intervention for children and young people, exceeding physical health (8/34, 24%) by more than 3 times. In addition, a substantial number of digital interventions were dedicated solely to children and young people. Digital interventions for children and young people were more likely to be delivered via computers (17/34, 50%) rather than smartphones (13/34, 38%). More than one-third of the studies (13/34, 38%) applied cognitive behavioral theory as the theory of digital interventions. The duration of the digital intervention for children and young people was more likely to vary depending on the target user rather than the target disease. Intervention components were classified into 5 categories: guidance, task and activity, reminder and monitoring, supportive feedback, and reward system. Potential challenges were subcategorized into ethical, interpersonal, and societal challenges. For ethical challenges, the consent of children and young people or caregivers, potential risk of adverse events, and data privacy issues were considered. For interpersonal challenges, the engagement of children and young people was affected by the preference or barrier of caregivers to participate in studies. For societal challenges, restricted ethnicity in recruitment, limited availability of digital technology, differences in internet use patterns between girls and boys, unified clinical settings, and language barriers were described. CONCLUSIONS We identified potential challenges and provided suggestions about ethical, interpersonal, and societal aspects to consider when developing and deploying digital-based interventions for children and young people. Our findings provide a thorough overview of the published literature and may serve as a comprehensive, informative foundation for the development and implementation of digital-based interventions for children and young people.
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Affiliation(s)
- Jinsoo Yun
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hyerim Lee
- Department of Psychology, College of Liberal Arts, Yonsei University, Seoul, Republic of Korea
| | - Dai-Jin Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In-Young Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Meelim Kim
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
- Health IT Center, Yonsei University Health System, Seoul, Republic of Korea
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Cavolo A, Gastmans C. Assent: going beyond acknowledgement for fair inclusion. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-108969. [PMID: 37045592 DOI: 10.1136/jme-2023-108969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/06/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Alice Cavolo
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Chris Gastmans
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
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Turan FD, Yangöz ŞT. Effect of educational interventions on level of epilepsy knowledge in children with epilepsy and parents: Systematic review and meta-analysis. J Clin Nurs 2023; 32:1381-1397. [PMID: 35534992 DOI: 10.1111/jocn.16346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/08/2022] [Accepted: 04/25/2022] [Indexed: 01/12/2023]
Abstract
AIM AND OBJECTIVES The aim of the study was to synthesise the effect of educational interventions on the level of epilepsy knowledge in children with epilepsy and parents. BACKGROUND Educational interventions are commonly used to provide knowledge about epilepsy management. One of the most important responsibilities of nurses is to inform children with epilepsy and parents in a skilful way. DESIGN Systematic review and meta-analysis based on PRISMA 2020. METHODS We searched CINAHL, Cochrane Library, Science Direct, Web of Science, Ovid, PubMed, Scopus, Springer Link, ProQuest, TR Index ending March 2021. The review followed the PRISMA guidelines. This meta-analysis was analysed in Comprehensive Meta-Analysis version 3 software. The risk of bias of included studies was assessed with the Cochrane handbook. The results were the level of epilepsy knowledge of children and parents. RESULTS Ten studies meeting the inclusion criteria were included in this meta-analysis, including four randomised studies and six non-randomised studies. Educational interventions had large effect on improving the level of epilepsy knowledge in children with epilepsy (p < .001, Hedge's g = 1.19) and parents (p < .001, Hedge's g = 1.41). As a result of the subgroup analyses, significant differences were found only in the type of educational intervention. It was found that traditional education is more effective than technology-based education in improving the level of epilepsy knowledge in parents (p = .005, Hedge's g = 1.77). CONCLUSION Educational interventions have high and beneficial effect on the level of epilepsy knowledge in the children with epilepsy and parents; can be used as effective interventions in the epilepsy management. However, due to low number of randomised controlled studies, further high-quality randomised controlled studies are needed about this topic. RELEVANCE TO CLINICAL PRACTICE The findings will contribute to the use of educational interventions in the epilepsy management for health professionals, especially nurses. Thus these interventions will contribute to improving epilepsy management of children with epilepsy and parents.
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Affiliation(s)
- Fatma D Turan
- Department of Pediatric Nursing, Faculty of Health Sciences, Aksaray University, Aksaray, Turkey
| | - Şefika T Yangöz
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Pamukkale University, Denizli, Turkey
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Participant Recruitment Issues in Child and Adolescent Psychiatry Clinical Trials with a Focus on Prevention Programs: A Meta-Analytic Review of the Literature. J Clin Med 2023; 12:jcm12062307. [PMID: 36983307 PMCID: PMC10055793 DOI: 10.3390/jcm12062307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction: There is a strong need to conduct rigorous and robust trials for children and adolescents in mental health settings. One of the main barriers to meeting this requirement is the poor recruitment rate. Effective recruitment strategies are crucial for the success of a clinical trial, and therefore, we reviewed recruitment strategies in clinical trials on children and adolescents in mental health with a focus on prevention programs. Methods: We reviewed the literature by searching PubMed/Medline, the Cochrane Library database, and Web of Science through December 2022 as well as the reference lists of relevant articles. We included only studies describing recruitment strategies for pediatric clinical trials in mental health settings and extracted data on recruitment and completion rates. Results: The search yielded 13 studies that enrolled a total of 14,452 participants. Overall, studies mainly used social networks or clinical settings to recruit participants. Half of the studies used only one recruitment method. Using multiple recruitment methods (56.6%, 95%CI: 24.5–86.0) resulted in higher recruitment. The use of monetary incentives (47.0%, 95%CI: 24.6–70.0) enhanced the recruitment rate but not significantly (32.6%, 95%CI: 15.7–52.1). All types of recruitment methods showed high completion rates (82.9%, 95%CI: 61.7–97.5) even though prevention programs showed the smallest recruitment rate (76.1%, 95%CI: 50.9–94.4). Conclusions: Pediatric mental health clinical trials face many difficulties in recruitment. We found that these trials could benefit from faster and more efficient recruitment of participants when more than one method is implemented. Social networks can be helpful where ethically possible. We hope the description of these strategies will help foster innovation in recruitment for pediatric studies in mental health.
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Norbäck K, Höglund AT, Godskesen T, Frygner-Holm S. Ethical concerns when recruiting children with cancer for research: Swedish healthcare professionals' perceptions and experiences. BMC Med Ethics 2023; 24:23. [PMID: 36918868 PMCID: PMC10012289 DOI: 10.1186/s12910-023-00901-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Research is crucial to improve treatment, survival and quality of life for children with cancer. However, recruitment of children for research raises ethical challenges. The aim of this study was to explore and describe ethical values and challenges related to the recruitment of children with cancer for research, from the perspectives and experiences of healthcare professionals in the Swedish context. Another aim was to explore their perceptions of research ethics competence in recruiting children for research. METHODS An explorative qualitative study using semi-structured interviews with key informants. Seven physicians and ten nurses were interviewed. Interviews were analysed using inductive qualitative content analysis. RESULTS The respondents' ethical challenges and values in recruitment mainly concerned establishing relationships and trust, meeting informational needs, acknowledging vulnerability, and balancing roles and interests. Ensuring ethical competence was raised as important, and interpersonal and communicative skills were highlighted. CONCLUSION This study provides empirical insight into recruitment of children with cancer, from the perspectives of healthcare professionals. It also contributes to the understanding of recruitment as a relational process, where aspects of vulnerability, trust and relationship building are important, alongside meeting informational needs. The results provide knowledge on the complexities raised by paediatric research and underpin the importance of building research ethics competence to ensure that the rights and interests of children with cancer are protected in research.
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Affiliation(s)
- Kajsa Norbäck
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden.
| | - Anna T Höglund
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
| | - Tove Godskesen
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Box 11189, 100 61, Stockholm, Sweden
| | - Sara Frygner-Holm
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
- Physiotherapy and behavioral medicine, Department of Women's and Children's Health, Box 593, 751 24, Uppsala, Sweden
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Brownings S, Hale L, Simonds LM, Jassi A. Exploring the experiences and responses of siblings living with a brother or sister with obsessive compulsive disorder. Psychol Psychother 2023; 96:464-479. [PMID: 36883716 DOI: 10.1111/papt.12454] [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: 08/08/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES The impact of having a child with diagnosed obsessive-compulsive disorder (OCD) can reportedly cause significant disruption to caregiver routines and negatively affect their mental health. Less is known about the impact to other first-degree relatives such as siblings due to limited research. It should not be assumed that findings in the caregiver literature can simply be applied to siblings. This study, therefore, aimed to explore the experiences and responses of cohabiting siblings of a brother or sister with an OCD diagnosis. METHOD Eight participant siblings were recruited from a UK specialist OCD NHS clinic and interviewed via telephone about their experiences co-habiting with a brother or sister with OCD. Interviews were transcribed and subjected to interpretative phenomenological analysis (IPA). RESULTS Two superordinate themes of 'OCD as a dangerous dictator' and the 'unifying/polarising influence of OCD on relationships' were interpreted from the eight participant experiences. Siblings spoke to OCD creating a dictatorial environment characterised by sibling loss, helplessness and adjustment. This fragile domestic environment seemingly pushed non-anxious siblings to the periphery of the family or conversely centralised their position through parentification. CONCLUSIONS Many of the sibling experiences of frustration, distress avoidance, helplessness and symptom accommodation are mirrored in the burgeoning caregiver literature. Longitudinal studies are required to track sibling experiences over the course of their siblings OCD journey and expand our knowledge in this area. Counselling services, sibling support groups and inclusion in family assessment, formulation and treatment are possible avenues of exploration for siblings of those with an OCD diagnosis.
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Affiliation(s)
- Stuart Brownings
- National and Specialist OCD, BDD and Related Disorders Service for Young People, Michael Rutter Centre, Maudsley Hospital, London, UK
| | - Lucy Hale
- Department of Psychology, University of Surrey, Guildford, UK
| | - Laura M Simonds
- Department of Psychology, University of Surrey, Guildford, UK
| | - Amita Jassi
- National and Specialist OCD, BDD and Related Disorders Service for Young People, Michael Rutter Centre, Maudsley Hospital, London, UK
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45
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Adolescent autonomy for the COVID-19 vaccine. J Public Health Policy 2023:10.1057/s41271-023-00398-6. [PMID: 36788273 PMCID: PMC9927041 DOI: 10.1057/s41271-023-00398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
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Rea S, Mikesell L, Cuddihy C, Perry M, Allison B. Exploring the Complexity of Telehealth Privacy Through a Lens of Adolescent Development. QUALITATIVE HEALTH RESEARCH 2023; 33:220-235. [PMID: 36655804 DOI: 10.1177/10497323231151596] [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: 06/17/2023]
Abstract
Many challenges exist related to ensuring adolescent privacy with health care providers (HCPs), and the rapid integration of telehealth visits has created additional complexities in organizing privacy for adolescents. Through interviews with adolescent patients and their parents (n = 34), this qualitative analysis aimed to explore the complicated relationship and balance of adolescent alone time with HCPs, parental presence and support, and organization of privacy in order to consider how privacy during telehealth visits may contribute to adolescents' healthy development. A framework by Blum et al. (2014) proposed four central goals of adolescent development: emotional security, engagement with learning, self-efficacy, and decision-making skills. This conceptual framework was used to outline the ways in which adolescent privacy during telehealth impacts adolescent development. Some adolescents reported that having their parents present during their telehealth visit afforded reassurance and comfort, and many parents explained that they served as a role-model during their adolescent's telehealth visit. However, other adolescents felt higher emotional security when they could establish an independent relationship with their HCP, with many describing how privacy during their telehealth visit enabled them to have more sensitive discussions with their HCP. Adolescents and parents also reported that telehealth allowed increased experiential learning for adolescents, given their proficiency with technology and ability to access their health care visits autonomously. Furthermore, the organization of privacy was complicated by a lack of understanding whose responsibility it was to facilitate alone time between the adolescent and HCP, as well as external factors such as location and quality of technology and the proximity of family members in the home. By ensuring opportunities for private healthcare encounters, both in telehealth and in-person visits, HCPs and parents can help support adolescents in achieving successful and healthy development.
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Affiliation(s)
- Samantha Rea
- 12267Wayne State University School of Medicine, Detroit, MI, USA
| | | | | | - Martha Perry
- 2332University of North Carolina System, Chapel Hill, NC, USA
| | - Bianca Allison
- 2332University of North Carolina System, Chapel Hill, NC, USA
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Martinelli V, Singh S, Politi P, Caccialanza R, Peri A, Pietrabissa A, Chiappedi M. Ethics of Bariatric Surgery in Adolescence and Its Implications for Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1232. [PMID: 36673981 PMCID: PMC9859476 DOI: 10.3390/ijerph20021232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Obesity is increasingly prevalent among adolescents. Clinical and research data support the use of bariatric surgery (BS) as a treatment option for severely obese adolescents, with good results in terms of weight loss, improvement or resolution of comorbidities, and compliance to follow up. Nevertheless, concerns still remain, with significant disparities among countries and ethical concerns mainly raised by performing an irreversible and invasive procedure in adolescence, with potential life-long alterations. In this context, the purpose of this narrative review was to discuss the main current ethical challenges in performing BS in adolescence and to inform appropriate clinical management in the field. The core ethical principles of autonomy, beneficence, nonmaleficence, and justice were revised in terms of patient-centered healthcare through the lens of psychosocial implications. The review concludes with a discussion regarding the potential directives for future research for effective, patient-centered, and ethical management of obesity in the adolescent population.
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Affiliation(s)
- Valentina Martinelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Simran Singh
- Medway Hospital, Windmill Rd, Gillingham ME7 5NY, UK
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Andrea Peri
- Department of Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Andrea Pietrabissa
- Department of Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
- Department of Surgery, University of Pavia, 27100 Pavia, Italy
| | - Matteo Chiappedi
- Vigevano Child Neurology and Psychiatry Unit, ASST Pavia, 27100 Pavia, Italy
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Deeb M, Alameddine D, Abi Radi Abou Jaoudeh R, Laoun W, Maamari J, Honeini R, Khouri A, Abou-Mrad F, Elia N, Abi-Gerges A. Knowledge about and attitudes toward medical informed consent: a Lebanese population survey. ETHICS & BEHAVIOR 2022. [DOI: 10.1080/10508422.2022.2153681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Mary Deeb
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Dana Alameddine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | | | - Widian Laoun
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Julian Maamari
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Rawan Honeini
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Alain Khouri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Fadi Abou-Mrad
- Faculty of Medical Sciences, Lebanese University, Lebanon; Memory Clinic, Division of Neurology, Saint Charles Hospital, Lebanon; Lebanon Memory Group for Clinical Research (GMRC-Liban), Lebanon
| | - Nassib Elia
- Faculty of Law, Sagesse University, Lebanon
- Judicial Studies Institute, Lebanese Ministry of Justice, Beirut, Lebanon
| | - Aniella Abi-Gerges
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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Cayouette F, O’Hearn K, Gertsman S, Menon K. Operationalization of assent for research participation in pre-adolescent children: a scoping review. BMC Med Ethics 2022; 23:106. [PMID: 36329421 PMCID: PMC9632024 DOI: 10.1186/s12910-022-00844-2] [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: 06/09/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Seeking assent from children for participation in medical research is an ethical imperative of numerous institutions globally. However, none of these organizations provide specific guidance on the criteria or process to be used when obtaining assent. The primary objective of this scoping review was to determine the descriptions of assent discussed in the literature and the reported criteria used for seeking assent for research participation in pre-adolescent children. METHODS Medline and Embase databases were searched until November 2020 using the term "assent" in the title or abstract. Inclusion criteria were (1) studies enrolling children which specifically described operationalization of the assent process and (2) studies of the assent process which provided a description of assent. Data collected included participant information, patient criteria for seeking assent, guidelines referenced, description of assent reported, how assent was obtained and assent information presented, and reported assent rate. For qualitative articles focusing on the assent process, important themes were identified. RESULTS A total of 116 articles were included of which 79 (68.9%) operationalized assent and 57 studies (%) described the assent process. The most commonly reported criterion used to determine the ability of a child to assent was age (35.4%, 28/79). The reported minimal age for obtaining pediatric assent varied considerably across and within jurisdictions (5-13 years; median 7.5 years, IQR 7.0, 9.75). Cognitive ability was reported as a criterion for obtaining assent in 5.1% (4/79) of studies. Assent rates were only reported in 17.7% (14/79) of citations and ranged from 32.0 to 100%. Analysis of the 57 studies describing the assent process identified several themes, including age thresholds, assessment of capacity, variable knowledge of pediatric assent and parental roles. CONCLUSION We found significant variation in criteria used for assessment of patient capacity, delivery of information used to obtain assent and documentation of the assent process. While we acknowledge that individual children, settings and jurisdictions may require different approaches to obtaining assent, there should be agreement on important principles to be followed with resulting common guidance on assessing capacity, delivering information and documentation of the assent process for publication.
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Affiliation(s)
- Florence Cayouette
- grid.28046.380000 0001 2182 2255Division of Critical Care, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON Canada
| | - Katie O’Hearn
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
| | - Shira Gertsman
- grid.414148.c0000 0000 9402 6172CHEO Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada ,grid.25073.330000 0004 1936 8227Present Address: Faculty of Medicine, McMaster University, Hamilton, ON Canada
| | - Kusum Menon
- grid.28046.380000 0001 2182 2255Division of Critical Care, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON Canada ,grid.414148.c0000 0000 9402 6172CHEO Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
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50
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Mihaly LK, Schapiro NA, English A. From Human Papillomavirus to COVID-19: Adolescent Autonomy and Minor Consent for Vaccines. J Pediatr Health Care 2022; 36:607-610. [PMID: 35941049 PMCID: PMC9356615 DOI: 10.1016/j.pedhc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
Adolescent minors in every state can give their own consent for some health care. Although parent consent is generally required for vaccination, there are exceptions in some states. Completion rates are low for recommended adolescent vaccines; allowing adolescents to consent may improve coverage, although more study is needed on barriers to vaccine completion and the feasibility of changes in consent laws. The COVID-19 pandemic highlights the importance of vaccines and related challenges. This policy brief reviews laws governing adolescent consent for health care, including vaccines, and recommends advocacy to support increased adolescent access to vaccines and improved public health.
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