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Plunkett C, Pilkington M. Beliefs, screening attitudes and breast cancer awareness of young women with neurofibromatosis type 1: A reflexive thematic analysis. J Health Psychol 2024:13591053241255053. [PMID: 38859614 DOI: 10.1177/13591053241255053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
Neurofibromatosis type 1 (NF1) predisposes individuals to benign and malignant tumours. Young women with NF1 (<50 years) have an up to five-fold increased risk of breast cancer. The UK adopts moderate cancer risk guidelines of NICE, advising women with NF1 to attend breast screening from 40 years. Previous results from a systematic review and meta-analysis found that breast cancer in this cohort predominantly occurs from 34 to 44 years. Without earlier screening, breast awareness is fundamental. Reflexive thematic analysis and semi-structured interview questions based on the health belief model explored whether a tailor-made breast cancer awareness intervention would be beneficial by examining beliefs, screening attitudes and breast cancer awareness of young women with NF1. Findings suggest the establishment of accessible and accurate NF1 and breast awareness information, development and implementation of a breast awareness intervention for young women with NF1, and healthcare professionals.
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Johansen L, O'Hare F, Shepard ER, Ayton LN, Pelentsov LJ, Kearns LS, Galvin KL. Exploring the support needs of Australian parents of young children with Usher syndrome: a qualitative thematic analysis. Orphanet J Rare Dis 2024; 19:129. [PMID: 38515174 PMCID: PMC10956185 DOI: 10.1186/s13023-024-03125-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/03/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Advancements in genetic testing have led to Usher syndrome now being diagnosed at a much earlier age than in the past, enabling the provision of early intervention and support to children and families. Despite these developments, anecdotal reports suggest there are substantial gaps in the services and supports provided to parents of children with Usher syndrome. The current study investigated the support needs of parents of children with Usher syndrome Type 1 when their child was aged 0 to 5 years. METHOD Purposive sampling was used, and six semi-structured interviews were conducted with Australian parents of children with Usher syndrome, Type 1. Data was analysed using modified reflexive thematic analysis. RESULTS Four key themes were identified as being central to the support needs of parents of children with Usher syndrome aged 0 to 5 years. (1) Social Needs referred to parents' need for various sources of social support, (2) Informational Needs described the lack of information parents received regarding Usher syndrome from treating professionals, (3) Practical Needs included supports needed to assist parents in managing the day-to-day tasks of caring for a child with a disability, and (4) Emotional Needs represented the emotional support (both formal and informal) that parents needed to be a positive support to their child. CONCLUSIONS Findings provide rich information for relevant support groups, policy makers, individual healthcare professionals, and professional governing bodies regarding the education of stakeholders and the development and implementation of best-practice treatment guidelines.
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Affiliation(s)
- L Johansen
- UsherKids Australia, Mordialloc, VIC, Australia
| | - F O'Hare
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
- Centre for Eye Research Australia, East Melbourne, VIC, Australia
| | - E R Shepard
- UsherKids Australia, Mordialloc, VIC, Australia
| | - L N Ayton
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, VIC, Australia
- Centre for Eye Research Australia, East Melbourne, VIC, Australia
| | - L J Pelentsov
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - L S Kearns
- Centre for Eye Research Australia, East Melbourne, VIC, Australia
- Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - K L Galvin
- Department of Audiology and Speech Pathology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia.
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Jones J, Cruddas M, Simpson A, Meade N, Pushparajah D, Peter M, Hunter A. Factors affecting overall care experience for people living with rare conditions in the UK: exploratory analysis of a quantitative patient experience survey. Orphanet J Rare Dis 2024; 19:77. [PMID: 38373961 PMCID: PMC10877794 DOI: 10.1186/s13023-024-03081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Although individually rare, collectively, rare conditions are common and affect a large number of people and are often chronic, life threatening and affect multiple body systems; the majority of them have no effective treatment. The literature has identified many specific challenges for those living with rare conditions, however, we do not know which of these in combination are most likely to impact how someone rates their overall experience of care. The aim of this study is to do further exploratory analysis of the Genetic Alliance UK 2020 Rare Experience survey data to identify which variables are most strongly associated with respondents' overall care experience. RESULTS There were strong associations between most of the selected survey variables and the overall rated experience of care variable. In the multiple linear regression only nine variables remained in the best fit model: 'Trust and confidence in hospital staff involved in ongoing care'; 'Satisfaction with information provided by healthcare professionals-following diagnosis'; 'The professionals providing care work as a team'; 'Feel care is coordinated effectively'; 'The timing and frequency of appointments are convenient for the patient/carer/family'; 'Whether or not there is a specific healthcare professional to ask questions of about the rare/undiagnosed condition'; 'Experience of searching for a diagnosis'; 'Knowledge of whether there is a specialist centre for the condition'; and 'Number of different clinics attend for the condition'. CONCLUSIONS Our findings indicate the challenges that play the largest part in explaining the varied experiences with rare disease healthcare in the UK for our survey respondents. These challenges should be further investigated with a broader sample of people affected by rare conditions, ideally through the implementation of a comprehensive national rare condition patient registry. Our findings highlight an important potential gap in the Framework, 'trust and confidence in healthcare professionals'; further research is required to fully understand the foundations of trust and confidence.
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Affiliation(s)
- Jennifer Jones
- Genetic Alliance UK, Creative Works, 7 Blackhorse Road, London, E17 6DS, UK.
- Department of Population Health Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Marie Cruddas
- Genetic Alliance UK, Creative Works, 7 Blackhorse Road, London, E17 6DS, UK
| | - Amy Simpson
- Institute of Public Care, Oxford Brookes University, Harcourt Hill Campus, Oxford, OX2 9AT, UK
| | - Nick Meade
- Genetic Alliance UK, Creative Works, 7 Blackhorse Road, London, E17 6DS, UK
| | - Daphnee Pushparajah
- ALEXION PHARMA UK LTD, 3 Furzeground Way, Stockley Park, Uxbridge, UB11 1EZ, UK
| | - Michelle Peter
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, Level 5, Barclay House, 37 Queen Square, London, WC1N 3BH, UK
| | - Amy Hunter
- Genetic Alliance UK, Creative Works, 7 Blackhorse Road, London, E17 6DS, UK
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Crowe AL, Kerr K, McAneney H, McMullan J, Duffy G, McKnight AJ. Stakeholder Perceptions of Complementary and Integrative Medicines from People Living with Rare Diseases in Northern Ireland: A Mixed Methods Study. Complement Med Res 2023; 31:107-115. [PMID: 38052188 PMCID: PMC11057444 DOI: 10.1159/000535480] [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: 08/19/2022] [Accepted: 11/16/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Only 5% of rare diseases have an approved treatment available, therefore patients often utilise complementary and integrative medicines (CIMs) to help manage their condition. Limited high-quality evidence-based studies are available which support the effectiveness of CIM, as it is difficult to show that an outcome is a direct result of the CIM intervention and not due to bias. Patients and healthcare professionals must weigh up the evidence quality, safety, efficacy, practical logistics, and financial implications of utilising CIM for rare diseases. This study aimed to elucidate perspectives of stakeholders (individuals with rare diseases, carers, family members, CIM practitioners and healthcare professionals), on the usage of CIM for rare diseases across Northern Ireland. METHODS This was a mixed methods study. An online survey was open from January to February 2019 (n = 29 responses). Themes identified from the survey were then discussed with stakeholders in a semi-structured discussion workshop in March 2019. RESULTS A limited number of participants responded to the survey (n = 29). Some individuals with rare diseases reported CIM as effective in the management of their condition, in particular acupuncture, dietary supplements, herbal medicines, homoeopathy, hydrotherapy, kinesiology, mindfulness, pilates, reflexology, tai chi, and yoga. However, a number of respondents (n = 7) experienced a negative side effect from CIM. Workshop participants raised concerns over the lack of information available about CIM and rare disease. Both the survey and workshop identified inequality of access with participants reporting CIM to be expensive. CONCLUSIONS More information, high-quality research, and education about CIM are required for patients and healthcare professionals to help make informed decisions about the usage of CIM for rare diseases. Improved communication, information, and health and social care in general would help individuals be more confident and knowledgeable about therapeutic options in relation to their rare disease(s). Einleitung Nur für fünf Prozent der seltenen Erkrankungen existiert eine zugelassene Behandlung, weshalb Patienten häufig komplementäre und integrative Medizin (CIM) nutzen, um ihre Krankheit zu behandeln. Es liegen nur wenige qualitativ hochwertige evidenzbasierte Studien vor, die die Wirksamkeit von CIM stützen, da sich schwer nachweisen lässt, dass ein Behandlungsergebnis direkt durch die CIM-Intervention bedingt und nicht Folge einer Verzerrung ist. Patienten und Angehörige der Gesundheitsberufe müssen die Qualität der Evidenz, die Sicherheit und Wirksamkeit sowie praktische logistische Aspekte und die finanziellen Folgen der Anwendung von CIM bei seltenen Erkrankungen abwägen. Mit der vorliegenden Studie sollte die Perspektive der Betroffenen (Menschen mit seltenen Erkrankungen, Betreuungspersonen, Familienangehörige, CIM-Praktiker und Angehörige der Gesundheitsberufe) in Bezug auf die Anwendung von CIM bei seltenen Erkrankungen in Nordirland untersucht werden. Methoden Es handelte sich um eine Studie mit gemischten Methoden. Eine Online-Umfrage war von Januar bis Februar 2019 geöffnet ( n = 29 Antworten). Die in der Umfrage ermittelten Themen wurden anschließend im März 2019 im Rahmen eines halbstrukturierten Diskussionsworkshops mit den Betroffenen erörtert. Ergebnisse Eine begrenzte Anzahl von Teilnehmern antwortete auf die Umfrage ( n = 29). Einige Personen mit seltenen Erkrankungen gaben an, dass CIM bei der Behandlung ihrer Erkrankung wirksam war, insbesondere Akupunktur, Nahrungsergänzungsmittel, pflanzliche Arzneimittel, Homöopathie, Hydrotherapie, Kinesiologie, Achtsamkeit, Pilates, Reflexologie, Tai Chi und Yoga. Einige Befragte ( n = 7) berichteten jedoch über negative Nebenwirkungen der CIM. Die Workshop-Teilnehmer äußerten Bedenken in Bezug auf den Mangel an Informationen über CIM und seltene Erkrankungen. Sowohl in der Umfrage als auch im Workshop zeigte sich eine Ungleichheit beim Zugang zu CIM und die Teilnehmer berichteten, dass CIM teuer sei. Schlussfolgerungen Patienten und Angehörige der Gesundheitsberufe benötigen mehr Informationen, qualitativ hochwertige Forschung und Aufklärung über CIM, um fundierte Entscheidungen über die Anwendung von CIM bei seltenen Erkrankungen treffen zu können. Eine bessere Kommunikation, Information sowie gesundheitliche und soziale Versorgung im Allgemeinen würden zu mehr Selbstvertrauen und Wissen der Betroffenen über die therapeutischen Möglichkeiten im Zusammenhang mit ihrer seltenen Erkrankung beitragen.
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Affiliation(s)
- Ashleen Laura Crowe
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK,
| | - Katie Kerr
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Helen McAneney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Julie McMullan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Gavin Duffy
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Amy Jayne McKnight
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Wooding EL, Morton MJS, Lim M, Mitrofan O, Mushet N, Sie A, Knight B, Ford T, Newlove-Delgado T. Childhood/adolescent Sydenham's chorea in the UK and Ireland: a BPSU/CAPSS surveillance study. Arch Dis Child 2023; 108:736-741. [PMID: 37225279 PMCID: PMC10447407 DOI: 10.1136/archdischild-2023-325399] [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: 01/30/2023] [Accepted: 04/30/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To conduct the first prospective surveillance study of Sydenham's chorea (SC) in the UK and Ireland, and to describe the current paediatric and child psychiatric service-related incidence, presentation and management of SC in children and young people aged 0-16 years. DESIGN Surveillance study of first presentations of SC reported by paediatricians via the British Paediatric Surveillance Unit (BPSU) and all presentations of SC reported by child and adolescent psychiatrists through the Child and Adolescent Psychiatry Surveillance System (CAPSS). RESULTS Over 24 months from November 2018, 72 reports were made via BPSU, of which 43 met the surveillance case definition of being eligible cases of suspected or confirmed SC. This translates to an estimated paediatric service-related incidence rate of new SC cases of 0.16 per 100 000 children aged 0-16 per year in the UK. No reports were made via CAPSS over the 18-month reporting period, although over 75% of BPSU cases presented with emotional and/or behavioural symptoms. Almost all cases were prescribed courses of antibiotics of varying duration, and around a quarter of cases (22%) received immunomodulatory treatment. CONCLUSIONS SC remains a rare condition in the UK and Ireland but has not disappeared. Our findings emphasise the impact that the condition can have on children's functioning and confirm that paediatricians and child psychiatrists should remain vigilant to its presenting features, which commonly include emotional and behavioural symptoms. There is a further need for development of consensus around identification, diagnosis and management across child health settings.
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Affiliation(s)
- Eva Louise Wooding
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Paediatrics, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | | | - Ming Lim
- Children's Neurosciences Centre, Evelina Childrens Hospital, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Oana Mitrofan
- Faculty of Health and Life Sciences, University of Exeter, Exeter, Devon, UK
- Devon Partnership Trust, Exeter, UK
| | - Nadine Mushet
- CAMHS, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Adrian Sie
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
- NHS Lanarkshire, Bothwell, South Lanarkshire, UK
| | - Brodie Knight
- Royal Hospital for Sick Children Yorkhill, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Tamsin Newlove-Delgado
- Children and Young People's Mental Health (ChYMe) Research Collaboration, University of Exeter Medical School, Exeter, Devon, UK
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Zybarth D, Brandt M, Mundlos C, Inhestern L. Impact of the COVID-19 pandemic on health care and daily life of patients with rare diseases from the perspective of patient organizations - a qualitative interview study. Orphanet J Rare Dis 2023; 18:154. [PMID: 37344904 DOI: 10.1186/s13023-023-02771-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic people affected by rare diseases (RD) or caregiver of affected children have faced additional challenges. The pandemic has affected physical and mental health, social life and has led to financial consequences. Our objectives were to identify the impact of COVID-19 (1) on health care and (2) on daily life and participation of patients with RDs or caregivers from the perspective of representatives of patient organizations. Moreover, we explored their perspective on experiences of pandemic stress and resources during the pandemic. RESULTS We conducted 18 semi-structured interviews with representatives of patient organizations (e.g. chairperson, members of the steering committee), who were asked about the experiences of their members. The interviews were transcribed verbatim and analyzed using the framework approach. We contextualized our findings on the basis of the International Classification of Functioning, Disability and Health (ICF) model and adapted it according to identified subthemes. Patients and caregivers were confronted with aspects of pandemic stress such as lack of information, access and information regarding vaccination and being a risk group for COVID-19 infection. Physical and mental functioning was reported to be negatively impacted. Lock downs and contact restrictions led, e.g., to increasing lack of nursing services or lack of necessary informal support. Participation e.g. in social life and work was reduced. Health care services including medical care and supportive care as well as additional therapies were disrupted and greater effort was necessary to organize care. According to participants, central resources were informal support networks, digitalization, patient organizations and individual characteristics. CONCLUSIONS Our study highlights the consequences of the COVID-19 pandemic on the situation of people affected by RDs and caregivers. Contextualization of the results into the biopsychosocial model reinforces the impact of the pandemic on health care as well as daily life and participation. Major challenges and difficulties were experienced during lockdowns and contact restrictions. Depending on the risk of an infection with COVID-19, certain patient groups were still isolated and reduced social contacts or still followed strict hygienic measures (e.g., wearing medical masks). Future pandemic control measures, e.g. on lockdowns and closing facilities, should consider the challenges of people with RDs and caregivers of affected children.
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Affiliation(s)
- David Zybarth
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maja Brandt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Mundlos
- Allianz Chronischer Seltener Erkrankungen (ACHSE) e.V, Berlin, Germany
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Uhlenbusch N, Bal A, Balogh B, Braun A, Geerts A, Hirschfield G, Janik MK, Lohse AW, Milkiewicz P, Papp M, Poppe C, Schramm C, Löwe B. Improving quality of life in patients with rare autoimmune liver diseases by structured peer-delivered support (Q.RARE.LI): study protocol for a transnational effectiveness-implementation hybrid trial. BMC Psychiatry 2023; 23:193. [PMID: 36964518 PMCID: PMC10039546 DOI: 10.1186/s12888-023-04669-0] [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: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Psychosocial support is a crucial component of adequate rare disease care, but to date psychosocial support needs of this patient population are insufficiently met. Within Q.RARE.LI, we strive to evaluate the effectiveness of a structured, transdiagnostic, and location-independent psychosocial support intervention in routine care of patients with rare autoimmune liver diseases in five countries and prepare its implementation. METHODS Within an effectiveness-implementation hybrid trial, we aim to a) investigate the effectiveness of the intervention in routine care in five diverse healthcare systems and b) assess implementation outcomes, examine and prepare the implementation context, and develop country-specific implementation strategies. To assess effectiveness, we will include N = 240 patients with rare autoimmune liver diseases. Within a two-armed randomized controlled trial (allocation ratio 1:1), we will compare structured and peer-delivered psychosocial support in addition to care-as-usual (CAU) with CAU alone. Outcomes will be assessed via electronic database entry prior to intervention, directly after, and at a three-month follow-up. Our primary effectiveness outcome will be mental health-related quality of life at post-assessment. Secondary outcomes include depression and anxiety severity, perceived social support, helplessness, and disease acceptance. Implementation outcomes will be assessed within a mixed-methods process evaluation. In a quantitative cross-sectional survey, we will examine perceived acceptability and feasibility in patients, peer-counselors, and healthcare providers involved in delivery of the intervention. In qualitative focus groups, we will analyze the implementation context and determine barriers and facilitators for implementation with different stakeholders (patients and/or representatives, peer-counselors, healthcare providers, health insurers). Based on these results, we will derive country-specific implementation strategies and develop a concrete implementation plan for each country. DISCUSSION The intervention is expected to help patients adjust to their disease and improve their mental quality of life. The transdiagnostic and location-independent program has the potential to reach patients for psychosocial support who are usually hard to reach. By preparing the implementation in five countries, the project can help to make low-threshold psychosocial support available to many patients with rare diseases and improve comprehensive healthcare for an often neglected group. TRIAL REGISTRATION ISRCTN15030282.
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Affiliation(s)
- Natalie Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Arpinder Bal
- Toronto Centre for Liver Disease, University Health Network, Toronto, Canada
| | - Boglárka Balogh
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Annika Braun
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Geerts
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Gideon Hirschfield
- Toronto Centre for Liver Disease, University Health Network, Toronto, Canada
| | - Maciej K Janik
- Department of Hepatology, Transplantology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ansgar W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Piotr Milkiewicz
- Department of Hepatology, Transplantology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
- Translational Medicine Group, Pomeranian Medical University, Pomeranian, Poland
| | - Mária Papp
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Carine Poppe
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Christoph Schramm
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Center for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Somanadhan S, O'Donnell R, Bracken S, McNulty S, Sweeney A, O'Toole D, Rogers Y, Flynn C, Awan A, Baker M, O'Neill A, McAneney H, Gibbs L, Larkin P, Kroll T. Children and young people's experiences of living with rare diseases: An integrative review. J Pediatr Nurs 2023; 68:e16-e26. [PMID: 36443134 DOI: 10.1016/j.pedn.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/26/2022]
Abstract
PROBLEM Rare diseases are any disease affecting fewer than five people in 10,000. More than 8000 rare diseases and 50-75% of all rare diseases affect children. The purpose of this review was to critically appraise and synthesize existing literature relating to the impact of rare diseases on children's day-to-day lives. ELIGIBILITY CRITERIA An integrative literature review was conducted using the CINAHL Plus, PsycINFO, and PubMed databases. Studies were included if they were a primary source was published between the years 2005 and 2019 and written in the English language. SAMPLE Eight primary sources met the inclusion criteria. RESULTS Seven main themes emerged from the review as follows: (i) the experience of stigmatisations, (ii) self-consciousness, (iii) restrictions in independent living, (iv) developing resilience/coping strategies, (v) psychological and emotional impact, (vi) social impact vs social connectedness and (vii) transition challenges. CONCLUSIONS The experience of having a rare illness differed across different age groups. Children (typically aged 3-10) with rare diseases generally view themselves and their lives the same way like their healthy peers. They were more likely to report being adaptive and resilient than those aged 12 or older. Young people reported being different compared to young children, and they faced numerous challenges related to their illness. IMPLICATIONS FOR PRACTICE To provide the best possible level of care for children and families with rare disorders, health services must be informed and equipped to provide the necessary supports specific to the unique needs of children and young people living with rare diseases.
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Affiliation(s)
- Suja Somanadhan
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland; UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), University College Dublin, Belfield, Dublin 4, Ireland.
| | - Ryan O'Donnell
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Shirley Bracken
- Children's Health Ireland at Temple Street Children's University Hospital, Temple St, Dublin 1 D01 XD99, Ireland.
| | - Sandra McNulty
- Children's Health Ireland at Temple Street Children's University Hospital, Temple St, Dublin 1 D01 XD99, Ireland.
| | - Alison Sweeney
- Children's Health Ireland at Temple Street Children's University Hospital, Temple St, Dublin 1 D01 XD99, Ireland.
| | - Doris O'Toole
- Children's Health Ireland at Temple Street Children's University Hospital, Temple St, Dublin 1 D01 XD99, Ireland. Doris.O'
| | - Yvonne Rogers
- Children's Health Ireland at Temple Street Children's University Hospital, Temple St, Dublin 1 D01 XD99, Ireland.
| | - Caroline Flynn
- Children's Health Ireland at Temple Street Children's University Hospital, Temple St, Dublin 1 D01 XD99, Ireland.
| | - Atif Awan
- Children's Health Ireland at Temple Street Children's University Hospital, Temple St, Dublin 1 D01 XD99, Ireland.
| | - Mona Baker
- Children's Health Ireland at Temple Street Children's University Hospital, Temple St, Dublin 1 D01 XD99, Ireland.
| | - Aimee O'Neill
- School of Psychology, Trinity College Dublin, the University of Dublin College Green, Dublin 2 D02 PN40, Ireland
| | - Helen McAneney
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland; UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), University College Dublin, Belfield, Dublin 4, Ireland.
| | - Lisa Gibbs
- Child & Community Wellbeing Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Philip Larkin
- Faculté de biologie et de médecine - FBM, Institut universitaire de formation et de recherche en soins - IUFRS, Bureau 1 -01/157 - SV-A Secteur Vennes - Rte de la Corniche 10 - CH-1010 Lausanne Université de Lausanne, Switzerland.
| | - Thilo Kroll
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland; UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), University College Dublin, Belfield, Dublin 4, Ireland.
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Rihm L, Dreier M, Rezvani F, Wiegand-Grefe S, Dirmaier J. The psychosocial situation of families caring for children with rare diseases during the COVID-19 pandemic: results of a cross-sectional online survey. Orphanet J Rare Dis 2022; 17:449. [PMID: 36572906 PMCID: PMC9791975 DOI: 10.1186/s13023-022-02595-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is affecting many areas of life and has posed additional strains on the highly vulnerable group of caregivers of children with rare diseases (RDs). The psychosocial situation of the family caregivers deserves more attention, both in research and practice. The current study explores the distress level of caregivers of children with RDs, their psychosocial information needs, and caregiver-reported health-related quality of life (HRQoL) of children with RDs in times of the COVID-19 pandemic. METHODS Data from a cross-sectional online survey conducted within the German CARE-FAM-NET project (children affected by rare diseases and their families-network) between March and August 2020 were examined. The study sample included 149 family caregivers, mostly mothers (83.2%) of 167 children with RDs. The survey assessed demographic and disease-related characteristics, distress and everyday problems of caregivers (Distress Thermometer for Parents; scale 0-10), psychosocial information needs (self-developed items; scale 0-100), and caregiver-reported HRQoL of the children with RDs (DISABKIDS Chronic Generic Measure, short-form; scale 0-100). Using descriptive statistics, we analyzed the psychosocial situation of families during the COVID-19 pandemic. We further conducted correlation analysis to investigate interrelations. RESULTS The distress level among caregivers was high (M = 6.84, SD = 2.43); 89.6% reported clinical distress (≥ 4). Everyday problems (e.g., sleep problems, fatigue, being out of shape, fears, feeling tense or nervous, and worry) were frequent. Caregivers reported a wide range of psychosocial information needs. In about half of the children (49.5%), caregiver-reported HRQoL was low, while average HRQoL (M = 58.7, SD = 19.5) was comparable to parent-reported norm data of children with severe clinical conditions. Distress correlated positively with psychosocial information needs (r = 0.40), and negatively with the caregiver-reported HRQoL of the children (r = - 0.46). CONCLUSIONS This study indicates a high psychosocial burden on family caregivers of children with RDs during the early COVID-19 pandemic, characterized by high distress levels and wide-ranging everyday problems, unmet psychosocial information needs, and reduced caregiver-reported HRQoL in children with RDs. The findings highlight the ongoing need for target group-specific, low-threshold support services (e.g., websites) during and after the pandemic.
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Affiliation(s)
- Lydia Rihm
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Mareike Dreier
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Farhad Rezvani
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Wiegand-Grefe
- grid.13648.380000 0001 2180 3484Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Mcmullan J, Lohfeld L, McKnight AJ. Needs of informal caregivers of people with a rare disease: a rapid review of the literature. BMJ Open 2022; 12:e063263. [PMID: 36523233 PMCID: PMC9748923 DOI: 10.1136/bmjopen-2022-063263] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Many people living with a rare disease (RD) are cared for by a family member. Due to a frequent lack of individual RD knowledge from healthcare professionals, the patient and their informal caregiver are frequently obliged to become 'experts' in their specific condition. This puts a huge strain on family life and results in caregivers juggling multiple roles in addition to unique caring roles including as advocate, case manager and medical navigator. We conducted a rapid review of literature reporting on the unmet needs of informal caregivers for people living with an RD. All searches were conducted on 14 September 2021, followed by a manual searches of reference lists on 21 September 2021. SETTING Searches were conducted in Medline, Embase, Web of Science, GreyLit and OpenGrey. RESULTS Thirty-five papers were included in the final review and data extracted. This rapid review presents several unmet needs identified by informal caregivers of persons with an RD. The related literature was organised thematically: caregiver burden, support through the diagnosis process, social needs, financial needs, psychological needs, information and communication needs and acknowledgement from healthcare professionals. CONCLUSIONS This review provides evidence that increased meaningful support is required for caregivers. Active engagement should be encouraged from this cohort in future research and awareness raised of the support available to improve the quality of life for families living with an RD. The unmet needs identified through this review will benefit people living with an RD, caregivers, healthcare professionals and policy makers.
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Affiliation(s)
- Julie Mcmullan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Lynne Lohfeld
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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11
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Nguyen CQ, Kariyawasam D, Alba‐Concepcion K, Grattan S, Hetherington K, Wakefield CE, Woolfenden S, Dale RC, Palmer EE, Farrar MA. ‘Advocacy groups are the connectors’: Experiences and contributions of rare disease patient organization leaders in advanced neurotherapeutics. Health Expect 2022; 25:3175-3191. [DOI: 10.1111/hex.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/20/2022] [Accepted: 09/29/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Christina Q. Nguyen
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Sydney New South Wales Australia
- Department of Neurology Sydney Children's Hospital Network Randwick New South Wales Australia
| | - Didu Kariyawasam
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Sydney New South Wales Australia
- Department of Neurology Sydney Children's Hospital Network Randwick New South Wales Australia
| | - Kristine Alba‐Concepcion
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Sydney New South Wales Australia
- Department of Neurology Sydney Children's Hospital Network Randwick New South Wales Australia
| | - Sarah Grattan
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Sydney New South Wales Australia
- Department of Neurology Sydney Children's Hospital Network Randwick New South Wales Australia
| | - Kate Hetherington
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Sydney New South Wales Australia
- Behavioural Sciences Unit, Kids Cancer Centre Sydney Children's Hospital Randwick New South Wales Australia
| | - Claire E. Wakefield
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Sydney New South Wales Australia
- Behavioural Sciences Unit, Kids Cancer Centre Sydney Children's Hospital Randwick New South Wales Australia
| | - Susan Woolfenden
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Sydney New South Wales Australia
- Sydney Institute Women Children and their Families Sydney New South Wales Australia
| | - Russell C. Dale
- Department of Neurology Sydney Children's Hospital Network Randwick New South Wales Australia
- Children's Hospital at Westmead Clinical School University of Sydney Westmead New South Wales Australia
| | - Elizabeth E. Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Sydney New South Wales Australia
- Centre for Clinical Genetics Sydney Children's Hospital Network Randwick New South Wales Australia
| | - Michelle A. Farrar
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health UNSW Sydney Sydney New South Wales Australia
- Department of Neurology Sydney Children's Hospital Network Randwick New South Wales Australia
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12
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Long JC, Best S, Nic Giolla Easpaig B, Hatem S, Fehlberg Z, Christodoulou J, Braithwaite J. Needs of people with rare diseases that can be supported by electronic resources: a scoping review. BMJ Open 2022; 12:e060394. [PMID: 36581982 PMCID: PMC9438091 DOI: 10.1136/bmjopen-2021-060394] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Rare diseases are characterised by low incidence, often with little evidence for effective treatments. Isolated patients and specialist centres for rare diseases are increasingly connected, thanks to the internet. This scoping review aimed to identify issues facing people with a rare disease that authors report may be addressed by electronic resources (mobile applications, websites, social media platforms, telehealth and online portals). DESIGN Scoping review guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. DATA SOURCES Medline, Embase and PsycInfo were searched, supplemented by hand searches of selected journals, in July 2021. ELIGIBILITY CRITERIA Peer-reviewed literature in English was searched using terms for rare disease (incidence <1:2000), electronic modalities (eg, mobile phone) and patient support terms. No date limit was set. Conference abstracts were included. DATA EXTRACTION AND SYNTHESIS Data extracted: rare disease/group of diseases, name of the e-resource, need identified in the patient cohort, features of the e-resource, any other findings or observations of interest. From this, a framework was developed synthesising features across diseases and resources. RESULTS Seventy-two papers were found (from 383). Fifty-six electronic resources were described in 64 papers, while 12 papers were exploratory studies. Cystic fibrosis (n=28) was the most frequently addressed, followed by haemophilia (n=16).Four domains and 23 subdomains of needs were extracted from the papers. The domains of needs were: support for self-management, access to high-quality information, access to appropriate specialist services, and social support. Subdomains are sometimes related to needs of individual rare diseases (eg, social isolation due to infection risk in people with cystic fibrosis). Fifteen electronic resources were identified that supported parents of children with rare disorders. CONCLUSIONS While it can be argued that rare diseases, per se, may be no less distressing or onerous to care for than a high prevalence disease, rare diseases have unique features: the lengthy odyssey to find a diagnosis, then appropriate specialists, the lack of evidence around effective treatments, guidelines or access to knowledgeable general health service providers. Designers of electronic resources are urged to consult key stakeholders to enhance the effectiveness and usability of resources for people with a rare disease.
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Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Zoe Fehlberg
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics Health Alliance, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - John Christodoulou
- Brain and Mitochondrial Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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13
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Gimenez-Lozano C, Páramo-Rodríguez L, Cavero-Carbonell C, Corpas-Burgos F, López-Maside A, Guardiola-Vilarroig S, Zurriaga O. Rare Diseases: Needs and Impact for Patients and Families: A Cross-Sectional Study in the Valencian Region, Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610366. [PMID: 36012000 PMCID: PMC9408677 DOI: 10.3390/ijerph191610366] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/12/2023]
Abstract
Families with rare diseases (RDs) have unmet needs that are often overlooked by health professionals. Describing these needs and the impact of the disease could improve their medical care. A total of 163 surveys were obtained from patients visiting primary care centres in the Valencian Region (Spain), during 2015-2017, with a confirmed or suspected diagnosis of RD. Of the 84.7% with a confirmed diagnosis, 50.4% had a diagnostic delay exceeding one year, and it was more prevalent among adults (62.2%). Families with paediatric patients were in a worse economic situation, with lower incomes and higher monthly disease-related expenses (€300 on average). These expenses were incurred by 66.5% of families and were mainly for medication (40.3%). Among them, 58.5% reported not being able to afford adjuvant therapies. The disease had an impact on 73.1% of families, especially on their routine and emotional state. Expenses, needs, and impacts were more frequent among families of patients with a history of hospitalisation or deterioration. Patients with delayed diagnosis had a higher consumption of drugs prior to diagnosis. People affected by RDs in the Valencian Region need therapies to improve their autonomy and emotional state. Health professionals should be aware of these needs.
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Affiliation(s)
- Cristina Gimenez-Lozano
- Preventive Medicine and Public Health, Hospital Universitario Doctor Peset, 46017 Valencia, Spain
| | - Lucía Páramo-Rodríguez
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, 46020 Valencia, Spain
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, 46020 Valencia, Spain
| | - Francisca Corpas-Burgos
- Economic, Demographic and Social Statistics Service, Valencian Institute of Statistics, Valencian Region, 46020 Valencia, Spain
| | - Aurora López-Maside
- Directorate General for Public Health and Addictions, Regional Ministry of Health, Valencian Region, 46020 Valencia, Spain
| | - Sandra Guardiola-Vilarroig
- Directorate General for Public Health and Addictions, Regional Ministry of Health, Valencian Region, 46020 Valencia, Spain
| | - Oscar Zurriaga
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, 46020 Valencia, Spain
- Directorate General for Public Health and Addictions, Regional Ministry of Health, Valencian Region, 46020 Valencia, Spain
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, University of Valencia, 46010 Valencia, Spain
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14
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Factors affecting pathways to care for children and adolescents with complex vascular malformations: parental perspectives. Orphanet J Rare Dis 2022; 17:271. [PMID: 35840977 PMCID: PMC9287854 DOI: 10.1186/s13023-022-02432-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background Complex vascular malformations (VMs) are rare disorders that can cause pain, coagulopathy, disfigurement, asymmetric growth, and disability. Patients with complex VMs experience misdiagnosis, delayed diagnosis, delayed or inappropriate treatments, and worsened health. Given the potential consequences of delaying expert care, we must identify the factors that impede or facilitate this access to care.
Results We performed semi-structured interviews with 24 parents (21 mothers; 3 fathers; median age = 42.5 years) of children with complex VMs and overgrowth disorders living in the US, recruited through two patient advocacy groups – CLOVES Syndrome Community, and Klippel-Trenaunay Support Group. We performed thematic analysis to assess parental perspectives on barriers and facilitators to accessing expert care. We identified 11 factors, representing 6 overarching themes, affecting families’ ability to access and maintain effective care for their child: individual characteristics (clinician behaviors and characteristics, parent behaviors and characteristics), health care system (availability of specialist multidisciplinary teams, care coordination and logistics, insurance and financial issues, treatments and services), clinical characteristics (accuracy and timing of diagnosis, features of clinical presentation), social support networks, scientific progress, and luck and privilege. Additionally, access to information about VMs and VM care was a crosscutting theme affecting each of these factors. These factors influenced both the initial access to care and the ongoing maintenance of care for children with VMs. Conclusion Parents of children with VMs report multiple factors that facilitate or impede their ability to provide their child with optimal care. These factors represent possible targets for future interventions to improve care delivery for families affected by VMs. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02432-4.
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15
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A Formative Study of the Implementation of Whole Genome Sequencing in Northern Ireland. Genes (Basel) 2022; 13:genes13071104. [PMID: 35885887 PMCID: PMC9316942 DOI: 10.3390/genes13071104] [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: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The UK 100,000 Genomes Project was a transformational research project which facilitated whole genome sequencing (WGS) diagnostics for rare diseases. We evaluated experiences of introducing WGS in Northern Ireland, providing recommendations for future projects. Methods: This formative evaluation included (1) an appraisal of the logistics of implementing and delivering WGS, (2) a survey of participant self-reported views and experiences, (3) semi-structured interviews with healthcare staff as key informants who were involved in the delivery of WGS and (4) a workshop discussion about interprofessional collaboration with respect to molecular diagnostics. Results: We engaged with >400 participants, with detailed reflections obtained from 74 participants including patients, caregivers, key National Health Service (NHS) informants, and researchers (patient survey n = 42; semi-structured interviews n = 19; attendees of the discussion workshop n = 13). Overarching themes included the need to improve rare disease awareness, education, and support services, as well as interprofessional collaboration being central to an effective, mainstreamed molecular diagnostic service. Conclusions: Recommendations for streamlining precision medicine for patients with rare diseases include administrative improvements (e.g., streamlining of the consent process), educational improvements (e.g., rare disease training provided from undergraduate to postgraduate education alongside genomics training for non-genetic specialists) and analytical improvements (e.g., multidisciplinary collaboration and improved computational infrastructure).
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16
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McMullan J, Crowe AL, Downes K, McAneney H, McKnight AJ. Carer reported experiences: Supporting someone with a rare disease. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1097-1108. [PMID: 33955634 DOI: 10.1111/hsc.13336] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/18/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
This exploratory study aimed to gain an understanding of carer reported experiences derived specifically from persons caring for someone with a rare disease. The survey took place online on the SmartSurvey platform from November 2019 to January 2020. The facilitated workshop took place in Bangor Carnegie Library, Northern Ireland. To be eligible to participate in the online survey respondents had to be adults caring for someone with a rare disease. Fifty-seven respondents took part, 15.8% male, 84.2% female. Thirty-two attendees were part of the facilitated workshop. While carers reported several positive aspects of their caring role, the majority of comments highlighted challenges such as sub-optimal interactions with healthcare professionals, insufficient (or absent) emotional, psychological and social support, lack of financial support and lack of awareness of existing support services. It is important that strategies are put in place to ensure that carers are given the time they need to care for themselves, and that awareness is raised of what support options are available for carers of people with a rare disease(s) from health and social care providers, charities or support groups.
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Affiliation(s)
- Julie McMullan
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science Block A, Belfast, UK
| | - Ashleen L Crowe
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science Block A, Belfast, UK
| | - Kirsten Downes
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science Block A, Belfast, UK
| | - Helen McAneney
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science Block A, Belfast, UK
| | - Amy Jayne McKnight
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science Block A, Belfast, UK
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17
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Nguyen CQ, Alba-Concepcion K, Palmer EE, Scully JL, Millis N, Farrar MA. The involvement of rare disease patient organisations in therapeutic innovation across rare paediatric neurological conditions: a narrative review. Orphanet J Rare Dis 2022; 17:167. [PMID: 35436886 PMCID: PMC9014615 DOI: 10.1186/s13023-022-02317-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The patient voice is becoming increasingly prominent across all stages of therapeutic innovation. It pervades research domains from funding and recruitment, to translation, care, and support. Advances in genomic technologies have facilitated novel breakthrough therapies, whose global developments, regulatory approvals, and confined governmental subsidisations have stimulated renewed hope amongst rare disease patient organisations (RDPOs). With intensifying optimism characterising the therapeutic landscape, researcher-advocate partnerships have reached an inflexion point, at which stakeholders may evaluate their achievements and formulate frameworks for future refinement.
Main text
Through this narrative review, we surveyed relevant literature around the roles of RDPOs catering to the rare paediatric neurological disease community. Via available literature, we considered RDPO interactions within seven domains of therapeutic development: research grant funding, industry sponsorship, study recruitment, clinical care and support, patient-reported outcome measures, and research prioritisation. In doing so, we explored practical and ethical challenges, gaps in understanding, and future directions of inquiry. Current literature highlights the increasing significance of ethical and financial challenges to patient advocacy. Biomedical venture philanthropy is gaining momentum amongst RDPOs, whose small grants can incrementally assist laboratories in research, training, and pursuits of more substantial grants. However, RDPO seed funding may encounter long-term sustainability issues and difficulties in selecting appropriate research investments. Further challenges include advocate-industry collaborations, commercial biases, and unresolved controversies regarding orphan drug subsidisation. Beyond their financial interactions, RDPOs serve instrumental roles in project promotion, participant recruitment, biobank creation, and patient registry establishment. They are communication conduits between carers, patients, and other stakeholders, but their contributions may be susceptible to bias and unrealistic expectations.
Conclusion
Further insights into how RDPOs navigate practical and ethical challenges in therapeutic development may enhance cooperative efforts. They may also inform resources, whose distribution among advocates, parents, and clinicians, may assist decision-making processes around rare disease clinical trials and treatments.
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18
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Carandang K, Poole J, Connolly D. Fatigue and activity management education for individuals with systemic sclerosis: Adaptation and feasibility study of an intervention for a rare disease. Musculoskeletal Care 2022; 20:593-604. [PMID: 35124888 PMCID: PMC9544914 DOI: 10.1002/msc.1617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 01/01/2023]
Abstract
Purpose Fatigue is an overlooked symptom for musculoskeletal diseases, including rare conditions like systemic sclerosis (SSc). The purpose of this study were the following: (1) to adapt the content and delivery method of an existing fatigue intervention, and (2) to determine the feasibility of Fatigue and Activity Management Education in Systemic Sclerosis (FAME‐iSS). Methods In Phase 1 adaptations were recorded using the Framework for Modification and Adaptations. In Phase 2, participants completed the 6‐week FAME‐iSS intervention and baseline, post‐intervention, and 3‐month follow‐up assessments measuring fatigue levels, fatigue impact, mental health, self‐efficacy, and use of energy conservation strategies. Qualitative data included a post‐intervention focus group and 3‐month follow‐up interviews. Results Three main changes were made to the original intervention: (1) the content was adapted from management of Lupus‐related fatigue to management of SSc‐related fatigue, (2) context for delivery from Ireland to United States, and (3) in‐person to online format. Participants (n = 4) were 51.8 ± 12.1 years old, had been diagnosed with SSc for 12.0 ± 8.0 years, were receiving disability support, and had college degrees. All participants had 100% attendance and completed all study activities. Participants had positive comments about the programme format, content, and implementation. Post‐intervention, improvements were observed in most measures. Moderate effect sizes were noted in fatigue and self‐efficacy scores. Conclusion Participants' positive responses supported the need for FAME‐iSS for people with SSc. Even with the small sample, FAME‐iSS led to improvements in fatigue and use of energy conservation strategies. The online format allowed for participation and sharing of ideas, especially during the global pandemic.
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Affiliation(s)
- Kristine Carandang
- Child and Adolescent Services Research Center, San Diego, California, USA
| | - Janet Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico, USA
| | - Deirdre Connolly
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Peláez Bejarano A, de las Aguas Robustillo Cortés M, Guzman Ramos MI. Patient experience in a rare disease: application of the IEXPAC questionnaire in hereditary transthyretin-mediated amyloidosis. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2021.1953468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ana Peláez Bejarano
- Unidad de Gestión Clínica Farmacia, Hospital Juan Ramón Jiménez, Huelva, Spain
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Llubes-Arrià L, Sanromà-Ortíz M, Torné-Ruiz A, Carillo-Álvarez E, García-Expósito J, Roca J. Emotional experience of the diagnostic process of a rare disease and the perception of support systems: A scoping review. J Clin Nurs 2021; 31:20-31. [PMID: 34137096 DOI: 10.1111/jocn.15922] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/23/2021] [Accepted: 06/02/2021] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVE To explore the experience of adult patients and adult patients' families, and their perception of the support systems received during the diagnostic process of rare diseases. BACKGROUND There are about 7,000 rare diseases that affect 7% of the world's population. Rare diseases are often underdiagnosed. This has been reported to have deleterious physical and psychological consequences in both the patients and their families, especially when institutional support during this process is low. DESIGN A scoping review was carried out following the 6-phase model proposed by Arksey & O'Malley and Levac et al., including the consultation phase in which patients diagnosed with rare diseases were interviewed to seek their views on the bibliographic evidence reviewed and their experience during the diagnostic process. METHODS The databases consulted were PubMed, CINAHL, Web of Science, SCOPUS, Cochrane Library, PsycINFO, OpenGrey, ProQuest Dissertations and Theses Global. They were explored from inception-July 2020, and qualitative, quantitative and mixed method studies were included. The Mixed Methods Appraisal Tool was used for the critical evaluation of the articles. The review was based on the guidance in the PRISMA-ScR statement. RESULTS The initial search identified 2,350 articles, of which 20 fully met the inclusion criteria and were therefore reviewed. In this analysis appeared two dimensions: internal factors: emotional aspects, and external factors: resources and support systems. RELEVANCE TO CLINICAL This review provides evidence on the emotional impact of the diagnostic process and during the communication phase of the definitive diagnosis. Health systems and professionals must be strengthened in order to improve the information, training and resources. Nurses can play a key role in coordinating communication and follow-up of those affected.
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Affiliation(s)
- Laia Llubes-Arrià
- Doctoral School, PhD Programme in Health, University of Lleida, Lleida, Spain
| | | | - Alba Torné-Ruiz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Elena Carillo-Álvarez
- Department of Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain.,Global Research on Wellbeing (GRoW) research group
| | - Judith García-Expósito
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Judith Roca
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS, Biomedical Research Institute of Lleida, Lleida, Spain
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McMullan J, Crowe AL, Bailie C, McKnight AJ. Evaluating the impact of COVID-19 on rare disease support groups. BMC Res Notes 2021; 14:168. [PMID: 33957984 PMCID: PMC8100734 DOI: 10.1186/s13104-021-05579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/20/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The impact of the current COVID-19 pandemic has been felt worldwide. Many vulnerable populations rely heavily on peer support provided by individual or collaborative groups. This study aimed to evaluate the impact of COVID-19 on groups supporting patients with a rare disease(s). Anecdotally the current pandemic significantly changed the way in which these groups operate and the services they can provide. DATA DESCRIPTION A targeted survey was conducted online with rare disease individual or collaborative groups. The results of the survey highlight the challenges individual and collaborative groups are facing during this pandemic and help to identify what support should be put in place to enable them to sustain their much-valued service through these trialing times. Groups have experienced an increase in calls to their helplines as well as followers to their websites and social media feeds. Groups are no longer meeting in person and so online meetings, webinars and zoom chats have become a regular occurrence. Fundraising was highlighted as an area of concern for such groups. It is hoped that this data might be used to highlight the support individual and collaborative groups require while also raising awareness of the value they bring to many.
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Affiliation(s)
- Julie McMullan
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science Block A, Grosvenor Road, Belfast, BT12 6BA UK
| | - Ashleen L. Crowe
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science Block A, Grosvenor Road, Belfast, BT12 6BA UK
| | - Caitlin Bailie
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science Block A, Grosvenor Road, Belfast, BT12 6BA UK
| | - Amy Jayne McKnight
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science Block A, Grosvenor Road, Belfast, BT12 6BA UK
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