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Wijesekera K, Kiff C, Aralis H, Sinclair M, Bursch B, Alejos JC, Lester P. Hybrid delivery of behavioral health screening and prevention intervention for pediatric heart transplant recipients and families: A randomized pilot study. Pediatr Transplant 2023; 27:e14577. [PMID: 37563804 DOI: 10.1111/petr.14577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/08/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND A significant number of pediatric heart transplant recipients and their families experience post-traumatic stress symptoms following transplantation, which can impact recipient behavioral and medical health outcomes. Preventive behavioral health interventions may improve outcomes, especially if interventions can be delivered at a distance to decrease barriers to mental health care. This pilot study examined the acceptability and accessibility of an evidence-informed resilience training program delivered using a video telehealth platform. A secondary aim was to assess the preliminary efficacy of the intervention on recipient behavioral health outcomes, perceived barriers to recipient medication adherence, parent behavioral health outcomes, and family functioning. METHODS Seventeen heart transplant recipients (8-18 years old) and their families were recruited and randomly assigned to a treatment as usual (n = 8) or an intervention group (n = 9). Baseline assessment data collected included demographic information and validated behavioral health measures. Follow-up assessments included the validated measures and acceptability and satisfaction ratings. RESULTS The study demonstrated that the program has high acceptability by recipients and parents, and a positive impact on recipients and parents, including significant reductions in youth behavioral difficulties as well as parent depression and post-traumatic stress symptoms. CONCLUSIONS Results of this study are promising and call for further evaluation of hybrid delivery models for behavioral health screening and prevention interventions for pediatric heart transplant recipients and their families.
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Affiliation(s)
- Kanchana Wijesekera
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Cara Kiff
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Hilary Aralis
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Maegan Sinclair
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brenda Bursch
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Juan C Alejos
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Patricia Lester
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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2
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West KB, Plevinsky JM, Amaral S, Laskin B, Lefkowitz DS. Predicting psychosocial risk in pediatric kidney transplantation: An exploratory cluster analysis of a revised Pediatric Transplant Rating Instrument. Pediatr Transplant 2023; 27:e14454. [PMID: 36518059 DOI: 10.1111/petr.14454] [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: 05/22/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Pediatric Transplant Rating Instrument (P-TRI) is a 17-item scale developed to assess psychosocial risk factors for poor outcomes after solid organ transplantation. Research has identified the limitations of the original instrument and proposed revisions to improve clinical utility. This project examined patterns of risk in children being evaluated for kidney transplant using a revised P-TRI. METHODS A multidisciplinary kidney transplant team revised the P-TRI. A social worker and a psychologist collaboratively completed the modified instrument for 37 children after the psychosocial pretransplant evaluation. Electronic medical records were reviewed for transplant status (transplanted, active waitlist, inactive) 1 year later. Exploratory cluster analyses and chi-square tests examined patterns of risk and correlates with cluster membership. RESULTS Three clusters were identified. The high-risk group (29.7%) had difficulties with medication and appointment adherence, strained relationships with the medical team, and the presence of parent psychiatric history. The medium-risk group (35.1%) had difficulties with parent knowledge, financial strain, and risk factors for medication nonadherence. The low-risk group (35.1%) demonstrated no difficulties with adherence or financial strain. Clusters were prospectively associated with transplant status, such that those in the high-risk group were less likely to be transplanted within 1 year post-evaluation. CONCLUSIONS The revised P-TRI demonstrated good construct validity as risk level appeared to be associated with transplant listing status 1 year post-evaluation. These results suggest that standardized pretransplant psychosocial risk assessment tools may have value in optimizing transplant access if they can be paired with targeted, multidisciplinary interventions to address concerns early in the transplant process.
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Affiliation(s)
- Kara B West
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jill M Plevinsky
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sandra Amaral
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin Laskin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Debra S Lefkowitz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Bastos Tavares AP, Seixas LBPDMG, Jayme CLW, Porta G, Seixas RBPDM, de Carvalho E. Pediatric Liver Transplantation: Caregivers' Quality of Life. Pediatr Gastroenterol Hepatol Nutr 2022; 25:489-499. [PMID: 36451695 PMCID: PMC9679308 DOI: 10.5223/pghn.2022.25.6.489] [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: 04/19/2022] [Revised: 06/29/2022] [Accepted: 10/03/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The survival rate of pediatric patients undergoing liver transplantation has increased considerably. Despite this, the period after transplantation is still complex and poses several challenges to the recipient's family, which is responsible for care management. Recently, more attention has been paid to the impact of this complex procedure on the quality of life of caregivers. Hence, this study is aimed at assessing the quality of life of caregivers of patients who have undergone liver transplantation and the aspects that influence it. METHODS This was an observational and cross-sectional study. From November 2020 to January 2021, short-form-36 questionnaires and additional questions were given to the main caregivers of children and adolescents who underwent pediatric liver transplantation. RESULTS Thirty-eight questionnaires were completed and the results revealed a lower quality of life in comparison to Brazilian standards, primarily in the mental domains (41.8±14.1 vs. 51.1±2.8; p<0.001). It did not show a significant association with socioeconomic or transplant-related factors, but it did show a negative impact on parents' perception of the child's health. Parents who reported worse health status for their children had a lower mental quality of life (44.1±13.8 vs. 33.3±12.6; p<0.05). CONCLUSION The caregivers of transplanted children have a lower quality of life than those of the local population. Psychological assistance should be routinely provided to parents for long-term follow-up to mitigate potential negative effects on the transplanted child's care.
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Affiliation(s)
- Ana Paula Bastos Tavares
- Department of Pediatric Gastroenterology, Brasília José de Alencar Children's Hospital, Brasília, Brazil
| | | | | | - Gilda Porta
- Department of Pediatric Hepatology and Liver Transplantation, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | | | - Elisa de Carvalho
- Department of Pediatric Gastroenterology, Brasília José de Alencar Children's Hospital, Brasília, Brazil
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Lerret SM, Flynn E, White-Traut R, Alonso E, Mavis AM, Jensen MK, Peterson CG, Schiffman R. Acceptability of an mHealth Family Self-management Intervention (myFAMI) for Pediatric Transplantation Families: Qualitative Focus. JMIR Nurs 2022; 5:e39263. [PMID: 35838761 PMCID: PMC9338419 DOI: 10.2196/39263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Around 1800 pediatric transplantations were performed in 2021, which is approximately 5% of the annual rate of solid organ transplantations carried out in the United States. Effective family self-management in the transition from hospital to home-based recovery promotes successful outcomes of transplantation. The use of mHealth to deliver self-management interventions is a strategy that can be used to support family self-management for transplantation recipients and their families. Objective The study aims to evaluate the acceptability of an mHealth intervention (myFAMI) that combined use of a smartphone app with triggered nurse communication with family members of pediatric transplantation recipients. Methods This is a secondary analysis of qualitative data from family members who received the myFAMI intervention within a larger randomized controlled trial. Eligible participants used the app in the 30-day time frame after discharge and participated in a 30-day postdischarge telephone interview. Content analysis was used to generate themes. Results A total of 4 key themes were identified: (1) general acceptance, (2) positive interactions, (3) home management after hospital discharge, and (4) opportunities for improvement. Conclusions Acceptability of the intervention was high. Family members rated the smartphone application as easy to use. myFAMI allowed the opportunity for families to feel connected to and engage with the medical team while in their home environment. Family members valued and appreciated ongoing support and education specifically in this first 30 days after their child’s hospital discharge and many felt it contributed positively to the management of their child’s medical needs at home. Family members provided recommendations for future refinement of the app and some suggested that a longer follow-up period would be beneficial. The development and refinement of mHealth care delivery strategies hold potential for improving outcomes for solid organ transplantation patients and their families and as a model to consider in other chronic illness populations. Trial Registration ClinicalTrials.gov NCT03533049; https://clinicaltrials.gov/ct2/show/NCT03533049
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Affiliation(s)
- Stacee Marie Lerret
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Erin Flynn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Rosemary White-Traut
- Department of Nursing Research, Children's Wisconsin, Milwaukee, WI, United States
| | - Estella Alonso
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alisha M Mavis
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Duke University School of Medicine, Raleigh, NC, United States
| | - M Kyle Jensen
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Caitlin G Peterson
- Division of Nephrology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, United States
| | - Rachel Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
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5
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Robertson T, Ahola Kohut S, Telfer H, Seifert-Hansen M, Mitchell J, Anthony SJ. Mindfulness-based retreat for mothers of paediatric heart transplant recipients: protocol for a pilot intervention study. BMJ Open 2022; 12:e060461. [PMID: 35803637 PMCID: PMC9272107 DOI: 10.1136/bmjopen-2021-060461] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mothers are often the primary caregivers for children requiring heart transplantation. Given that a mother's ability to successfully cope with the demands of her caregiving role may be predictive of positive familial psychosocial outcomes, it is critical that maternal coping is assessed and supported in paediatric healthcare. Mindfulness-based programmes are proposed as one intervention that may enhance quality of life, improve distress tolerance and coping and reduce social isolation in caregiving populations. This pilot study aims to investigate: (1) the implementation success of a mindfulness-based retreat (MBR), and (2) the effectiveness of a MBR at improving quality of life, distress tolerance, coping and perceived social support for mothers of paediatric heart transplant recipients. METHODS AND ANALYSIS A convergent parallel, mixed-method design is proposed for this pilot, exploratory study. Twenty mothers will participate in this pilot MBR held at a resort in Ontario, Canada. Quantitative data will be obtained using five standardised instruments completed at three time points: (T1) 24-hours prior to the intervention, (T2) immediately on completion of the intervention, and (T3) three months post-intervention. Qualitative data will be collected from all participants both through semi-structured focus groups at T2 and individual telephone interviews at T3. Focus groups and individual interviews will be transcribed verbatim for thematic analysis. Quantitative and qualitative data will be merged and compared during interpretation to ensure that the intervention implementation and effectiveness of the MBR retreat are described with comprehensive accuracy. The primary outcomes will be feasibility in relation to implementation effectiveness and participants' perception of social support for efficacy of the MBR intervention. ETHICS AND DISSEMINATION This study received Institutional Research Ethics Board approval from The Hospital for Sick Children (Number: 1000064719). Informed consent will be obtained prior to participant enrolment. Findings will be disseminated via conference presentations and submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Taylor Robertson
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sara Ahola Kohut
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Heather Telfer
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mirna Seifert-Hansen
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joanna Mitchell
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Samantha J Anthony
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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6
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Duncan-Park S, Danziger-Isakov L, Armstrong B, Williams N, Odim J, Shemesh E, Sweet S, Annunziato R. Posttraumatic stress and medication adherence in pediatric transplant recipients. Am J Transplant 2022; 22:937-946. [PMID: 34837457 PMCID: PMC8897237 DOI: 10.1111/ajt.16896] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 01/25/2023]
Abstract
Adolescent transplant recipients may encounter a range of potentially traumatic events (PTEs) pre- and posttransplant, yet little is known about the relationship between posttraumatic stress symptoms (PTSS) and medication adherence in this population. In the present study, adolescent recipients and caregivers completed psychosocial questionnaires at enrollment. Outpatient tacrolimus trough level data were collected over 1 year to calculate the Medication Level Variability Index (MLVI), a measure of medication adherence. Nonadherence (MLVI ≥2) was identified in 34.8% of patients, and most (80.7%) reported ≥1 PTE exposure. Levels of PTSS indicating likely posttraumatic stress disorder (PTSD) were endorsed by 9.2% of patients and 43.7% of caregivers. PTSS and MLVI were significantly correlated in the liver subgroup (r = .30, p = .04). Hierarchical multivariable linear regression analyses revealed overall patient PTSS were significantly associated with QoL (p < .001). PTEs are common in adolescent recipients; a minority may meet criteria for PTSD. PTSS screening to identify nonadherence risk requires further investigation and addressing PTSS may improve QoL. Caregivers appear at greater risk for PTSD and may require their own supports. The study was approved by each participating center's Institutional Review Board.
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Affiliation(s)
- Sarah Duncan-Park
- Icahn School of Medicine at Mount Sinai, NY, NY
- Fordham University, Bronx, NY
| | | | | | | | | | | | | | - Rachel Annunziato
- Icahn School of Medicine at Mount Sinai, NY, NY
- Fordham University, Bronx, NY
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7
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Triplett KN, Mayersohn GS, Masood SS, Pickwith K, Mbroh H, Killian M. Posttraumatic Growth in Youth, Young Adults, and Caregivers Who Experienced Solid Organ Transplant. J Pediatr Psychol 2021; 47:965-977. [PMID: 34957509 DOI: 10.1093/jpepsy/jsab134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore posttraumatic growth (PTG) in pediatric patients who have undergone solid organ transplant (SOT) and their caregivers, and to examine potential correlates of PTG. METHOD Youth and young adults with a history of SOT (heart, kidney, liver) at least 1 month prior to participation and caregivers completed measures of PTG, demographic, and medical factors. In total, 59 youth (M = 12.68 years, SD = 1.91), 21 young adults (M = 19.37, SD = 0.82), and 95 caregivers (M = 37.95 years, SD = 9.37) participated. RESULTS Overall, 67% of youth, 76% of young adults, and 89% of caregivers reported PTG within the medium to very high range. Appreciation of Life was the highest PTG subscale across all groups. Youth and caregiver PTG scores were significantly positively correlated. Religious affiliation and religious coping were positively associated with PTG for caregivers, and the relationship yielded large effect sizes for young adults. Caregivers of children with kidney transplants endorsed lower PTG than other organ types and caregivers of children who had an acute medical condition endorsed greater PTG than caregivers of children who had chronic illness. CONCLUSION Findings suggest the pediatric SOT experience can yield positive changes such as a greater appreciation of life. Although small sample sizes may have led to reduced power for detecting significant findings for some analyses, results suggest religious, medical, and parent-child relationship factors are likely related to PTG in pediatric SOT and warrant future investigation.
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Affiliation(s)
- Kelli N Triplett
- Department of Solid Organ Transplant, Children's Medical Center Dallas, Dallas, TX, USA.,Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Gillian S Mayersohn
- Department of Psychology, St. Louis Children's Hospital, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Saba S Masood
- Department of Solid Organ Transplant, Children's Medical Center Dallas, Dallas, TX, USA.,Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Kristine Pickwith
- Department of Solid Organ Transplant, Children's Medical Center Dallas, Dallas, TX, USA
| | - Hayden Mbroh
- Department of Psychiatry, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry, University of Southern California, Los Angeles, CA, USA
| | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
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Grant A, Ng VL, Nicholas D, Dhawan A, Yazigi N, Ee LC, Stormon MO, Gilmour SM, Schreiber RA, Carmody E, Otley AR. The effects of child anxiety and depression on concordance between parent-proxy and self-reported health-related quality of life for pediatric liver transplant patients. Pediatr Transplant 2021; 25:e14072. [PMID: 34245065 DOI: 10.1111/petr.14072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND HRQOL is a key outcome following pediatric LT. Parent-proxy reports may substitute for patients unable to report their own HRQOL. This study compared parent-proxy and self-reported HRQOL in children who have undergone LT. METHODS Pediatric LT recipients between the ages of 8 and 18 years, and a parent, completed self and proxy versions of the PeLTQL questionnaire, PedsQL Generic and Transplant modules, and standardized measures of depression and anxiety. RESULTS Data from 129 parent-patient dyads were included. Median parent age was 44 years, and most (89%) were mothers. Median patient age was 2.5 years at LT and 13.6 years at the time of study participation. Parents had significantly lower scores than patients on PedsQL total generic (70.8 ± 18.5 and 74.3 ± 19.0, p = .01), PeLTQL coping and adjustment (63.0 ± 15.6 and 67.3 ± 16.2, p < .01), and social-emotional (66.3 ± 14.9 and 71.9 ± 15.6, p < .001) domains. Higher patient anxiety and depression were related to larger absolute differences between parent-proxy and self-reported scores on all HRQOL measures (all p < .05). In this disparity, parents reported higher HRQOL scores than their child as self-reported anxiety and depression scores increased. CONCLUSIONS Differences in concordance between parent-proxy and self-reported HRQOL scores can be more prominent when children have more symptoms of anxiety and depression. Children's mental health symptoms should be queried, if feasible, when interpreting differences in parent and child reports of HRQOL.
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Affiliation(s)
- Amy Grant
- Maritime Intestinal Research Alliance, IWK Health Centre, Halifax, NS, Canada
| | - Vicky L Ng
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | | | - Nada Yazigi
- MedStar Georgetown Transplant Institute, Washington, DC, USA
| | - Looi C Ee
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, QLD, Australia
| | | | | | | | - Erin Carmody
- Maritime Intestinal Research Alliance, IWK Health Centre, Halifax, NS, Canada
| | - Anthony R Otley
- Maritime Intestinal Research Alliance, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
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9
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Masood SS, Triplett KN, Killian M, Mayersohn GS, Desai DM. Examining the association of medical complications and posttraumatic stress symptoms in pediatric solid organ transplant patients and their caregivers. Pediatr Transplant 2021; 25:e14030. [PMID: 34076930 DOI: 10.1111/petr.14030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) have been reported by pediatric solid organ transplant (SOT) patients and their caregivers well after transplantation. This study examined the relationship between PTSS, medication adherence, and medical complications in SOT patients and their caregivers. A secondary aim examined the association between patient and caregiver-reported PTSS. METHODS Pediatric SOT patients (N = 69) and caregivers (N = 73) reported on PTSS by completing the Child PTSD Symptom Scale (patients 8-17 years) or the Impact of Events Scale-Revised (patients 18 years and older and caregivers). Patient medication adherence was assessed using the Medication Level Variability Index (MLVI). Patients were dichotomized as experiencing a post-transplant medical complication (ie, transplant-related hospital admission prior to the year completing measures of PTSS) or no complications. RESULTS Medication adherence was not significantly associated with patient or caregiver PTSS. A moderate effect size was found for elevated young adult and caregiver PTSS and the presence of a medical complication. Generally, the association between self-reported patient and caregiver PTSS was low. CONCLUSIONS The presence of elevated PTSS in young adult patients may be partially explained by the presence of proximal medical complications and more so by comorbid psychiatric diagnoses in child and adolescent patients (based on exploratory analyses). Caregivers of patients with medical complications within the past year reported higher levels of PTSS. Overall, transplantation and its associated impact on PTSS may be unique experience for patients versus caregivers. Qualitative research may further elucidate these experiences and inform future clinical interventions.
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Affiliation(s)
- Saba S Masood
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Solid Organ Transplant, Children's Health - Children's Medical Center, Dallas, TX, USA
| | - Kelli N Triplett
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Solid Organ Transplant, Children's Health - Children's Medical Center, Dallas, TX, USA
| | - Michael Killian
- Department of Solid Organ Transplant, Children's Health - Children's Medical Center, Dallas, TX, USA.,College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Gillian S Mayersohn
- Department of Psychology, St. Louis Children's Hospital, St. Louis, MO, USA.,Washington University School of Medicine, St. Louis, MO, USA
| | - Dev M Desai
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Solid Organ Transplant, Children's Health - Children's Medical Center, Dallas, TX, USA
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10
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Prevalence of post-traumatic stress disorder in caregivers of pediatric neurosurgical patients. Childs Nerv Syst 2021; 37:959-967. [PMID: 33111174 DOI: 10.1007/s00381-020-04938-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Having a child receive a neurosurgical diagnosis creates significant stress and anxiety in caregivers. The stress of these life-threatening and emotionally charged diagnoses may put caregivers at risk for developing post-traumatic stress disorder (PTSD). While PTSD has been studied in a variety of caregivers of pediatric populations, to the best of our knowledge, it has yet to be examined in caregivers commonly seen in general pediatric neurosurgical practices. This study was designed to gain an understanding of the prevalence of PTSD within this population. METHODS A cross-sectional survey method was utilized. Participants completed both a survey to provide demographic information, and the Posttraumatic Stress Checklist for DSM-5 (PCL-5) which is used to make a provisional diagnosis of PTSD. Surveys were distributed both in person and online between December 2018 and April 2019. RESULTS One hundred sixty-eight surveys were included in the study. According to the DSM-5 diagnostic criteria, 44.6% (n = 75) of caregivers screened positively for a provisional diagnosis of PTSD. The specific neurosurgical diagnosis (p = 0.002), number of surgeries (p = 0.008), and category of the last surgery (p = 0.026) impacted the rate of PTSD symptoms in this population. Most caregivers who screened positive for PTSD experience a high level of disturbing memories and physical reactions to the events and avoid reminders of the medical experience. Caregivers also report a loss of interest in activities, feel distant from other people, and have difficulties with concentration and sleep. There was no significant relationship between caregivers who identified having a high level of anxiety before their child was diagnosed and who screened positive for PTSD. CONCLUSION This study has identified a higher number of caregivers screening positive for PTSD within pediatric neurosurgical patients, than previously reported in other populations. Specific neurosurgical diagnosis, number of surgeries, and category of last surgery all impact a positive screen for the condition. Caregivers who avoid remembering events surrounding their child's diagnosis are at a higher risk of having the condition. The results highlight the need to identify ways to decrease the impact of a pediatric neurosurgical diagnosis on the mental health of caregivers. Future research focused on early mental health intervention for caregivers of pediatric neurosurgical patients may be helpful in reducing the long-term impact of this difficult condition.
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11
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Amatya K, Monnin K, Steinberg Christofferson E. Psychological functioning and psychosocial issues in pediatric kidney transplant recipients. Pediatr Transplant 2021; 25:e13842. [PMID: 33012109 DOI: 10.1111/petr.13842] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
Research demonstrates that psychological factors are important for positive transplant outcomes, though there is little literature that synthesizes these factors in a comprehensive model among pediatric kidney transplant patients. This review analyzes psychological and psychosocial factors related to medical outcomes and overall well-being post-transplant by utilizing the PPPHM and referencing the existing literature on risk and resilience. Pediatric kidney transplant recipients are more susceptible to mental health concerns such as depression, anxiety, and ADHD, as well as developmental and neurocognitive delays, compared to healthy peers. Complex medical care and psychosocial needs for patients have implications for family functioning, parental and sibling mental health, and youth readiness to transition to adult care. It is important to carefully monitor patient functioning with empirically validated tools and to intervene in a multidisciplinary setting as early as possible to identify patients at risk and reduce potential negative impact. Psychologists are uniquely trained to assess and address these issues and are a valuable component of multidisciplinary, culturally competent care. While research in this expansive field is improving, more data are needed to establish gold standard approaches to mental health and psychosocial care in this population.
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Affiliation(s)
- Kaushalendra Amatya
- Divisions of Nephrology and Cardiology, Children's National Hospital, Washington, DC, USA.,Pediatrics and Psychiatry & Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kara Monnin
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA
| | - Elizabeth Steinberg Christofferson
- Solid Organ Transplant Surgery, Children's Hospital Colorado, Aurora, CO, USA.,Departments of Psychiatry and Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Post-Traumatic Stress Reactions in Caregivers of Children and Adolescents/Young Adults with Severe Diseases: A Systematic Review of Risk and Protective Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010189. [PMID: 33383784 PMCID: PMC7796025 DOI: 10.3390/ijerph18010189] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/22/2022]
Abstract
Severe illnesses in children and adolescents/young adults (AYAs) may represent a complex burden for patients and their caregivers, including a wide range of mental disorders, particularly post-traumatic stress disorder (PTSD). Few events are as potentially traumatizing as having a son or a daughter diagnosed with a severe, life-threatening, or disabling disease. The presence of PTSD symptoms in caregivers may compromise their efficacy as caregivers and negatively affect the child’s well-being. This systematic review aims at outlining potential risk and protective factors for the development of PTSD symptoms in caregivers of children and AYAs affected by severe acute or chronic illnesses. Thirty-one studies on caregivers of children and AYAs affected by severe, acute, or chronic diseases were included. Socio-demographic and socio-economic characteristics, illness-related distress, psychiatric symptoms, support, and coping styles were found as potential risk/protective factors across studies. It is crucial to consider risk factors affecting caregivers of severely ill young patients, in order to plan focused interventions aimed at preventing an adverse clinical outcome in caregivers and at enhancing caregivers’ coping skills, in order to ultimately improve their quality of life.
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13
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Martin Saborido C, Borobia AM, Cobas J, D'Antiga L, Frauca E, Hernández-Oliveros F, Jara P, López-Granados E, Muñoz JM, Nicastro E, Ojeda JJ, Pérez-Martínez A, Torres JM, Carcas A. Effectiveness of immunosuppression minimisation, conversion or withdrawal strategies in paediatric solid organ and haematopoietic stem cell transplantation: a protocol of a systematic review and meta-analysis. BMJ Open 2020; 10:e037721. [PMID: 33273046 PMCID: PMC7716658 DOI: 10.1136/bmjopen-2020-037721] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Paediatric transplantation is the only curative therapeutic procedure for several end-stage rare diseases affecting different organs and body systems, causing altogether great impact in European children's health and quality of life. Transplanted children shift their primary disease to a chronic condition of immunosuppression to avoid rejection. Longer life expectancy in children poses a greater risk of prolonged and severe side effects related to long-term immunosuppressive (IS) disabilities and secondary cancer susceptibility. The goal remains to find the best combination of IS agents that optimises allograft survival by preventing acute rejection while limiting drug toxicities. This systematic review will aim to determine the optimal IS strategy within the so-called minimisation, conversion or withdrawal strategies. METHODS AND ANALYSIS We will search the following databases with no language restrictions: Cochrane Central Register of Controlled Trials in the Cochrane Library, OvidSP Medline and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; OvidSP Embase Classic+Embase; Ebsco CINAHL Plus, complete database; WHO International Clinical Trials Registry Platform search portal. We will include controlled and uncontrolled clinical trials along with any prospective or retrospective study that includes a universal cohort (all participants from a centre/region/city over a certain period). Cases series and cross-sectional studies are excluded. Two review authors will independently assess the trial eligibility, risk of bias and extract appropriate data points. The outcomes included in this review are: patient survival, acute graft rejection, chronic graft rejection, diabetes, graft function, graft loss, chronic graft versus host disease, acute graft versus host disease, surgical complications, infusion complications, post-transplant lymphoproliferative disease, liver function, renal function, cognition, depression, health-related quality of life, hospitalisation, high blood pressure, low blood pressure, cancer-other, cancer-skin, cardiovascular disease, bacterial infection, Epstein-Barr infection, cytomegalovirus infection, other viral infections and growth.
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Affiliation(s)
- Carlos Martin Saborido
- Institute for Health Research (IdiPAZ), La Paz University Hospital Biomedical Research Foundation, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, Hospital Universitario La Paz, Madrid, Spain
- Pharmacology Department, Autonomous University of Madrid, Madrid, Spain
| | - Javier Cobas
- Children's Hospital Manager, La Paz University Hospital, Madrid, Spain
| | - Lorenzo D'Antiga
- Centre for Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Esteban Frauca
- Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | | | - Paloma Jara
- Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | | | - Jose María Muñoz
- General Hospital Medical Director, La Paz University Hospital, Madrid, Spain
| | - Emanuele Nicastro
- Centre for Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Juan Manuel Torres
- Institute for Health Research (IdiPAZ), La Paz University Hospital Biomedical Research Foundation, Madrid, Spain
| | - Antonio Carcas
- Clinical Pharmacology Department, Hospital Universitario La Paz, Madrid, Spain
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14
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Abstract
Children with medical complexity (CMC) are a unique pediatric patient population with increased exposure and interactions with the health care system and reliance on family caregivers. These attributes place CMC at high risk of overmedicalization (OM). This article reviews the risk factors for OM in CMC and presents an algorithm that primary providers can use to recognize and address this issue. Involvement of a broad multidisciplinary team, including child advocacy when needed, is recommended. The article also focuses on challenges and additional considerations that arise when medical child abuse as the cause of OM is suspected in this population. [Pediatr Ann. 2020;49(11):e478-e485.].
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15
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The current outcomes and future challenges in pediatric vascularized composite allotransplantation. Curr Opin Organ Transplant 2020; 25:576-583. [PMID: 33044345 DOI: 10.1097/mot.0000000000000809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We review the outcomes and future challenges associated with pediatric vascularized composite allotransplantation, including follow-up data from our bilateral pediatric hand-forearm transplantation. RECENT FINDINGS In 2015, the first heterologous pediatric upper extremity hand-forearm transplant was performed at the Children's Hospital of Philadelphia, and in 2019, the first pediatric neck reconstructive transplantation was performed in Poland. The 5-year follow-up of the pediatric upper extremity recipient demonstrates similar growth rates bilaterally, an increase in bone age parallel to chronologic age, and perhaps similar overall growth to nontransplant norms. The pediatric upper extremity recipient continues to make gains in functional independence. He excels academically and participates in various extracurricular activities. Future challenges unique to the pediatric population include ethical issues of informed consent, psychosocial implications, limited donor pool, posttransplant compliance issues, and greater life expectancy and therefore time to inherit the many complications of immunosuppression. SUMMARY Currently, we recommend pediatric vascularized composite allotransplantation (VCA) for bilateral upper extremity amputees, preferably on immunosuppression already, and those patients who would have the most potential gain not available through standard reconstructive techniques while being able to comply with postoperative immunosuppression protocols, surveillance, rehabilitation, and follow-up.
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16
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Ben-Ari A, Benarroch F, Sela Y, Margalit D. Risk factors for the development of medical stress syndrome following surgical intervention. J Pediatr Surg 2020; 55:1685-1690. [PMID: 31839372 DOI: 10.1016/j.jpedsurg.2019.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/09/2019] [Accepted: 11/19/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric surgical procedures involve traumatic stress that may cause psychological distress, leading to decreased adherence to continued surgical follow-up and delayed physical recovery. Risk factors for pediatric medical trauma, however, have not been studied enough. We aim to define the risk factors detectable during hospitalization in pediatric surgery and characterize children at risk of developing PTSD, in order to focus preventive interventions on these children. METHODS The participants in this prospective study were parents of 235 children aged 1-13 years hospitalized in a pediatric surgical ward, who form a representative sample of patients of this age in the ward. They completed questionnaires measuring symptoms of psychological distress, 3-5 months after discharge. RESULTS Higher parental stress, parental concerns regarding family social support, and parental concerns regarding sibling problems had a significant positive correlation with the children's emotional distress measured 3-5 months after hospitalization. Among children aged 1-5 years, emergency (as opposed to elective) operation and a higher number of invasive procedures were also positively correlated with the children's PTSS. CONCLUSIONS There is a need to develop measurements for identifying children at high risk for developing posttraumatic stress following surgical intervention; guidelines for developing such a screening instrument are outlined. TYPE OF STUDY Prognosis study (level of evidence - 1).
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Affiliation(s)
- Amichai Ben-Ari
- Department of Behavioral Sciences, Ariel University, Israel; Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Fortu Benarroch
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yaron Sela
- School of Psychological Sciences, Tel Aviv University
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17
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Ridings LE, Anton MT, Winkelmann J, Davidson TM, Wray L, Streck CJ, Ruggiero KJ. Trauma Resilience and Recovery Program: Addressing Mental Health in Pediatric Trauma Centers. J Pediatr Psychol 2020; 44:1046-1056. [PMID: 31298276 DOI: 10.1093/jpepsy/jsz053] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/23/2019] [Accepted: 06/03/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Approximately 225,000 children sustain injuries requiring hospitalization annually. Posttraumatic stress disorder (PTSD) and depression are prevalent among pediatric patients and caregivers post-injury. Most U.S. trauma centers do not address patients' mental health needs. Better models of care are needed to address emotional recovery. This article describes the engagement and recovery trajectories of pediatric patients enrolled in the Trauma Resilience and Recovery Program (TRRP), a stepped-care model to accelerate emotional recovery following hospitalization. METHODS TRRP is designed to (a) provide in-hospital education about post-injury emotional recovery and assess child and caregiver distress; (b) track mental health symptoms via a 30-day text-messaging program; (c) complete 30-day PTSD and depression phone screens; and (d) provide evidence-based treatment via telehealth or in-person services or referrals, if needed. All 154 families approached were offered TRRP services, 96% of whom agreed to enroll in TRRP. Most patients were boys (59.8%), and average age was 9.12 years [standard deviation (SD) = 5.42]. Most injuries (45.8%) were sustained from motor vehicle accidents. RESULTS In hospital, 68.5% of caregivers and 78.3% of children reported clinically significant distress levels. Over 60% of families enrolled in the texting service. TRRP re-engaged 40.1% of families for the 30-day screen, 35.5% of whom reported clinically significant PTSD (M = 13.90, SD = 11.42) and/or depression (M = 13.35, SD = 11.16). Most (76%) patients with clinically significant symptomology agreed to treatment. CONCLUSIONS Our intervention model was feasible and increased reach to families who needed services. Efforts to improve follow-up engagement are discussed, as are initial successes in implementing this model in other pediatric trauma centers.
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Affiliation(s)
| | | | | | | | - Lauren Wray
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Center, Medical University of South Carolina
| | - Christian J Streck
- Department of Surgery, College of Medicine, Medical University of South Carolina
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18
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Lerret SM, White-Traut R, Medoff-Cooper B, Simpson P, Adib R, Ahamed SI, Schiffman R. Pilot study protocol of a mHealth self-management intervention for family members of pediatric transplant recipients. Res Nurs Health 2020; 43:145-154. [PMID: 31985067 PMCID: PMC7047587 DOI: 10.1002/nur.22010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/30/2019] [Indexed: 01/19/2023]
Abstract
Solid-organ transplantation is the treatment of choice for end-stage organ failure. Parents of pediatric transplant recipients who reported a lack of readiness for discharge had more difficulty coping and managing their child's medically complex care at home. In this paper, we describe the protocol for the pilot study of a mHealth intervention (myFAMI). The myFAMI intervention is based on the Individual and Family Self-Management Theory and focuses on family self-management of pediatric transplant recipients at home. The purpose of the pilot study is to test the feasibility of the myFAMI intervention with family members of pediatric transplant recipients and to test the preliminary efficacy on postdischarge coping through a randomized controlled trial. The sample will include 40 family units, 20 in each arm of the study, from three pediatric transplant centers in the United States. Results from this study may advance nursing science by providing insight for the use of mHealth to facilitate patient/family-nurse communication and family self-management behaviors for family members of pediatric transplant recipients.
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Affiliation(s)
- Stacee M Lerret
- Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rosemary White-Traut
- Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | - Pippa Simpson
- Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Riddhiman Adib
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, Wisconsin
| | - Sheikh Iqbal Ahamed
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, Wisconsin
| | - Rachel Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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19
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Butsriphum N, Getsuwan S, Prabpram W, Chuthapisith J, Tanpowpong P, Lertudomphonwanit C, Treepongkaruna S. Family Function in Pediatric Liver Transplant Recipients Residing In a Developing Country. Transplant Proc 2020; 52:920-925. [PMID: 32173590 DOI: 10.1016/j.transproceed.2020.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pediatric liver transplantation (LT) can affect recipients' family function; however, inconsistent results between studies exist, and data from developing nations are sparse. We aimed to evaluate family function and identify factors associated with suboptimal function in pediatric LT recipients. METHODS A cross-sectional study was performed at a teaching hospital in Bangkok, Thailand between May 2018 and December 2018. We included the families of children aged 2 to 18 years who underwent LT for at least 1 year. Chulalongkorn Family Inventory (CFI) was used to evaluate the family function in these children comparing with families of healthy children. Family function was interpreted from the total CFI score and characterized as dysfunctional, normal-functioned, and well-functioned. RESULTS We enrolled families of 82 LT recipients and 72 healthy children. LT recipients had median age of 7.4 (interquartile range: 4.5-10.3) years. Eighteen children (22%) had a single parent, and at least one unemployed parent was reported in 25%. Most (96%) had well-functioned families, and none had a dysfunctional family. Furthermore, the total score was not significantly different between families of LT and healthy children (P = .95). LT families had a higher score in problem-solving (P < .01) and lower score in the affective involvement and general functioning dimension (P < .01 and .02, respectively). Among the LT children, postoperative bile leakage was associated with lower overall family function score. CONCLUSIONS Even though most recipients had good family function, physicians should pay close attention to specific aspects of family function, especially in children with certain postoperative complications.
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Affiliation(s)
- N Butsriphum
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Getsuwan
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - W Prabpram
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - J Chuthapisith
- Division of Child Development, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - P Tanpowpong
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - C Lertudomphonwanit
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Treepongkaruna
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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20
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Annunziato RA, Stuber ML, Supelana CJ, Dunphy C, Anand R, Erinjeri J, Alonso EM, Mazariegos GV, Venick RS, Bucuvalas J, Shemesh E. The impact of caregiver post-traumatic stress and depressive symptoms on pediatric transplant outcomes. Pediatr Transplant 2020; 24:e13642. [PMID: 31880384 DOI: 10.1111/petr.13642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 11/26/2022]
Abstract
PTSS as well as symptoms of depression have been reported in children who experience a serious medical adversity as well as their caretakers. The adverse effects of PTSS, when experienced by the patients, on medical outcomes have been clearly documented. However, the impact of those symptoms, if any, when experienced by the caretakers on child outcomes has not been investigated prospectively. We evaluated whether caregiver PTSS and depression symptoms predict adherence to medications and medical outcomes in a prospective multisite study. Four hundred children participated in MALT. Caretaker PTSS were assessed by the IES and depressive symptoms by CES-D. During 2 years of follow-up, the MLVI was used to determine adherence. Centrally read, biopsy-confirmed organ rejection was the primary medical outcome. IES scores were not associated with either adherence or rejection outcomes. In contrast, there were significant correlations between CES-D (depression) scores and lower adherence, r = .13, P < .001, and a trend toward higher scores on the CES-D among those whose children had experienced rejection, 12.4 (SD = 10.9) versus 9.1 (SD = 8.6), P = .077. Caregivers' PTSS were not a risk factor for poor child outcomes in this cohort, whereas depression symptoms were associated with non-adherence and possibly increased rates of rejection. Further study can validate if caregivers' depression as opposed to PTSS confers greater risk and should be a focus during the clinical care of medically ill children.
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Affiliation(s)
- Rachel A Annunziato
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | | | - Christina J Supelana
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | - Claire Dunphy
- Icahn School of Medicine at Mount Sinai, New York, New York
- Fordham University, Bronx, New York
| | | | | | - Estella M Alonso
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | | | - John Bucuvalas
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, New York, New York
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21
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Cross-cutting view of current challenges in paediatric solid organ and haematopoietic stem cell transplantation in Europe: the European Reference Network TransplantChild. Orphanet J Rare Dis 2020; 15:16. [PMID: 31941528 PMCID: PMC6964053 DOI: 10.1186/s13023-020-1293-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023] Open
Abstract
The low prevalence of European paediatric transplanted patients and scarcity of resources and expertise led to the need for a multidisciplinary network able to improve the quality of life of paediatric patients and families requiring a solid organ or haematopoietic stem cell transplantation. The European Reference Network (ERN) TransplantChild is one of the 24 ERNs established in a European legal framework to improve the care of patients with rare diseases. ERN TransplantChild is the only ERN focused on both solid organ and haematopoietic stem cell paediatric transplantation, based on the understanding of paediatric transplantation as a complex and highly specialised process where specific complications appear regardless the organ involved, thus linking the skills and knowledge of different organ disciplines. Gathering European centres of expertise in paediatric transplantation will give access to a correct and timely diagnosis, share expertise and knowledge and collect a critical mass of patients and data that increases the speed and value of clinical research outcomes. Therefore, the ERN TransplantChild aims for a paediatric Pan-European, Pan-transplant approach.
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22
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Zhang Y, Wang J, Jin S, Xiang B, Yang J, Li K, Huang B, Lai W, Yan L, Zhao J. Post-traumatic stress disorder in living donors after pediatric liver transplantation: A cross-sectional investigation study. Medicine (Baltimore) 2019; 98:e15565. [PMID: 31096459 PMCID: PMC6531068 DOI: 10.1097/md.0000000000015565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Liver transplantation can lead to post-traumatic stress disorder (PTSD) in recipients, but the risk factors associated with PTSD in living donors are unknown. To investigate this progression in pediatric living donors, a cross-sectional investigation was carried out.All participants completed 2 questionnaires: a PTSD self-rating scale (PTSD-SS) and a validated Chinese version of the Medical Outcomes Study Short Form-36 (SF-36). Clinical and demographic data were collected from medical records and self-report questionnaires. Univariate analysis was conducted to identify statistical differences.The prevalence of full PTSD (all symptom clusters) and partial PTSD (2 out of 3 symptom clusters) was 12.1% and 31.1%, respectively. Those with an educational status of elementary school (P = .001), who were donors to their children (P = .008), who were in the first 6 months after transplant (P < .001), or were involved in transplants where the recipients had severe complications (P = .02) were more likely to have higher PTSD-SS scores than other groups. The non-PTSD group had a higher health-related quality-of-life score compared with the full and partial PTSD groups in the domains of physical function, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. In addition, the occurrence of PTSD was related to a poorer quality of life.The occurrence of PTSD was common in living donors after pediatric liver transplantation. Those with a lower educational status, who were donors to their children, were in the first 6 months after transplant, or were involved in transplants where the recipients had severe complications were most likely to experience PTSD. Post-traumatic stress symptom severity was significantly associated with a poorer quality of life after transplant.
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Affiliation(s)
| | | | | | | | | | | | | | - Wei Lai
- Department of Intensive Care Unit, West China Hospital of Sichuan University, Chengdu City, Sichuan Province, China
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23
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Lerret SM. Using MHealth to Improve Outcomes for Children Following Solid Organ Transplant. J Pediatr Nurs 2019; 46:134-135. [PMID: 30797610 DOI: 10.1016/j.pedn.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Stacee M Lerret
- Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States of America.
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24
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Wightman A, Bradford MC, Smith J. Health-related quality of life changes following renal transplantation in children. Pediatr Transplant 2019; 23:e13333. [PMID: 30548760 PMCID: PMC10762692 DOI: 10.1111/petr.13333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Studies of HRQoL after kidney transplant have yielded conflicting results. We sought to assess the impact of kidney transplant on HRQoL. METHODS We performed a retrospective study using the PedsQL3.0ESRD module during dialysis and at 3 and 12 months following kidney transplant in 56 recipients. For the entire cohort, we described HRQoL scores at each time point and used ANOVA models to test for associations between demographic and transplant-related factors and post-transplant scores. We used linear mixed models to investigate interactions between transplant and demographic and transplant-related factors and to estimate differences between mean pre- and post-transplant scores. Longitudinal changes in HRQoL were assessed by t test. RESULTS We found increases in all mean total scores, including subscales, at each assessed time period from dialysis to 3 months post-transplant to 12 months post-transplant. Post-transplant total scores did not differ by gender, race, proximity to hospital, allograft source, or dialysis modality, but did differ by recipient age. Among participants with both pre- and post-transplant observations, total scores increased for both recipients and parent-proxies. CONCLUSIONS This study affirms the association between kidney transplant and improvement in HRQoL in the first year following transplant. Future research should further explore outcomes over the longer-term and factors contributing to HRQoL among this population.
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Affiliation(s)
- Aaron Wightman
- Division of Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Division of Nephrology, Seattle Children’s Hospital, Seattle, WA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Miranda C. Bradford
- Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA
| | - Jodi Smith
- Division of Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Division of Nephrology, Seattle Children’s Hospital, Seattle, WA
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25
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Wightman A, Zimmerman CT, Neul S, Lepere K, Cedars K, Opel D. Caregiver Experience in Pediatric Dialysis. Pediatrics 2019; 143:peds.2018-2102. [PMID: 30696758 DOI: 10.1542/peds.2018-2102] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric dialysis is thought to be burdensome on caregivers given their need to assume dual responsibilities of parental and medical management of their child's chronic illness. In this study, we seek to describe the experience of parental caregivers of children receiving chronic dialysis for end-stage kidney disease. METHODS We performed semistructured interviews of primary caregivers of children with end-stage kidney disease receiving chronic peritoneal dialysis or hemodialysis for at least 8 weeks from March 2016 to April 2017 at 3 pediatric dialysis centers in the United States. We performed a thematic analysis to inductively derive and identify themes and subthemes related to positive and negative caregiver experiences. RESULTS Thirty-five caregivers completed interviews. Four major themes were identified, each with several subthemes: (1) caregiver medicalization (subthemes: diagnosis and initiation, disease management, and the future), (2) emotional adjustment (initial and/or acute phase, acceptance, personal growth, and medical stress and psychological burden), (3) pragmatic adaptation (disruption, adaptation of life goals and/or sense of self, and financial impact), and (4) social adjustment (relationship opportunity, relationship risk, advocacy, family functioning, and intimate relationships). These themes and subthemes reflected a broad range of experiences from positive to severely burdensome. CONCLUSIONS Caregivers of patients on dialysis report a broad range of positive and burdensome experiences. These results reveal a need for continued advocacy to support families with a child on dialysis and can be used to develop targeted measures to study and improve caregiver experience in this population.
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Affiliation(s)
- Aaron Wightman
- Divisions of Nephrology, .,Bioethics and Palliative Care, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Cortney Taylor Zimmerman
- Section of Psychology, Nephrology Service, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Shari Neul
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee; and
| | - Katherine Lepere
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - KristiLynn Cedars
- Division of Psychology, Department of Psychiatry and Behavioral Medicine, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Douglas Opel
- Bioethics and Palliative Care, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
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Vascularized composite allotransplantation in children: what we can learn from solid organ transplantation. Curr Opin Organ Transplant 2018; 23:605-614. [DOI: 10.1097/mot.0000000000000576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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No Trauma, no Problem: Symptoms of Posttraumatic Stress in the Absence of a Criterion A Stressor. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9692-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Ari AB, Peri T, Margalit D, Galili-Weisstub E, Udassin R, Benarroch F. Surgical procedures and pediatric medical traumatic stress (PMTS) syndrome: Assessment and future directions. J Pediatr Surg 2018; 53:1526-1531. [PMID: 29129330 DOI: 10.1016/j.jpedsurg.2017.10.043] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/07/2017] [Accepted: 10/07/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Surgical procedures involve traumatic stress. Children may develop chronic psychological distress and dysfunction after surgery, with consequent reluctance to comply with medical follow-up care. A literature review of this topic shows that it has been understudied. Our study aims to assess the frequency and characteristics of symptoms of persistent psychological distress in children following surgery, which have not been documented before, in order to promote its awareness and its early identification. METHODS Parents of 79 children (aged 1-6) that were hospitalized in a pediatric surgical ward, comprising a representative sample, completed three validated questionnaires assessing their children's psychological symptoms 3-5months after the hospitalization. RESULTS A significant portion of children suffer from psychological distress 3-5months after hospitalization. Moreover, 10.39% of the children exhibited symptoms of PTSD, and 28.6% of parents reported that the child's distress causes dysfunction. Additionally, our findings emphasize the parents' concerns regarding the child's behavior, function, and health following hospitalization. CONCLUSION Since a significant prevalence of hospitalization-related traumatic stress is documented, the awareness to it has to be improved, in order to reduce its frequency and increase adherence to medical follow-up care. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Amichai Ben Ari
- Department of Behavioral Sciences, Ariel University, Israel; Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | | | | | | | - Raphael Udassin
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Fortu Benarroch
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Sharkey CM, Bakula DM, Wolfe-Christensen C, Austin P, Baskin L, Bernabé KJ, Chan YM, Cheng EY, Delozier AM, Diamond DA, Ellens RE, Fried A, Galan D, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Nokoff NJ, Scott Reyes KJ, Palmer B, Poppas DP, Paradis A, Tishelman A, Yerkes EB, Chaney JM, Wisniewski AB, Mullins LL. Parent-Rated Severity of Illness and Anxiety among Caregivers of Children Born with a Disorder of Sex Development Including Ambiguous Genitalia. Horm Res Paediatr 2018; 90:308-313. [PMID: 30566934 PMCID: PMC6421083 DOI: 10.1159/000495422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Parents of children born with disorders of sex development (DSD) often experience anxiety, but risk factors, including parental perception of the severity of their child's DSD, have not been examined. We hypothesized that severity of illness (SOI) ratings would relate to parental anxiety, and would be higher for parents of children with a potentially life-threatening DSD (e.g., 21-hydroxylase deficiency). METHODS Eighty-nine parents (Mage = 33.0, 56.2% mothers) of 51 children (Mage in months = 8.7) with a DSD including ambiguous genitalia were recruited from 12 specialized DSD clinics. Parents completed questionnaires prior to genitoplasty, 6 months post-genitoplasty, and 12 months post-genitoplasty (if completed). Data were analyzed with linear mixed modeling. RESULTS Parental anxiety decreased over time, χ2(1) = 10.14, p < 0.01. A positive relationship between SOI and anxiety was found, with SOI being a strong predictor of anxiety (b = 0.53, p < 0.01; χ2[1] = 5.33, p < 0.05). An SOI by time interaction indicated SOI had an increasing effect on anxiety over time, b = 0.06, p < 0.05; χ2(1) = 6.30, p < 0.05. There was no diagnosis by SOI interaction. CONCLUSION Parental anxiety decreased over time, but those with higher SOI ratings reported greater initial anxiety followed by slower resolution over time. Underlying etiology of DSD had no effect on the relationship between SOI and anxiety.
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Affiliation(s)
| | | | | | | | - Laurence Baskin
- University of California San Francisco Medical Center, San Francisco, CA
| | - Kerlly J. Bernabé
- Komansky Children’s Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY
| | | | - Earl Y. Cheng
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | | | | | | | | | - Denise Galan
- Komansky Children’s Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY
| | | | - Thomas Kolon
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | - Theresa Meyer
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | | | | | | | - Dix P. Poppas
- Komansky Children’s Hospital, New York Presbyterian Weill Cornell Medicine, New York, NY
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Bitton S, Tuval-Mashiach R, Freedman S. Distress Levels among Parents of Active Duty Soldiers during Wartime. Front Psychol 2017; 8:1679. [PMID: 29018394 PMCID: PMC5622972 DOI: 10.3389/fpsyg.2017.01679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/12/2017] [Indexed: 11/25/2022] Open
Abstract
Objective: Military service is a highly stressful period both for the soldiers serving and for their parents. Surprisingly, parents’ experience has been mostly ignored in the research. This study’s goal is to shed light on the experience and distress levels of parents of active duty combat soldiers during Operation Protective Edge, a military operation carried out by the Israel Defense Forces during July and August of 2014. Methods: During the advanced stages of the operation, 69 parents of Israeli male combat soldiers (55 mothers and 14 fathers) completed an online survey measuring symptoms of Posttraumatic Stress Disorder (PTSD-Checklist-5) and distress (Brief Symptom Inventory-18). Participants were recruited using a convenience sample, by posting ads on the public Facebook pages of the researchers and of the groups dedicated to parents of Israeli soldiers. Results: Parents’ depression and anxiety symptom levels were higher than depression and anxiety symptom levels of the adult community norms in Israel. General distress rates of parents were similar to those presented by adults in southern Israel who were exposed for 7 years to the ongoing threat of daily rocket fire from Gaza, and higher than rates of a non-threatened Israeli population. Finally, 20.2% of the parents presented PTSD-like symptoms, a higher percentage than the probable PTSD diagnosis rates that were found in the general population in Israel during previous terror waves. Conclusion: This study provides preliminary evidence of soldiers’ parents’ distress and indicates the need for a better understanding of the impact of military service on soldiers’ parents.
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Affiliation(s)
- Shahar Bitton
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | | | - Sara Freedman
- School of Social Work, Bar-Ilan University, Ramat Gan, Israel
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Pérez-San-Gregorio MÁ, Martín-Rodríguez A, Borda-Mas M, Avargues-Navarro ML, Pérez-Bernal J, Conrad R, Gómez-Bravo MÁ. Post-traumatic growth and its relationship to quality of life up to 9 years after liver transplantation: a cross-sectional study in Spain. BMJ Open 2017; 7:e017455. [PMID: 28918413 PMCID: PMC5640137 DOI: 10.1136/bmjopen-2017-017455] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/17/2017] [Accepted: 08/01/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Little is known concerning post-traumatic growth (PTG) after liver transplantation. Against this backdrop the current study analysed the relationship between PTG and time since transplantation on quality of life. Furthermore, it compared PTG between liver transplant recipients and their caregivers. DESIGN Cross-sectional case-control study. SETTING University Hospital in Spain. PARTICIPANTS 240 adult liver transplant recipients who had undergone only one transplantation, with no severe mental disease, were the participants of the study. Specific additional analyses were conducted on the subset of 216 participants for whom caregiver data were available. Moreover, results were compared with a previously recruited general population sample. OUTCOME MEASURES All participants completed the Posttraumatic Growth Inventory, and recipients also filled in the 12-Item Short-Form Health Survey. Relevant sociodemographic and clinical parameters were also assessed. RESULTS In the sample of 240 recipients, longer time since transplantation (>9 years) was associated with more pain symptoms (p=0.026). Regardless of duration, recipients showed lower scores on most quality of life dimensions than the general population. However, high PTG was associated with a significantly higher score on the vitality quality of life dimension (p=0.021). In recipients with high PTG, specific quality of life dimensions, such as bodily pain (p=0.307), vitality (p=0.890) and mental health (p=0.353), even equalled scores in the general population, whereas scores on general health surpassed them (p=0.006). Furthermore, liver transplant recipients (n=216) compared with their caregivers showed higher total PTG (p<0.001) and higher scores on the subscales relating to others (p<0.001), new possibilities (p<0.001) and appreciation of life (p<0.001). CONCLUSIONS Our findings highlight the protective role of PTG in the long-term outcome of liver transplant recipients. Future studies should analyse and develop psychosocial interventions to strengthen PTG in transplant recipients and their caregivers.
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Affiliation(s)
| | - Agustín Martín-Rodríguez
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - Mercedes Borda-Mas
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | | | - José Pérez-Bernal
- Critical Care and Urgencies, University Hospital Virgen del Rocío of Seville, Seville, Spain
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany
| | - Miguel Ángel Gómez-Bravo
- Hepatic-Biliary-Pancreatic Surgery and Liver Transplant Unit, University Hospital Virgen del Rocío of Seville, Seville, Spain
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Cousino MK, Rea KE, Schumacher KR, Magee JC, Fredericks EM. A systematic review of parent and family functioning in pediatric solid organ transplant populations. Pediatr Transplant 2017; 21. [PMID: 28181361 DOI: 10.1111/petr.12900] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 12/23/2022]
Abstract
The process of pediatric solid organ transplantation (SOT) places new and increased stressors on patients and family members. Measures of family functioning may predict psychological and health outcomes for pediatric patients and their families, and provide opportunity for targeted intervention. This systematic review investigated parent and family functioning and factors associated with poorer functioning in the pediatric SOT population. Thirty-seven studies were identified and reviewed. Studies featured a range of organ populations (eg, heart, liver, kidney, lung, intestine) at various stages in the transplant process. Findings highlighted that parents of pediatric SOT populations commonly report increased stress and mental health symptoms, including posttraumatic stress disorder. Pediatric SOT is also associated with increased family stress and burden throughout the transplant process. Measures of parent and family functioning were associated with several important health-related factors, such as medication adherence, readiness for discharge, and number of hospitalizations. Overall, findings suggest that family stress and burden persists post-transplant, and parent and family functioning is associated with health-related factors in SOT, highlighting family-level functioning as an important target for future intervention.
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Affiliation(s)
- Melissa K Cousino
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - Kelly E Rea
- University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - Kurt R Schumacher
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA
| | - John C Magee
- University of Michigan Transplant Center, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.,University of Michigan Transplant Center, Ann Arbor, MI, USA.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
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Abstract
Liver transplantation originated in children more than 50 years ago, and these youngest patients, while comprising the minority of liver transplant recipients nationwide, can have some of the best and most rewarding outcomes. The indications for liver transplantation in children are generally more diverse than those seen in adult patients. This diversity in underlying cause of disease brings with it increased complexity for all who care for these patients. Children, still being completely dependent on others for survival, also require a care team that is able and ready to work with parents and family in addition to the patient at the center of the process. In this review, we aim to discuss diagnoses of particular uniqueness or importance to pediatric liver transplantation. We also discuss the evaluation of a pediatric patient for liver transplant, the system for allocating them a new liver, and also touch on postoperative concerns that are unique to the pediatric population.
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Family Impact and Infant Emotional Outcomes Following Diagnosis of Serious Liver Disease or Transplantation in Infancy. J Pediatr Gastroenterol Nutr 2017; 64:528-532. [PMID: 27673709 DOI: 10.1097/mpg.0000000000001404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Research is lacking into the emotional effects on families of serious chronic illness in infants. We examined the effect of the diagnosis of serious liver disease in infants upon parent psychological symptoms and family functioning. We hypothesized that parent psychological symptoms, family functioning, and father engagement will predict infant emotional outcomes. METHODS Parents of infants recently diagnosed with serious liver disease completed validated questionnaires about parent stress, family function, impact of the illness on the family, and father engagement. The measures were repeated after 1 year, with the addition of the Child Behavior Checklist (CBCL). RESULTS Parents of 37 infants participated. Parent stress and family functioning scores were not elevated. Parent psychological symptoms, family function, and father engagement did not predict infant outcome. For mothers, infant diagnosis other than biliary atresia, number of outpatient visits, and impact of the illness on the family explained 32% of the variation in CBCL (P = 0.001). For fathers, socioeconomic status, infant diagnosis other than biliary atresia, whether the infant had had a transplant, and impact of the illness on the family explained 44% of the variation in CBCL (P < 0.001). CONCLUSIONS Parents and families appear to be resilient in coping with serious infant illness. Infant diagnosis other than biliary atresia and parental perceptions of high impact of the illness on the family are indicators of negative emotional outcomes for infants with serious liver disease. Psychosocial interventions for infants with chronic illness should target reducing the impact of illness on the family.
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Sahin Y, Virit O, Demir B. DEPRESSION AND ANXIETY IN PARENTS OF CHILDREN WHO ARE CANDIDATES FOR LIVER TRANSPLANTATION. ARQUIVOS DE GASTROENTEROLOGIA 2017; 53:25-30. [PMID: 27281501 DOI: 10.1590/s0004-28032016000100006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 12/02/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The primary stress factor for families in the pre-transplant period is reported as the waiting time for suitable organs, leading to anxiety, despair, and distress. OBJECTIVE We investigated the psychosocial factors, anxiety and depression, in the parents of children who are candidates for liver transplantation. METHODS Thirty-five pediatric liver transplantation candidates and their 38 parents, from February to August 2014, were included. Participants were evaluated using the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression Scale (CGI). RESULTS We found that a significant number of parents (n=25, 65.7%) were diagnosed with clinical psychiatric disease: 18.4% (n=7) with depression and 47.3% (n=18) with anxiety disorders. There was a significant difference in the examination scores of parents between genders (P <0.05). There was also a significant difference in CGI and HAM-D scores of parents relative to the history and presence of liver disease (P <0.05). CONCLUSION The rate of these disorders was high in relation to the prevalence of depression and anxiety disorders in the community reported in the literature. Therefore, it is necessary to evaluate psychosocial factors of parents of all transplant candidate children as a part of routine care so that the high-risk to family members and to enable early intervention.
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Affiliation(s)
- Yasin Sahin
- Department of Pediatric Gastroenterology-Hepatology and Nutrition, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey;, Istanbul University, Department of Pediatric Gastroenterology-Hepatology and Nutrition, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul , Turkey
| | - Osman Virit
- Department of Psychiatry, Faculty of Medicine, Gaziantep University, Istanbul, Turkey., Gaziantep University, Department of Psychiatry, Faculty of Medicine, Gaziantep University, Istanbul , Turkey
| | - Bahadir Demir
- Department of Psychiatry, Faculty of Medicine, Gaziantep University, Istanbul, Turkey., Gaziantep University, Department of Psychiatry, Faculty of Medicine, Gaziantep University, Istanbul , Turkey
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Abstract
OBJECTIVES Most infants with biliary atresia (BA) require liver transplantation (LT) after hepatoportoenterostomy (HPE), including those who initially clear jaundice. The aim of the present study was to identify clinical and routine laboratory factors in infants with BA post-HPE that predict native liver survival at 2 years. METHODS A retrospective cohort study was conducted in 217 patients with BA undergoing HPE in Sydney, Australia and Toronto, Canada between January 1986 and July 2009. Univariate and multivariate logistic regression using backwards-stepwise elimination identified variables at 3 months after HPE most associated with 2-year native liver survival. RESULTS Significant variables (P < 0.05) on univariate analysis included serum total bilirubin (TB) and albumin at 3 months post-HPE, bridging fibrosis or cirrhosis on initial liver biopsy, ascites of <3 months post-HPE, type 3 BA anatomy, age at HPE of >45 days, change in length z scores within 3 months of HPE, and center. On multivariate analysis, TB (P < 0.0001) and albumin (P = 0.02) at 3 months post-HPE, and center (P = 0.0003) were independently associated with native liver survival. Receiver operating characteristic analysis revealed an optimal cut-off value of TB <74 μmol/L (4.3 mg/dL; area under the receiver operating characteristic curve 0.8990) and serum albumin level >35 g/L (3.5 mg/dL; area under the receiver operating characteristic curve 0.7633) to predict 2-year native liver survival. TB and albumin levels 3 months post-HPE defined 3 groups (1: TB ≤74 μmol/L, albumin >35 g/L; 2: TB ≤74 μmol/L, albumin ≤35 g/L; 3: TB >74 μmol/L) with distinct short- and long-term native liver survival rates (log-rank P < 0.001). Length z scores 3 months post-HPE were poorer for group 2 than group 1 (-0.91 vs -0.30, P = 0.0217) with similar rates of coagulopathy. CONCLUSIONS Serum TB and albumin levels 3 months post-HPE independently predicted native liver survival in BA when controlling for center. Serum albumin level <35 g/L in infants with BA who were no longer jaundiced at 3 months post-HPE was a poor prognostic indicator. Poorer linear growth and absence of significant coagulopathy suggest a role for early aggressive nutritional therapy in this group.
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Samyn M. Parents and carers of young people with liver transplantation: Lost in transition? Pediatr Transplant 2017; 21. [PMID: 27981692 DOI: 10.1111/petr.12855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Marianne Samyn
- Pediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
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Health-Related Quality of Life after Pediatric Liver Transplantation: A Qualitative Analysis of the Perspectives of Health Care Providers. Can J Gastroenterol Hepatol 2017; 2017:5274923. [PMID: 28713797 PMCID: PMC5496102 DOI: 10.1155/2017/5274923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/28/2017] [Indexed: 11/19/2022] Open
Abstract
With improved survival outcomes after pediatric liver transplantation (LT), health-related quality of life (HRQoL) is an important outcome metric. Understanding the elements contributing to HRQoL after LT in children would enable more targeted strategies towards optimizing best outcomes. This qualitative study aimed to explore health care providers (HCP) perceptions about HRQoL after pediatric LT. Thirteen experienced HCP participated in two focus group discussions. Data analysis via a thematic analysis approach revealed 4 major themes: "LT as a facilitator of better HRQoL," "coping and adapting to LT," "living with a transplanted liver," and "the family context." HCP identified elements that both enhance (improved physical health, peer relationship, and activities of daily living) and challenge (need for immunosuppression, transplant follow-up, and restrictions) the multidimensional domains of HRQoL. HCP perceived LT to be a stressful life-changing event for children and their families. Patients and their parents' ability to cope and adjust positively to LT was perceived as a key contributor to better HRQoL. HCP perspective highlights the importance of promoting psychosocial support and a family-centered care delivery model towards the overarching goal of optimizing durable outcomes.
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Taskıran G, Sürer Adanır A, Özatalay E. Living with the unknown: Posttraumatic stress disorder in pediatric bone marrow transplantation survivors and their mothers. Pediatr Hematol Oncol 2016; 33:209-18. [PMID: 26949991 DOI: 10.3109/08880018.2016.1149749] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bone marrow transplantation (BMT) is used to treat children with various hematologic, oncologic, and metabolic diseases. Although the treatment can be lifesaving, it is also physically and psychologically demanding for both the child and caregivers. In previous studies, BMT is found to be related with anxiety, posttraumatic stress disorder (PTSD), depression, and psychosocial problems both in children and parents. The aim of this study was to investigate PTSD in pediatric BMT survivors and their mothers compared with the healthy controls. Twenty-seven BMT survivors and their mothers and 28 healthy peers and their mothers were recruited as the study group and as the comparison group, respectively. All children were interviewed using Child Posttraumatic Stress Disorder-Reaction Index (CPTSD-RI) for assessing posttraumatic stress responses. As for mothers, Clinician-Administered PTSD Scale (CAPS) was used. In healthy children and mothers, instead of BMT, the most important traumatic event reported by them was included. All data were analyzed by a neutral statistician from the Department of Biostatistics of the university. The BMT group, both children and mothers, obtained significantly higher PTSD rates than the control group (66.5% and 17.8%, respectively, in children; 57.6% and 7%, respectively, in mothers). However, there was a weak correlation between survivors' and mothers' posttraumatic stress responses. These findings suggest that BMT is a significant stressor for both children and mothers. Clinicians should be aware of psychiatric symptoms of children who underwent such a life-threatening condition. Combination of medical treatment with psychosocial support is imperative.
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Affiliation(s)
- Gülseren Taskıran
- a Department of Child and Adolescent Psychiatry , Antalya Training and Resarch Hospital , Antalya , Turkey
| | - Aslı Sürer Adanır
- b Department of Child and Adolescent Psychiatry , Akdeniz University School of Medicine , Antalya , Turkey
| | - Esin Özatalay
- b Department of Child and Adolescent Psychiatry , Akdeniz University School of Medicine , Antalya , Turkey
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Kubota A, Yamakawa S, Yamamoto E, Kosugi M, Hirano S, Shiraishi J, Kitajima H, Yoneda A, Taduke Y, Mitani Y, Watanabe T, Takifuji K, Yamaue H. Major neonatal surgery: psychosocial consequence of the patient and mothers. J Pediatr Surg 2016; 51:364-7. [PMID: 26589187 DOI: 10.1016/j.jpedsurg.2015.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/19/2015] [Accepted: 09/15/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE Our previous studies of long-term QOL after major neonatal surgery revealed an unexpectedly high incidence of mental retardation as well as emotional and psychosocial problems, and the patients' QOL correlated with maternal QOL and post-traumatic stress disorder (PTSD). The main purpose of this study was to clarify the risk factors affecting long-standing maternal PTSD. MATERIALS AND METHODS Sixty-eight patients, aged between 6 and 17years, and their mothers were enrolled in this study. The underlying diseases included congenital diaphragmatic hernia in 21, anorectal anomalies in 25 and esophageal atresia in 22. Psychoanalysts carried out intelligence tests, the Child Behavior Checklist and QOL evaluation in the patients. QOL was evaluated with WHOQOL26 and PTSD with IES-R questionnaires in their mothers. The mothers were divided into two groups; low- and high-risk groups according to PTSD score. RESULTS Patient QOL scores correlated positively with maternal QOL (p<0.05) and negatively with maternal PTSD scores (p<0.05). There were significant differences in total number of hospital admissions (p<0.05), feeling of economic burden (p<0.05), and satisfaction with husband's help (p<0.01) between the two groups. CONCLUSION Risk factors for maternal PTSD include repeated hospitalization, a feeling of economic burden, and lack of satisfaction with husband's help.
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Affiliation(s)
- Akio Kubota
- Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan; Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan.
| | - Sakiko Yamakawa
- Department of Developmental Pediatrics, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Etsuyo Yamamoto
- Department of Developmental Pediatrics, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Megumi Kosugi
- Department of Developmental Pediatrics, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Shinya Hirano
- Department of Developmental Pediatrics, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Jun Shiraishi
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Hiroyuki Kitajima
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Akihiro Yoneda
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Yuko Taduke
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Yasuyuki Mitani
- Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Takashi Watanabe
- Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Katsunari Takifuji
- Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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Supelana C, Annunziato RA, Kaplan D, Helcer J, Stuber ML, Shemesh E. PTSD in solid organ transplant recipients: Current understanding and future implications. Pediatr Transplant 2016; 20:23-33. [PMID: 26648058 PMCID: PMC4769648 DOI: 10.1111/petr.12628] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 12/16/2022]
Abstract
PTSS are quite prevalent in transplant recipients, although full-scale PTSD may not be that common. Those symptoms have been linked to poor transplant outcomes, perhaps owing to non-adherence to medications and other recommendations, brought about by the avoidance dimension of the PTSD/PTSS construct (patients may avoid taking their medications because they serve as reminder of the emotionally traumatic event--the transplant). It is possible to treat PTSD via specific psychotherapeutic techniques, and the treatment has been shown to be safe and likely effective in other populations. Therefore, practitioners who treat transplant recipients should be familiar with the presentation and treatment of those symptoms. This manuscript provides a systematic literature review of the PTSD/PTSS presentation in the pediatric transplant setting, a synthesis of available research findings, and suggestions for current care and future research.
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Affiliation(s)
- C Supelana
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children's Hospital, New York, NY., Fordham University, Department of Psychology, Bronx, NY
| | - RA Annunziato
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children's Hospital, New York, NY., Fordham University, Department of Psychology, Bronx, NY
| | - D Kaplan
- Fordham University, Department of Psychology, Bronx, NY
| | - J Helcer
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children's Hospital, New York, NY., Fordham University, Department of Psychology, Bronx, NY
| | - ML Stuber
- UCLA Geffen School of Medicine, Los Angeles, CA
| | - E Shemesh
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children's Hospital, New York, NY
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Ethical Considerations in the Psychosocial Evaluation of Pediatric Organ Transplant Candidates, Recipients and Their Families. ETHICAL ISSUES IN PEDIATRIC ORGAN TRANSPLANTATION 2016. [DOI: 10.1007/978-3-319-29185-7_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Early Traumatic Stress Responses in Parents Following a Serious Illness in Their Child: A Systematic Review. J Clin Psychol Med Settings 2015; 23:53-66. [DOI: 10.1007/s10880-015-9430-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kikuchi R, Kamibeppu K. Parents' quality of life and family functioning in pediatric organ transplantation. J Pediatr Nurs 2015; 30:463-77. [PMID: 25605616 DOI: 10.1016/j.pedn.2014.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 11/15/2022]
Abstract
Solid organ transplantation is an important treatment option for pediatric patients in end-stage organ failure. The impact of pediatric organ transplantation on parents' quality of life and family functioning has been found to be substantial, but findings on this topic have not previously been consolidated. Thirty-one studies were selected for analysis after a database search on this topic. We present future research questions and suggestions to improve clinical practice based on the integration of this knowledge.
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Affiliation(s)
- Ryota Kikuchi
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, the University of Tokyo.
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, the University of Tokyo
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Kikuchi R, Ono M, Kinugawa K, Endo M, Mizuta K, Urahashi T, Ihara Y, Yoshida S, Ito S, Kamibeppu K. Health-related quality of life in parents of pediatric solid organ transplant recipients in Japan. Pediatr Transplant 2015; 19:332-41. [PMID: 25651866 DOI: 10.1111/petr.12435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 01/19/2023]
Abstract
Few studies have examined HRQOL in pediatric Tx recipients' parents. This study investigated HRQOL in these parents and relationships between HRQOL and perceived burden of nurturing, family functioning, and social support. Self-report anonymous questionnaires and a survey of medical records were completed between September and December 2013. The SF-36v2, which evaluates physical, psychological, and social health, was used to measure HRQOL. While values for physical and psychological health were higher than standard values (Cohen's d = 0.34 and 0.17, respectively), social health scores were lower (d = 0.21). "Parental consultation unrelated to donation" (standardized partial regression coefficient: β = -0.52) was associated with physical health. "Family functioning" and "Commuting time between home and primary follow-up hospital" (β = 0.57 and -0.31) were related to psychological health. "Total score for perceived burden of nurturing" (β = -0.31) was related to social health. Regarding parental HRQOL, while physical and psychological health was favorable, social health was impaired. In clinical practice, interventions targeting parents' physical conditions and facilitation of community and family understanding and support to share recipients' nurturing are important in improving parental HRQOL.
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Affiliation(s)
- Ryota Kikuchi
- Department of Family Nursing, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan; Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
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Muscara F, McCarthy MC, Woolf C, Hearps SJC, Burke K, Anderson VA. Early psychological reactions in parents of children with a life threatening illness within a pediatric hospital setting. Eur Psychiatry 2015; 30:555-61. [PMID: 25618445 DOI: 10.1016/j.eurpsy.2014.12.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022] Open
Abstract
RESEARCH IN CONTEXT Parents of children with life threatening illness or injuries are at elevated risk of distress reactions, involving symptoms of acute stress disorder, depression and anxiety. Currently, the impact of child illness factors is unclear, and to date research systematically examining the prevalence of these psychological reactions across different illness groups with an acute life threat is sparse. This is important to explore given that studies show that parent functioning impacts on the psychological adjustment and recovery of the ill child. WHAT DOES THIS STUDY ADD?: At four weeks following a child's diagnosis of a serious illness, 49-54% of parents met DSM-IV criteria for acute stress disorder, across a number of illness groups, whereas 15-27% of parents were in the moderate/severe range for depression and anxiety, and 25-31% for stress. Results from this study demonstrate that rates and severity of these psychological reactions in parents of seriously ill children do not vary according to illness type. BACKGROUND A life threatening childhood illness/injury can lead to significant distress reactions in parents, with independent studies finding such reactions in several different illness groups. To date, there is limited research systematically comparing the prevalence of adverse parental psychological reactions across different childhood illness groups with an acute life threat. This study aimed to investigate the frequency and severity of symptoms of acute traumatic stress, depression, anxiety and general stress in parents, following admission of their child to hospital for a life threatening illness. The study also aimed to explore the relationship between these symptoms, and to determine whether they differ according to illness/injury. METHODS Cross-sectional data from a prospective, longitudinal study are reported. Participants were 194 parents of 145 children (49 couples), admitted to cardiology (n=53), oncology (n=40) and pediatric intensive care units (n=52), for serious illnesses/injuries. Parents completed self-report questionnaires within four weeks of hospital admission. RESULTS Rates of acute traumatic stress (P=0.262), depression (P=0.525), anxiety (P=0.453) and general stress symptoms (P=0.720) in parents were comparable across illness type, with 49-54% reaching criteria for acute stress disorder, 15-27% having clinical levels of depression and anxiety, and 25-31% for general stress. Anxiety was most strongly associated with acute traumatic stress (r=0.56), closely followed by stress (r=0.52) and depression (r=0.49), with all correlations highly significant (P<0.001). CONCLUSIONS These findings provide evidence that the child's medical condition is not associated with parents' experience of clinically significant psychological symptoms, and emphasize the importance for health care providers to be aware of these potential psychological reactions in parents, regardless of the type of illness.
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Affiliation(s)
- F Muscara
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia; Psychology Service, Royal Children's Hospital, Melbourne, Australia.
| | - M C McCarthy
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia; Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - C Woolf
- Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia
| | - S J C Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
| | - K Burke
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; The Parenting Research Centre, East Melbourne, Australia; Parenting and Family Support Centre, School of Psychology, University of Queensland, Queensland, Australia
| | - V A Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia; Psychology Service, Royal Children's Hospital, Melbourne, Australia
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Kaller T, Petersen I, Petermann F, Fischer L, Grabhorn E, Schulz KH. Family strain and its relation to psychosocial dysfunction in children and adolescents after liver transplantation. Pediatr Transplant 2014; 18:851-9. [PMID: 25307019 DOI: 10.1111/petr.12367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 12/01/2022]
Abstract
Parental functioning is essential to children's development. Therefore, this cross-sectional single-center study examined the prevalence of family strain in 181 parents and its associations to psychosocial functioning in their children after LT. Median age at LT was one yr. Mean time elapsed since LT was 5.8 yr. The IFS, and the SDQ were applied to parents. Family strain in the present sample was comparable to that in the German normative group of families with a chronically ill or disabled child, but families of LT recipients showed a significantly higher financial impact, impact on coping, and impact on siblings (p < 0.001). Younger age of patients at survey, a more severe clinical course, child's restrictions, and financial losses following LT were determined as significant predictors of family strain (R(2) = 0.42). Parents reported less family strain after living-related compared with deceased donation. Family strain was significantly correlated to psychosocial dysfunction in children post-LT. Present findings demonstrate a risk of maladjustment to the post-LT condition in families. They emphasize the importance of psychological assessment of parents and patients during transplant and follow-up to ensure the best achievable long-term outcome of patients.
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Affiliation(s)
- T Kaller
- Center of Clinical Psychology and Rehabilitation, University Bremen, Bremen, Germany
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Brosig C, Pai A, Fairey E, Krempien J, McBride M, Lefkowitz DS. Child and family adjustment following pediatric solid organ transplantation: factors to consider during the early years post-transplant. Pediatr Transplant 2014; 18:559-67. [PMID: 24923434 DOI: 10.1111/petr.12286] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 11/29/2022]
Abstract
Adjusting to life after transplant can be challenging to pediatric solid organ transplant recipients and their families. In this review, we discuss a number of important factors to consider during the first 2-3 yr after transplant (defined as the "early years"), including transitioning from hospital to home, returning to physical activity, feeding and nutrition, school reentry, potential cognitive effects of transplant, family functioning, and QOL. We highlight steps that providers can take to optimize child and family adjustment during this period.
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Affiliation(s)
- Cheryl Brosig
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Abstract
The rapid development of new diagnostic tests and improved therapy, especially the success of liver transplantation, has changed the outcome for children with liver disease, many of whom survive into adolescence without liver transplantation. The indications for transplantation in adolescence are similar to pediatric indications and reflect the medical advances made in this specialty that allow later transplantation. These young people need a different approach to management that involves consideration of their physical and psychological stage of development. A focused approach to their eventual transition to adult care is essential for long-term survival and quality of life.
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50
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Lefkowitz DS, Fitzgerald CJ, Zelikovsky N, Barlow K, Wray J. Best practices in the pediatric pretransplant psychosocial evaluation. Pediatr Transplant 2014; 18:327-35. [PMID: 24802341 DOI: 10.1111/petr.12260] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 01/27/2023]
Abstract
Assessment of psychosocial functioning is an often-included component of the pretransplant evaluation process. This study reviews several domains of assessment that have been related to post-transplant outcomes across solid organ transplant populations. These include evaluation of patient and family past adherence, knowledge about the transplantation process, and their neurocognitive, psychological, and family functioning. To date, few comprehensive pretransplant evaluation measures have been standardized for use with children; however, several assessment measures used to evaluate the aforementioned domains are reviewed throughout the study. Additionally, this article discusses some developmental, illness-specific, and cultural considerations in conducting the psychosocial evaluation. We also discuss ethical issues specific to the pediatric psychosocial evaluation. Recommendations are advanced to promote a comprehensive evaluation that identifies family strengths and risk factors as they begin the transplant journey.
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